appeals specialist rn resume example with 17 years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Professional Summary
Compassionate Registered Nurse with 20 years of experience in offering comprehensive patient care in long term care, hospice, homecare, medicare, as well as in-patient settings. Works well with diverse patient population and fosters trusting relationships to improve outcomes. Efficiently coordinates with healthcare professionals to advance patient care.
Skills
Patient and family advocacy
Chronic disease management
Case management
Medication distribution
Strong clinical judgment
Care plan development
Hospice philosophy understanding
Palliative care awareness
Prior authorization processing
Writing Medicare appeals through medical chart review
Education
Hibbing Community CollegeHibbing, MNExpected in ā āAssociate of Arts:Nursing - GPA:
Work History
Castle Senior Living - Appeals Specialist RN Mukwonago, WI, 04/2020 - Current
Communicated effectively with staff, including members of operations, finance and clinical departments.
Communicated verification and authorization status updates with department to facilitate decision-making for patient admissions and insurance coverage.
Effective task prioritization and great work ethic.
Conducted research, gathered information from multiple sources and presented results.
Demonstrated respect, friendliness and willingness to help wherever needed.
Proved successful working within tight deadlines and fast-paced atmosphere.
Created plans and communicated deadlines to ensure projects were completed on time.
Worked flexible hours; night, weekend, and holiday shifts.
Equipped patients with tools and knowledge needed for speedy and sustained recovery.
Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom reoccurrence.
Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
Facilitated therapeutic communication, conflict resolution and crisis intervention by redirecting negative behaviors and helping patients regain or improve coping abilities to prevent further disability.
Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Performed ongoing assessments to evaluate mental health needs, working with multidisciplinary team to develop, initiate, manage and modify individualized plans of care.
Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
Delivered medications via oral, IV and intramuscular injections, monitoring responses to address new concerns.
Documented patient information obtained from interviews concerning symptoms, medications and prior treatment.
Kept optimal supply levels in treatment rooms, triage and other areas to meet typical patient loads.
Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
Fairview Range Homecare And Hospice - Registered Nurse Case Manager City, STATE, 01/2008 - 11/2017
Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
Trained new nurses in proper techniques, care standards, operational procedures and safety protocols to optimize performance and safety.
Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
Educated patients and loved ones about different treatment options and outside care approaches, reducing burden on hospital resources.
Authored initial assessments of patients and family to develop plans for individual home care needs. Ā·
Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
Participated in on-call rotations to deliver after-hours care.
Administered medications and treatments as prescribed by physicians.
Followed all instructions for medication administration and treatment plans as prescribed by physicians.
Liaised with physicians regarding patient needs, performance and changes.
Negotiated with suppliers and vendors to procure medical equipment, supplies and services.
Responded promptly and professionally to patient questions and concerns.
Actively engaged in on-call rotations to deliver continuous quality care to patients.
Delivered medications via oral, IV and intramuscular injections, monitoring responses to catch and address new concerns.
Thoroughly assessed and examined patients and documented history of current and previous conditions, diseases and injuries along with medications currently being taken.
Guardian Angels - RN Unit Manager City, STATE, 05/2004 - 01/2008
Handled any complaints from patients and families and ensured patient care needs were wet.
Oversaw RNs, LPNs, nursing aides, medical clerks and support staff and performed staffing scheduling duties.
Provided targeted care and treatment to geriatric and post surgical patients.
Conducted patient assessments, recorded vitals and analyzed records and charts to define care requirements.
Trained and coached new employees on protocols and best practices to promote ideal patient outcomes.
Contributed substantially to successful department JCAHO accreditation by consistently operating to highest standards of care.
Assisted patients with bathing, dressing, hygiene and grooming.
Participated in facility surveys and inspections made by authorized governmental agencies.
Conducted monthly patient case conferences, in-services and staff meetings to educate staff and facilitate good communication.
Managed caseload of 20 clients, providing education, treatments, IV therapy, venipuncture and wound care.
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