Case Manager Utilization Review

Danielle McSorley, BSN, RN, CCM

**************@*****.*** 215-***-****

**** ******** *****, *******, ** 19021

Experience

Case Manager/Utilization Review

Temple University Hospital

August 2016-September 2019

• Level of Care Review proficiently using Interqual 2019, Epic, and Navinet

• Geriatric Case Manager/Disease Management primary focus

• Creating partnerships with medical payers to ensure proper payment

• Ensuring time efficient and safe discharges of medically complex clients

• Resourcing with multiple durable medical and pharmacy vendors

• Extensive collaboration within the multidisciplinary team for time effective discharges

• Procuring relationships with insurance companies

• Relentless advocacy and teaching for the client and family to enhance future Holistic Wellness Register Nurse/Case Manager

Mercy Fitzgerald Hospital

August 2015 - July 2016

• Review/Discharge Planning Daily activities include reviewing clinical information for acute admissions

• Utilization review with concurrent reviews and assist with retrospective appeals

• Care Enhance Review Management Guidelines

• Proficient in utilization review/concurrent review/SNF rehab reviewer, pre-certifications of elective procedures, transitional care discharge planning, use of state systems and MHS systems ER Utilization Reviewer

Taylor Hospital

August 2008-December 2012

• Utilization Management/Utilization Review/Discharge Planning

• Daily activities include reviewing all clinical information for Inpatient and ER admission reviews

• The extensive use of Interqual - Care Enhance Review Management Guidelines

• Use of State systems and MHS systems *McKesson Interqual Certification, Allscripts

• Proficient in utilization review/concurrent review/SNF rehab prior authorizations, pre-certifications of elective procedures, and transitional care discharge

• Responsible for Social Work for entire Hospital during weekend position Adult Case Manager

Health Partners Plans

March 2007-July 2015

• Utilization Management/Utilization Review/Discharge Planning utilizing Interqual Guidelines

• CPHM Certification

Skills & Specialization

Mckesson, Discharge Planning, Prebuilt Software, Epic, Techniques, Pharmacy, Utilization Review, Medical, Register Nurse, Teaching

Education

Holy Family University January 2016-May 2020

Bachelors in Science of Nursing

Roxborough Memorial School of Nursing

Diploma in Nursing May 2001-May 2003

Contact this candidate