Manager Quality Assurance
Resume:
Evelyn Ruiz Crespo
Phone: 386-***-****
Objective:
Eager to contribute to the growth of a progressive company requiring strong Medical Case Management and analytical organizational skills.
Experience 2010 to Present Humana Daytona Beach, FL
* Dedicated Medical Case Manager for specific members.
* Responsible for Telephonic Medical Case Management of Humana Medicare members.
* Duties include Educating, coordinating and facilitating members care. Oncology Desease Management, HEDIS and Desease management
* Excellent interpersonal communication skills with physicians, members, manager and employee
* Interact with members, Medical providers and others in problem solving techniques
2010 to 2010 Sedgwick CMS Lake Mary, Florida
* Dedicated Medical Case Manager for specific clients.
* Responsible for Telephonic Medical Case Management of Workers’ Compensation Department.
* Duties include Utilization Review, Quality Assurance and Retrospective Review of claims.
* Excellent interpersonal communication skills with physicians, clients, manager and employee
* Interact with employers, Adjusters, Medical providers and others in problem solving techniques
2002–2010 Travelers Insurance Orlando, Fl
Telephonic Case Manager
* Dedicated Medical Case Manager for specific clients.
* Responsible for Telephonic Medical Case Management of Workers’ Compensation Department.
* Duties include Utilization Review, Quality Assurance and Retrospective Review of claims.
* Excellent interpersonal communication skills with physicians, clients, manager and employee
* Interact with employers, Adjusters, Medical providers and others in problem solving techniques.
1992- 2005 Registered Nurse Sanford, Fl
RN
* Perform all nursing duties in Oncology, medical surgical, Orthopedic and general floors.
* Computer Knowledge.
* In Hospital certifications.
* Preceptor of new Nurses
2000-2002 Spectrum Managed Care Lake Mary Fl.
Telephonic Case Manager
* Dedicated Medical Case Manager for Sperion temporary agency company.
* Responsible for Medical Case Management of this account for States of Tennessee, Georgia,
* North Carolina, South Carolina, Alabama and Florida.
1997-2000 Genex Managed Care Winter Park, Fl.
Telephonic Case Manager and Utilization Review Supervisor
* Managed Telephonic Case Management unit which consisted of Nurses and Administrative Assistants.
* Supervised the Education, Pre-certification and Quality Assurance Departments.
* Assisted in preparation and Education of Workers Compensation legal aspects.
1995-1997 Visiting Nurse Association. Orlando, Fl
Hi-Tech-Intravenous/Oncology Field Nurse.
* Responsible for management of all aspects in patient care process for Hope & Recovery home health, oncology and intravenous Departments in home, hospital and Nursing home settings
* 1993-1995 Oncology/Hematology Group Deltona, FL.
* RN
* Responsible for all aspects of Chemotherapy, Oncology and Hematology education,
* Administration & constitution if medications for chronic long term and terminally ill patients, in
* Hospital, home and office settings.
Education Daytona Beach Community College Daytona Beach, Fl
* Completion Associate degree in Nursing.
* Various Seminars/classes in AIDS, Oncology, Orthopedic, Workers’ Compensation, Managed
Care Arrangement, and Computer conferences.
Other Experience Bilingual Spanish & English.
RN Active License for the States of Florida, New York, Vermont and Connecticut.
Earned 75% college expense through part time jobs at the college involving computer, clerical and general office duties.
References Furnished upon request.
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