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inpatient er case manager resume example with 17+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary

Effective and compassionate Case Manager with over 20 years of experience and exemplary coordination ability. Solid clinical, utilization review, and case management experience. Highly competent with passion for coordinating quality care for patients. Offering exemplary interpersonal skills and commitment to helping patients receive effective care in line with preferences and standards.

Skills
  • High level of personal accountability
  • Problem resolution capability
  • Culturally competent care
  • Patient/family focused
  • High level of autonomy
  • Independent judgment and decision making
  • Ability to communicate effectively and efficiently with healthcare providers
  • Understanding of Medicare/Medicaid processes
  • Capable of prioritizing patient case load and clinical demands
  • Transition planning
  • Utilization management
  • Variance tracking/avoidable days
  • Psychosocial interventions/crisis interventions
  • Strong clinical judgment
  • Patient and family advocacy
  • EMR / EHR
Work History
Inpatient/ ER Case Manager, 06/2018 to Current
Corizon HealthLetha, ID,
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration
  • 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
  • Participated in patient and family planning process, as well as provided instructions and addressed question and concerns
  • Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations
  • Liaised with physicians regarding patient needs, performance and changes
  • Responded promptly and professionally to patient questions and concerns .EMR to maintain database of relevant information for practitioners to access and coordinate patient care
  • Supervised and maintained all utilization review documentation through EMR
  • Supported and perform clinical appeals
  • Promoted patient and family comfort during challenging recoveries to enhance healing and eliminate non-compliance problems
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies
  • Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented all patient interactions and interventions in electronic charting systems
  • Addressed disruptions in patient care, including delays in discharge, postponed procedures and discharge equipment unavailability
  • Assist patients and families in developing discharge plan including coordination of community based resources ,admission to post-acute care such as acute rehabilitation or skilled nursing facility
  • Provide clinical information to payors,monitor length of stay,seek necessary care authorizations and appealing medical denials
  • Assist with interventions when patients are facing complex medical issues including end of life, or social issues such as abuse ,neglect and addiction
  • Provide patients with community resources to pursue benefits for which patients maybe eligible
  • Work with interdisciplinary care team to identify ,manage,and correct avoidable days/extended stays
  • Patient flow: Coordination ,facilitation of care
  • Denial management : Validating ordered level of care is appropriate utilizing interqual clinical criteria
Registered Nurse Case Manager, 04/2015 to 06/2018
Nascentia HealthRome, NY,
  • Educated and supported home healthcare providers with training, guidance, mentoring and resources required to achieve objectives."
  • Educated patients and loved ones about different treatment options and outside care approaches
  • Prepared clinical notes and updates for review by primary physician
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed
  • Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods
  • Initiated appropriate preventive and rehabilitative nursing procedures
  • Effectively communicated with physicians regarding patient needs, performance, medications and changes
  • Coordinated rehabilitative and preventive nursing processes and procedures
  • Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes
  • Liaised with physicians regarding patient needs, performance and changes
  • Participated in patient and family planning process, as well as provided instructions and addressed question and concerns
  • Negotiated with suppliers and vendors to procure medical equipment, supplies and services
  • Complete in home nursing assessment
  • Coordination of care
  • Advocates for members
  • Complete accurate and timely documentation in EMR
  • Updated patient charts with data such as medications to keep records current and support accurate treatments
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs
  • 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
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed
  • Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods
  • Participated in patient and family planning process, as well as provided instructions and addressed question and concerns
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration
  • Effectively communicated with physicians regarding patient needs, performance, medications and changes
  • Administered physical examinations and documented history of current and previous conditions, illnesses and injuries
  • Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care
RN Case Manager, 06/2003 to 04/2015
Nashoba Nursing Service & HospiceCity, STATE,

Perform initial and periodic assessments of geriatric, adult and pediatric patients

Provide patient and caregiver education

Manage resources

Provide monitor direct and indirect care

Perform nursing activities within plan of care

Ensure compliance

Develop and implement nursing care plans

Education
Associate of Science: Nursing , Expected in 2003
Mount Wachusett Community College - Gardner, MA
GPA:

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Resume Overview

School Attended

  • Mount Wachusett Community College

Job Titles Held:

  • Inpatient/ ER Case Manager
  • Registered Nurse Case Manager
  • RN Case Manager

Degrees

  • Associate of Science

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