Manager Management
Resume:
Nicola Lester
Email: abqdgs@r.postjobfree.com
Address: ***** **** ***** **
City: Adelanto
State: CA
Zip: 92301
Country: USA
Phone: 760-***-****
Skill Level: Experienced
Salary Range: $83,000
Primary Skills/Experience:
See Resume
Educational Background:
See Resume
Job History / Details:
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Nicola Lester, BSN
18781 Dogwood Ct, Adelanto, CA 92301 Phone: 760-***-****, E-Mail: abqdgs@r.postjobfree.com
Quality Evaluator/Case Management
A highly motivated, result driven professional experienced in healthcare management, (case management)diseased management, and advise nurse, education, technical support management with over 25 years of nursing experience. Recognized for the ability to contribute through leadership to the development of innovative clinical systems, enabling the delivery of highly effective patient care. As a Case Manager; articulate leader well versed in developing roadmaps in collaboration with senior leadership to develop, plan, and implement innovative solutions to exceed levels of patient care and management. A multitude of versatile skills transferrable into any administrative setting to create and maintain high levels of efficiency and productivity.Advanced understanding of customer needs with diligent attention to details resulting in superior customer service.Maintains a high level of personal drive, confident nature and an aggressive attitude in achieving results.
technologies worked on
Microsoft Office Suite (Excel, Word)
Areas of Expertise
Clinical and Administrative Leadership
Organization Scheduling
Monitoring, Evaluation and Research
Highly Organized and Strong Analytical Abilities
Account Management
Leadership and Strategy
Regulatory Compliance
Development and Implementation of Policy
Able to multi-task in fast-paced environments
Articulate Oral and Written Communication
Training
Problem Resolution and Decision Making
Business Solutions
Reports and Documentation
Professional Experience
HCA: Norcross, GA
Apr 2012 thru
Oct 2012-
HCA is a leading provider for health care services. The company comprises of locally managing facilities that includes 163 hospitals and 110 free standing surgery centers in 20 states and England
Clinical Appeals Specialist
April 2012thru Oct 2012
Responsible for monitoring denials of claims with an assigned group of hospitals
Major Contributions
Accountable for executing appropriate reports
Contact insurance companies to resolve claims denied for clinical reason
Identify incorrect coding for various procedures or incorrect documentation issues and resolve errors in a timely manner
WellPoint/Anthem Blue Cross : Atlanta, GA
Apr 2008- oct 2012
Anthem Blue Cross and Blue Shield have operations in nine states. The core health operations are organized into four strategic business units.
Quality Evaluator/Case Manager
Apr 2008- Oct 2012
Responsible for developing and implementing internal and external training for registered nurses that were case managers, advise nurses, and disease management.
Major Contributions
Facilitated and determined departmental training needs and priorities for case managers, RN advise nurses and disease management model
Enhanced understanding on changes in policies, procedures, regulations, new products, technologies and meeting identified needs and demands of the company
Developed ways to improve learning opportunities
Provided training and obtained feedback from associates as well as management
Ensured training that was consistent with testing methods and results, by utilizing presentation modules on policies, procedures, regulations, technologies, etc
Assisted management with identifying training trends and opportunities for development ensuring that training is consistent with all medical management staff
Anthem Blue Cross : Atlanta, GA
Sept 2004-Apr 2008
The core health operations are organized into four strategic business units: Anthem Midwest, East, West and Southeast.
Health Advocate/Case Manager
Sept 2004- April 2008
Tasked at promoting optimal level of care in an assigned employer group as a Case Manager
Major Contributions
Was able to utilize resources within the members health plan to achieve healthier outcomes that were cost effective and able to show a win-win situation agreement for all parties involved
High customer satisfaction with only 1% denial to overall claims
Assessed and approved prior approvals for utilization of services in a HMO module
Piedmont Hospital : Atlanta, GA
Mar 1999
- Sept 2004
Piedmont Hospital is a private, not-for-profit, acute-care, tertiary facility offering most major medical, surgical and diagnostic services.
Hospital Case Manager / RN Nurse Reviewer
Mar 1999- Sept 2004
E
Evaluates the clinical status of patients using evidence based criteria to determine medical necessity for hospitalization, clinical progression and continued acute care needs. Utilized information about clinical condition, prior level of functioning and anticipated treatment plan to support a safe, smooth transition to other levels of care.
KAISER PERMAMENTE: ATLANTA GA Sept 2000- July 2003 (Part- Time, 2nd job)
ADVISE NURSE 24/7 nurse line. I evaluated and triaged inbound calls for clients with specific health needs and or referrals for emergent care or to the nearest clinics for follow up.
Major Contributions
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