Prior Authorization, Case Manager, many years of clinical experience

Sarah Nieman

Shelbyville, Kentucky

**********@***.*** – 502-***-****

Professional Experience

Collabera – November 2020 – March 2022

Clinical Review Clinician – Molina Healthcare

Perform prior authorization and continued stay reviews for Behavioral Health members using eligibility criteria and evidence based clinical guidelines.

Referred appropriate cases to the Medical Director with complete and succinct clinical information.

Make referrals to other clinical programs.

Humana – August 2011 – May 2020

Appeals Nurse

Expedite resolution of authorizations and appeals

Utilize clinical knowledge, policy and clinical records in making determinations

Coordinate internal and external resources

Document and summarize the results of the authorization or appeal

Telephonic Disease Manager

Educate patients in five major disease entities: Diabetes, COPD, Asthma, CHF, and Major Depression

Motivate patients to overcome personal constraints to improving their disease management using Motivational Interviewing techniques.

Monitor patient’s progress towards improved health management

Sterling Medical – May 2006 – March 2011

Kentucky National Guard Case Manager

Monitor over 300 Kentucky National Guard Soldier's medical records for health issued that might interfere with service in the National Guard

Prepare records for review by physician for health issued that might interfere with deployment readiness

Assist Soldiers to obtain necessary treatment

Additional Skills

Proficient in Microsoft Word, Excel, and Outlook

Reliable - able to complete work in required time frame and with a high degree of accuracy

diligent, dependable, and conscientious

Articulate in verbal and written communication

Education

BSN from Chamberlain College of Nursing 2012

Certified Case Manger (CCM)

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