Tracy Pillsbury has over 20 years of experience in nursing and case management. She is currently a Service Center Supervisor at Health Direct, where she supervises case managers, provides training, evaluates performance, and ensures quality case management. Previously, she has held roles as a clinical care manager, hospice nurse, training coordinator, and staff nurse. She holds certifications in case management and as a legal nurse consultant.

1. TRACY J PILLSBURY, RN, CCM, LNCC
Maitland, Florida
352-598-4950
WORK HISTORY:
2005 – Present
Service Center Supervisor, Health Direct, Worker’s Compensation Telephonic Case Management unit.
 Supervises Telephonic Nurse Case Managers and Administrative Support staff, on and off site,
in concert with Telephonic Case Management/UR/Medical Affairs units. Manages all aspects of
daily operations in concert with both Clayton and Pittsburgh units to ensure even and timely
assignments
 Trains new hires and provides ongoing program and regulatory training for all staff
 Evaluates individual Case Manager’s performance to ensure timely coordination of medically
appropriate treatment based upon injury, adherence of state regulatory guidelines, and
documentation and application of state mandated and/or Official Disability Guidelines, with the
goal of returning the injured worker safely to the workplace, while containing health care and
indemnity costs
 Evaluates quality of case management services including medication appropriateness, causation
analysis, and return to work; formulates collaborative plans with claim adjusters, working towards
successful clinical outcomes while attempting to mitigate claim cost
 Manages files specific to Severity Predictive Modeling product; works directly with assigned
Case Managers to evaluate highly complex and costly claims to ensure current medical
treatment is appropriate. Ensures recommendations for cost mitigation are made to claims
managers in preparation for settlement proceedings and/or Medicare Set Aside allocations.
 Completes multiple quality analysis/file reviews of varying focus to evaluate customer
satisfaction and timeliness guarantees, regulatory compliance, network vendor usage, and
internal program requirement adherence
 Provides ongoing employee performance coaching and feedback, including but not limited to the
performance review process
 Prepares and presents Targeted Improvement Plans to staff as necessary, with implementation
and follow through directly with employee until sustained improvement is
demonstrated/resolution is achieved or advancement to formal performance counseling
 Serves as clinical liaison between the Maitland unit and AIG claim offices located in Alpharetta,
GA, Charlotte, NC, Tampa, FL and Louisville, KY; travels annually for onsite quality audit
meetings and as needed
 Provides back up to Service Center Manager for facility management issues and
IMT/emergency response. Onsite designated AED responder

2. 2005 RN Clinical Care Manager, Senior Home Care
 Coordinated, implemented and evaluated plans of care as established by staff RN.
 Conducted periodic re-assessments of client needs based on Medicare guidelines.
 Supervised and monitored performance, productivity, and skill of all field employees.
 Assigned incoming referrals to field personnel based on patient acuity.
 Reviewed and coded all Medicare OASIS forms.
2003 - 2005 RN Case Manager, Hospice of Marion County
2003 RN Training Coordinator, Experience Works Home Health Services
2002 –2003 Business manager, sales, and marketing director for spouse’s new business
1999 – 2002 Stay-at-home mother
1997 – 1999 Staff RN, Munroe Regional Medical Center – Medical/Surgical/Telemetry Unit
CERTIFICATIONS:
Certified Case Manager, Certificate # 98617
Certified Legal Nurse Consultant # 34132041
LICENSURE:
State of Florida, Registered Professional Nurse, License # 3179022
State of North Carolina, Rehab Professional, License # 212465
EDUCATION:
1997 Graduate of Central Florida Community College, Associate Degree Nursing Program
ACCOMPLISHMENTS:
2014 Mentee for the AIG Global Operations Mentor Program
2013 – 2014 Led team to achieve quality Case Management goals while providing flexibility and
support to senior HDi management as Interim Service Center Manager of the Maitland
unit. Continues to provide ongoing support and training during the transition period to the
new Service Center Manager.