Case Manager or Registered Nurse or Nurse Manager

MARIANNE BRIGANDO 52L Franklin Greens South ost.net * 732-207-3106

* Somerset, New Jersey 08873 * 732-321-7506

*

mb1224db4@westp

Accomplished hospital advocate with 20 years experience in clinical and financia l management ensuring quality patient outcomes and cost containment. MEDICAL MANAGER * CLINICAL APPEALS MANAGER * CASE MANAGER * MEDICAL APPEALS AND DENIALS MANAGER * MANAGER OF CLINICAL OUTCOMES SUMMARY OF QUALIFICATIONS * Registered Nurse with 20 years of progressively responsible experience in dire ct patient care and case utilization management in long term and acute care sett ings. * Ability to define and monitor professional standards to insure clinical excell ence in meeting program goals. * Insures continuous improvement in the delivery of customer focused quality car e to result in ongoing compliance with regulatory and accrediting agencies. * Provides monthly operational reports of case management activities to senior m anagement. * Ensures timely and accurate completions of all coded related denials, recordin g, monitoring and follow-up in accordance with set timelines. * Ability to track all cases in appeal for performance measurement and outcome p urposes along with keeping intake staff apprised of payer success stories and co aching how to overcome payer objections to coverage. * Able to track and analyze all cause data resulting in decreased reimbursement. PROFESSIONAL EXPERIENCE COORDINATOR, QUALITY MANAGEMENT November 2007 - Present JFK MEDICAL CENTER Edison, New Jersey JFK Medical Center is a major medical center and health care complex. It include s resources, healthy features and healthy living topics. * Responsible for measuring clinical outcomes as mandated by CMS. Interact and i ntervene with the New Jersey Department of Health. * Facilitate peer review groups in an effort to investigate quality issues. MANAGER, MEDICAL APPEALS/MANAGED CARE REIMBURSEMENT November 1998 - November 200 7 JFK MEDICAL CENTER (SOLARIS HEALTHCARE) Edison, New Jersey JFK Medical Center Solaris Healthcare is recognized for being responsive and sen sitive to community needs, extending beyond traditional boundaries, in order to achieve higher levels of community health and access. * Supervised Case Management staff regarding daily operational issues within the department. * Reported department variances and system delays in interdisciplinary hospital staff. * Used New Jersey HMO regulations to submit appeals for all medical and administ rative denied claims. Submitted data to VHA-East coast and New Jersey Hospital A ssociation. * Worked cooperatively with case management staff in an attempt to minimize deni ed days on inpatient cases. * Completed comparative summary reporting for financial purposes. * Monitored and reviewed cause data for denied claims, provided recommendations for nursing and physician staff practice on a monthly basis. * Analyzed data regarding trends and practice patterns with Managed Care compani es. Accomplishments: * Increased revenue of 1.7 million dollars on the average, annually in reversed claims. * Successfully responsible for a decrease in denied days from 13% to 5%. * Member of Finance Revenue Executive Committee. * Developed and implemented work flow processes to increase financial revenue. UTILIZATION REVIEW NURSE/DISCHARGE PLANNER November 1997 - November 1998 JFK MEDICAL CENTER (SOLARIS HEALTHCARE) Edison, New Jersey

* Successfully managed 50 cardiac patients. Assessed appropriate length of stay. * Used Milliman & Robertson Guidelines and InterQual criteria to apply utilizati on management for Medicare, Medicaid, and Managed Care populations. Accomplishments: * Implemented a preceptor program for new UR staff. * Credited with completing variance monitoring and assessment of inappropriate d iagnostic testing. ADDITIONAL EXPERIENCE * Registered Nurse. JFK Medical Center (Solaris Healthcare). Edison, New Jersey. 1995 - 1997. * Clinical Case Manager. Union Hospital. Union, New Jersey. 1994 - 1995. * Registered Nurse. Union Hospital. Union, New Jersey. 1992 - 1994. * Licensed Practical Nurse. Union Hospital. Union, New Jersey. 1991 - 1992. * Licensed Practical Nurse. Cranford Health and Extended Care Center. Cranford, New Jersey. 1989 - 1991. EDUCATION AND TRAINING BACCALAUREATE COURSEWORK IN BUSINESS AND FINANCE 1997 KEAN COLLEGE Union, New Jersey ASSOCIATE DEGREE IN NURSING 1992 ELIZABETH GENERAL SCHOOL OF NURSING Elizabeth, New Jersey DIPLOMA IN PRACTICAL NURSING UNION COUNTY COLLEGE Cranford, New Jersey SELECTED TRAINING AND ACCOMPLISHMENTS * Licensed Registered Nurse in New Jersey and New York. * Physician education regarding InterQual and Milliman & Robertson criteria. PROFESSIONAL ASSOCIATIONS