Case Management Human Resources

LORRAINE BRATIS

***** ***** ***** *****, *******, Texas 77059

**************@*****.*** 281-***-**** (c)

EXECUTIVE SUMMARY

Highly motivated and detail oriented with extensive pharmacy laboratory training, patient service, call center, MTM, case management, medical, training, medical assistant, and managerial skills, with emphasis on adherence policies and procedures. Solid foundation in medical terminology, medical case management, workers’compensation claim coordinator and processor.

LICENSES AND CERTIFICATIONS

National Pharmacy Technician Certificate #10054322

Texas Board of Pharmacy Registration #258489

Kentucky Board of Pharmacy Registration #PT00171641

North Carolina Board of Pharmacy Registration #66394

BLS CPR Certification #L-264271

Blood Borne Pathogens #L-264284

HIPAA Certification #L-264285

EMPLOYMENT HISTORY

Human Resources/EHS - Workers’ Compensation Coordinator

September, 2022 — September, 2024 Charles River Laboratories

•Conduct investigations, manage files with an emphasis on file quality (including timely contact and proper documentation and proactive resolution of outstanding issues). Achieve a positive end result by returning injured party to work and coordinating the appropriate medical treatment in collaboration with MCO/TPA. Case management throughout life of claim to ensure internal and external process adherence

•Collaborate with Medical Case Manager to integrate the delivery of medical services into the overall claim strategy.

•Evaluate claims for potential fraud.

•Negotiate settlement of claims within designated authority.

•Participate in Telephonic and/or onsite File Reviews. Respond to inquiries – verbal and written. Keep injured worker apprised of claim status

•Collaborate with management on workers’ compensation claim administration, including injury reporting, drug testing, and transitional work programs.

•Interact with workers’ compensation third party administrators (TPAs) and managed care organizations (MCOs) to ensure proper handling of claims that align with organizational and plant objectives.

•Communicate effectively and build cross-functional relationships with Human Resources, EHS, and Operations.

•Schedule and participate in claim conferences to discuss strategy, reserves, and settlement authority and communicate these decisions internally, as necessary.

•Collaborate with workers’ compensation claim counsel on high-risk or litigated claims.

•Communication with employees regarding FMLA, LOA, and WC

•Communicate workers’ compensation losses as well as perform analysis to determine trends in workers’ compensation claims.

•Manage all aspects of the claim file including reviewing for accuracy and ensuring payment for all bills and settlements.

•Compare current policy/procedures to current regulations and best practices across the industry.

•Attend ongoing training related to workers’ compensation, including captive insurance and state monopolistic insurance programs.

•Restructured internal worker’s compensation program and SOP for injury reporting process for multiple sites based on corporate policy and state law

•Created SOP for Occupational Health and Safety Compliance

•Initial education and ongoing training of people leaders and staff on injury reporting process

•Injury data collection for internal training and environmental health and safety purposes

•Collect and manage injured worker reports, facilitating worker compensation claim forms, communicating extensively with TPA, MCO, legal team and state officials to ensure proper external claim review and processing for medical only and TTD claims.

•Review and maintain medical records to determine certification or dispute of claims

•Represented the company by determining to certify or dispute injury claims, working with TPA and legal team to gather information to present case

•Monitored SAP entry to ensure time recorded correctly per policy, advising on discrepancies

•Payroll and wage reporting for total temporary disability claims

•Return to work facilitation with management to accommodate medical restrictions, including the location of other job duties/departments as necessary

•Initial and ongoing training of 100+ member management team and 1500+ employees regarding workplace injury reporting process and WC policies

Pharmacovigilance Coordinator

April, 2021 – July 2021 ProPharma Group (Contract Position)

Human Resources - Covid-19 Case Manager/ Accommodations

February, 2021 — July, 2023 US Bank (Contract Position)

Human Resources - Covid-19 Case Manager

November, 2020 — September 2022 Charles River Laboratories (Contract Position)

•Managed HR representative and laboratory supervisors conducting internal Covid-19 contact tracing and containment procedures

•Provided guidance and case resolution based on CDC guidelines and internal procedures

•Initiated and performed internal Covid-19 case investigations with medically presumed and lab confirmed cases to identify and document outbreaks, workplace clusters, and individual cases

•Created and maintained COVID emergency response SOP

Covid-19 Case Manager and Trainer

October, 2020 — February, 2021 Comcast (Contract Position)

•Initiated and performed internal Covid-19 case investigations with medically presumed and lab confirmed cases to identify and document outbreaks, workplace clusters, and individual cases

•Acquired information on all possible case contacts and contact locations, researching any necessary information including submission of medical record and laboratory result requests and conducted internal contact tracing in necessary situations

•Continued case management through end of disease progression and continued follow up with patients monitoring their symptoms, referring to medical care, and clearing them to cease quarantine and resume normal activities

Epidemiology – Covid-19 Case Manager

July, 2020 — November, 2020 Harris County Department of Public Health (Contract Position)

•Initiated and performed Covid-19 case investigations with lab confirmed cases to identify and document outbreaks, healthcare and non-healthcare related workplace clusters, and school clusters, and determine possible locations and sources of infection/transmission.

