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Registered Nurse Manager

Location:
Raleigh, NC
Posted:
December 18, 2020

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Resume:

Lisa J. Msarsa

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

Raleigh, NC *7604

919-***-****

Objective

To obtain a position as a Registered Nurse that will provide the opportunity for professional development in all aspects of healthcare and medical review.

Functional Summary

· Experienced case manager in a variety of settings: skilled nursing facility, long term acute

care hospital and insurance industry.

· Work independently and effectively in a variety of medical environments and scenarios.

· A team player that is always eager and prepared to assist colleagues in the completion of daily

duties and assignments.

Professional Experience

December 2013-March 2015.

Aetna.

Cary, NC.

Worked remotely as a case manager. Performed outreach to insurance plan members, in order to assess for their needs. Targeted members that were most vulnerable for readmission to the hospital. Performed proactive discharge planning Worked closely with plan providers to provide assistance with plan benefits. Functioned as a case manager liaison for the Duke Medical Center medicare population.

March 2015-present.

Aetna/CVS.

Cary, NC.

Worked remotely as a UM Nurse Consultant, for the medicare population and occasionally with the commercial population. Performed initial and concurrent reviews. Appropriately referred members for case management, behavioral health and social work. Attended daily MD rounds and actively participated in member discussion. Worked in the EMR system for Ohio Health. Volunteered for various reach projects, in the UM Dept. Worked closely with my co-workers to foster an environment of teamwork.

February 2013-November 2013.

Division of Medical Assistance.

Kelly Services.

Worked in a contract capacity, answering inquiries re: Med Solutions approvals for various procedures.

February 2011-October 2013.

Select Specialty Hospital

Durham, North Carolina

Case Manager. Coordinating care for critically ill patients who are ventilator dependent, require care for tracheostomy, parenteral nutrition, IV antibiotics or complex wounds. Provided utilization review for commercial insurance and Medicare replacement policies. Worked closely with patients and families to ensure a safe discharge to the next appropriate level of care.

April 2009-February 2011

Wake Medical Center

Raleigh, North Carolina

Case Manager. Worked closely with physicians & all members of the interdisciplinary team in order to facilitate a safe & appropriate discharge for every patient. Conduct concurrent reviews and provide clinical to various insurance companies. Worked with various home health, DME, ALF & Skilled Nursing facilities on a daily basis. Worked independently, in order to make sound nursing decisions.

August 2006-April 2009

Blue Ridge Healthcare

Raleigh, North Carolina

Case Manager. Worked closely with numerous managed care insurance plans, in order to ensure that patient's skilled nursing facility stay is covered. Provided discharge planning for managed care patients. Ensured that patients had the appropriate home health, DME and access to community resources. Provided patient teaching. Acted as a liaison between patients & their families.

August 2005-July 2006

Dorothea Dix Hospital

Raleigh, North Carolina

Psychiatric Registered Nurse. Worked with acutely & chronically ill psychiatric patients. Also worked w/ dual diagnosis populations. Acted as Charge nurse on psychiatric research unit. Administered medications. Acted as group facilitator. Provided patient & family teaching on an ongoing basis. Adhered to strict research protocol. Adhered to HIPAA guidelines daily. Performed venipuncture & EKGs. Worked closely with the treatment team, in order to provide the best patient care possible.

2003-2005

BlueCross BlueShield of North Carolina

Durham, North Carolina

State Medical Review Analyst. Reviewed requests for service from a diverse database of health organizations. Requests included approval for various surgical procedures, durable medical equipment and home health needs. Also, received NC Healthchoice training. Adhered to the HIPAA Guidelines in the course of conducting my daily affairs. Worked to achieve complete customer satisfaction. Functioned effectively as a cohesive member of the SHP team.

Education

1998

Wake Technical Community College

Raleigh, N.C.

Associate Degree in Applied Nursing Science

1992

Union County College

Plainfield, N.J.

Emergency Medical Technician Certification

1990

Kean University

Union, N.J.

Bachelor of Arts, Psychology

References available upon request



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