Case management
Resume:
Kathleen McMahon, RN, BSN, CCM
*** ****** ****** *********, ** 18018
267-***-**** *********@*****.***
Professional Overview
30+ years of clinical experience as a Registered Nurse in various settings
10+ years experience in Case Management and Utilization Management
10+ years experience in supervisory and leadership roles with extensive practice in training, staff development, and education
Proficient in using computer applications such as Word, Excel, Outlook; familiar with InterQual; comfortable using medical chart format including Electronic Medical Records
20+ years Registered Nursing experience in the state of New Jersey
10+ years Registered Nursing experience in the state of Pennsylvania
Professional Experience
AETNA, Bethlehem, PA 2019 to Present
Case Manager
Work in close telephonic collaboration with patients and families, the medical team, and interdisciplinary team members to provide comprehensive services to the insured.
Review all documentation from specialists and consult with physicians and therapists.
PRIME HEALTHCARE, Bristol, PA 2014 to 2019
Senior Case Manager
Manages, analyzes, and coordinates the daily activities of the unit to ensure departmental productive goals are met with regard to quality timeliness, accuracy and consistency of medical decisions.
Performs evaluations of workflows and improves processes that impact the department.
Acts in expert role to resolve difficult and complex matters.
Represents the plan with external customers, providers and agencies; represents the department on internal committees and participates in special projects.
Performs utilization management for members from enrollment, pre-certification, and utilization management to discharge addressing all transitions of care.
Identifies and implements cost saving/revenue generating opportunities.
Assists the director in coordinating regulatory, quality, and accreditation activities.
Leads the team of case managers and provides mentoring to staff members.
ACCOLADE INC, Plymouth Meeting, PA 2013 to 2014
Clinical Health Assistant
Triage telephone calls from patients in behavioral health and medical triage; use computerized database to facilitate access to necessary parties.
Work closely with providers, nurses, insurance companies, patient families, and all other members of the organization by teaching, communicating therapeutically, and negotiating solutions.
Responsible for staging care and directing patients to providers.
Listen, demonstrate empathy, and utilize problem-solving techniques to resolve patient concerns.
Conduct full behavioral health assessments, educate patients on their roles in their treatments, and aid them in accessing healthcare solutions.
Follow up on patients with chronic conditions and assist patients to get appropriate care in compliance with treatments.
Negotiate billing, identify insurance processing errors, and arrange payment plans on behalf of patients.
TEMPLE UNIVERSITY HOSPITAL, Philadelphia, PA 2009 to 2013
Case Manager, (2009 - 2013)
Earlier Career
ARIA HEALTH, Philadelphia, PA 2004 to 2009
Catheterization Lab Nurse & Telemetry Nurse
CARRIER CLINIC, Belle Mead, NJ 2001 to 2003
Adolescent Psychiatric Nurse
JFK MEDICAL CENTER, Edison, NJ 2000 to 2001
Neurological Surgery Unit
TRENTON PSYCHIATRIC HOSPITAL, Trenton, NJ 1999 to 2000
Head Psychiatric Nurse
PINNACLE HEALTH ENTERPRISES, New Brunswick, NJ 1998 to 1999
Case Management Nurse – On-site Case Management
PRUDENTIAL, Linden, NJ 1997 to 1998
Workers Compensation Case Management
VISITING NURSE OF CENTRAL JERSEY, Red Bank, NJ 1994 to 1997
Supervisor – Clinical Reimbursement of 3 Health Centers
PRUDENTIAL, Iselin, NJ 1992 to 1994
Case Management Nurse – Major Clients & National Accounts
PALM BEACH GARDENS HOSPITAL, Palm Beach Gardens, FL 1983 to 1992
Invasive Coronary Unit Nurse
Education & Professional Development
Thomas Edison State College, Trenton, NJ
Bachelor of Science Degree in Nursing (2009)
Henry Ford Community College, Dearborn, MI
Associate Degree in Nursing (Cum Laude) & Associate Degree of Liberal Arts (Cum Laude) (1983)
Academy of Health Sciences, San Antonio, TX
Eye, Ear, Nose, Throat Specialist – United States Army (1977)
CCM Certification
Registered Nurse in the State of New Jersey
License Num. 26NR07940200
Registered Nurse in the State of Pennsylvania
License Num. RN548595
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