Elizabeth (Beth) Desimone, RN, BSN

Garnet Valley, Pa 19060

bethdesimone@verizon.net
Cell: 610-453-5085
www.linkedin.com/in/bethdesimone/

Strong Case Manager with leadership, team building and decision making abilities. Excellent communication
and organizational skills for coordinating and managing patients, families, physician needs, who are
experiencing emotional and health conditions. Demonstrates superior reliability and maintains confidentiality.

Highmark. Inc

May 2015- Sept. 2015

Care Manager-Utilization Review

Reviewed precert requests for medical necessity, evaluating clinical information for concurrent
reviews and Inpatient stays.
Concurred with Medical Director for appropriateness of care and medical criteria.
Provided appropriate consultation and referral to Case Management.
Maintained accurate records of all communications and interventions.
Reviewed/shared clinical information with physician-facility-vendor so member has best
discharge plan possible in place.

Humana Cares

June 16, 2014-May 8, 2015

Care Manager

Serviced the Medicare/Medicaid population and are dedicated to helping people achieve health.
Assist with chart reviews and audits to ensure compliance with health care plan.
Provided education within the scope of nursing practice for members and families enabling
them to become proactive with their own healthcare.

Guided member and family to make best use of their healthcare benefits while coordinating
their discharge plan.

Ensured member and family understand all physician/hospital instructions so they can make
informed decisions regarding their healthcare.

Initiated communication between physician, vendor, facility, member, and caregiver so

beneficiary has best care possible.

Coordinated with vendors and necessary personnel to make certain the appropriate care and
equipment are provided in a timely manner so flow of care is uninterrupted.

Aetna Healthcare Corporation

January 2007-March 2014

Case Manager: Adult Complex Case Manager (2007-2010); Pediatric Complex Case Manager (20102012); Private Duty Nursing Specialist (2012)

Serviced employer groups, individuals, college students, part-time and hourly workers, health
plans, health care providers, governmental units, government-sponsored plans, labor groups
and expatriates.
Worked telephonically with members, providers, facilities, and vendors to coordinate proper
delivery and oversight of medical services.

Performed pre-certification process for prescribed treatment/home care-therapies by gathering

relevant data and information through clinical telephonic interviews with the injured employee;
provider(s); and the employer.
Evaluated and coordinates medical and rehabilitative services using cost containment strategies.
Plans a proactive course of action to address issues presented to enhance the injured
employee's short and long-term outcomes.
Assessed and identified barriers to recovery; determined goals, objectives, and potential
alternatives to care.
Worked as an advocate to promote the injured employee's best interest, addressing treatment
alternatives, quality and cost effective health care and rehabilitative services.
Established/maintained communication between member, provider, vendor and facility to make
certain all therapies and equipment are provided in timely manner.
Assisted with record reviews/audits to ensure NCQA and plan sponsor compliance.

CHILDRENS HOSPITAL OF PHILADELPHIA PRIMARY CARE CENTER AT COBBS CREEK

February 2001-Nov 2006- Large primary pediatric office associated with teaching facility for newborn to age 22.

Triage Consulting Nurse and Clinician

Telephone triage according to standard protocols using Epic system.

Ensured appropriate patient care (via telephone triage) for both urgent and routine medical
problems, prescription refills, and requests for information as well as patient/family education
within the scope of nursing practice.
Assisted in the development of policies/procedures related to clinical services as well as
providing coverage in the clinical setting.
Performed nursing duties related to patient care as needed.
Assisted with chart reviews and audits to ensure compliance with health care plans.
o Elected as Superior Employee February 2006

Strengths
Honors commitments, establishes effective communication with members/team, actively researches
opportunities to accept leadership roles, quickly volunteers for projects, team player, and manages case
load effectively.

Education
BSN, Nursing, Pennsylvania State University, University Park, PA

Technical Skills- Microsoft Word/Excel/PowerPoint/Outlook

Certifications and Licenses
RN Licensure in Pennsylvania, Delaware, and Florida
Member of Pennsylvania Nurses association and Case Management Society of America