Medical Management
Resume:
Cecilia Harvey Inc.
Rancho Santa Margarita,
California 92688
jl1xeh@r.postjobfree.com
Work Experience:
Cecilia Harvey INC.
Jan 2000
Medical interpretation of all case specifics for any medical record.
IME fact witness providing support as a patient advocate.
Medical expert witness for all litigation services.
Screening cases for merit based on current medical standards and appropriate treatment in medicine.
Research for all additional interpretation for medical legal services.
ISYS
September 2006 – August 2010
Field case management services for workers compensation cases in Southern California.
Directing appropriate medical treatment and instruction of care to all treating providers.
Reserving appropriate cost for medical treatment, disability needs and duration of claims needs.
Create return to work alternatives with medical management team, employers, and claims.
Corvel
January 2005 – August 2006
telephonic services for utilization review services.
Provide utilization review services for workers compensation claims under ACOEM guidelines
Interpret appropriate medical management for authorization of treatment for workers compensation
Provide treatment savings and help set file reserves for claims.
CompPartners
April 2000 to 2004
Contracted telephonic and field case management for Everest Insurance and ACCA Insurance Co.
Direct contact with employers, injured workers and doctors and claims adjusters governing the workers compensation claim.
Determine appropriate medical management in relation to the workers compensation claim.
Creating network group of facilities and M.D.
CCSI
September 1998 to 2005
Contracted telephonic and field case management for Paula Insurance and Southern California Risk Management Insurance Co.
Determine medical necessity of specific treatment and channeled treatment to contracted providers.
Working directly with claims management with reserves and medical management.
Negotiate price for equipment, facility and treatment.
Blue Cross of California – Costa Mesa Ca.
October 1996 to September 1998
Telephonic and field case management for Unicare and Keenan Insurance Co.
Working with claims management with reserves and medical management for group health and
Standardized policies for standing orders and review guidelines.
Intracorp, Inc. – Anaheim, Ca.
December 1994 to July 1996
Telephonic case management throughout the United States.
Negotiated treatment plans to successful return to work and completion of treatment.
Working directly with claims examiner for accurate reserves and appropriate medical management.
Allergan, Inc. – Irvine Ca.
March 1993 to October 1996
Allergan Institutional Review Board Member.
Reviewing protocols and consents for ongoing investigation of drug studies.
Reviewed safety and effectiveness of clinical drug studies.
Children’s Hospital of Orange County – Orange, Ca.
June 1990 to July 1995
Outpatient Clinic RN
Pediatric & Neonatal Intensive Care Unit RN
Medical Surgical Units RN
Western Medical Center – Santa Ana, Ca.
March 1989 to October 1992
Pediatric Medical Surgical and Intensive Care Unit RN
Newborn Nursery and Neonatal Intensive Care Unit
Adult Intensive Care Unit
Medical Surgical Unit
Education
California State University Dominguez Hills
Student for Bachelor of Science, Nursing.
Saddleback College, Associate Science Degree, Registered Nurse.
Vicki Milazzo Institute, Florida 2008
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