Morrisville Registered Nurse

Jacqueline Bates, RN CCM

** ***** **** ********, *** York 13209 (M.) 315-***-**** *****************@*****.***

EDUCATION

Onondaga Community College, Syracuse, NY.

Associates in Nursing, College of Associated and Applied Sciences, May 1990.

State University of New York at Morrisville, Morrisville, NY.

Associates of Associated and Applied Sciences, May 1981.

CERTIFICATIONS

Registered Nurse, State of New York, 1990 - Present

Clinical Case Management Certified, 1999 - Present

PROFESSIONAL EXPERIENCE

PMA Management Corporation, Syracuse NY. 2013 to Present

●Understanding and application of in Jurisdictional guidelines, pharmacy reviews and medical spend daily

●Assess and review complex pharmacy files and coordinate direction using problem solving and team collaborative skills

●Significant history with review of age pending and problem solving

●Evaluating major catastrophic claims to assist with file direction and fostering an optimistic and positive environment

●Create return to work goals with clients and professionals to achieve optimal outcomes for clients with pharmaceutical claims and catastrophic claims

●Train and assist new colleagues on case management with pharmaceutical entities

CNA Insurance, Syracuse, NY. 2008-2013; 1998-2005

●Managed medical treatment and disability duration on worker's compensation files with an emphasis on early return to work in a positive and collaborative environment with other medical professionals.

●Engaged in pharmacy reviews to help reduce prescription drug costs

●Initiated and managed a pharmacy program in New York and New England Region States in federal compensation claims

●Experienced in managing disability claims for big corporations and companies.

●Held licensure in NY, MA, ME, RI, VT, NJ, PA, NH, TX

Liberty Mutual/Wasau Insurance, 2005-2008.

●Medical expertise in High Exposure files to reduce medical spend for clients and their respective companies.

●Medical file review of liability claims and their causal relationship to create the best medical care for clients needs.

●Managed 6 jurisdictions to assess and coordinate appropriate care for clients

●Reviewed and analyzed files for triage and medical necessity

QUALIFICATIONS

●30 years of experience in both clinical and non-clinical team environments

●Experience of being in a supervisory role on a collaborative team

TECHNICAL SKILLS

Operating and navigating Guidewire claims systems

Firm knowledge in operating Microsoft suite and google drive systems

Ability to operate work from home software with VPN system

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