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Personal Health Nurse Consultant Ii Resume Example

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

Insightful Webster University Licensed Professional Counseling student seeking practicum and internship experience. Client-focused Registered Nurse with over twenty years of proven successful experience in case management and leadership. Recognized consistently for performance excellence and contributions to success in the case management industry. Accomplished at fostering meaningful relationships and developing effective short-term and long-term plans to achieve client goals. Compassionate nature and exceptional communication skills. Passionate about patient support and advocacy. High level of professionalism and initiative demonstrated through individual and team-oriented interactions.

Skills
  • Excellent Verbal and Written Communication
  • Teamwork and Collaboration
  • Emotional Support
  • Effective at communication with diverse populations
  • Case management proficiency
  • Adept at treatment and discharge planning
  • Skilled in intake interviewing
  • Self-motivated professional
  • Gallops Strengths include Relator, Connectedness, Maximizer, Responsibility, Consistency
  • Sees continuing education as priority for growth
  • Documentation and Recordkeeping
  • Computer Proficiency in Word, Excel, Power Point, and Visio
  • Friendly, Positive Attitude
  • Relationship Building
  • Composure and Emotional Control
Work History
03/2017 to 12/2020
Personal Health Nurse Consultant II Chg Healthcare Virginia Beach, VA,
  • Managed population of over 25,000 members
  • Provided ongoing counseling to help patients deal with conditions and processes.
  • Demonstrated ability to advocate for and strive to protect health, safety, and rights of patient.
  • Assessed and evaluated mental health needs, working with multidisciplinary team to initiate, manage, and modify individualized care plans.
  • Addressed disruptions in patient care, including delays in discharge, postponed procedures, HEDIS measures, and discharge equipment unavailability.
  • Managed support services and fostered communication among social workers, therapists, hospital staff, and patients.
  • Took active role in patient and family planning process, detailing instructions, responding appropriately, and effectively to questions and concerns.
  • Provide analysis and recommendations to senior management team regarding cost effective alternative benefits and treatment plans.
  • Worked directly with members to ensure holistic care was provided.
  • Worked directly with Case Managers and Discharge Planners to effectively plan and implement successful discharges for GEHA members.
  • Ability to utilize effective strategies to prevent readmissions.
  • Actively listened to members, handled concerns quickly and escalated major issues to supervisor
09/2007 to 03/2017
Care Management Administrator Bluecross Blueshield Of Tennessee, Inc. Nashville, TN,
  • Spearheaded and implemented 15 new care management projects to expand scope of engagement. (9 projects were completed in one year)
  • Recruited, hired, coached and supervised thirty medical professionals in delivering quality patient care.
  • Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions and common goals.
  • Designed and introduced leadership development, coaching and team management model, resulting in promotion of employees into increased levels of responsibility.
  • Developed and implemented new policy and interpretation procedures to maintain standards of care and meet quality assurance benchmarks.
  • Served as mentor in GEHA’s company mentoring program.
  • Part of implementation team for Pre-existing insurance program (Federal) Completed all policies and procedures and benefit structure in two-month timeframe.
  • Part of task force to institute company telecommute program.
  • Part of implementation team to achieve initial medical accreditation.
  • Exceeded all team goals assigned by Senior management team
  • Administered GEHA’s Direct Care Contract network to define quality metrics and outcome reporting process.
  • Improved member experience through consistent hard work and dedication to mentoring staff.
09/1999 to 08/2007
Credentialing Supervisor Government Employee’s Health Association, Lee’ S City, STATE,
  • Conducted research on emerging trends in credentialing industry and capitalized on creating new credentialing department.
  • Managed 10 employees to reduce workflow stoppage and achieve on-time project completion.
  • Identified individual employee's unique work styles and adapted management methods.
  • Applied strong leadership talents and problem-solving skills to maintain team efficiency and organization of workflows.
  • Streamlined operations of department by establishing electronic “mass” processes.
  • Strengthened operational efficiencies and traceability by enhancing software database including all custom reports and queries.
  • Developed initial accreditation analysis and achieved GEHA’s initial accreditation acceptance.
  • Created, implemented, and spearheaded GEHA's medical and dental peer review committees.
  • Development, administration and cost containment of department's annual one million dollar budget.
  • Exceeded department goals established by Executive committee and GEHA's board of directors.
  • Created and implemented forward-thinking initiatives to improve employee engagement
07/1992 to 08/1999
Medical Case Manager Government Employee’s Health Association, Lee’ S City, STATE,
  • Analyzed and managed catastrophic cases for potential medical case management intervention.
  • Worked with different disciplines to provide cohesive care to patients.
  • Primary individual assigned to high profile, potentially volatile cases.
  • Worked with medical teams, patients and families to implement effective treatment plans.
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration resulting in over 1 million dollars in savings each year.
  • Provided analysis and recommendations to senior management team regarding cost effective alternative benefits and treatment plans.
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs
  • Documented case notes daily and coordinated follow-up for seamless case management
  • Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients
  • Coordinated individualized discharge plans to manage safe transition back into community and home environments.
Education
Expected in 12/2022
Master of Science: Licensed Professional Counseling Student
Webster University - St Louis, MO
GPA:

4.0 GPA

Expected in 12/2016
Bachelor of Science: Registered Nurse
Webster University - St Louis, MO
GPA:
  • Graduated magna cum laude
Expected in 05/1986
Diploma Degree in Nursing: Diploma Degree in Nursing
Saint Lukes College of Nursing - Kansas City, MO,
GPA:
Affiliations

The Commission for Case Manager Certification

Certifications

Certified Case Manager

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Resume Overview

School Attended
  • Webster University
  • Webster University
  • Saint Lukes College of Nursing
Job Titles Held:
  • Personal Health Nurse Consultant II
  • Care Management Administrator
  • Credentialing Supervisor
  • Medical Case Manager
Degrees
  • Master of Science
  • Bachelor of Science
  • Diploma Degree in Nursing