GRIGORIANA SPENCIUC RN,MBA

**** ******* *** #***

Cypress, CA 90630

714-***-****

EDUCATION

USC University California BBA,MBA

USA RN Licence #464882

PROFESSIONAL EXPERIENCE

RN,MBA Case Manager 01/2005-8/2009

> Review new referrals and transfer roster for acceptance of claims that meet medical referral

> Make timely and effective three point contact as appropriate

> Direct injured worker to network provider

> Assess medical issue on original claims

> Develop,implement and document medical disability

> Negotiate medical services and medical equipment cost

> Communicate with claim case manager regarding medical issue

> Refer case for vendor management

> Arrange second opinion examen with the approval of claim case manager for QME

Clinical Staffing Registry 2000-2004

RN,MBA Discharge Planning

> Review files

> Contact medical insurance regarding patient status

> Discharge patients with appropriate medical services(home health,DME equipment)

Core Disability Company 1999-2000

RN,MBA Nurse reviewer

> Perform telephonic clinical review

> Assess and evaluate on going treatment to determine medical necessity of services

> Obtained clinical information from medical providers

> Participate in quality management

Saint Mary Medical Center 1995- 1999

RN,MBA Clinical Manager

> Communicate with physicians,patients,family members

> Develop and document cost saving analysis

> Hiring and orienting new staff members

> Utilization Review,case management and discharge planning for Medi-Cal,

Medicare,HMO and private insurance for Home Health

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