Mentor Request Application
First Name
  
Last Name  
City, State, Zip  
Email  
Phone Number  
   
   

 

 I would like to be mentored in the areas of:

Leadership

Fundamentals of Managed Care

Certification in Managed Care Nursing

Integrating Managed Care into a Hospital Setting

Utilization Management/Review

Disease Management

Please Choose:

Process Disease Management

Specific Disease State -
please give us the disease state

Appeal Management

Medicare/Medicaid Managed Care

Administration/Management

Patient Education

Technology/Internet

Reporting

Research

Quality Improvement/Performance Improvement

Case Management
 
   

 

 I prefer to be mentored by (select one):

Dan Berman

Patricia Conley

Nancy Eberhard

Jan Gilbert

 Kathy Graham

Melida Melise-Grant

Vineta Mitchell

Sheryl Riley

 Carrissa Sanchez

I understand I may be assigned to a mentor other than my preference