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Clinical Advisor Resume Example

Resume Score: 80%

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CLINICAL ADVISOR
Professional Summary

Highly motivated LPN with 20 years experience in a robust variety of nursing roles and settings, with interest in a position that focuses on providing knowlege and enhancement to both the provider and consumer experience within the ever-changing healthcare system.

Skills

*Knowlege and understanding of CMS regulations governing healthcare delivery

*Strong computer skills

*Resourcefullness in obtaining information and accomplishing objectives

*Courage and creativity  to think 'outside the box' when appropriate

*Ability to elicit cooperation and lead effectively

*Ability to think quickly and react productively in adverse situations

*Confidence in speaking/comunicating both interpersonally and publicly

*Ability to learn and retain information quickly for practical and logical application

*Ability to problem solve with consideration to all perspectives for well-rounded solutions

*Ability to work autonomously, with self regulation of efficiency and effectiveness

*Passion for teaching and ability to articulate information to align with a given population/individual's learning needs

*Adaptable to change

*Desire to learn new skills and develop competencies

Work History
Clinical Advisor 11/2013 to Current
Humana Insurance Company – Louisville, KY

*Review submitted clinical information against CMS and/or MCG to determine appropriateness of level of care provided

*Corroborate with both facility and internal case managers to facilitate safe discharge plans and outcomes for plan members

*Participate in both virtual and off-site initiatives to develop pilot programs and process enhancements

*Held appointed position of SME(Subject Matter Expert) within my role, providing assistance to leadership with managing reports, process changes and serving as a resource to my peers and preceptor to new hires

*Created and proposed ideas and tools that were subsequently adopted by my regional team to improve efficiency in tasks and communication with constituents

*Maintained an active role in my region's engagement committee, facilitating virtual and live activities to boost and sustain cohesiveness and morale

*Received both a regional STAR award by my immediate leader, as well as a nomination by Senior leadership for a national SUMMIT award for explemplory performance in ensuring member safety

Utilization Management Nurse 03/2008 to 10/2013
Aetna Life Insurance Company – Hartford, CT

*Utilization review of acute inpatient, skilled nursing facility, acute rehabilitation, and Long Term Acute Care cases. 

*Proactive discharge planning to and from afore noted levels of care. 

*Successfully adapted to multiple sudden and involuntary role changes within the company, with limited training 

*Achieved score of 100% on most internal case audits  Attained exemplary performance reviews and subsequent incentive rewards 

*Received accolades from colleagues and constituents in the form of team "e.thank you's" within and via email/telephone calls to my leadership

*Maintained knowledge of policies, procedures and products through completion of technology based and  instructor training courses 

*Sought out by co-workers in varying roles as a resource for information and assistance with technology, as well  as efficient work flow practices

High-Tech Residential Pediatric Nurse 08/2007 to 03/2008
Pediamanor – Pipersville, PA

*Complete medical, emotional andsocial maintenance of children with ventilator dependency, tracheotomy and gastric  tube care, enteral feeding needs, physical and mental developmental challenges within a group home setting. 

*Administered and monitored medication and maintained appropriate and accurate documentation 

*Provided education and support to family members and therapists 

*Promoted peer interaction and age appropriate activities for social development 

*Maintained equipment and supplies to optimize function and promote an aseptic environment

Education
Associate of Science: Nursing CurrentExcelsior College - Albany, NY (home based program)
Technical Diploma : General Practical Nursing1996 Upper Bucks County Vocational /Technical School- Perkasie, PA
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Resume Overview

Companies Worked For:

  • Humana Insurance Company
  • Aetna Life Insurance Company
  • Pediamanor

School Attended

  • Excelsior College
  • Upper Bucks County Vocational /Technical School

Job Titles Held:

  • Clinical Advisor
  • Utilization Management Nurse
  • High-Tech Residential Pediatric Nurse

Degrees

  • Associate of Science : Nursing Current
    Technical Diploma : General Practical Nursing 1996

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