•Acquired information on all possible case contacts and contact locations, researching any necessary information including submission of medical record and laboratory result requests, and forwarding complete files to appropriate contact tracing teams.

•Continued case management through end of disease progression, including contacting ISP for medical records, lab results, and death records, and continued follow up with patients and their families directly, until death or patient recovery

•Issued control orders to actively contagious patients; ensuring patients complied with mandatory isolation requirements through direct patient follow up; forwarding cases to enforcing agencies if they were non-compliant.

•Deemed patients recovered through symptom evaluation per CDC guidelines; issued recovery letters; advised patients on current CDC practices and recommendations.

•Completion of Case Report Forms, Death Summaries, Case Summaries

Case Manager- Certified Pharmacy Technician – Lead Patient Engagement Specialist TX

October, 2017 – April, 2019

February, 2015 — April, 2016 Physicians Pharmacy Alliance (Contract Position)

•Responsible for efficiently pitching/selling program details and enrolling new patients into pharmacy program through in-home visits as well as remotely via call center environment

•Performing in home visit with patients to completely and correctly obtain and document patients entire medical history and medication profile, case management until transitioned

•Maintain customer/patient confidentiality per HIPAA and company standards

•Maintain prescription prioritization throughout prescription processing including translation of SIG codes, product selection, counting and measuring drugs, capping and uncapping vials and bottles in mail order pharmacy environment

•Entering new patient profiles and prescriptions into medication input software system

•Operations Comply with all federal and state laws, company SOP at all time

• Assessed patients for reasons of medical non-compliance

•Maintain schedule appointment time and preparation of expense reports

•MTM

•Implemented pharmacy technician training program

•Training and assessment of pharmacy technicians/Program Training and continued point of contact for referring physicians

•Research, initiate, and follow through on patient advocacy, locating local resources for low-income patients, making any necessary referrals to assist with compliance

Certified Pharmacy Technician/Dispensary Technician/ Case Manager

April, 2016 – February, 2017 Physicians Alliance/Lancaster Hematology Oncology Care

•Responsible for verifying and entering prescription into medication input software system, filling, and dispensing of prescriptions

•Maintain prescription prioritization throughout prescription processing including translation of SIG codes, product selection, counting and measuring drugs, capping and uncapping vials and bottles and occasional compounding

•Patient medication management by closely monitoring all patients’ prescriptions prior to scheduled appointment to ensure medications are filled, communicating directly with physicians to accommodate needs, MTM

•Research, initiate, and follow through on patient advocacy and medication monetary and medication replacement resource programs for financially challenged patients; Case Management

•Resolve Third Party rejections and complete any manual claim forms; Medical Billing

•Initiate and finalize prior authorizations with insurance companies and PBMs for oral and IV chemotherapy medications as well as radiographic procedures, blood work and medical office visits

•Inventory control including Purchasing medications along with weekly and monthly auditing and revenue monitoring; Medication returns, credits, billing

•Maintain patient confidentiality per HIPAA and company standards, complying with all federal and state laws, rules and regulations, and company standards

•Front Office Assistant – checked patients in/out, verified insurance, scheduled testing, chart prep, scheduling/rescheduling

Lead Certified Pharmacy Technician

September, 2014 — November, 2014 CVS

2005- 2014 Homemaker/Stay at home mother

Medical Office Manager/Medical Assistance/Medical Billing/Medical Reception

August, 2004 — September, 2005 Dr. Joseph T. Schwartz

Pharmacy Technician

April, 2003 — January, 2004 Wal-Mart Pharmacy

Customer Care Pharmacy Technician

July, 2000 — May, 2001 Drugstore.com

Pharmacy Technician

November, 1998 — February, 2000 Eckerd Drugs

Pharmacy Technician

September, 1998 — November, 1998 CVS

EDUCATION

Kingsway Regional High School

High School Diploma

Degree date: 1993

Atlantic Cape Community College

Psychology

Degree date: 2006

Penn Foster

Diploma, Pharmacy Technician

Degree date: 2011

Western Governors University

Enrolled, BS Business Administration Human Resources Management

Anticipated Graduation: 2024

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