Jason Krawchuck has over 20 years of experience as a registered nurse and is seeking a management position in corporate healthcare. He currently works as a Senior Manager at Blue Cross and Blue Shield of New Mexico, where he oversees multiple teams and helped develop New Mexico's Medicaid healthcare plans. He has a proven track record of success in clinical operations management, medical review, and utilization management.

1. Jason Krawchuck, RN
9808 Lorelei Lane NE
Albuquerque, New Mexico 87111
Home: 505.797.7066
Cell: 505.818.8413
E-mail: jason.krawchuck@gmail.com
Objective
To utilize my 20 years of Registered Nursing experience to obtain a challenging management
position within the Corporate Healthcare industry with opportunities for educational and
career advancement
Vision
I am an ambitious, confident self-starter with strong desire to learn, contribute, and lead
within a successful healthcare corporation.
Licensure
Registered Nurse, New Mexico--Active, Unrestricted License (1995 - current)
Experience
Blue Cross and Blue Shield of New Mexico 11/2005 – current
Albuquerque, NM
Senior Manager Clinical Business Solutions 08/13 - current
• Senior Manager of multiple clinical and non-clinical professionals within the
Government programs division of Health Care Management
• Medical Review Unit – managed and developed team of nursing professionals
responsible for ensuring accurate adjudication of claims based upon retrospective
medical review for NM Medicaid (Centennial Care), Illinois Government programs
and the Medicare Advantage Programs
• Utilization Management - responsible for 2 teams of professionals performing the
daily operations of utilization management for the NM Medicaid (Centennial Care)
program and the Illinois Medicaid/ Medicare programs.
• Electronic Content Management – responsible for the development of the internal
content management system to accurately store, retrieve and distribute incoming
medical records across multiple departments for New Mexico and Illinois product
lines. Managed team of non professional staff to perform daily operations
• Responsible for the development, implementation and daily operations of the new
Medicaid health care plans for the BCBS Government Programs division
Medical Review Unit Senior Supervisor 10/09 – 08/13
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2. • Supervise a team of clinical and non-clinical professionals in the completion of
detailed clinical/ financial review of rendered services for all HCSC commercial
products and State of New Mexico government products
• Supervision and development of professionals to ensure the multitude of corporate
policies and contracts are upheld and applied according to our established policies.
• Work in collaboration with multiple internal corporate departments in ensuring the
medical review of the documentation supports the medical necessity and commercial
contract/ member benefits
• Development of internal policies, procedures and productivity/ quality matrix
reporting
Health Services Unit UM/CM Senior Supervisor 08/09 – 10/09
• Supervised a team of 13 clinical professionals in the completion of
medical/utilization review activities and complex Case Management. Responsibilities
included supervision of prior authorization reviews, concurrent reviews and ongoing
Case Management of complex and high utilization of resource cases.
• Worked as interim supervisor
Medical Review Senior Supervisor 07/08 – 08/09
• Supervised a team of 14 clinical professionals in the completion of
medical/utilization review activities, including prior authorization reviews, level of
care reviews, and fraud and abuse initiatives in a dedicated service setting
• Ensured and verified services requested are covered under the Medicaid Program in
accordance with Medicaid regulations and performance standards in a cost-effective
manner
• Successfully instituted quality monitoring and training programs to meet Medicare
and Medicaid guidelines while achieving high provider participation and valuable
feedback in the development and implementation of provider trainings by webcast
• Successfully developed and implemented medical review productivity standards
• Assisted the Medical Assistance Division (MAD) with rewriting the Medicaid
Utilization Review regulatory guidelines relating to the Intermediate Care
Facilities/Mentally Retarded and Nursing Facility prior authorization requirements
Medical Review Trainer 09/2007 – 07/2008
• Responsible for creating materials and conducting provider training for 18 medical
review types
• Developed and maintained relationships with New Mexico Health and Human
Services departments; MAD, HSD and ALTSD
• Developed and implemented provider training by webcast (Microsoft Live Meeting)
and continued in-person sessions
Jason Krawchuck, RN 2

3. • As a member of the leadership team, I acted as a lead resource by management to
provide nurse reviewers with guidance, mentoring, problem resolution and training
Medical Reviewer II 11/2005 – 09/2007
• Responsible for New Mexico Long Term Care, Outpatient Therapy, and Disabled &
Elderly Waiver authorizations
• Processed, reviewed, interpreted, and determined client eligibility based on New
Mexico Medicaid regulations and service standards
• Effectively processed significant volumes of daily work while consistently exceeding
NMMUR quality measure and productivity requirements
Peak Medical Corporation 07/2004 – 11/2005
Albuquerque, NM
Medicare Review Manager
• Developed, implemented, and managed Medicare/Medicaid internal quality
management and medical review program for each facility
• Successfully managed department and instituted quality monitoring and training
program to ensure that nurse documentation, both facility- and district-wide, were
appropriate and within the Medicare/Medicaid LTC guidelines
• Reported directly to the Vice President of Clinical Reimbursement
Sun Bridge Healthcare Corporation 01/2002 – 7/2004
Albuquerque, NM
Lead RN Medical Reviewer
• Directly responsible for all department nurse medical reviewers
• Responsible for coordinating and completing all Sun Bridge Healthcare facilities’
Medicare Part A/B medical reviews
• Responsible for successfully coordinating, preparing, and representing Sun Bridge
Healthcare during Medicare Part A/ B Administrative Law Judge hearings
Integrated Specialty Hospital 03/2001 – 03/2002
Albuquerque, NM
• RN working with high risk long term care patients; wound care, IV therapy and
rehabilitation
Presbyterian Home Healthcare 10/2000 – 03/2003
Jason Krawchuck, RN 3

4. Albuquerque, NM
• Home Healthcare RN – PRN - wound care and IV therapy
HealthSouth Rehabilitation Hospital 05/1999- 02/2001
Albuquerque, NM
• RN working directly with intensive long term rehabilitative patients
St Joseph’s Hospital 12/1998 – 05/1999
Albuquerque, NM
• RN working on a Telemetry/ Sub Acute Care Cardiac unit
Nurse Finders 08/1998 – 03/2003
Albuquerque, NM
• RN-PRN working with home healthcare residents
Lovelace Medical Center 07/1995 – 08/1998
Albuquerque, NM
• Home Health Care Primary Care Nurse 10/1997 – 08/1998
• Medical/Surgical Nurse – surgical floor 07/1995 – 10/1997
Education
University of Phoenix
• Bachelor of Science in Business Administration with Honors - 2006
Central New Mexico (CNM) Community College (formerly T-VI)
• Associate of Science in Nursing – RN program with Honors
References
Available upon request
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