Linda J. S.

McNeese, RN, BA, CCM

1008 Wake Drive
Richardson, Texas 75081
Home Phone Number: 972-235-4870
Email lmcd9b16@westpost.net
USA Citizen
As a Case Manager, teaching and educating the patient on the disease process was
given to patients and case manageras phone number and name were given to patien
t to call with any questions or problems. Wellness and prevention are very impor
tant for the overall care of the patient as well as educating the patient about
his disease process at the time of his illness.
Q-TEMPS INSURANCE STAFFING.
6-14-2010 to 9-2010.
Dallas, Texas
972-759-8360 x113
Case manager worked as a temporary employee for an insurance company.
Telephonic Case Manager for Workmanas Compensation Company. CCM worked as an adv
ocate for the injured worker. As a telephonic case manager, CCM contacted the pa
tient, employer and medical providers and worked closely with claim adjuster to
make a plan of action to bring case to MMI. CCM reviewed treatment plans for med
ical necessity as related to the injury and assisted with return to work issues.
CCM completed documentation of notes and reports in the appropriate manner and
worked within the state laws.
BLUE CROSS BLUE SHIELD TEXAS.
5-22-2006 to 3-25-2010
Richardson, Texas
1-800-462-3275
Telephonic Case Manager of catastrophic and complex medical and surgical cases f
or a medical health insurance company. Case manager completed preauthorizations,
negotiated fees for out of network Texas facilities, contacted patients and pro
viders, and reviewed for medical necessity. Case manager worked with the medical
directors with difficult cases and reviews. Managed new and current cases and f
ollowed up with patientsa treatment in the hospital, discharge plans and home ca
re. Case
manager managed neurocognitive cases and completed um authorizations for these c
ases. Duties of case managers vary but the case manager remains an advocate for
the patient.
Catastrophic and complex medical and surgical cases included patients with cance
r and treatment received, including oncology therapy and its side effects. At ti
mes the cancer was in remission but the side effects from the oncology and radia
tion were still being treated. Complex medical cases included diabetes when they
became surgical for amputations, and the many complications of diabetes with ki
dney failure, blindness, infection, etc. Strokes and acquired brain injuries wer
e both medical and surgical; case manager managed patients and their treatment a
nd disease processes who were on transplant lists and waiting for transplants. C
ase manager managed cases that were high claim risk patients, multiple admission
s, multiple injury cases, any cases that were in the hospital longer than 10 day
s, COPD, diseases of the liver, vascular system and heart disease and surgery. C
ase manager taught and educated patients regarding their disease and wellness pr
evention. Also the case manager performed depression screenings and advised pati
ents of their options and informed patients of treatment available if test were
positive for depression.
Case manager managed patientas cases whenever a patient requested a case manager
.
GENEX SERVICES INC.
6-20- 2005 to 4-2006
Glen Allen, Virginia 23060
804-762-4260
Nurse reviewer worked in the District of Columbiaas workeras compensation office
and was a contracted employee. A nurse employed to review the Districtas worker
s compensation files on past and current cases. Reviewer reported to the claims
adjuster and furnish a written timeline on all cases. Completed and reviewed all
preauthorization requests. Reviewed documentation to evaluate if the current tr
eatment was related to the old injury and if so to explain how and why this trea
tment should be covered as part of the workeras compensation claim. This reviewe
r was to be available to the adjusters and/or employees of the District.
AMERICAN WHOLE HEALTH, INC. Now it is WHOLE HEALTH NETWORK
800-274-7526
11-28-04 to 06-05
Sterling, Va. 20166
Alternative Health, job title assistant manager in QU.
Reviewed physical therapy reports for medical necessity and worked with the phys
ical therapist that was in charge of the final decision. Worked with the company
chiropractors and reviewing chiro requests for treatment. Completed reports for
special projects.
APOGEN TECHNOLOGIES CONTRACTOR.
9-2003 to 11-2004
Apogen
100 Sun Avenue, Suite 500
Albuquerque, New Mexico 87109
505-884-2300
Apogen Technologies, contractor to DOE in Washington DC.
Worked for the Office of Worker Advocacy for the Energy Employees Occupational I
llness Compensation Program Act Part D-DOE State Workeras Compensation Assistanc
e Program.
Process Trainer for Case managers.
Trainer maintained manuals, oriented new employees to the OWA processes, and ret
rained employees as needed. Lead employee during mass orientation, assisted with
training over 200 new employees who consisted of case manager assistants, case
manager technicians, data quality analysts, case managers and supervisors. Compl
eted duty guidelines for case managers, data control analyst, and other employee
s.
Case Manager
Case manager for the DOE program, acts as an advocate for the applicant. Duties
were to assess the claim, to review incoming documentation to support claim, to
analyze and to prepare the file for physician panel review. Oriented new staff t
o case processing. As case manager processed complex occupational illness claims
; examined illness claims for factual and medical sufficiency and legal correctn
ess; conducted appropriate research and investigated that claims were consistent
with regulations, utilized support staff; initiated document requests; document
ed appropriate information into case management system; and completed highlight
reports for review.
