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yyyyyy x. yyyyyy

0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx •



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.


key skills


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.


clinical experience:

  • 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.


professional experience

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


professional education

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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