Inpatient/ ER Case Manager Resume Example Heywood Healthcare Athol Hospital

INPATIENT/ ER CASE MANAGER

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
Heywood Healthcare Athol Hospital – Athol, MA

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
Fallon Health – Worcester, MA

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 wellas 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 & Hospice – Shirley, MA

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 , 2003
Mount Wachusett Community College - Gardner, MA

Resume Overview

Companies Worked For:

Heywood Healthcare Athol Hospital
Fallon Health
Nashoba Nursing Service & Hospice

School Attended

Mount Wachusett Community College

Job Titles Held:

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

Degrees

Associate of Science : Nursing , 2003

Inpatient/ ER Case Manager Resume Example

Resume Score: 80%

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