Lisa D. English BS, RN

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

Roseville, CA 95747

210-***-****

ad26bq@r.postjobfree.com

Education:

California State University at Chico, California Bachelor of Science in Business Management 1989

San Antonio College, Texas Associate Degree in Nursing 2000

Experience:

July 2023 – November 2023

Health Texas Case Manager

Develop, implement, and review healthcare plans for patients that are geriatric, recovering from serious injuries, or dealing with chronic illnesses.

Work within and outside of hospital or medical facility.

Identify patient needs, plan their treatment and observe improvement.

Work as a team with other health care providers to achieve a goal.

Advocate for financial assistance and insurance coverage for patients.

Familiar with CPT codes, DRG and Billing Practices.

Concurrent review and Discharge Planning.

December 2022 – May 2023

Centene/Prior Authorization Nurse

Provide timely review of authorization requests.

Ensure the requests meet national standards and contractual requirements.

Promote the quality and cost effectiveness of patient care using clinical acumen.

Provide prior authorization that is required for complex treatment or prescription.

Reduce the cost of expensive treatments by first requiring a lower-cost alternative.

March 2022 – October 2022

AmerisourceBergen/DMNE Nurse Educator

Ensure that crucial medications efficiently, reliably, and securely reach healthcare providers.

Assist in launching new products and services to meet the needs of current and future customers.

Provide drug distribution and consulting related to medical business operations and patient services.

Foster a positive impact on healthcare around the world by advancing the development and delivery of pharmaceuticals and healthcare products.

Educate patients on newly released pharmaceuticals and how to effectively utilize these drugs.

July 2021 – February 2022

Nexus Enterprises/Quality Auditor

Ensure workman’s compensation cases and disability cases are submitted with correct processes with accuracy and compliance.

Collect information from nursing reports, medical notes, and other patient care records to help assess the quality of care.

Manage medical records in healthcare settings and insurance companies.

Ensure that correct processes and systems are followed from quality of care and medical necessity to regulations, complaints, and insurance claim coding.

Provide patients with financial care and make sure they get what they are entitled to.

September 2017 – July 2021

Medtronic/Clinical Specialist

Educate, support, and promote self-management of diabetes while utilizing an automated insulin delivery system.

Collect patient data to monitor health status and manage the patient’s conditions.

Use motivational interviewing techniques to engage participants and achieve enrollment into program.

Provide services and education for patients with insulin pumps when in need.

Help control diabetes with the use of exercise, nutrition, medications, and checking blood sugar.

October 2016 - September 2017

Vitas Healthcare/Field Case Manager Hospice Care

Provide hands on nursing care around the clock in the patient’s home or a hospice.

Manage pain and other symptoms.

Provide support to patient and families.

Assist in the process of death with dignity.

Provide postmortem care including cleaning and preparing the deceased patient for family viewing.

July 2016 – September 2016 (Temp Position)

Wellmed Medical Management/Quality Auditor

Collect information from nursing reports, medical notes, and other patient care records to help assess the quality of care.

Manage medical records in healthcare settings and insurance companies.

Ensure that correct processes and systems are followed from quality of care and medical necessity to regulations, complaints, and insurance claim coding.

Provide patients with financial care and make sure they get what they are entitled to.

April 2015 - July 2016

Molina Healthcare/Utilization Management

Provide timely review of authorization requests.

Ensure the requests meet national standards and contractual requirements.

Promote the quality and cost effectiveness of patient care using clinical acumen.

Provide prior authorization that is required for complex treatment or prescription.

Reduce the cost of expensive treatments by first requiring a lower-cost alternative.

June 2010 - January 2014

United Healthcare/Supervisor Utilization Review Prior Auth

Supervision of a team of 15 RNs and overseeing their duties.

Make sure patient receive the care they need.

Ensure staff is following set policies and procedures.

Hire and train nursing staff.

Achieve critical clinical healthcare goals, with an emphasis on improving patient care delivery, quality and outcomes.

Act as a liaison between nursing staff and physicians.

October 2004 - March 2007

Wellmed Medical Management/Congestive Heart Failure Case Manager

Develop, implement, and review healthcare plans for patients that are geriatric, recovering from serious injuries, or dealing with chronic illnesses.

Work within and outside of hospital or medical facility.

Identify patient needs, plan their treatment and observe improvement.

Work as a team with other health care providers to achieve a goal.

Advocate for financial assistance and insurance coverage for patients.

January 2001 – October 2003

Metropolitan Methodist Hospital/Labor and Delivery staff and Charge Nurse

Monitor and provide care for the mother and her baby.

Serve as an expert in the birthing process.

Provide intensive support for the patient, and is ready to intervene, at a moment’s notice.

Monitor vital signs for baby and mother, including heart rate and blood pressure.

Administer medications.

Identify and assist with handling complications.

Assist with surgery, in the event of a cesarean delivery.

Licensures in Multiple States:

Primary Registered Nursing License Obtained in California Board of Nursing Examiners for the State of California, 05/10/2007. License number 703349

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