Sheresa Russell
Riverside
Summary
Dedicated Clinical Case Manager with significant experience in medication prior authorization and clinical documentation. Expertise in problem-solving, critical thinking, and time management for effective patient care.
Overview
18
18
years of professional experience
Work History
Clinical Case Manager
Ann & Robert H. Lurie Children's Hospital of Chicago
Chicago, IL
05.2023 - Current
- Completed needed prior authorizations for medications, transfers, inpatient admissions, home care admissions or home care medications.
- Facilitated any needed insurance denial or appeal processes using LOMN, articles, clinical information or peer to peer options.
- Also worked with inpatient, retail and specialty pharmacies on medication approvals and denials for dispensing.
- Worked with inpatient financial clearance and counselors to help with patient insurance coverage needs.
- Worked with the State of Illinois and all commercial insurances for medication approvals via Cover My Meds, Phone, Paper Fax or via direct contact with insurance case managers.
- Coordinated interdisciplinary plans for pediatric patients, ensuring comprehensive support and communication among teams.
- Conducted thorough assessments to identify patient needs and develop tailored intervention strategies.
- Facilitated family meetings to discuss care options, enhancing patient involvement in treatment decisions.
- Collaborated with external agencies to secure resources and services for families in need of additional support.
Clinical Liaison With CMH/Lurie Children's
Option Care
Itasca, IL
08.2008 - 05.2023
- Worked with Lurie inpatient and outpatient teams to transition patients home and provide needed home therapies or medications.
- Provided needed clinicals, communication and updates for insurance approvals and appeals. Appropriately offering medication alternatives as needed-per available insurance formulary.
- Facilitated communication between clinical teams and patients to ensure seamless care transitions.
- Developed educational materials for healthcare professionals to enhance understanding of home infusion therapies. Currently have professional instruction videos on Option Care site.
- Implemented process improvements that streamlined referral management, increasing efficiency in patient onboarding.
Education
Bachelor of Science - Nursing
Chicago State University
Chicago, IL05-1998
Skills
- Significant Medication Prior Authorization and Denial Experience
- Knowledge and extensive experience with using Cover My Meds
- Years of home health experience and home medication/infusions
- Professional knowledge and years of experience working with medicaid and commercial insurances
- Clinical documentation
- Problem-solving
- Time management
- Multitasking and organization
- Critical thinking
Timeline
Clinical Case Manager
Ann & Robert H. Lurie Children's Hospital of Chicago
05.2023 - Current
Clinical Liaison With CMH/Lurie Children's
Option Care
08.2008 - 05.2023
Bachelor of Science - Nursing
Chicago State University