Audrey Pellicano RN-BC MS Certified English Tutor

Experience

• 

  Healthfirst

  Jun 2007 - Apr 2012

  Intensive Case Manager

  Telephonic case manager with a caseload of >200 plan participants with multiple comorbid conditions providing early education on disease process and appropriate interventions working with members with multiple morbiditiesWorked with dual plan participants on establishing appropriate plan of careCoordinated with participants treating physicians for best possible outcomeCoordinated with third parties to find appropriate services for discharge planning with appropriate follow up post hospitalization Show less

• 

  Wise Widow

  Nov 2011 - Jun 2016

  Grief Recovery Specialist and CEO

  Audrey is a Grief Recovery Specialist and Health Counselor. As a Grief Recovery Specialist to widows Audrey provides support and insight focusing on the necessary tools after sustaining a personal loss. She authored and self published a handbook "Six Secrets to Surviving Loss". She hosted a weekly internet radio show Grief Talk with Audrey where she interviewed guest authors and experts in the field of grief and loss.

• 

  Oscar Health

  Jun 2014 - Jan 2018

  Board certified in Case Management and served as Manager of Case Management and Utilization Review for Oscar Health Insurance in NYC. A new concept at Oscar was developed and she held the position of Manager of the Complex Case Management team developed in 2017 with nurses working both telephonically and in the field both in NY and in Texas with the most complex members. Working collaboratively across company teams the CCM program was designed to meet both NCQA and DMHC regulations working with unique platforms such as Jira, the issue and project tracking product, and the Oscar developed Rosco platform. worked with the CCM team designing the program description, processes and procedures, member needs assessment and nurse performance evaluations. As manager of a remote team of Utilization Review nurses together we were successful in consistently meeting state specific and regulated turn around time for authorizations. All UR nurses at Oscar became MCG certified as part of their professional development providing them with a sense of mastery of their chosen specialty. Specialties: *Certified Nurse Case Manager RN-BC*Certified Health Education Specialist CHES Show less Audrey joined Oscar, a technology and data based commercial Health Insurance Company, in June of 2014 to develop their Case Management program for members with Diabetes. She was able to reach out to almost 500 members obtaining their latest lab work and determining their health literacy around managing health and well being. Working across teams she was able to assist in the development of an appropriate initial platform for Case Management. In this role and in working with the CDE, she assisted in developing educational materials for members challenged with DM T1 and DM T2 to be sent electronically through a secure platform. Audrey was able to create with the help of the product team Oscar's member facing care plan, an NCQA requirement. Show less

  • Nurse Manager of Case Management and Utilization Review

    Sept 2016 - Jan 2018

  • Nurse Case Manager

    Jun 2014 - Sept 2016
• 

  CareMore Health

  May 2018 - Jan 2019

  East Coast Regional Manager of Case Management Collaboration and Intergration

  Responsible for the implementation and integration of new services/clients in the assigned region. Sets CareMore care management performance goals and metrics and serves as the operational lead.Manages operational and oversight activities of the care management program including the development and implementation of metrics to monitor productivity, composition of program descriptions and development of workflows and job aids.Leads regional care management activities and functions and ensures consistent delivery across all regional locations. Manages quality improvement, cost containment, care management and member and provider grievance resolution.Develops and executes a performance strategy for the assigned region and serves as the subject matter expert assisting in the development and implementation of new programs and lines of business. Acts as the liaison to Legal, Compliance and Quality department on issues and supports audits and develops corrective action plans. Monitors and tracks performance identifying areas for improvement and implements enhancements to improve outcomes. Represents the department at regional meetings and the health plan in vendor and client meetings. Hires, trains, coaches, counsels and evaluates performance of direct reports. Show less

• 

  CareMore Health

  Feb 2021 - Jun 2022

  Concurrent Utilization Review Nurse

  Concurrent review RN for inpatient hospitalizations and skilled nursing services, responsibilities include:Extensive review of patient medical records with close attention to the appropriateness of healthcare expendituresKnowledge of appropriate review criteria to compile an accurate account of the patient's clinical picture such as the Milliman Care GuidelinesApplication of guidelines to clinical review analysis of lab reports and test outcomesAccurate and appropriate clinical documentation to ensure that the health care services are being administered to the patients in the highest quality yet at the same time cost-efficient and in compliance with the current regulationsContinuous review and audit of the patient’s treatment file. In order to prevent unnecessary procedures, ineffective treatment, and unnecessary extensive hospital staysResponsible for coordinating with the health care team regarding the patient’s discharge planning needs Show less

• 

  Audrey Pellicano RN-BC, MS

  Mar 2023 - now

  ANA Certified Nurse Case Manager RN-BC, CHES/Certified Health Education Specialist

  Rising to top leadership in your field has its many challenges. Not the least of which is just plain FEAR. With the technique of Clinical Guided Imagery you gain access to your intuitive knowing which guides your life choices. As a Registered Nurse and Wellness Coach, certified in both Hypnotherapy and Clinical Guided Imagery, I bring a wealth of knowledge from clinical experience over the past 40 years as well as my own personal development. Working with me is a journey of personal discovery.In 1991 I had my first and last anxiety attack. I was a single parent of 4 young children and the triggering thought was how am I going to raise them? Fear and panic. There’s always a triggering thought. Vowing never to have that experience again, I returned to my morning meditation practice. The awareness of each moment returned. I was calm.In 1997 I continued my studies of meditation and Clinical Guided Imagery, a powerful tool which enables introspection and a path to discovery. My purpose? To coach and guide those dealing with anxious thoughts that were blocking them in life. I worked with clients fearful of crossing bridges limiting their travel opportunities, college students with fear of upcoming exams, women with health challenges and women fearful of not achieving in the world of business. Coaching them using Clinical Guided Imagery they discovered their path to moving forward and away from fear.What’s blocking you? What's holding you back? Show less