Manager Care

Martha G. Longa, RN, BSN, CCM

** **** ****** ( Londonderry, NH 03053 ( Phone: 603-***-**** (

*******@*******.***

SUMMARY OF QUALIFICATONS

PROFESSIONAL EXPERIENCE

Schaller Anderson/ An Aetna Company; Bedford NH

Concurrent Review/ Care Coordinator; September 2008- June 2013

. Performed comprehensive concurrent reviews to identify, evaluate, monitor

and coordinate care for State of NH Medicaid clients with focus of out of

state facilities admissions.

. Collaborate with hospital physicians, medical directors, primary care

physicians and facility case managers in daily activities to improve care

and facilitate optimal outcomes, optimal discharges.

. Identify gap in care and readmission risk with providers and care

coordinator to reduce readmission, facilitate appropriate placement and

care plans.

. Utilizes negotiations skill to secure appropriate options and services

necessary to meet member's benefits and health care needs.

. Analyzed and provide accurate data for timely reporting to State of NH

for yearly and quarterly out of state admissions report.

. Work closely with out of state facilities and state providers to redirect

care to in state network when appropriate.

. Participate in the development/ training of staff as needed.

CIGNA Healthcare; Chattanooga TN Division

Telephonic In Patient Case Manager; November 2005- September 2008

. Perform proactive, effective concurrent review for members in acute

inpatient facilities in Maryland. Focus on effective coordination of care

to prevent medically unnecessary or avoidable hospitalization,

inappropriate delays in care and services. Discharge planning with goal

to increase member satisfaction, maximize employer's health benefit and

minimize gaps in care. Coordination of discharge plans to appropriate step

down level of care to minimize readmission/ poor outcomes.

Home Health & Hospice Care, Nashua NH

Case Manager/ Telehealth Nurse for Home Heath care agency, June 2003- Nov.

2005

. Review care plan, staff education to identify and recommend appropriate

plan of care and utilization of services. Obtain authorization, coordinate

care with variety of payer sources (MCO, worker's comp, auto carriers,

federal programs) Utilization review/ audits for services rendered for

Medicare Population.

. Contributed to the development of a Telehealth Disease Management program

for agency. Scope of involvement included vendor selection, development of

Telehealth policies, chart audits, publishing outcome data quarterly,

presented provider education programs, poster presentation at September

2005 Case Management Society NE Conference.

CIGNA Healthcare; Concord NH

Case Manager, October 1997 - June 2003

. Identify, monitor and coordinated care in a managed care plan among

members, their families and healthcare providers, focusing on delivery of

care to maximize quality of life, utilizing benefits more efficiently,

ensuring the most appropriate treatment plan and supportive setting.

OPTIMA HEALTH, Manchester, NH

Staff Nurse, Elliot Hospital and Catholic Medical Center; Manchester NH

Jan. 1988-October 1997

. Delivery of acute inpatient care on Medical Surgical Units.

.Completed coursed in Diabetic, Neurological and Renal patient management,

Basic Iv Therapy, Basic Dysrhythmias, Mock Code Preceptor

.Committee Served: Dialysis Procedure, CVA Pathway, Nurse Practice, Mock

Code Preceptor Team

EDUCATION

RIVIER COLLEGE, SCHOOL OF NURSING, Nashua, NH

BSN Degree, May 1999

NEW HAMPSHIRE TECHNICAL INSTITUTE, Concord NH

AND Degree, May 1988

CERTIFICATIONS:

Certification in Case Management (CCM), December 2001

Certification in Medical Surgical Nursing, May 1995

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