Experience

RTW, Inc.

• United States
• Insurance
• 1 - 100 Employee

• MANAGER, Medical Services and Nurse Quality Assurance

  • 2006 - 2016

  (telecommuter) Provide leadership, training, support and oversight in medical service department of physicians, nurses and administrative support. Project Manager lead to develop, implement and deliver oversight of new medical services processes. - Led, developed and implemented medical cost savings programs and procedures, achieving 30% return on investment. - Mitigated opioid over-usage in workers’ compensation as project manager lead. Created and directed workers’ compensation opioid program… Show more Provide leadership, training, support and oversight in medical service department of physicians, nurses and administrative support. Project Manager lead to develop, implement and deliver oversight of new medical services processes. - Led, developed and implemented medical cost savings programs and procedures, achieving 30% return on investment. - Mitigated opioid over-usage in workers’ compensation as project manager lead. Created and directed workers’ compensation opioid program resulting in 45% reduction of opioid usage timeframes. - Designed and implemented new documentation format, leading testing process. - As Project Manager lead, customized, directed and executed clinical programs with pharmacy benefit management companies, leading to 20%+ decrease in overall pharmacy spend. - Managed cost containment by initiating a nurse-oversight structure, decreasing patient disability periods. - Established processes, policies, procedures and training of medical service products, increasing revenue and bringing on new clients in a timely fashion while delivering outstanding customer service. - Built and maintained medical vendor relationships, providing variable capacity, meeting staffing needs. - Led medical service team through coaching and providing feedback, consistently realizing expectations. - Acted as major stakeholder of post-acquisition merger of 2 workers compensation claims organization, collaborating with IT, ensuring understanding of needs and overseeing clinical pharmacy processes and managed care network changes, leading to transition.

• CASE MANAGEMENT TRAINING AND COMPLIANCE SPECIALIST

  • 2002 - 2006

  (telecommuter) Provided training and oversight of corporate nursing roles and nursing products. Developed and maintained nurse corporate policies and procedures, best practices, case management reference manuals and training materials. - Created dynamic training program, producing quality Nurse Case Manager (NCM) team of nurses. - Led quality improvement meetings and continually achieving process improvements, decreasing claim costs. - Ensured quality product delivery by developing quality… Show more Provided training and oversight of corporate nursing roles and nursing products. Developed and maintained nurse corporate policies and procedures, best practices, case management reference manuals and training materials. - Created dynamic training program, producing quality Nurse Case Manager (NCM) team of nurses. - Led quality improvement meetings and continually achieving process improvements, decreasing claim costs. - Ensured quality product delivery by developing quality oversight process and committing to obtaining outcome-based quality.

• Nurse Case Manager - Workers Compensation

  • 1994 - 2002

  Bloomington, MN Achieved $9M in premium growth over 1st 3 years with satellite start-up company, maintaining 98%+ customer retention.



Prudential Insurance

• Nurse Case Manager - Catastrophic

  • 1991 - 1994

  Minneapolis, MN Negotiated medical costs while ensuring quality medical care. Precertification of in patient hospital stays.