Shirley Miles Stanfield

Case Management Nurse @Cigna Health Spring

US

Medical Management - Case Management AnalystResponsible for case management and pre-certification of various procedures and surgeries including cardiac procedures (CABG, TAVRs), laminectomies, fusions (cervical and lumbar), knee and hip replacements, PCIs, re-vascularization, stents, and IV meds. Process various therapies including physical, occupational and speech. Collaborate with healthcare providers and members to optimize member benefits and promote effective use of resources. Assess medical necessity of inpatient admissions, outpatient services, surgical and diagnostic procedures, home health care, durable medical equipment and out of network services. Conduct pre-certification to ensure compliance with medical policy, member eligibility, benefits and contracts with CMS guidelines. Processed authorizations for GA, TN, AL, IL, AZ, PA, FL, NC, SC, Mid-Atlantic. Specialities include: Cigna Commercial, Medicare, Amerigroup, BCBS and various IPAs, PODs.