Case Management Manager
Resume:
Hixson, TN *****
Ofc: 423-***-****
Fax: 423-***-****
Cell: 423-***-****
Email: **********@***.***
Deborah A. Swanger RN CCM LNC
Experience
****-******* *********** ********or and PriMedical Inc Chattanooga, TN
Owner-Operator/Case Manager/Legal Nurse Consultant
Assist multiple insurance claim managers with multi-state, ongoing medical management to provide the most appropriate care for optimum medical outcomes in the most cost-effective manner possible with high return on investment.
Provide leadership for all clinical/medical parties involved in worker’s compensation to guide them successfully through the process as they change, by providing education, instruction and follow up.
Provide leadership of the medical and employment team by providing optimum consultation that ensures compliance of all requirements by all team members and resulting in reduction of worker’s compensation costs.
Developed, operates, and manages a success medical/legal consulting company offering services to several national and state insurance companies that typically align with Medicare standards for reimbursement.
Work as a team member directly with medical and ancillary providers, employers, adjustors and attorneys in the management of claims, loss prevention, utilization, quality/risk management and the meshing of clinical issues.
Network, communicate with and assist the medical community with the navigation of the worker’s compensation program in regard to legislation, guidelines etc. resulting in improvement in compliance of new and existing laws and statutes.
Work in conjunction with the legal community in regard to litigation issues that has resulted in the successful defense of high-cost medical claims. Activities involve navigating extensive and complex medical records, providing chronologies, recommendation of specific providers, assisting with the development of deposition content, communicating with appropriate medical society as needed for particular issues, etc.
1995-2005 Intracorp/CIGNA Chattanooga, TN
Disability Management Specialist
Field case medical management of worker’s compensation claims resulting in reducing the cost of claims with an average ROI of 3:1.
1994-1995 Home Health Care Dunlap, TN
Director of Nursing/Supervisor
Assisted various home care agencies in the start up operations of local offices.
Prepared agency for all governmental agency visits, reviews, inspection etc.
Developed and hired appropriate staff for all areas of care.
1993-1994 Medshares Home Care Cleveland, TN
Assistant Administrator
Instrumental in the successful start-up and ongoing operations of multiple office home care agency resulting in increased revenue and profits.
Prepared agency for all governmental agency visits, reviews, inspection etc.
1992-1993 HCA Nashville, TN
Head Nurse Cardiac step-down/Southern Hills and Centennial
Complete management of unit specializing in cardiac care.
1990-1992 Superior Home Care Dunlap, TN
Director of Nursing/Regional
Opened and operated multiple thriving home care offices resulting in improvement in profits while maintaining quality care.
1982-1989 Sequatchie General Hospital Dunlap, TN
CNO/Director of Nursing/Head Nurse
Member of the executive management team with responsibilities of multiple acute care departments.
Education
2022- Currently preparing to begin education to complete a Masters in Health Administration.
1999-2002 College for Professional Studies Boca Raton, FL
Legal Nurse Consulting Diploma.
Graduated summa cum laude.
1979-1982 Baroness Erlanger School of Nursing Chattanooga, TN
Diploma Registered Nurse
Graduated magna cum laude.
Certifications: CCM, CCRN, Certified Chemotherapy Nurse
Ongoing additional education and college credits in nursing and forensic curriculum.
Awards/Affiliations
Dorothy Hocker Award- 1982-Excellence in Nursing academics and service.
Cecile Quillian Award- 1988-Excellence in the field of home care nursing.
Member of AAMCN (American Association of Managed Care Nurses)
Presentations Soft tissue injuries and the medical management- TVA OCIP
Safety Conference – 2013
Case Management in Worker’s Compensation- CCMSA Spring Conference- 2013
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