Diana Briones has over 25 years of experience in case management and utilization management. She is currently a Supervisor at United HealthGroup, where she supervises a team and manages projects. Previously she held several manager and director roles with increasing responsibility, supervising staff and managing departments. Her experience includes managing workers compensation and health benefits programs.

1. Diana L. Briones, RN, CCM 1002 Auburn Drive Arlington, TX 76012
210-606-4316 (Cell) d.briones@att.net
OBJECTIVE: Continue on my career path with an organization that values commitment,
integrity and allows for continued professional growth.
EXPERIENCE:
April 2010 United HealthGroup – Optum Shared Services/UMR
To Present
September 2016 to present: Supervisor, Case Management
Coordinate, supervise and accountable for daily activities of assigned team of
professional staff who perform Case Management and Utilization Management.
Coordinate work activities with other members of leadership team, identify and
resolve operational issues using defined processes, expertise and judgment.
Manage assigned projects, ongoing processes improvements with input from CM
staff and leadership team. Traveled to Manila in October 2016 to provide training
on medical management system and UM processes and continue to partner with
our offshore leadership team to assure ongoing communication, training for new
hires and promote their success. Work with the Account Management team and
update employer group reports and provide monthly updates to the groups via
WebEx.
April 2013 to August 2016: Senior Case Manager
Serve as a resource to the Case Management team, assisting Management
team with customer reporting, mentoring of staff, completion of monthly quality
audits, provide input on current and proposed work flows, and update job aids.
Also serve as an ongoing tester for medical management platform. Provided CM
and UM process training for new hires and have also provided ongoing and
refresher training for Case Management staff on processes/work flows and
continue to serve as a resource to the team. Participation in weekly Management
Team meetings and work on projects as assigned by Management Team. Other
skills utilized include problem solving, decision making, communication,
leadership, flexibility, conflict resolution skills and working independently and
effectively as a telecommuter.
April 2010 to March 2013 Nurse Case Manager
Telecommuter position providing proactive telephonic medical case management
(CM) services for multiple clients. Cases include catastrophic medical cases as
well as Oncology. Duties include identifying opportunities for CM intervention
while using sound judgment in coordinating care and services for patients while
working within benefit plan, facilitating safe and appropriate alternative care
settings, coordinating with discharge planners, negotiating discounts and
alternative levels of care with vendors, establishing collaborative working
relationship with other Case Managers, patients, providers and customers. Other
duties include email or formal reporting, maintaining confidentiality and accurate
documentation, meeting or exceeding productivity standards and positive cost
savings.
July 2008 JI Companies Austin, TX
To April 2010 Manager, Utilization Management
Manage day to day operations of department which handles Workers Compensation and Group
Health benefits for self-insured employer groups. Managed a total of nine staff, both clinical and

2. non-clinical. Responsible for department budget, hiring, training, mentoring and termination of
staff. Monthly client reporting which included on-site client meetings as well as monitoring of UM
activities and adherence to regulations. Also oversaw all Case Management activity performed
by contracted vendors and implemented internal case management program.
April 2007 Evercare/United Healthgroup Dallas, TX
July 2008 Health Services Manager
Manager for new Medicaid product which included development and implementation of program
as well as managing the already implemented Medicare product. From April 2007 to
implementation in February 2008, the time was spent on further developing the products, project
management, finalizing policies/procedures and workflows. This also included on-boarding of
new staff, both clinical and non-clinical, including screening, interviewing and hiring and
termination. Responsible for 20 clinical and non-clinical staff, both telecommuters and in-office as
well as running the Fort Worth office. Managed Service Coordinator staff as they performed
Case Management activities for their assigned members.
March 2006 Great West Healthcare Dallas, Texas
March 2007 Regional Care Director
Responsible for regional implementation of corporate and regional medical management
strategies and goals, manage the daily operations of the medical outreach department. Monitor
and evaluate care management staff performance activities in relation to established care metrics
and data from quality evaluations, provide decision support to the regional and corporate
leadership teams through analysis of reports data, internal and external benchmarking and
qualitative assessment of medical outreach activities. Provide clinical and administrative
leadership, facilitate collaboration between staff and other matrix partners for Medical
Outreach/Quality activities. Partner with other Regional Care Directors as business owners for
implementation of corporate goals, regional business plan, and other clinical programs at the
corporate and regional level. Maintain company operations by initiating, coordinating, and
enforcing operational, personnel, and corporate medical policies and procedures. Complied with
all appropriate regulatory and accreditation needs. Recruitment/retention of staff and acts as the
direct manager of the medical outreach team which included Manager, Nursing staff and non-
cllinical staff, total of 20 staff members. Report to VP/Medical Director and Regional President.
Nov 2000 Avidyn Health, Inc (formerly ValueCHECK) Dallas, Texas
To Feb 2006 Oct 2005 to Feb 2006 Manager/Utilization Management and Case Management
Managed these two departments in the San Antonio, TX office. Responsible for the day to day
operations of the teams with assistance from supervisory staff, monitoring and meeting daily call
metrics. Substantial customer and staff interaction, Completed Best Practice work with other
Managers from Dallas and Wausau offices. Managed all UM and CM activity for assigned
regional areas.
May 2004 to Oct 2005 Manager/Disease Management, Clinical Program Manager for
Medical Management System Conversion
Management of Disease Management staff and one Case Management team and one non-
clinical specialist total of 15 staff members, report to Director of Operations. Manage staffing
issues including retention, hiring, and termination of staff, conduct daily productivity reports, and
evaluate individual caseloads, budget management Retention of clients by resolving any
identified issues and supporting the sales and account management departments with
presentations and implementation of new groups. Involvement in interdepartmental
communication between three regional centers as well as Senior Management team. Continued
development of Disease Management program including Best Practice work for three regional
centers. Project management for system conversion occurred in August of 2004, this included
communication with IT Project Manager and staff, Vendor, Senior and Middle Management from
three regional centers and staff regarding identified issues and resolution of those issues in order
to successfully implement new system.

