Adam Y. Email & Phone Number

Westfield, In, Us

Responsible for maintaining daily operations of a team of remote telephonic nurses providing specialty medication patient education.

Whitestown, Indiana, United States

Team Leader for RN Pharmaceutical Prior Athorization Review Team

Whitestown, Indiana

● Provide high-quality, efficient clinical review of prior authorization requests for specialty and commercial medications, employing professional judgment in interpreting available clinical information and patient data against coverage criteria and communicating clinical and plan information to internal and external customers.● Whitestown Coverage Review Department Employee of the month, May 2017.● Voluntary additional opportunities: Preceptor for nurse clinical case review training… Show more ● Provide high-quality, efficient clinical review of prior authorization requests for specialty and commercial medications, employing professional judgment in interpreting available clinical information and patient data against coverage criteria and communicating clinical and plan information to internal and external customers.● Whitestown Coverage Review Department Employee of the month, May 2017.● Voluntary additional opportunities: Preceptor for nurse clinical case review training class, presenter for multiple clinical roundtables regarding specialty and commercial medications and associated diagnoses, facilitator for IRR review discussion, Site Safety Committee secretary.● Consistent achievement of high quality scores on internal audits. Show less

Indianapolis, Indiana Area

Lead Predetermination Review Nurse● Provided medical necessity service and medication reviews, clinical review and advice to claims specialists regarding billing issues requiring clinical interpretation, clinical adjudication of critical illness and disability claims against criteria based on supporting materials, and providing management of the external review process.Nurse Case Manager● Coordinated health care for chronic disease or complex needs patients including transplants… Show more Lead Predetermination Review Nurse● Provided medical necessity service and medication reviews, clinical review and advice to claims specialists regarding billing issues requiring clinical interpretation, clinical adjudication of critical illness and disability claims against criteria based on supporting materials, and providing management of the external review process.Nurse Case Manager● Coordinated health care for chronic disease or complex needs patients including transplants, dialysis, chemotherapy, radiation, and high-cost cases for members in self-funded health insurance plans. This included communicating client condition developments to key stakeholders including self-funded clients, arranging specialty medication reviews with external specialty vendors, step-down therapy with clinics, and durable medical equipment with DME suppliers, negotiating and authorizing home health care, extended care facility, and subacute mental health services, and verifying contract claims pricing and resolving disputes with pharmacy vendor. Show less

Carmel, Indiana

● Directed and supervised daily operations of a multidisciplinary clinical home care team of 12-18 professional direct-reports to deliver first-class services throughout Indiana and support corporate services nationally. This included clinical documentation reviews, performance appraisals including providing feedback, discipline including termination and performance track initiation and monitoring, and appropriate follow-up with CEO, Director of Nursing, and HR, participating in prospective… Show more ● Directed and supervised daily operations of a multidisciplinary clinical home care team of 12-18 professional direct-reports to deliver first-class services throughout Indiana and support corporate services nationally. This included clinical documentation reviews, performance appraisals including providing feedback, discipline including termination and performance track initiation and monitoring, and appropriate follow-up with CEO, Director of Nursing, and HR, participating in prospective employee interviews, customer complaint review, incident investigations, and service recovery efforts.● Communicated daily with physicians, allied health professionals, clients, families, and the CEO/owner regarding patient care, customer service and compliance.● Instructed Medicare Conditions of Participation course for new professional staff nationwide.● Presented skilled staff in-service to a national corporate professional audience.● Led site daily on-call clinical review and customer service escalation/ resolution meeting. Show less

Indianapolis, Indiana Area; Lafayette, Indiana Area; Nw & South Service Areas

● Coordinated health care for patients with chronic diseases, complex healthcare needs, or dysfunctional medical homes for a highly-varied population of clients in the home, inpatient, and institutional settings.● Care management software development and implementation committee RN representative.● Three-time Silver Award recipient for outstanding service/ support.

Indianapolis, Indiana Area

● Coordinated, delivered, and documented nursing care for monitored critical care patients in Progressive Care.● Member of HCAHPS and PULSE quality improvement teams.● Honors: Community Health Network PRIIDE Heroes Nominee for Patients First value, May 2010, PCU Employee of the Month winner- February 2010, nominee- May 2010, and three-time Daisy Award nominee for outstanding patient care.

Continuation of prior position in onsite occupational health on a PRN basis.

Indianapolis, Indiana Area; Frankfort, Indiana; Lafayette, Indiana

● Provided onsite initial assessment, injury management, rehabilitation services, ergonomic analysis, education, and CPR/ First Aid training for industrial employees at contracted sites.● Directed and continually improved onsite care in order to reduce client exposure to OSHA recordable incidents.● Communicated with medical providers, clients, safety and workers’ compensation specialists, safety teams, and plant and hospital managers to consistently provide efficient onsite injury… Show more ● Provided onsite initial assessment, injury management, rehabilitation services, ergonomic analysis, education, and CPR/ First Aid training for industrial employees at contracted sites.● Directed and continually improved onsite care in order to reduce client exposure to OSHA recordable incidents.● Communicated with medical providers, clients, safety and workers’ compensation specialists, safety teams, and plant and hospital managers to consistently provide efficient onsite injury management services. Show less

Owner and operator of general partnership operating web and person-to-person medical supply enterprise. Experiences included designing and publishing e-commerce website, marketing, establishing financial processing contract, and running day-to-day operations.

● Provided contract sports medicine and rehabilitation services at Greenwood Community High School, community events, and in the outpatient physical therapy clinics.● Authored model HIPAA policy for St. Francis Sports Medicine outreach program.

● Provided athletic health care for intercollegiate athletes in 17 NAIA Division I teams in 10 sports.● Instructed courses in assessment and sex education/ HIV and AIDS.● Supervised student athletic trainer clinical education and competency program, assisted with daily program operations, and administered all aspects of the athletic drug testing program.● NAIA- Athletic Trainers’ Association: President-Elect, Secretary, PR and Election Committee Chairs.

Provided comprehensive athletic training coverage to athletes and extracurricular participants in high school setting on staff of two part-time certified athletic trainers during graduate school.

Observed and provided onsite and in-clinic sports medicine, physical therapy, and occupational health care at Lafayette Home Hospital and Industrial Rehab Associates facilities in Lafayette, IN and onsite at Subaru-Isuzu Automotive (now, Subaru of Indiana Automotive, Lafayette) and Indiana Packers Corporation (Delphi).

Bsn, Nursing

Activities and Societies: Sigma Theta Tau International Nursing Honor Society; Alpha Chi Honor Society. Magna cum Laude.

Master Of Science, Sports Health Care

Bachelor Of Arts, Sports Medicine

Emt-B Certificaiton

Diploma, College Prep