Danica Lyon Warfield, Rn, Bsn, Ccm Email & Phone Number

Eagan, MN

Tampa/St. Petersburg, Florida Area

Jacksonville, Florida Area

• Designed and developed clinical program interventions and facilitated work sessions to optimize the achievement of strategic business objectives
• Analyzed health metrics and constructed reports and spreadsheets utilizing non-identifiable member data, to strengthen and enhance clinical program engagement
• Operated as knowledge expert for Aetna clinical programs, specializing in complex Case Management

Linthicum, MD

• Supervised day-to-day Case Management activities and performed program reporting to ensure adherence to NCQA and documentation requirements
• Collaborated with account teams to manage potentially negative outcomes and to enhance Plan Sponsor relationships
• Executed medical and disability claim drill down for catastrophic claimant reports and monthly Plan Sponsor engagement meetings

Washington D.C. Metro Area

• Performed patient care activities and implemented treatment plans per physician’s orders
• Collaborated with allied services to ensure continuum of care for assigned clients
• Assisted in assessing, developing, coordinating, and revising teaching programs for medical staff

Linthicum, MD

• Performed precertification review, admission review, concurrent retro review using Milliman Care Guidelines and Aetna Clinical Policy Guidelines
• Coordinated with facility Case Managers and Discharge Planners to ensure seamless transition of patients to the appropriate level of care
• Authorized and coordinated required services in accordance with plan benefits