Charlene M. Lail
289 Summer Winds Lane
Inman, S.C. 29349
864-494-1204
Work History:
Humana Insurance, Charlotte, NC
Clinical Advisor/Work at Home Feburary 2008-October 2010
Perform Utilization Management for members in assigned facilites. Facilitate discharge planning, continuity and appropriate setting of care and services. Initiate appropriate relationships with both members and providers in pursuit of "Perfect Service."
Liberty Mutual Insurance Group, Spartanburg, SC
Utilization Management Nurse April 2006-August 2007
Process treatment request in adherence to state regulatory guidelines, URAC requirements and internal policies and procedures.
DHEC, Spartanburg, SC
Child Health Nurse August 2003-March 2006
Assess client's to determine healthcare needs and develop a plan of care. Prepare, document and bill services to Medicaid. Participate in case collaboration and consultation.
Nationwide Insurance, Greenville, SC
Claims Medical Specialist October 2001-October 2002
Responsible for reviewing medical records for casualty claims to evaluate alleged injuries. Worked closely with
Special Investigative Unit and Legal Department. Attended mediations and arbitration to interpret medical records
and expedite file closings.
Claimsware,Inc./ManageMed, Greenville, South Carolina
Case Manager January 2001-August 2001
Responsible for implementing a case management program for third party administrator.
St. Francis Healthcare System, Greenville, South Carolina
Case Manager May 1998-January 2001
Responsibilities included implementing a utilization management program. Case Management experience in
ICU/CVRU/ORTHO/NEURO.
BlueCross/BlueShield, Greenville, South Carolina January 1996-March 1998
Managed Care Coordinator
Responibilities included implementing an onsite Utilization Management/Case Management program at
Greenville Memorial Hospital.
...
Login or Register to view the full resume.
