Sign in

Manager Medical

New Braunfels, Texas, 78130, United States
December 15, 2018

Contact this candidate



*** *********

New Braunfels, TX 78130

Cell: 832-***-****

Home: 830-***-****

Career Objective

Continue to utilize and leverage the skills developed through a successful career in the health care industry over the last 20 years. Identify and secure a position commensurate with these skills in an organization that values and rewards customer service, initiative, process discipline, and strong work ethic.


Administrative Writing Skills, Reporting Skills, Supply Management, Scheduling, Microsoft Office Skills, Organization, Time Management, Presentation Skills, Equipment Maintenance, Travel Logistics, Verbal Communication

A disciplined and self-motivated individual with extensive experience in case management and coordination in the medical field

Familiar with all aspects of the exacting requirements of record keeping and management in medical facilities

Recipient of numerous awards during career acknowledging strong strategic planning skills and performance against goals

Comfortable in the organizational structure and reporting relationship environment of a medical facility

Work History

UnitedHealth CARE

Houston/ Austin, Texas

Service Coordinator September, 2013- Present

Basic Structured, standard approach to work.

Unrestricted LVN Licensure in the State of Texas.

85% travel to member homes.

Telecommute while working with various computer office programs and clinical programs.

Use excellent nursing judgment to assess, evaluate, and recommend treatment decisions for members throughout the risk stratification spectrum.

Coach member’s in psychosocial and medical needs.

Educate members on medical and psychosocial needs.

Assess member needs to ensure safety, ADLs/ IADLs are met.

Facilitate member’s ability to remain in their homes/ community safely.


Pasadena, Texas

Temporary Job

Discharge Coordinator Feb. 2013 – June, 2013

Coordinate seamless discharge planning for skilled nursing facility

Initiate and maintain Transitions Program for follow-up of patients with diagnoses of pneumonia, congestive heart failure and acute myocardial infarct in accordance with CMS guidelines to decrease recidivism rates

Communicate with managed care organizations to ensure continued authorizations for skilled nursing facility

Track Transitions Program patients after discharge to avert readmissions to acute care facilities

Manage and track credentialing for managed care networks


Houston, Texas

Community Case Manager Dec. 2011 - June 2012

Identify high risk patients for case management intervention and coordinate the delivery of cost-effective, quality based health care services for health plan members

Implement alternative treatment plans that address individual needs of the member, their benefit plan, and community resources

Direct intervention with moderate to high risk members and provide support and oversight to other team members

Manage high and low risk members

Communicate with providers of medical services and equipment to facilitate referrals, development of discharge planning and alternative treatment plan development

Initiate contact with patient/family, physician, and health care providers/suppliers to discuss the alternative treatment

Plan and conduct on-site or in-home evaluations, as necessary

Monitor, evaluate, extend, revise or close treatment plans, as appropriate

Evaluate cases for quality of care

Communicate case management decisions with all relevant parties

Understand and follow policies and procedures; produce and submit reports in a timely manner

Handle high acuity and complex cases

Serve as a professional resource to other Case Managers

Initiate and lead the multi-disciplinary care planning process

Practice Coordinator Sep. 2008 – Nov. 2011

Improve HEDIS Guideline compliance through proper coding and documentation techniques

Increase healthcare plan reimbursement through proper coding

Coordinate care of patients with physician offices, health plan, and disease management vendors

Review and participate in medical chart audits

Implement and maintain method of chronic disease management identification

Collaborate with physicians, other practice coordinators, and staff


Houston, Texas

Case Manager Sep. 2007 – July 2008

Communicate with physicians, nurses, patients, and families to gather information regarding need for appropriate skilled nursing admissions on a patient-by-patient basis

Negotiate contracts with managed care companies to allow benefits for admissions and extended stays

Monitor trends regarding skilled nursing stay

Assist patients with financial needs and obtaining funding for skilled nursing care

Appeal denials from managed care organizations for payments of skilled nursing care


Houston, Texas

NURSE CASE MANAGER 2 Jan. 2002 – Apr. 2007

Coordinate and implement the Patient Identification/Implant Process

Drive utilization of the patient relationship marketing (CRM) system, fulfilling the educational needs/implant logistics for patients

Work directly with field sales to meet quotas/revenue objectives by ensuring patients are provided adequate education

Create a rapid and user friendly path for patients deciding VNS Therapy is the best choice for them

Ensure accuracy of Patient Identification forms to implement the patient education program

Collaborate with sales team to ensure patient barriers are removed and internal and external resources are aligned to facilitate the implant process

Follow-up with patients to provide education on VNS Therapy; either through an immediate phone education and/or scheduling them for field education

Provide support to teammates for the completion of letters of medical necessity and prior authorizations on behalf of the health care provider

Work with patients and care providers to insure quick and easy access to surgical consults, surgical scheduling and VNS Therapy

Participate in territory conference calls to ensure efficient patient identification and strategies are used on every VNS Therapy candidate

Initiate appeal denials on behalf of physicians and hospitals

Attend regional or national meetings, as required

Occupational License

Licensed Vocational Nurse License Expires: Oct 31, 2018

Texas Board of Vocational Nurse Examiners, Pasadena, Texas


Axia University of Phoenix (Online) Phoenix, Arizona

3+ years

Major: Bachelor of Science; Business

Minor: Healthcare

GPA: 3.88

San Jacinto College North Campus Houston, Texas

1 year

Major: Licensed Vocational Nurse

GPA: 3.57


134 Trailwood

New Braunfels, TX 78130

Cell: 832-***-****

Home: 830-***-****


Dawn Larrabee, LVN, Service Coordinator, United Health Care

Office: 952-***-****

Cell: 512-***-****


I have known Dawn approximately 2 years through our working relationship with United. I trained Dawn as a new employee. Dawn works with me in the H2060 Team.

Megan Roegelein, RN, Service Coordinator, United Health Care

Office: 952-***-****

Cell: 281-***-****


I have known Megan approximately 2 years through our working relationship with United. I trained Megan as a new employee. Megan works on the Complex Care Team.

Lori Underwood, Girling and Nurse’s Unlimited Manager of PAS Attendants

Cell: 512-***-****

I have known Lori for 2 years. I met Lori while in field working with United and coordinating member’s care through assessments and authorizations.

Contact this candidate