Dawn M.

Dawn M. Email and Phone Number

Clinical Appeals RN - Clinical Advancement - UHC Clinical Services @ UnitedHealthcare
minnetonka, minnesota, united states
Dawn M.'s Location
Baldwin City, Kansas, United States, United States
About Dawn M.

As a registered nurse complex case manager at Optum, I manage the care of Medicare patients with complex and chronic conditions. I have a CCM certification and over 14 years of experience in the healthcare industry. I am an expert in care management, utilization review, data abstraction, and health information. I use MS Office, MCG, NCQA, CMS, and HEDIS standards and guidelines to ensure quality and compliance.Besides my nursing career, I am also a successful entrepreneur and a community leader. I founded and own the first coffee shop and bakery in Wellsville, KS, where I employ and train local residents as baristas. I have a strong background in computer aided drafting and design, and I have a high level of computer and tech skills. I opened this business in 2018 to create a positive impact on my community and provide employment opportunities. I am proud to say that we survived COVID-19 and continue to serve our loyal customers with quality products and services. I am driven by my passion for community health, wellness, and social responsibility.

Dawn M.'s Current Company Details
UnitedHealthcare

Unitedhealthcare

View
Clinical Appeals RN - Clinical Advancement - UHC Clinical Services
minnetonka, minnesota, united states
Website:
uhc.com
Employees:
3757
Dawn M. Work Experience Details
  • Unitedhealthcare
    Clinical Appeals Rn
    Unitedhealthcare Aug 2024 - Present
  • Aurora Coffee Co Llc
    Small Business Owner
    Aurora Coffee Co Llc May 2018 - Present
    Wellsville, Kansas
    - Opened the first coffee shop and bakery in Wellsville, KS- Built a brick-and-mortar business from the ground up that would benefit the community- Employer of 4-9 employees, trained as Baristas- We survived COVID-19!
  • Sno Shack In The Back
    Business Owner
    Sno Shack In The Back May 2018 - Present
    Wellsville, Kansas
  • Optum
    Registered Nurse Complex Case Manager
    Optum Nov 2022 - Aug 2024
    Kansas City Metropolitan Area
    - Complex case management of Medicare population- Post-hospital management of patient's healthcare activities- Discover and connect patients with health resources
  • American Health Holding
    Rn Clinical Case Manager
    American Health Holding Jun 2022 - Sep 2022
    Remote
  • Aetna, A Cvs Health Company
    Rn Clinical Case Manager
    Aetna, A Cvs Health Company Oct 2019 - Dec 2020
    - Assessment of member's health risk, medical history, behavioral health history, medication history and care needs using motivational interviewing techniques- Appropriate referrals for services and special programs as deemed necessary- Extensive review of claims data to determine a complete medical history and treatment path- Consult with other team members to overcome barriers of care- Maintain contact with clients as directed by state Medicaid guidelines- Complete and maintain plans of care in accordance with Medicaid guidelines, HEDIS measures, NCQA standards and case management goals- Thorough documentation of all relevant information per state and company guidelines, in accordance with quality measures
  • Unitedhealth Group
    Rn Community Transitions Case Manager
    Unitedhealth Group Oct 2012 - Oct 2019
    Overland Park, Kansas
    Working with KanCare and the HCBS program, I help people achieve their dream of leaving the nursing home and getting back into the community, enjoying greater independence and dignity while supporting their safety and well-being.- Assess Medicaid/KanCare clients for HCBS waiver services- Extensive knowledge of available waiver programs (FE, PD, TBI, IDD, etc)- Complete and maintain plans of care in accordance with Medicaid guidelines, HEDIS measures and NCQA standards- Client contact every 90 days (telephonic or in-person) and update for changes in condition- In between telephonic and home visits, assist clients as needed- Assist clients in crisis with available community services- Facilitate a safe transition of nursing home clients back into the community- Coordinate with multiple agencies to support client wellbeing- Training of new employees, mentoring, training document creation- Thorough documentation of all relevant information per state and company guidelines, in accordance with quality measures
  • Vintage Park At Gardner
    Resident Care Director
    Vintage Park At Gardner Jun 2012 - Nov 2012
    Director of Nursing
  • Meadowbrook Rehabilitation Hospital
    Registered Nurse
    Meadowbrook Rehabilitation Hospital Sep 2011 - Jun 2012
    Registered Nurse / Charge Nurse - Post-Acute Rehab, SNF, LTC, TBI
  • Correct Care Solutions
    Registered Nurse
    Correct Care Solutions Sep 2007 - Sep 2011
    Correct Care Solutions / Johnson County Corrections & Juvenile Detention CenterRegistered Nurse / Charge Nurse

Dawn M. Education Details

Frequently Asked Questions about Dawn M.

What company does Dawn M. work for?

Dawn M. works for Unitedhealthcare

What is Dawn M.'s role at the current company?

Dawn M.'s current role is Clinical Appeals RN - Clinical Advancement - UHC Clinical Services.

What schools did Dawn M. attend?

Dawn M. attended Neosho County Community College, Universal Technical Institute Of Arizona Inc.

Who are Dawn M.'s colleagues?

Dawn M.'s colleagues are Eric Huska, Gabriela Isabel S., Hayleigh Hood, Luz Lopez, Doris Myles, Kiersten Vincent, Mph, Michele Naccarato.

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