ROSEMARIE RISERVATO, RN, BSN, CCM

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

Watervliet, New York 12189

Cell 1-518-***-****

E-mail: adsxj9@r.postjobfree.com

EXPERIENCE:

**/****- */**/**- ANTHEM, INC.- Albany, New York- Nurse Case Manager II- FT

I work from my home, providing members of the NYC Group, a dedicated unit for a 900,000 member group. I receive referrals and reach out to the members to offer them our services, which consist of assessment of their knowledge of their new or chronic conditions, providing education to the member, written information, helping the members set goals and reassessment of their progress, possible referrals to Dieticians, Social Workers, etc. We assist the hospital Nurse Case Managers and Social Workers with discharge planning also.

3/12- 10/2015- GENEX SERVICES, INC.- DeWitt, New York and Albany, New York

RN Field Case Manager- FT – I worked out of my home, handling Workers’ Compensation files. I met with the claimants, providers and employers to coordinate their care and facilitate a return to work. I provided full Case Management services, including cost containment strategies, discharge planning and utilization review.

9/03- 1/07- GENEX SERVICES, INC.- Islandia, New York and Albany, New York

RN Field Case Manager- FT – I worked out of my home, handling Workers’ Compensation and No- Fault files. I met with the claimants, providers and employers to coordinate their care and facilitate a return to work. I provided full Case Management services, including cost containment strategies, discharge planning and utilization review.

6/11- 6/12- REED GROUP- East Greenbush and Latham, New York

RN Case Manager FT- Basic member contact for Short Term Disability questions. I received calls from a queue and assisted them with answering simple questions and entering data into the system.

10/08-3/11- CAPITAL DISTRICT PHYSICIAN’S HEALTH PLAN.- Albany, New York

RN Medicaid Nurse Case Manager- FT- My main role was to attempt contact with each new member in the Medicaid division to assist them in understanding their coverage, as well as assist them with their health concerns. I would send them literature and tools to help them understand their conditions and when needed I would refer them to appropriate departments for further assistance. When needed, I would make calls to their providers for clarification of any questions they may have. I would encourage using urgent care centers as opposed to emergency departments if the need was not emergent. Forming trusting relationships first and foremost was my goal.

ROSEMARIE RISERVATO, RN, BSN, CCM

adsxj9@r.postjobfree.com

05/08-09/08- SARATOGA HOSPITAL – Saratoga Springs, New York

Full time Care Manager providing services on the Oncology Unit as well as the Renal/Dialysis Unit. I provided Care Management services including but not limited to: Discharge planning, Hospice referrals, providing concurrent needs, weekly Interdisciplinary meetings, etc.

03/07-05/08– COVENTRY WORKERS’ Comp Services, formerly CONCENTRA INTEGRATED SERVICES

RN Field Case Manager- FT- I worked out of my home, handling Workers’ Compensation and No- Fault files. I met with the claimants, providers and employers to coordinate their care and facilitate a return to work. I provided full Case Management services, including cost containment strategies, discharge planning and utilization review. I resigned this position to work at Saratoga Hospital.

10/06- present – LTCG (formerly Nations Care Link) – Minneapolis, Minnesota

Independent Contractor- I perform assessments for various long term care insurance companies. The assessments are done either in the home or alternate setting such as a nursing home or senior housing. There are many types of assessments, which range from a claims assessment for people already insured, to a comprehensive assessment for people applying for long term care coverage.

I also perform facility evaluations.

The claims assessment is a basic assessment which includes height, weight and BP. The comprehensive assessment is very detailed, includes a mini mental assessment as well as sitting and standing activities which are viewed.

12/06- 2/07 –TRAVELERS INSURANCE COMPANY – Albany, New York

RN Medical Case Manager– I provided telephonic Case Management services, pre-authorizing procedures and surgeries based on guidelines and protocols. I was in contact with the Injured Worker, employer and providers at the request of the Claims Case Manager at various points of the claim. Once I had assisted in returning the Injured Worker back to work, either in a light/modified duty position with/without restrictions, or to their regular full duty position, I would close my portion of the file. (Reluctantly resigned due to family situation at the time)

ROSEMARIE RISERVATO, RN, BSN, CCM

adsxj9@r.postjobfree.com

9/05- 10/06- VISITING NURSE SERVICE OF SCHENECTADY AND SARATOGA COUNTIES – Schenectady, New York

Working as an On Call Nurse from 4:30 PM- 8 AM Friday through Friday, alternating weeks with another Nurse. We worked 7 nights on, then 7 nights off. I answered the pager as service paged me when a patient calls in after hours. I took the messages and returned the patient’s call. I triaged the call to determine if a visit to them needed to be made or if it could wait until the morning when another nurse would be sent to visit them. I may suggest they call 911 if the situation warranted emergency action.