3. June 2003 to Mar 2004 Supervisor of Case and Disease Management
Supervision of Case and Disease Management staff with a total of 26 direct
reports. Developed and Chaired Quality Steering Committee, facilitated
communication and implementation of all recommendations for the areas of
Documentation, Reporting, Billing and Savings as well as putting into place a
formal quality audit process. Managed staffing issues including hiring and
termination of staff, conducting daily productivity reports and evaluating individual
caseloads and hours. Problem solving with clients regarding CM/DM issues.
Involvement in interdepartmental communication and meetings and resolving
identified issues. Continued development of Disease Management program
including supporting the marketing department with presentations. Project
management assignments including Case Management Best Practices
recommendation with business partners and new systems selection and
implementation team. Effectively established collaborative relationships with
CM/DM staff, Utilization Management team as well as senior management.
Feb 2003 to May 2003 Disease Management Project Lead
Plan, create and implement Disease Management (DM) Program under the
supervision of Director of Case Management/Disease Management. Programs
included Asthma, CHF, Diabetes, Oncology and Maternity. This included
researching other DM programs, preparing format for DM Program, researched
URAC Statutes and Regulations for compliance and each specific disease to
obtain accurate and most recent clinical information, identified educational items
for each disease and prepared assessments and workflow for each disease.
Other duties included working with each Disease Manager to obtain input
regarding reference and educational information for their specific program as well
as working with the DM team for feedback and input on program workflow as well
as providing program updates via conference calls, individual phone calls and
emails. In preparing program, this also required upkeep of DM Project Work Plan
for documentation of process and updates to Director regarding progress,
identified needs and recommendations. CM/DM Director, Physician Advisor,
Specialist Reviewer and Quality Assurance Department reviewed each DM
Program for recommendations and changes made as recommended. Additional
duties include travel to vendor’s location for training on software application for
data entry of program content and for training of CM/DM staff on use of updated
version of software. Responsible for training DM staff regarding program,
process and workflow. Other duties assigned during work on this project include
mentoring and training of two RN’s transitioning from UR to CM/DM department
including preparing training outline and all training materials utilized, both paper
and online. Have also prepared daily report for Director of CM/DM and Referral
Analysts showing CM billed hours and open caseload showing daily, weekly and
monthly totals for each CM. Worked with CM team by assisting with late
activities, making calls, documenting clinical and any other items in order to help
team in meeting monthly productivity goals. Also developed information for DM
Program to be used by Marketing Department.
Nov 2000 to Feb 2003 Nurse Case Manager
Proactive telephonic medical case management (CM) services for multiple
clients. Duties include identifying opportunities for CM intervention while using
sound judgment in coordinating care and services for patients while working
within benefit plan, facilitating safe and appropriate alternative care settings,
coordinating with discharge planners, negotiating discounts and alternative levels
of care with vendors, establishing collaborative working relationship with other
Case Managers, patients, providers and customers. Other duties include
communication with customers via phone, email or formal reporting, maintaining

