Case Manager Patient Care

Anna L. Zimmerly, BSN, RN

Email: ****.********@*****.*** Phone: 614-***-**** Location: Columbus, OH LinkedIn: linkedin.com/in/anna-zimmerly-94235732a

Professional Summary

Experienced Registered Nurse (BSN, RN) with 25 years in healthcare, specializing in utilization management, case review, patient advocacy, and care coordination. Proven track record of enhancing patient outcomes, optimizing healthcare processes, and collaborating across interdisciplinary teams. Committed to continuous professional development and achieving measurable improvements in patient care and operational efficiency. Skills & Competencies

• Utilization Management & Prior Authorization

• Case Management & Care Coordination

• Patient Advocacy & Education

• Evidence-Based Critical Decision-Making

• Interdisciplinary Team Collaboration

• Electronic Medical Records (EMR/EHR), CMS & Insurance Policy Guidelines

• ICD-10 & CPT Coding

• Leadership & Mentorship

• Communication & Problem-Solving

Professional Experience

Career Break (Oct 2024 – Present)

• Layoff/position eliminated

Theoria Medical (Remote)

Clinical Care Specialist RN Case Manager (Aug 2024 – Oct 2024)

• Developed and maintained 100% up-to-date patient care plans for chronic conditions, tracking monthly progress.

• Increased patient adherence to treatment plans by 20% through regular education and engagement strategies.

• Achieved a 95% satisfaction rate among patients by providing personalized care coordination via text, email, and phone.

UnitedHealth Group – Optum (Remote)

RN Preservice Review (Prior Authorization) (Sep 2022 – Aug 2024)

• Maintained a 90%+ communication efficiency rate while managing 15-20 preservice healthcare service requests daily.

• Reduced processing errors by 25% by carefully reviewing patient medical records and diagnostic reports.

• Improved workflow efficiency by 15% by identifying and implementing process improvements for prior authorization reviews.

Care Coordinator RN Case Manager (Jul 2022 – Sep 2022)

• Developed and executed 100+ personalized care plans, enhancing patient health engagement and self-management.

• Achieved a 20% improvement in patient health outcomes through reassessment and coordination with healthcare professionals.

• Ensured 100% of patients received follow-up communication to support long-term health management.

Senior Nurse Clinical Coordinator – Specialty Pharmacy (Jul 2020 – Jul 2022)

• Coordinated with sales, intake, pharmacists, and nursing (in-house and outsourced skilled nursing) for intravenous antibiotics, TPN, hydration, IVIG, and SCIG medications.

• Increased compliance with clinical protocols by 30% through mentorship and training of nursing staff.

• Reduced patient complaints by 40% by improving response times and issue resolution strategies.

• Developed new workflow strategies that cut wait times by 25% in specialty pharmacy services.

Interim HealthCare (Columbus, OH)

RN Intake Coordinator (Oct 2019 – Apr 2021)

• Reviewed referral information for insurance, correct ICD-9/ICD-10 coding, CPT coding, and needs for skilled nursing, physical therapy, occupational therapy, speech therapy, and medical social workers.

• Streamlined patient intake process, reducing admission delays by 50%.

• Improved referral communication by 50%.

• Managed data entry of PHI and maintained HIPAA compliance.

• Increased patient and family satisfaction scores by 35% through clear, empathetic explanations of procedures.

Option Care Health (Columbus, OH)

Infusion Case Manager RN (Sep 2018 – Oct 2019)

• Ensured 98% treatment adherence by educating patients and families on infusion procedures and self-care.

• Performed start of care, recertification, and resumption of care visits while managing a caseload of 30-50 patients.

• Successfully managed infusion therapy for 150+ patients, ensuring compliance with physician orders.

Aetna Better Health (Columbus, OH)

Clinical Nurse Manager (Jul 2016 – Oct 2017)

• Led a team of healthcare professionals, increasing team morale by 20% through leadership development.

• Implemented new care protocols, reducing hospital readmission rates by 15%.

• Performed home and telehealth visits every sixty days and as needed for medication reviews, ensuring medication compliance and communicating with providers regarding changes in condition.

• Coordinated provider visits, transportation, and community resources for financial assistance and nutritional needs.

Mount Carmel Home Care (Columbus, OH)

RN Case Manager (Jul 2013 – Jul 2016)

• Developed and managed care plans that reduced unnecessary ER visits by 45%.

• Advocated for patient services, securing 100% approval for essential treatments and medications.

• Provided skilled nursing visits and performed care in wound care, diabetic education, medication education and compliance, CHF management, and Foley catheter care and changes.

Medicaid Waiver Program (Columbus, OH)

RN Case Manager (Jan 1998 – Jan 2013)

• Developed and managed care plans that reduced unnecessary ER visits by 25%.

• Advocated for patient services, securing 100% approval for essential treatments and medications.

• Provided skilled nursing visits and performed care in wound care, diabetic education, Foley catheter care and changes, and bowel elimination preparation and evacuation. Education

• Post University – Bachelor of Science in Nursing (BSN)

• Columbus State Community College – Associate of Applied Science in Nursing Certifications & Licenses

• Ohio Compact Licensure

• New York RN Licensure

• InterQual Certification (UnitedHealth Group)

• MCG Certification (UnitedHealth Group)

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