Manager Case
Resume:
SHARON BAMBAS
Naperville, IL *****
********@*****.***
Authorized to work in the US for any employer
Telephonic Nurse Case Manager
GENEX Services, LLC - Schaumburg, IL
April 2018 to December 2019
Worked closely with claims adjusters for Worker's Compensation insurance company. Made first contact with every new claimant to gather injury information and provide support. Coordinate DME for post-surgical claimants. Discussed physical therapy progress with physical therapists. Followed up with non-represented claimants for physician visit information. Contacted physicians for visit notes and work status reports. Furnished medical explanations to all claims adjusters. Provided UM/UR services on request.
Sr. Specialist, Appeals and Grievances
Molina Healthcare - Oak Brook, IL
November 2016 to August 2017
Using state, company specific, and MCG Guidelines, received cases from department staff to add clinical information. Then analyzed each case to input clinical information for a recommendation to approve or deny a state - sponsored benefit service.
Work closely with physicians in two states, as well as staff pharmacists to ensure with state and federal guidelines, as well as Molina's internal guidelines, to remain in compliance with all applicable laws and guidelines. This work entailed state and federal Health Care members.
Remote Worker's Compensation Case Manager, RN
Seven Corners, Inc - Carmel, IN
October 2015 to March 2016
Coordinate care between injured workers and providers, attorneys and claims adjusters. Communicate between all parties involved to ensure return to work status as soon as possible. Visit with providers and injured workers at provider visits, gather clinical information and provide updates to involved parties. Helped workers return to work quickly, provided insight to involved parties concerning clinical status. Developed positive relationships with injured workers and providers quickly to ensure compliance with goals of return to work status. Coordination of care, discharge planning, provider communications, S
WORK EXPERIENCE
patient communications. This position allows me to develop relationships with injured workers and providers quickly to accomplish goals.
UM Case Manager
Chicago Health System - Westmont, IL
June 2014 to October 2015
Case Management/UM, discharge planners, patients, and managed care organizations. As a UM Case Manager, managed utilization services in a team environment and ensured quality of my services delivered to all medical group members through daily review of hospitalizations, tertiary care hospitalizations, ancillary services and any other health care services requested. Conducted audits and applied medical necessity criteria to approve or deny services. ACO, HMO, POS, PPO,
Medicare and Medicaid insurance experience.
Case Manager
Alta Staff - Chicago, IL
November 2013 to February 2014
Working as insurance nurse case manager/utilization review. (12 week staffing assignment) Hospice Case Manager
Optum / United Health Care
March 2013 to September 2013
RN Case Manager, Clinical Lead
First Hospice Care
August 2012 to February 2013
Case Manager
Odyssey Hospice
May 2011 to May 2012
Manage caseload of 12 - 16 patients in home settings, long-term care settings and assisted living settings. Supervised ancillary staff, CNA's and LPN's, as appropriate. MSN in Executive Leadership
Chamberlain College of Nursing
March 2015 to Present
Bachelor of Science
Walden University
July 2014
Associate of Applied Science in Nursing in Nursing in Nursing Oakton Community College - Des Plaines, IL
EDUCATION
Microsoft Office Suite (10+ years)
Faxing
Copying
Case Management
Documentation
Microsoft Office
problem solving
Management
Professional Registeted Nurse
July 2003 to May 2020
SKILLS
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CERTIFICATIONS AND LICENSES
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