Corinne Heldt

Experience

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  Aetna

  Mar 1996 - Dec 2001

  • Provided disability process, protocols, and regulations training for new employees and existing staff which included nurses and disability service representatives • Training staff on computer programs and protocols• Participated in the design and development of the Disability Training Curriculum • Case management of clients disability claims in the short and long term, by gathering clinical information, certifications and referrals as appropriate• Educate clients, employers and medical personnel regarding managed disability process.• Resource to staff in systems applications

  • Nurse Educator - Disabilty

    Jul 1997 - Dec 2001

  • Managed Disabilty Nurse Consultant

    Mar 1996 - Jul 1997
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  Intracorp

  Apr 2002 - May 2006

  Nurse Case Manager- Workers' Comp

  • Gather and examine information related to the injury including medical condition and treat-ment to formulate a plan of action for successful return to work.• Coordinate and monitor medical care related to the injury, including plans of care within Pre-ferred Provider Network, verify the scheduling of medical appointments and prompt follow-up to obtain results of such.• Identify actual and potential needs (assets and barriers) that will impact return to work• Evaluate effectiveness of actions taken with the coordination of medical care to determine if the injured worker is obtaining desired outcomes and goals established within the individual-ized treatment plan• Determine work status, expected return to work (transitional or full duty), length of disability and treatment plan and coordinate return to work with employer and the carrier representative Show less

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  Coventry Health Care

  Jun 2006 - Dec 2014

  Telephonic Nurse Case Manager

  • Works telephonically with workers’ compensation patients, employers, providers, and claims adjusters to coordinate and assure appropriate medical and disability services.• Performs pre-certification process for prescribed treatment by gathering relevant data.• Evaluates and coordinates medical and rehabilitative services using cost containment strate-gies. • Assists the injured employee by providing medical and disability education. • Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employ-ee’s safe and timely return to work.• Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Show less

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  Reyes Holdings

  Dec 2014 - now

  • Manages a staff of corporate nurses who provide guidance and oversight of business unit employees medical progress resulting from a work or non-work-related injury/illness. o Make recommendations for alternatives and intervening as necessary consistent with ap-propriate statutory requirements, company policies, and applicable plan provisions.• Oversees all vendors providing medical services to employees through our workers compensation program/Leaves( STD- FMLA) o including nurse triage, bill review, pharmacy benefits, utilization review, case management, diagnostics, Physical therapy. • Evaluates vendors that provide medical management services through our workers compensa-tion program. • Locates new vendors and programs that will enhance outcomes for employees and the business.• Provides training to local Human Resource, management and safety contacts.• Develops and provides clinic protocols to clinics providing medical evaluation and treatment of our employees.• Oversee TCM and FCM vendors providing direct service to employees.• Man, the serious injury hotline and engage the appropriate resources for serious injuries.• Participate in BU meeting providing results of medical management programs. • Resolves issues that arise with our TPA which cause delays in medical treatment.• Assists in special projects as directed. Show less Rosemont IL• Determines claimant service needs of employees making recommendations for alternatives and intervening as necessary consistent with appropriate statutory requirements, company policies, and applicable plan provisions.• Oversees vendors that provide medical management services.• Provides training to local Human Resource, management and safety contacts.• Update all panels for panel states.• Assists in locating and implementing new offsite clinic options.• Oversee TCM and FCM vendors providing direct service to employees.• Participate in roundtables/claim reviews.• Participate in BU meeting providing results of medical management programs. Show less

  • Manager, Medical Management Programs, IDM

    Mar 2020 - now

  • Corporate Nurse Case Manager- IDM

    Dec 2014 - Mar 2020