Irina Ekelman, RN, BSN, CCM

Compassionate Leader and Health Care Professional Extensive Knowledge of Utilization Management, MCG, Denial Management , Case Management and CMS regulations Mastery of Microsoft Office programs (Word, Excel, and PowerPoint). Proficient in multiple EMR systems( EPIC, PCC, AXXESS) PROFESSIONAL EXPERIENCE Management of the day to day operations through the teams providing care navigation, utilization management ,denial management functions, and any health plan related disease management activities Coordination and direct case management including budget recommendations, outcomes measurement, and process improvement Contribution to the clinical, quality, financial and patient satisfaction outcomes of the health system Working with physicians group and affiliates, inpatient, post-acute and quality improvement to ensure compliance with all regulatory requirements Management of Health Risk assessments, disease management of chronic conditions, as well as lifestyle management programs and clinical services for the Health Plans (BCBS, CIGNA,HMOI,AETNA) Delivery of proven clinical programs (CHF, HTN, CAD, Diabetes, Asthma, and Behavioral Health) to increase employee productivity and satisfaction while reducing employer’s health costs Screening, Assessment and stratification of Health Program enrollees and implementation of the appropriate service plan based on stratification Management of Telehealth Graduate of 2016 Leadership Academy Leading Others Stroke Certified Peer Recognition to Exemplify Excellence in Nursing Recipient Loyalty Awards recipient Employee of the year 2005 DRG Assurance ICU quality improvement and cost containment/Society of Critical Care Medicine, National Coalition of Health Care) Certified Legal Nurse Consultant (CLNC) Certified Case Manager (CCM) - The American Institute of Outcomes Case Management CPR /ACLS Instructor