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Marilyn Bajeux


 0000 xxxxxx xxxx , xxxx , xxxxx 00000


Executive Profile


Results-driven Professional Nurse seeking to contribute expertise in client/patient relations, holistic patient care, creative development processes, as well as a host of relevant skills regarding resident populations in various care settings.  Eager to apply this specialized skill set toward actively collaborating with a dynamic organization in providing outstanding patient care.   


Key Skills

  Strong Leadership Skills

  Detail Oriented

  Staff Development



  Psychiatric Nursing


  Strategic Partnerships

Substance-Abuse Nurse

  Creative Development

   Efficiency Best Practices













- Focuses on efficient utilization management with emphasis on discharge planning.

- Understands and appropriately manages member's benefits to maximize health care quality.

- Collaborates with physician reviewers, case managers, project leaders and associates within organization to optimize member care and ensure a constructive provider experience.

- Facilitates review process by communication with all relevant parties to obtain and share information relating to benefits and the utilization management process.

- Collaborates with all relevant parties in order to develop, implement, authorize, and document treatment plans that include treatment goals, interventions, and expected clinical outcomes.

- Identifies and refers members who may benefit from high-risk case management and disease state management intervention.

- Educates and supports clients regarding benefits, eligibility, organizational policies and processes with the goal to empower the individual.

- Maintains professional licensure and seeks out continuous learning opportunities to enhance understanding of clinical management, trends in patient care, utilization management and other topics applicable to carrying out job responsibilities in an educated manner.

- Utilizes technology systems to efficiently enter case information, check benefits and eligibility look up policy and procedures, and validate provider contractual statuses.

- Develops and executes strategic customer-service initiatives in order to increase loyalty and retention. 

- Completes cost avoidance and other reports and tracking tools to capture impact and scope of medical management responsibilities.







Professional Career








































Blue Cross Blue Shield of MA                                                             2006-Present

Position: Telephone Nurse Reviewer


  Primary responsibilities include comprehensive review of all outpatient physical therapy and home care claims as related to patient insurance coverage.  This includes both concurrent and retrospective analyses. 


Bridge of Recovery Detoxification Center                                     2003-Present

Position: Detox Nurse


  Primary responsibilities include direct patient care as well as coordination of staff care services related to patient population.  Also responsible for regular assessments regarding physical and emotional statuses and consequent nursing interventions as necessary.  



Arbour Hri Hospital                                                                                    2001-2003

Position: Psychiatric Nurse


  Primary responsibilities included direct physician assistance involving examinations, various treatment programs, administration of relevant tests, as well the coordination of admissions and discharges of patient population. 



Mariner Health Nursing Home                                                                1998-2001

Position: Psychiatric Nurse


  Primary responsibilities included management and oversight of clinical staff, comprehensive and inclusive patient care, including but not limited to, direct assistance with Activities of Daily Living (ADLs), pain management, psycho-social needs, dietary requirements, medication administration, sanitation and hygiene requirements, as well as crisis intervention methods as needed.   




- Bachelor of Science - Nursing, Emmanuel College


- Bachelor of Arts - Economics, Suffolk University








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