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Nurse Case Manager Resume Example

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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Professional Summary

Experienced Registered Nurse with over 10 years of experience in Healthcare and Third Party Insurance Disability. Excellent reputation for resolving problems, using clinical knowledge, natural interpersonal strengths and technical abilities. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Knowledgeable about EMR charting, medication administration and interdisciplinary collaboration focused on optimizing patient care and support. Quality-focused and efficiency-driven leader.

Skills
  • Critical Thinking
  • Accurate Documentation
  • Decision Making
  • Creative Problem Solving
  • Compassionate and Caring
  • Attention to Detail
  • Needs Assessment
  • Treatment Recommendations
  • Routine Examinations
  • Delegation and Motivation
  • Medical Procedure Preparation
Work History
07/2018 to Current Nurse Case Manager Ardent Health Services | Topeka, KS,

Performing clinical reviews of referred claims

Documenting decision rationale and completing medical review of all claims to ensure information substantiates disability.

Provides clear and appropriate follow-up recommendations for ongoing medical management of claims.

Ensures appropriate recommendations are made on claims.

Selected for WalMart COVID Team to assist in bringing over 500,000 backlogged claims current.

Working in collaboration with examiners to support and offer resources and assistance in performance of duties related to claims management to maintain high-quality and efficient claim handling.

12/2014 to 08/2017 Registered Nurse, Medical-Surgical Unit Christiana Care Health System | Milford, DE,
  • Provided direct patient care, stabilized patients and determined next course of action.
  • Performed emergency medical procedures such as BLS, ACLS and other condition stabilizing interventions.
  • Administered medications via oral, IV and intramuscular injections and monitored responses.
  • Ordered and analyzed diagnostic tests to identify and assess patient conditions.
  • Managed care from admission to discharge.
  • Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom reoccurrence.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
  • Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.
  • Managed patient pain relief and sedation by providing non-pharmacological and pharmacological interventions.
  • Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
  • Advised patients and caregivers of proper wound management, discharge plan objectives, safe medication use and disease management.
  • Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
  • Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
  • Monitored patient reactions to drugs and carefully documented findings.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Led successful team comprised of RNs, LPNs and ancillary staff.
  • Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments, and supervising team comprised of nurses, LPNs, technicians and unit clerks.
  • Minimized hospital stays with recovery-centered approaches, reducing average in-patient stay length.
  • Secured controlled narcotics and distributed medication on schedule to meet patient needs and minimize misuse opportunities.
  • Monitored patient vital signs to perform thorough condition assessments.
05/2010 to 10/2014 Registered Nurse Thedacare | Neenah, WI,
  • Administered medications via oral, IV and intramuscular injections and monitored responses.
  • Managed care from admission to discharge.
  • Provided direct patient care, stabilized patients and determined next course of action.
  • Led successful team comprised of RNs, LPNs and ancillary staff.
  • Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments, and supervising team comprised of nurses, LPNs, technicians and unit clerks.
  • Taught patients how to improve lifestyle choices, dramatically reducing chance of symptom reoccurrence.
  • Managed quality care for patients with heart failure, end-stage renal disease and coronary artery disease.
  • Secured controlled narcotics and distributed medication on schedule to meet patient needs and minimize misuse opportunities.
  • Provided exceptional care to high-acute patients needing complex care such as ventilator management, extensive wound care and rehabilitation.
  • Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
  • Implemented medication and IV administration, catheter insertion and airway management.
  • Collected blood, tissue and other laboratory specimens and prepared for lab testing.
  • Monitored patient condition by interpreting and tracking EKG readings, identifying irregular telemetry readings and updating team members on changes in stability or acuity.
  • Evaluated healthcare needs, goals for treatment and available resources of each patient and connected to optimal providers and care.
  • Reviewed post-operative orders and continuously monitored patients' post-operative vitals, set up PCA and fluids and oriented patients to unit.
  • Conferred with physicians to discuss diagnoses and devise well-coordinated treatment approaches.
  • Delivered proper care to victims of domestic violence at urgent care clinic.
  • Maintained quality care and comfort for patients with heart failure, pulmonary hypertension and other conditions.
  • Minimized hospital stays with recovery-centered approaches, reducing average in-patient stay length.
  • Organized and managed care of patients undergoing various therapies and procedures.
  • Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
  • Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
  • Monitored patient reactions to drugs and carefully documented findings.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
Education
Expected in 05/2010 Bachelor of Science | Nursing University of Memphis, Memphis, TN, GPA:

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Resume Overview

School Attended
  • University of Memphis
Job Titles Held:
  • Nurse Case Manager
  • Registered Nurse, Medical-Surgical Unit
  • Registered Nurse
Degrees
  • Bachelor of Science