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Martha Melinda Hebron

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RN Case Manager

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  • Axion
    Case Manager
    Axion
    Apr 2024 - Dec 2024 (9 months)
    Provided telephonic case management for Medicare Advantage members, focusing on chronic disease management, high blood pressure, and diabetes. Assisted members in navigating healthcare benefits, treatment plans, and medication adherence. Conducted prior authorization reviews, ensuring patients received necessary treatments within compliance guidelines. Triaged inbound and outbound patient calls, escalating urgent cases as needed. Collaborated with healthcare providers, pharmacists, and insurance teams to resolve medication and treatment issues.
  • H
    Hospice Nurse Case Manager
    Jan 2017 - Feb 2025 (8 years 2 months)
    Provide comprehensive care and emotional support to clients with terminal illnesses. Coordinate multidisciplinary hospice care teams, including healthcare providers, at-home care services, mental health specialists, and spiritual advisors. Develop and implement individualized care plans addressing medical and social service needs. Educate patients and families on disease progression, palliative care options, and coping strategies. Deliver hands-on nursing care, administer medications, and manage symptoms to enhance quality of life. Support families through the end-of-life process, provide bereavement counseling, and coordinate final arrangements. Perform utilization review to ensure appropriate hospice services are authorized and aligned wi
  • U
    Ambulatory Care Nurse
    UnitedHealthcare (UHC)
    May 2004 - Aug 2021 (17 years 4 months)
    Managed utilization review requests received via phone or fax from hospitals or physician offices. Utilized Milliman/InterQual criteria to assess coverage eligibility for procedures and acute inpatient admissions. Reviewed clinical criteria and made authorization determinations, including approving or denying requests, and drafting appropriate correspondence as needed. Escalated non-authorized cases or those not meeting MCG criteria to the Medical Director for final review and determination. Accurately documented call details and case progress in the system for tracking and compliance purposes. Referred members to health plan’s case management programs when additional support or intervention is required. Addressed benefit-related inquiries
  • UnitedHealth Group
    RN Case Manager
    UnitedHealth Group
    Apr 2004 - Apr 2021 (17 years 1 month)
    Health Insurance
  • N
    Nurse
    Mar 2004 - Dec 2004 (10 months)
    Conducted HEDIS medical record reviews, ensuring compliance with NCQA and CMS guidelines. Abstracted data from electronic and paper medical records, ensuring accuracy in reporting.
  • INOVA Fairfax Hospital
    Registered Nurse
    INOVA Fairfax Hospital
    Aug 2000 - Dec 2006 (6 years 5 months)
    Provided critical care nursing in IMC/ICU units, managing ventilated patients, IV drips, and complex medication regimens. Coordinated patient care among multiple specialties, ensuring effective treatment planning. Educated families on treatment options, post-hospitalization care, and chronic disease management.
  • S
    Surgical Nurse
    Apr 1998 - Aug 2000 (2 years 5 months)
    Managed post-operative and trauma patient care, including pain management, wound care, and IV therapy. Provided patient education regarding medication management and discharge instructions.
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