Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Highly skilled and enthusiastic professional Registered Nurse, with a compact license and over 10 years of case management, clinical review and skilled nursing experience. I am open and motivated to learn, grow and excel in any capacity in the healthcare arena. My Fields of Interest are Behavioral Health and Wellness.
Skills
Multidisciplinary team collaboration
Seasoned in medical clinical procedures
Staff Management
Medication dispensing
Relationship building and retention
Patient education and counseling
Wellness services
Drug utilization review
Work History
11/2019 to 09/2020
Behavioral Health Care ManagerAnthem, Inc. – Falls Church, VA,
Performed admission reviews for medical necessity based on MCG specifications.
Performed prior authorization review of services requiring pre-auth.
Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Collaborated with Medical Directors, managers, and team members to quickly assess the need for members to remain in treatment and ensure that facilities deliver appropriate treatment, while managing rapidly changing conditions of patients.
Recorded details regarding all therapies, including ECT, ABA, medication and documented court orders to keep patient charts updated.
Conducted concurrent reviews to assess ongoing behaviors and conditions, and updated clinical supervisors with current information in rounds.
Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
12/2015 to 11/2019
Behavioral Health Care ManagerAnthem, Inc. – Forrest City, AR,
Performed admission reviews for medical necessity based on MCG specifications.
Performed prior authorization review of services requiring pre-auth.
Communicated with healthcare team members to plan, implement and enhance treatment strategies.
Collaborated with Medical Directors, managers, and team members to quickly assess the need for members to remain in treatment and ensure that facilities deliver appropriate treatment, while managing rapidly changing conditions of patients.
Recorded details regarding all therapies, including ECT, ABA, medication and documented court orders to keep patient charts updated.
Conducted concurrent reviews to assess ongoing behaviors and conditions, and updated clinical supervisors with current information in rounds.
Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
09/2012 to 12/2015
Behavioral Health Case ManagerAnthem, Inc. – Fort Smith, AR,
Conducted assessments to determine individual needs and developed personalized care plan to address stated objectives.
Verified successful coordination of counseling efforts with mental health professionals, doctors, social workers and others.
Managed over 25 patients while monitoring and evaluating care plans.
Applied evidence-based techniques such as behavioral activation, problem-solving treatment and motivational interviewing to support behavioral interventions.
Recorded patient progress and treatment recommendations in Care Compass and Facets management system to be shared with medical providers, psychiatric consultant and others involved in patient's care.
Evaluated patients based on mental and physical parameters discovered through interviews and standardized assessments.
Worked with family members, with patient's consent, to develop support networks and multifaceted coping techniques focused on patient's needs.
Maintained excellent attendance record, consistently arriving to work on time.
Served as a resource expert to other Behavioral Health Care Managers, assisted with complex cases, participated in inter/interdepartmental teams, peer reviews, projects, and initiatives, such as the implementation of Mental Health Rehabilitation Team, an initiative mandated by the State to implement thousands of Plans of Care in each patient's chart by a certain time period. This initiative saved the company thousands of dollars.
Assisted patients with obtaining resources such as housing, transportation, etc.
09/2012 to 08/2014
Care Manager-BHCvs Health – Rocklin, CA,
Interpreted regulations to identify patient care requirement criteria to be monitored and establish systems to achieve compliance.
Coordinated with healthcare staff from various disciplines to devise, carry out and manage personalized care plans to benefit patient health and recovery.
Assessed healthcare needs and monitored effectiveness and progress plans to achieve desired outcomes.
Monitored inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness, as well as processed appeals and set up peer reviews.
Collaborated with RNs and Medical Directors, attended Weekly team meetings directed by facility medical director and managers.
Performed concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience and provided information to providers regarding mental health and substance abuse benefits.
Education
Expected in
Associate of Applied Science: Pre-Nursing Baton Rouge Community College - Baton Rouge, LA GPA:
Expected in
Bachelor of Applied Science: Nursing Southern University And A & M College - Baton Rouge, LA GPA:
Accomplishments
Collaborated with a team of clinical professionals in the development of The Mental Health Rehabilitation Team. The team was developed to create Plans of Care in over 10,000 plus member records, mandated by the State, within a timeframe of four months. The project was successfully done and we were able to save the company thousands of dollars.
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