I also held a temporary position there as a Nurse Liaison servicing Albany Medical Center and Albany Memorial Hospital. This was a position lasting approximately 5 months. I would go see the patient in the hospital once a referral had been made to the agency. I would read the patient’s chart, determine the patient’s needs, speak with the hospital Case Manager or Social Worker, and write up the referral, then follow the patient through hospital discharge, setting up their start of care.

2/03 to 9/03- MEDINSIGHTS, a division of GAB ROBINS- Hauppauge, New York

RN Field Case Manager- FT- I worked out of my home, handling Workers’ Compensation files. I met with the claimant and medical providers to coordinate their care and facilitate a safe return to work.

1/03 to 4/03- PRECISION HEALTH RESOURCES- Jericho, New York

RN Field Case Manager- PT- Temp

Managing Workers’ Compensation files- meeting with the claimant, their providers, the customer- all with a mutual goal in mind- to return the claimant to work as soon as they are safely able to do so.

3/02 to 10/02- DOCTORS CARE NETWORK- Lake Success, New York

RN Case Manager/ Utilization Nurse

Telephonically followed patients upon admission to the hospital through discharge, assessing appropriateness of each hospital day using Interqual criteria. Made recommendations to the hospital Social Workers and Case Managers regarding discharge plans.

I also case managed a caseload of Disease Management Clients, providing education and utilization management to them. This system was vital to keeping the clients well through prevention.

Position terminated due to company no longer in operation. After the company closed, I remained on as a Consultant, visiting providers and TPA MD’s to provide public relations services.

ROSEMARIE RISERVATO, RN, BSN, CCM

adsxj9@r.postjobfree.com

3/00 to 6/01- UNIVERSITY COMMUNITY HOSPITAL- Tampa, Florida

RN Case Manager/ Utilization Mgmt Nurse- also PD Staff Nurse- Med/Surg

Evaluated all patients upon admission and each concurrent day to determine appropriateness of the admission and continued stay using Interqual criteria. Responsible for discharge planning, any social issues and securing insurance payments. I also filled in approximately one day per week as a Med/Surg Staff Nurse.

98 to 99- Temporary

UNITED HEALTHCARE- (Managed Access) On-Site Reviewer

PRUDENTIAL and AETNA INSURANCE COMPANIES (Medical Systems Review) HEDIS Reviews

3/98 to 7/99- CIGNA HEALTHCARE- Tampa, Florida

Patient Services- RN On-Site Reviewer

Using Interqual and Milliman & Roberts criteria, went to hospitals and SNU to review patient’s medical records upon admission and then do concurrent reviews. Assisted in discharge planning and home needs. Had direct contact with physicians, patients and their families as well as contact with Cigna’s Medical Director on a daily basis. Took part in interdisciplinary meetings depending upon the institution’s policies.

7/95 to 3/98- REGIONAL MEDICAL CENTER @ BAYONET POINT- Hudson, Florida

RN Case Manager/ Utilization Mgmt Nurse- also PD Staff Nurse- Med/Surg

Using Interqual criteria, evaluated the appropriateness of every new admission, also their concurrent days, cost containment, insurance reviews and discharge planning. Had training in Milliman & Roberts criteria. I also filled in approximately one day per week as a Med/Surg Staff Nurse. In addition, on days off, I would assist the Nursing Management Department in chart reviews for Quality Assurance and to prepare for inspections.

10/95 to 8/97- CRAWFORD & COMPANY- Tampa, Florida

RN Case Manager- On-Site Reviewer

While employed full time at REGIONAL MEDICAL CENTER, I also worked part time as Field Case Manager for selected Workers Comp cases. Used Interqual criteria as well as Milliman & Roberts criteria depending upon the insurance company the claimant was insured by.

11/94 to 3/95- CNA INSURANCE- Melville, New York

RN Telephonic Case Manager- Provided case management services to injured workers telephonically. Back to work emphasis. Pilot program.

ROSEMARIE RISERVATO, RN, BSN, CCM

adsxj9@r.postjobfree.com

3/93 to 3/94- THE CENTER FOR REHABILITATION- Hauppauge, New York

Patient Services Representative

Marketing position- visited physicians and hospitals to obtain patients to receive therapies at one of the center’s locations.

1/91 to 1/93- THE TRAVELERS INSURANCE COMPANY- East Meadow, New York

Medical Coordinator- (No-Fault Dept.)

Coordinated care for claimants injured in automobile accidents. Visited the claimants at the hospital, their homes, followed their progress and spoke with their provider(s) of care to ascertain that proper care was being given while also managing the cost of their care within their policy limits. Provided in-service training to No-Fault and Liability personnel.

EXPERIENCE:

**Please note that many dates may overlap as I worked at some of these positions simultaneously.

EDUCATION:

ADELPHI UNIVERSITY-Garden City, New York

BSN

LICENSURE:

Registered Professional Nurse

New York: 426837

Certified Case Manager

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