Candie Cook
Coraopolis
Summary
Accomplished and certified professional with 18+ years of nursing experience. Current experience of providing direct case management services to a diverse population. Demonstrates expertise in managing complex caseloads and connecting clients to appropriate resources. Proven ability to build and maintain productive relationships with clients, stakeholders, and service providers. Skilled in analyzing client needs, developing effective service plans, and providing compassionate person-centered care.
7 years of experience with care coordination including discharge planning, utilization review, and MCG Guidelines.
Overview
18
18
years of professional experience
Work History
Oncology Case Manager
Cigna
07.2017 - Current
- Managed a caseload of 50+ patient's
- Adhere to company medical policies and guidelines to identify, review, assess, and allocate members for plan participation according to their identified health and financial needs
- Identify members' understanding deficits regarding their specific plan and situation, and provide the appropriate education, support, and materials to facilitate informed decision-making and understanding
- Communicate with providers and other members of each patient's healthcare team to coordinate individualized and comprehensive care according to plan specifications
- Utilize the telephone and other electronic communication formats to remotely monitor member care, including conducting admission reviews, post-discharge calls, and discharge planning
- Collaborate with the Medical Director on case reviews to review/render decisions on pre-determination cases (chemotherapy, radiation therapy, clinical trials, etc.), and assist members in obtaining second opinions
- Meet or exceed set monthly goals and complete monthly job update reviews
- Completes ongoing education and training courses as required by the company
- Utilization review, peer to peer, and appeals knowledge
- Knowledge of MCG Guidelines and clinical review for prior authorization and concurrent reviews
- Preceptor to new hires.
Registered Nurse
Heritage Valley Health System
06.2006 - 06.2017
- Utilized critical thinking skills to assess changes in patient conditions, recognize complications and intervene appropriately
- Managed multiple tasks while providing timely, high quality patient care
- Demonstrated ability to work independently as well as collaboratively within a team environment
- Certified to administer chemotherapy
- Medical/Surgical experience
- Surgical orthopedic experience
- Taught pre-operative classes to the orthopedic patients
- Preceptor to new hires.
Education
Associate in Applied Science (A.A.S.) in Nursing -
Community College of Beaver County
Monaca, PA05.2006
Skills
- Discharge Planning
- Family Education
- Case Management
- Care Coordination
- Utilization review
- Utilization Management
- EMR / EHR
- Organization and Multitasking
- Problem-Solving
- Case Documentation
- Resource Identification
Affiliations
- Greater Pittsburgh Chapter of Oncology Nursing Society - Director at large
Timeline
Oncology Case Manager
Cigna
07.2017 - Current
Registered Nurse
Heritage Valley Health System
06.2006 - 06.2017
Associate in Applied Science (A.A.S.) in Nursing -
Community College of Beaver County