Nurse Client Manager - TRAVELERS INSURANCE - WEST BRIDGEWATER, MA
(2024-01)
- Perform Utilization Review and Retrospective Review on medical treatment requests to ensure services are clinically appropriate and necessary based on jurisdictional Medical Necessity Guidelines.
- Collaborate with Claim Professionals to Analyze clinical data and medical history, ensuring Payment Integrity by identifying discrepancies between requested and actual services.
- Consult with medical providers and attorneys to coordinate complex clinical care, maintaining strict Regulatory Compliance and documenting all interventions within Health Management Systems.
- Assess and develop strategic return-to-work plans for injured employees, focusing on Quality Assurance and maximum medical improvement metrics.
Unit Manager/staff Nurse - ROYAL HEALTH - NORWELL MA
(2022-06 - 2024-01)
- Conducted detailed Clinical Record Analysis and extensive documentation to provide continuity of care while adhering to Medicare Regulations and Medicaid Regulations.
- Executed Quality Assurance protocols for patient care, monitoring wound care and stroke recovery to ensure clinical non-compliance issues were identified and addressed.
- Managed Clinical Assessment for new admissions and implemented patient care plans aligned with ambitious standards of medical necessity.
- Leveraged in-depth understanding of drug mechanisms and pharmacology to support patient care and clinical documentation in hospice and high-acuity settings, preparing for protocol-driven research environments.
- Supervised and Provided Provider Education to nursing assistants to ensure the delivery of high-quality clinical services and adherence to unit protocols.
Clinical Client Manager - VITRA HEALTH - BOSTON, MA
(2023-01 - 2024-01)
- Analyzed and managed KPIs for a clinical team of 90+ caregivers, ensuring clinical appropriateness and operational efficiency for 300+ clients.
- Assessed and trained AFC/GAFC caregivers on Regulatory Compliance and clinical standards to minimize financial leakage and improve service delivery.
- Served as a subject matter expert in Clinical Assessment, facilitating internal audits to guarantee medical and financial integrity across client portfolios.
- Collaborate with care managers to optimize hiring forecasts and clinical staffing based on retrospective reviews of client needs.
Customer Success Manager - CORETELLIGENT - WESTWOOD, MA
(2020-01 - 2021)
- Maintained consultative relationships with clients to ensure Payment Integrity by auditing service delivery against contractual obligations.
- Advocated for client requirements across the organization, conducting Quality Assurance reviews to ensure service level agreements were consistently met.
- Documented and identified opportunities for service enhancement through data analysis and client feedback loops.
Customer Success Manager - EZE CASTLE INTEGRATION - BOSTON, MA
(2018-12 - 2020-09)
- Led access control implementation for 300 clients, ensuring Regulatory Compliance with security standards and preventing unauthorized environment access.
- Assessed and managed client onboarding and off-boarding processes, focusing on accurate documentation and clinical-style mindfulness in service requests.
- Analyzed client service trends to foster long-term partnerships and contribute to sustained organizational growth.
Client Project Manager - IHS MARKIT - CAMBRIDGE, MA
(2014-09 - 2018-11)
- Ensured on-time and on-budget completion of deliverables through rigorous Clinical-style analysis of project plans and financial invoicing.
- Trained internal teams on Salesforce CRM, functioning as a technical lead for data integrity and system implementation.
- Analyzed and monitored research updates via Connect portal, evaluating progress and ensuring compliance with established project agendas.
- Collaborate with diverse stakeholders, including CEOs and CTOs, to maintain high satisfaction rates through precise and initiative-taking project oversight.
Paralegal - Multiple Practices-Contract - Newton/Quincy, Massachusetts
(2011-05 - 2014-09)
Paralegal Internship - Norfolk District Attorney's Office - Quincy, Massachusetts
(2009-06 - 2009-06)
