yyyyyy x. yyyyyy
0000 xxxxxx xxxx , xxxx , xxxxx 00000
xxx-xxx-xxxx • firstname.lastname@example.org
skilled managed care professional eager to contribute clinical expertise as well as strong leadership skills and organization talents toward actively supporting an organization in maximizing performance.
respected healthcare manager with distinguished 20-year career leading managed care, clinical and personnel management operations. in depth expertise in utilization management, call center operations, hospice, case management, and disease control. strong background in nursing, with specific expertise in organizational, time-management and patient care capacities. hand-selected to serve as consultant for bank of america and general electric, effectively providing expert advice on all health care related issues. effectively directed clinical and non-clinical staff and actively collaborated in human resource operation functions such as personnel training, evaluating performance and providing guidance/mentoring. proven ability to maintain the highest levels of confidentiality and uphold the ethical standards of the healthcare profession.
managed care experience:
- skillfully provided a broad range of utilization, case management and hospice services to medical and behavioral adolescent and adult health members.
- facilitated productive vendor relationships to achieve competitive pricing for out of network contracts, in-network providers and multiple contracts. .
- actively served as catastrophic case manager for major hmo/medicare clients, providing community resources for all members.
- consistently provided quality patient care, through iv management, catheterization, wound care, burns, cardiac care, dialysis, and medication administration services.
- successfully performed physical assessment examinations on medical surgical patients, including vital signs, collect specimens, draw abg s, monitoring avi pumps, ventilators, pulse ox, and oxygen flow meters.
- educated patients on operation procedures, medication dispensing and at-home care.
senior case manager blue cross blue shield 2009-present
manager of prior authorizations and referrals centene 2008-2009
lead case manager/senior case manager blue cross blue shield 1997-2008
assistant supervisor um dept; aetna health plans 1991-1995
charge nurse university of medicine & dentistry date-date
master s of business administration keller graduate school of management 2002
bachelors of science in nursing bloomfield college bloomfield, nj 1984
certified case manager present
member national association of professional women
member georgia chapter; case management society of america
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