Clinical Resource Coordinator resume example with 16+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK Home: (555) 432-1000 - Cell: - resumesample@example.com - -
Professional Summary
Multifaceted Clinical Resource Coordinator/Case Manager with almost 10 years experience in healthcare as a
registered nurse in outpatient, inpatient, and utilization review settings. Master's-prepared in Health Law
with a concentration in Hospital Regulatory Compliance. Skilled in leadership roles for patient safety and
risk reduction.
Education and Training
Expected in September 2005
Bachelor of Science: Nursing Drexel University - Philadelphia, PA GPA: Nursing
Expected in May 2001
Bachelor of Science: Psychology St. Joseph's University - Philadelphia, PA GPA: Psychology I NTERESTS
Nursing Licensure, State of Pennsylvania Department of Public Health Renewed October 2014
Expected in
Master of Jurisprudence: Health Law Widener University School of Law - Wilmington, DE GPA: Graduated Cum Laude Health Law Graduated Cum Laude
Expected in
Special concentration in Hospital Regulatory Compliance and Legal Nurse Consulting. Classes included Healthcare Safety, Quality, and Liability, Healthcare Regulatory Compliance, and Healthcare Research.
Eligible for Certified in Healthcare Compliance (CHC): - , GPA:
Expected in
Nursing Accelerated Career Entry (ACE) Program: - , GPA:
Certifications
Healthcare Compliance Risk Management
Medicare and Medicaid Regulations HIPAA Regulations
Audits Quality and Safety
Documentation Compliance
Interests
Registered Nurse - State of Pennsylvania ADDITIONAL I NFORMATION LICENSES AND CERTIFICATIONS Nursing Licensure, State of Pennsylvania Department of Public Health Renewed October 2014 HONORS & AWARDS Sigma Theta Tau International - Nu Eta Chapter May 2005 Honor Society of Nursing Drexel University
CERTIFICATIONS Registered Nurse - State of Pennsylvania ADDITIONAL I NFORMATION LICENSES AND CERTIFICATIONS Nursing Licensure, State of Pennsylvania Department of Public Health Renewed October 2014 HONORS & AWARDS Sigma Theta Tau International - Nu Eta Chapter May 2005 Honor Society of Nursing Drexel University
Skill Highlights
Guest services
Inventory control procedures
Merchandising expertise
Loss prevention
Cash register operations
Product promotions
Professional Experience
04/2012 to Current
Clinical Resource Coordinator – , ,
Hospital of the University of Pennsylvania Philadelphia, PA Perform initial utilization review for a caseload of 15-20 patients on inpatient, outpatient, and observation hospitalizations by examining charts and sending a summary to commercial third-party payers, as well as Medicare and Medicaid.
Ensure that proper documentation to qualify diagnoses and treatment is present in the chart by educating nurses and doctors on the severity of illness and intensity of service, as stated by InterQual® guidelines.
Communicate with payers to provide concurrent review of hospitalization to make certain that the patient's stay in the hospital will be covered by insurance.
Dialogue with patients and families during their hospital stay to assess their physical, economic, and social barriers to a safe and proper discharge.
Arrange discharge services for patients in the home such as visiting nurses, physical therapy, hospice, durable medical equipment (DME), and home health aides.
Initiate prior authorizations in order to have necessary medications approved for coverage by insurance, in addition to exploring alternative medications that may be more affordable should coverage be denied.
Coordinate resources in the hospital and community for those without insurance or the means to adequately pay for their care following hospitalization.
Attend weekly unit-based clinical leadership (UBCL) meetings with an interdisciplinary team to review Penn Medicine Safety Net Reports and discuss improvements on issues such as readmissions, discharge documentation, and medication management.
Facilitate transfer to a more appropriate hospital setting based on acuity, or, in conjunction with social work, to a sub-acute facility.
Serve as department liaison for clinical informatics.
Review complicated discharge dispositions at clinical high risk meetings to share knowledge and resources.
07/2007 to 04/2012
Outpatient Cardiology Nurse – , ,
Hospital of the University of Pennsylvania Philadelphia, PA Worked with several general cardiologists in an outpatient setting, caring for patients with a variety of cardiac diseases, including but not limited to myocardial infarction, cardiomyopathy, arrhythmia, congenital heart defects, hypertension, hyperlipidemia, and resultant sequelae.
Interviewed new patients by telephone and reviewed past medical, surgical, and family history in preparation for their upcoming visit with the cardiologist, oftentimes obtaining past records from previous doctors or hospitalizations.
Reviewed patients' history, symptoms, allergies, medications, and performed a basic assessment prior to the arrival of the doctor.
Developed a clinic with two doctors and one other nurse where once weekly, patients with an impending surgery that necessitate clearance by a cardiologist were assessed, often for a procedure in the next 1-10 days.
Called patients and apprised them of their test results, offering education on the tests themselves and their implications, as well as methods for treatment and prevention.
Interacted with patients' insurance companies to pre-authorize a test or medication, supplying the explanation of medical necessity if it was in question.
Consulted with patients in the office and over the telephone for a weekly cardiac risk prevention clinic in which patients with elevated and at times uncontrolled cholesterol and triglycerides are seen, providing medication and symptom follow-up.
10/2005 to 06/2007
Clinical Nurse IAspen Valley Hospital – City, STATE,
Cared for patients in a cardiac step-down unit before and after procedures such as percutaneous coronary intervention, electrophysiology study, radiofrequency ablation, cardioversion, pacemaker and implanted cardioverter defibrillator insertion, and antiarrhythmic medication load.
Treated patients with varying degrees of heart failure, COPD, diabetes, and other ailments by implementing prescribed interventions and providing education for outpatient care and primary prevention and rehabilitation.
Served as co-chair of the Diabetes Committee of the Quality Improvement Team for the floor, performing regular audits regarding blood glucose measurement, hyperglycemia and hypoglycemia management, and educating nurses and patient care associates concerning proper interventions.
Aided in redevelopment and launch of the student nurse program on the floor by working with managers and a nurse educator to organize goals and timed outcomes, and routinely was shadowed by a student nurse for an eight hour shift during their junior or senior years, helping them to transition to graduate nurse.
Developed a guide including medications, abbreviations, conversions, and patient education tools for first-year cardiac nurses on the floor as a project for the BSN residency program by working with the Yale-New Haven Hospital Department of Pharmacy and nurse educators.
01/2004 to 09/2004
Vocational Training Specialist – , STATE,
Assisted individuals with varying degrees of mental retardation in paid vocational work.
Assessed conduct in the workplace and instituted goals regarding individuals' behavior.
Organized reports to clinicians and supervisors concerning vocational and behavioral progress.
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Resume Overview
School Attended
Drexel University
St. Joseph's University
Widener University School of Law
Job Titles Held:
Clinical Resource Coordinator
Outpatient Cardiology Nurse
Clinical Nurse I
Vocational Training Specialist
Degrees
Bachelor of Science
Bachelor of Science
Master of Jurisprudence
Special concentration in Hospital Regulatory Compliance and Legal Nurse Consulting. Classes included Healthcare Safety, Quality, and Liability, Healthcare Regulatory Compliance, and Healthcare Research.
Eligible for Certified in Healthcare Compliance (CHC)