CNA
10-1996 to 9-2003
CNA at Ellicott City, Maryland and Dallas, Texas
800-262-1113, Dallas, Tx.
RN case manager. (Telephonic and Field case manager.) Medical Claims Consultant.
UR preauthorizations.
Workeras Compensation and liability claims.
Medical claims consultation is a cursory review of records or documents with a f
ocus on the specific assignment. The referral source is given either a verbal or
written report stating what needs to be completed in order to move case toward
resolution and/or Consultant must have the ability to analyze the medical, factu
al and legal issues and complete a concise and logical report for the Claims Dep
artment. Medical claims consultant reviewed medical records and completed claim
file reviews for a life care planner to complete cost reserve analysis and/or Me
dicare Set Aside and assist claims adjuster with claims. Written reports complet
ed when requested by customer.
Worked as a Medical claim consultant in Dallas, Texas and in Virginia. Worked on
e on one with claims adjuster and life care planners.
As telephonic case manager, worked with workeras compensation injured workers. P
atientas advocate, contacted injured workers, assisted injured worker to obtain
the necessary medical treatment needed to obtain wellness in a timely cost effec
tive manner. Ultimate goal in workeras comp is for the patients to reach maximum
medical improvement and reenter the work place. As a telephonic case manager, m
ade 3 point contact with patient, employer and medical providers. RN worked with
in the Workeras Compensation State Guidelines, and assisted with preauthorizatio
n request following State Guidelines while working in Texas. Documentation compl
eted after each case manager action.
RN and adjuster met with employers and completed file reviews.
In Virginia, worked in the field as a case manager making direct contact with me
dical doctors, physical therapists, hospitals and injured workers to discuss tre
atment and work status. Documentation completed in appropriate manner.
Worked independently for CNA in the North Eastern area at a home office.
TRAVELERS INSURANCE CO.
4-96 to 10-96 and 12-94 to 5-95
Richardson, Texas 75081
972-808-9676
Workeras Compensation Department
Also completed preauthorization.
Disability Manager & Case Manager
(Telephonic case manager.)
Case Manager for workeras compensation injured workers. Assisted with return to
work issues. Assisted the injured worker to obtain reasonable and medically nece
ssary treatment. Contacted injured worker, employer, and medical care providers.
Worked as a team with claims adjuster.
12-1994 to 5-1995
RN Nurse Reviewer for HMO claims.
Medical health claims.
Reviewed medical records for medical necessity and payment.
HMO insurance policies. (Later HMO part became Met Life)
CRA, INC. (CRA in Irving, Texas is now Concentra.).
Employee formerly worked for CRA.
6-94 to 12-94 and 5-95 to 4-96
Irving, Texas
972-364-8000
UR preauthorization.
Case Manager
(Telephonic case manager and field case manager.)
Workeras Compensation and disability claims.
Telephonic case manager for workeras compensation injured workers. Maintained ca
se charts daily. Contacted injured workers, employers, physicians and other care
professionals for treatment plans and return to work. Reviewed medical for medi
cal necessity as related to the injury. Performed pre-authorization of procedure
s as needed within the state workers compensation guidelines.
As a field case manager, met with injured worker, doctors, therapists and profes
sionals to discuss treatment and work status. Reviewed treatment plans for medic
al necessity as related to the injury. Assisted with return to work issues. As a
field case manager worked disability and workeras compensation claims.
BAYLOR UNIVERSITY MEDICAL CENTER.
1988 to 1990
Dallas, Texas
214-820-0111
GI Lab Nurse
Patient admit nurse prior to GI procedures, post procedure recovery nurse until
discharged from lab.
DALLAS MEDICAL AND SURGICAL CLINIC.
1973 to 1993
Dallas, Texas
Now called Texas Medical and Surgical Clinic
214-345-1414
RN Office Nurse
Worked in Dr. George Fosmireas office, general surgeon.
Assisted surgeon with minor surgery and procedures. Assisted the doctor with col
onoscopy procedures with sedation in office. (Day surgery hospital on second flo
or.) Scheduled procedures, surgeries, and appointments. Performed patient teachi
ng and assisted family and patient as needed. Other duties consisted of ordering
supplies, diagnosis and procedure coding for billing and assisted with training
nurses hired for the other surgeons. Worked directly for Dr. Fosmire in his off
ice.
EDUCATION
Grayson County College
6101 Grayson Drive
Denison, Texas 75020
903-463-8796
Received Associate Degree in Applied Science
Registered Nurse
Name: Linda J. S. McNeese
Amberton University
1700 E. Gate Drive
Garland, Texas 75041
972-279-6511
Bachelor of Arts
Received BA 5-1995
*******Professional Development
Name: Linda McNeese
Education
Also attended El Centro Community College, Richland Community College and East T
exas State University.
Currently Registered as a RN for Texas.
Certifications
Certified Case Manager (CCM)
Received 1999
Certification in the name of Linda McNeese
Currently certified.
Linda McNeese, RN, BA, CCM