Workers Compensation Review Nurse
Resume:
Sheri Guileyardo -Neathery
Denham Springs, LA. 70726
Summary: Knowledgeable and self motivated with excellent organizational skills. Demonstrates above average ability for attention to details, time planning and problem solving. Effective communication skills to interface with all levels of personnel and promote positive client relations. Experience in handling a variety of tasks and responsibilities simultaneously and effectively.
Professional Experience:
Travelers Insurance, Alpharetta GA
Medical Case Manager 2003 – 2022
Total case management for workers compensation cases with a major emphasis on returning to work. Arrange for appropriate medical treatment in a timely manner. Review medical records to pre cert medical care, various therapies, diagnostic test and surgery. Schedule vendor services, arrange for transportation and translation services for the injured party as needed. Obtain job descriptions from the employer to coordinate a safe and effective return to work for both modified and full duty. Review and approve vendor bills. Assist with training for both current and new employees. Direct liaison between all parties involved with an injured worker. Compendium, Inc. Lawrenceville, GA
Nurse Case Manager 2002 - 2002
Total case management for workers compensation for state employees. Review medical records and physical therapy evaluations. Authorize appropriate treatment and procedures in a timely manner. Assist employers when calling in the first report of injury. Assist the injured workers with questions concerning their rights and role under workers compensation according to the state guidelines. Schedule diagnostic testing, functional capacity evaluations and work hardening programs with necessary. Negotiate fees and prices with durable medical companies. Approve prescriptions for the injured party. Arrange transportation and translation services when necessary.
Corvel Corporations, Tampa, FL
Nurse Case Manager 1999 – 2000
Total case management for workers compensation cases for county school board employees. Review of medical records, discuss with providers appropriate treatment and procedures, pre cert surgeries, treatments and diagnostic testing for medical necessity, communicate with employers and physicians to facilitate return to work for modified and full duty, coordinate transportation for the injured workers, update and maintain job description bank to assist nurses and claims adjusters with reasonable length of disability based upon injury and work duties. Travelers Medical Claims Services, Tampa FL
Nurse Case Manager and Utilization Review Nurse
Total case management for workers compensation cases for corporate accounts. Pre certifications (utilization review) of surgeries, therapy and diagnostic testing with providers. Negotiate fees with durable medical companies, hospitals and therapy facilities. Scheduling diagnostic test and medical case management with an average case load of 80 – 100 active files. Public relations with claims adjusters, employers, injured workers, physicians and therapists. Direct focus on medial case management with a major emphasis on return to work. Schedule in services for nursing continuing education credits. Train new employees. Education:
Nursing School at Humana Health Institute in St. Petersburg, FL 1991 – 1992
Southeastern Louisiana University in Hammond, LA
Majored in Psychology
1987 – 1989
Professional Development: Attend various in-services throughout the year for continuing education credits.
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