Medical Case Manager
Resume:
Michelle Blackhurst
Canonsburg, Pa. 15317
Home: 724-***-****
Cell: 412-***-****
*****************@*****.***
Professional Summary:
A motivated individual with over 11 years of professional experience within the healthcare arena. Throughout my career, I have gained diverse experience in various capacities. Coupled with a Bachelor of Science in Nursing, I possess excellent communication and interpersonal skills.
Education: Duquesne University Pittsburgh, PA
Bachelor of Science in Nursing, 1996
Accomplishments/Rewards:
• “Cameo of Caring” award for Cardiovascular Surgical Unit at St. Clair Hospital in April 2005.
• Elected as Peer Advisory Team President for National Franchise Oogles n Googles™ in April 2007.
• Elected to speak at National Franchise Oogles n Googles™ Retreat in August 2007 and July 2008 – “$0 - $13,000 in 12 months.”
• Personally featured in August 2007 issue of “Entrepreneur Magazine and February 2008 in “Entrepreneur Start-Up Magazine.”
Employment History:
Associates in Rehabilitation 05/10 – Present
Field Nurse Case Manager
• Providing case management services to various employers/insurance companies by assisting them with workman’s compensation and short term disability claims.
• Case Management services involve attending appointments with physicians, physical therapists, hospitals and injured workers to ensure an accepted diagnoses and reasonable and necessary treatment for that diagnosis.
• A self motivated position and required to work in a virtual work environment with detailed billable time.
Travelers Insurance 12/08 to 05/10
Medical Case Manager Workers Compensation
• Office based telephonic medical case management with emphasis on early intervention, return to work planning, coordination of quality medical care on claims involving disability and medical treatment.
• Review medical injury and disease management claim files, injuries and effects of any pre-existing health issues that may affect a patient's recovery.
• Develop medical management strategy and give the provider information necessary to facilitate a return to work plan on claims requiring disability management.
• Work with medical providers and suggest cost effective treatment alternatives.
• Authorize medical treatment and associated diagnostic testing on assigned claims as allowed by state or policy jurisdictions.
• Provide technical assistance and act as a resource for claim handling staff.
• Document all contacts and outcomes related to case activity in computer system.
• Comply with established Best Practices and time sensitive Utilization Review.
Southwestern Pennsylvania Eye Surgery Center 12/07 to 12/08
Registered Nurse – Eye Surgery Center
Caring for patients undergoing eye surgery including cataract removals, plastic surgery and retinal detachment surgery in a recovery room setting.
Oogles n Googles™ 12/05 to Present
Franchise Business Owner/Operator
Own and operate the Pittsburgh franchise for Oogles n Googles™ which provides all inclusive themed birthday parties and preschool enrichment programs for children ages 3 thru 10 years old. Responsible for managing a staff of 6 people, selling enrichment programs to over 20 daycare facilities, and selling over 150 birthday parties.
St. Clair Hospital 8/00 to 02/08
Registered Nurse – Cardiovascular Surgical Unit
Caring for patients recovering from Coronary Artery Bypass Graft surgery in a critical care setting and following the patient through their recovery until discharge.
Registered Nurse – Intensive Care Unit
Caring for critically ill patients including those suffering from Pneumonia, Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, Renal Failure, and Gastrointestinal Bleeding.
Registered Nurse – Inpatient Rehabilitation Unit
Providing rehabilitation nursing to patients recovering from Cerebrovascular Accidents and Orthopedic Surgeries in a sub-acute care setting.
Humana 01/04 to 06/04
Personal Nurse Navigator
Nursing support via phone for Humana members who suffered from recent hospitalization or long term disease in a virtual home office setting.
Allegheny General Hospital 04/00 to 08/00
Registered Nurse – 5B/Surgical Intensive Care Unit
Provided care for those suffering from complications related to Coronary Artery Bypass Graft Surgery in a critical care setting.
Grand Strand Regional 04/98 to 04/00
Registered Nurse/Relief Charge Nurse – Progressive Care Unit
Cared for those recovering from Coronary Bypass Graft Surgery, Cardiac Catheterization, and unstable Angina on a step-down unit.
Health South Mountain View 08/97 to 04/98
Registered Nurse
Provided care for those suffering from traumatic brain injuries in a sub-acute care setting.
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