pediatric nurse care manager lead resume example with 17+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Professional Summary
Experienced and highly motivated Nurse Care Manager achieves expected outcomes, demonstrates leadership and serves as resource in management of clinically complex patients. Displays excellent interpersonal and team-building skills and collaborates effectively with physicians, nurses and members of healthcare team. Proficient and functional working knowledge of computer databases, electronic medical record systems and information technology.
Skills
Team Building
Training and mentoring
Patient education and counseling
Multidisciplinary team collaboration
Work History
01/2014 to CurrentPediatric Nurse Care Manager LeadAliso Ridge Behavioral Health & Anaheim Community Hospital | Aliso Viejo, CA,
Care management of pediatric members.
Care management adult members.
Manage case load of over 40 patients prior to promotion to Lead Care Manager.
Coordinated and analyzed sustainable person-centered care plans involving internal and external providers.
Collaboration on member’s behalf with primary care physician (PCP), multiple specialty physicians and community vendors.
Arranged transportation and documented details of discharge transition plans.
Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing and other enabling services for patients.
Facilitated assessment of individual physiological, psychological, financial, cultural and family situation and coordinated social services to address individual and family needs.
Assessed healthcare needs and monitored effectiveness and progress plans to achieve desired outcomes.
Resource coordination on member’s behalf to California Children’s Services (CCS) and Tri-Counties Regional Center (TCRC).
Review and reconciliation of claims related to CCS-shared cases.
Community education on Gold Coast Health Plan Care Management program.
Identified opportunities to optimize communication within inpatient and cross-continuum teams to drive effective patient flow and sustainable care transitions from hospital and home, within community care settings and implement supplemental care and services for high-risk patients.
Offered leadership, support and clinical expertise within care management teams to achieve outcomes.
Spearheaded and implemented new projects to expand scope of engagement.
Participation in quality improvement teams related to new program development, policies/procedures, and identification of unmet needs for GCHP members.
Currently serving on leadership team for Ventura County Pact Coalition.
01/2010 to 01/2015Intake Registered NurseSun Life Financial | Detroit, MI,
Triaged potential patients to determine if criteria is met for admission to treatment program.
Facilitated admission process.
Provided referrals for other resources if patient was not eligible for services.
Managed prior authorization process.
Performed ongoing assessments to evaluate mental health needs, working with multidisciplinary team to develop, initiate individualized plans of care.
Collaborated with interdisciplinary healthcare personnel to meet patients' personal, physical, psychological and cognitive needs.
Documented patient information obtained from interviews concerning symptoms, medications and prior treatment.
01/2010 to 01/2014Health AdvisorPinnacleCare | City, STATE,
Provided individualized care management, support and education for patients and their families to ensure positive clinical outcomes.
Cultivated relationships with medical professionals while helping patients navigate healthcare system.
Coordinate all aspects of patient's healthcare with interdisciplinary team.
Identified need to facilitate second opinions, resources and review of medical records.
Collaborated with research department to provide patients and physicians with most current information related to medical conditions, treatments, and clinical trials.
Provided unbiased support and assistance to patients, physicians, and other stakeholders.
Coordinated all aspects of palliative care in outpatient setting.
Promoted available resources and connected individuals with services.
01/2004 to 01/2010Senior Specialty Nurse Case ManagerAnthem Blue Cross / WellPoint | City, STATE,
Quality of Care Initiative.
Development and implementation of key elements of this program for Medicare/Medicaid population.
Evaluated program for cost-effectiveness.
Monitored services and resources needed to respond to member’s health care needs.
Conducted clinical assessments to identify individual member knowledge, skills, and behavioral needs.
Provided members with tools to promote independence in health care compliance.
Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
Educated patients and caregivers on healthcare protocols and processes.
Education
Expected in 10/2021 to to Bachelor’s Degree | in ProgressGrand Canyon University, Phoenix, ArizonaGPA:
Expected in 05/1999 to to Associates Degree in Nursing | Nursing College Of The Canyons, Valencia, CAGPA:
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