4. confidentiality, and accurate documentation to file, meeting or exceeding
productivity standards and positive cost savings to customers. Other duties
volunteered for include co-author of CM Training Manual, assisting other CM with
data sorting and preparation of Default Pricing List for CM Department; also have
served as preceptor for new Case Managers.
July 1998 Intracorp/Cigna Dallas, TX
To Nov 2000 Nurse Care Specialist (CIGNA Integrated Care)
Case Management services for integrated model for Worker’s Compensation and
STD/LTD claims. Perform initial and ongoing medical evaluation of all disability
cases channeled to clinical path. Communication with client, providers and
Benefits Specialists to determine current status and to assess future needs.
Managed cases in accordance with customer specifications using pre-
established guidelines and criteria assuring quality and appropriate service
delivery. Evaluate need for and facilitate alternative level of treatment through
telephonic contact with client and medical providers, establish appropriate
treatment plans, negotiate level of care, intensity and duration of treatment with
providers, negotiate return to work with employers, maintain accurate record
system of claims, work with other team members to effect a safe and early return
to work. Other duties assigned by department Supervisor included assisting with
Marketing by assisting with presentations to potential and active customers,
training for Philadelphia office Case Managers on policies, procedures, workflow
and system training, monthly Quality Assurance reviews on files managed by
other team Case Managers, back-up for Supervisor for employees and
customers when Supervisor was unavailable.
March 1998 Intracorp Dallas, TX
To July 1998 Early Assessment Case Manager
Case Manager for Worker’s Compensation. Utilized Case Management skills for
timely, safe return to work. Contacts included injured worker, provider, adjuster
and employer. Knowledge of various State Jurisdictions with emphasis on Texas
and California, Utilization Review skills as well as strong computer skills.
Sept 1997 Texas Scottish Rite Hospital for Children Dallas, TX
To Feb 1998 R.N. Orthopedic Coordinator/Ambulatory Care
Pediatric Orthopedic Case Management services in outpatient clinic setting.
Duties included Patient/family education, case management of outpatient
population, assisting physicians and other healthcare professionals in clinic.
Follow up of outside tests ordered, phone messages, missed appointments,
assisting LVN with scheduling of clinics and other assigned duties.
July 1997 Arlington Memorial Hospital Arlington, TX
To Sept 1997 Staff Nurse
Nursing care of pre and post-operative patients utilizing all nursing skills along
with care planning, computerized documentation, and medication administration.
August 1991 Trinity Regional Hospital Ft. Dodge, IA
To July 1997 May 1996 to July 1997 Surgical Case Manager
Case Management of surgical patients from admission to discharge along with
Pre-operative educational home visits to patients undergoing total hip, total knee
replacement and post-operative Home Health Care visits as needed. Assisted in

5. development and implementation of Case Management program. Experienced
in clinical expertise in previous work experience including problem solving,
decision making, communication, and leadership, flexibility and conflict resolution
skills along with working very closely with Utilization Review staff. Also provided
education for Case Management staff and developed a collaborative and
effective working relationship with physicians and other healthcare professionals.
Member of Patient/Family Educational Committee, assisted in implementation
and education of staff on Interdisciplinary Patient/Family Education Teaching
Protocols.
August 1991 to April 1996 Staff Nurse
Nursing care of General Surgical/Orthopedic patients, transcribing physician’s
orders, data entry for procedures, tests ordered, use of computer for
implementing and updating plans of care, and order entry. Other responsibilities
included IV Support Nurse, PACE and AXIS trainer. Member of Design Team for
Patient Focused Care implementation. Preceptor for new staff members.
EDUCATION: Iowa Central Community College, Ft. Dodge, IA
Associate Degree Nursing, June 1991
Nimitz High School, Irving, TX
PROFESSIONAL Registered Texas State Board of Nursing
STATUS: CCM status effective 12/4/99
UHC Sages of Clinical Services Nominee 2012, 2014
iNSpire Mentoring Program participant 2016
REFERENCES: Available upon request

6. development and implementation of Case Management program. Experienced
in clinical expertise in previous work experience including problem solving,
decision making, communication, and leadership, flexibility and conflict resolution
skills along with working very closely with Utilization Review staff. Also provided
education for Case Management staff and developed a collaborative and
effective working relationship with physicians and other healthcare professionals.
Member of Patient/Family Educational Committee, assisted in implementation
and education of staff on Interdisciplinary Patient/Family Education Teaching
Protocols.
August 1991 to April 1996 Staff Nurse
Nursing care of General Surgical/Orthopedic patients, transcribing physician’s
orders, data entry for procedures, tests ordered, use of computer for
implementing and updating plans of care, and order entry. Other responsibilities
included IV Support Nurse, PACE and AXIS trainer. Member of Design Team for
Patient Focused Care implementation. Preceptor for new staff members.
EDUCATION: Iowa Central Community College, Ft. Dodge, IA
Associate Degree Nursing, June 1991
Nimitz High School, Irving, TX
PROFESSIONAL Registered Texas State Board of Nursing
STATUS: CCM status effective 12/4/99
UHC Sages of Clinical Services Nominee 2012, 2014
iNSpire Mentoring Program participant 2016
REFERENCES: Available upon request