Maria Elinor Manuel
Camarillo,CA
Summary
Dedicated and results-driven Medical Management Nurse Leader with over 17 years of progressive experience in case management, pre-certification, concurrent reviews, and clinical operations oversight. Proven ability to lead teams, mentor peers, and drive process improvements that enhance patient outcomes and operational efficiency. Experienced in leading cost of care initiatives to improve care quality, control medical costs, and ensure compliance with DMHC, state and federal regulations. Recognized for strong collaboration, training, and auditing skills, and a deep commitment to delivering high-quality, patient-centered care.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Nurse Medical Management I/II/Senior/Lead
Anthem Blue Cross
07.2006 - Current
- Managed daily operations for clinical and non‑clinical teams to ensure timely, accurate case reviews and consistent policy application in compliance with DMHC, state, and federal regulations.
- Conduct training and refresher sessions for new and existing associates to maintain alignment with organizational standards.
- Develop and revise job aids, workflows, and in-service training materials to optimize work efficiency.
- Created the yearly Inter‑Related Review Assessment since 2015 and performed monthly audits to evaluate associates’ knowledge and adherence to company policies to drive consistent quality and regulatory compliance.
- Monitor case management referrals, including repatriation and redirection to reduce patient out-of-pocket costs and improve care coordination, including transitions to lower levels of care (SNF, ARU, LTAC).
- Led cost‑of‑care initiatives by overseeing utilization, case, and disease management programs to improve care quality, reduce medical costs, and ensure compliance with DMHC and all state/federal regulations
Registered Nurse
St. John's Pleasant Valley Hospital
2004 - 2009
- Delivered compassionate, nursing care to diverse patient populations in a hospital setting.
- Monitored patient conditions, administered medications, and documented clinical observations accurately.
- Educated patients and families on post-discharge care, medication management, and health maintenance.
- Ensured compliance with hospital protocols, safety standards, and regulatory requirements.
Education
Bachelor of Science - Nursing
United Doctor's Medical Center & Colleges
Quezon City, Philippines03-1994
Skills
- Utilization, Quality, and Case Management Review
- Team Leadership & Staff Development
- Process Improvement & Workflow Optimization
- Internal Auditing & Quality Assurance Review
- Cross-functional Collaboration with Leads, Managers, and Departments
- Pre-Certification, Concurrent, and Retrospective Review
- Systems: ACMP, EncoderPro, MCG, OMPTA, WCF, Microsoft Outlook and Microsoft Excel
Certification
- RN Licenses: California, Colorado, Nevada (Active)
- German Language Certification – Deutsche Sprach Schule, Switzerland (1994)
Languages
English
Native or Bilingual
Tagalog
Native or Bilingual
German
Limited Working
Timeline
Nurse Medical Management I/II/Senior/Lead
Anthem Blue Cross
07.2006 - Current
Registered Nurse
St. John's Pleasant Valley Hospital
2004 - 2009
Bachelor of Science - Nursing
United Doctor's Medical Center & Colleges
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