rn case manager resume example with 10+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
:
Professional Summary
Registered Nurse Case Manager with 10+ years of experience dedicated to quality care of diverse patients. Work effectively with all levels of healthcare providers, physicians and administrators to address patient needs. Extensive experience in leadership and employee management in the nursing field.
Accomplishments
Quality Assurance - Ensured and enforced medical office compliance with HIPAA, OSHA and CLIA regulations for maximum quality and control.
Supervision - Headed onboarding process for new nursing staff.
Human Resources - Assisted in new hire process by calling and scheduling appointments with candidates, filling out required paperwork and preparing new hire manuals.
Research - Completed group study focused on patient comfort, costs and test results, which resulted in increased patient satisfaction.
Supervised team of 25-30 staff members.
CCM certified- active.
Skills
Compassionate and Caring
Clear Patient Communication
Patient Condition Monitoring
Preventive Healthcare
Care Coordination
Accurate Documentation
Creative Problem Solving
Critical Thinking
Decision Making
Patient Care Assessment
Delegation and Motivation
Microsoft Office
Community Program Referrals
Group and Individual Instruction
Staff Development
Improvement Recommendations
Verbal and Written Communication
Employee Coaching
Group Trainings
Quality Control
Task Prioritization
Productivity Improvement
Complex Problem Solving
Project Management
Staff Leadership
Work History
RN Case Manager, 01/2019 - Current Country Manor – Sartell, MN,
Created individualized care plans based on nursing diagnosis and incorporated appropriate nursing methods to achieve positive outcomes.
Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
Worked with suppliers and vendors on provision of medical equipment, items and services.
Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
Initiated timely response to emails, voicemails and written correspondence.
Demonstrated knowledge of company mission and goals and mentored employees in reaching objectives aligned with company core values.
Escalation of barriers with providers via provider contractors and other vendors.
Timely response and assistance with grievance complaints.
Collaboration with UM team to ensure safe discharge transition of care.
Assist with prior authorization process, out-of-network waivers, LOAs, and team collaboration on barriers.
RN Case Manager/UM Nurse, 10/2015 - 01/2019 Surgery Partners – Oxford, MS,
Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
Administered medications via oral, IV and intramuscular injections and monitored responses.
Initiated appropriate preventive and rehabilitative nursing procedures.
Performed evaluations on consistent basis to address changes in patient needs, conditions and medications, altering care plans when required.
Effectively communicated with physicians regarding patient needs, performance, medications and changes.
Vaccinated patients to protect individuals from measles, pneumonia, influenza and other illnesses of concern.
Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
Managed and streamlined referral queues by efficiently prioritizing patients and clearing insurance obstacles.
Utilized Milliman Care Guidelines in conjunction with Medicare criteria to issue authorization approvals and denials.
Worked directly with the company medical director to control costs, review authorizations, and optimize patient care.
Leadership/Management support- designated leader in the absence of the manager.
Special projects focusing on quality improvement processes.
Director of Nursing, 04/2011 - 04/2015 The Kidz Club – City, STATE,
Collaborated with staff, management and external groups to coordinate patient care.
Performed rounds to observe care and interview staff, residents and families.
Established new policies and updated existing policies to improve standard of care for patients.
Participated in management team meetings to discuss patient status, census changes and complaints or concerns.
Developed positive employee relations, incentives and recognition programs to promote teamwork and mutual respect.
Evaluated work performance of 25-30 nursing personnel to determine wage increases and implement discipline.
Recruited and developed quality individuals to develop accountable top quality staff.
Identified department issues to recommend corrective actions.
Planned and assigned workload to nursing staff to direct patient care.
Fostered excellence by example by "setting pace" and being hands on mentor to clinical staff.
Monitored and inspected staff processes to eliminate hazards posed for both patients and staff while ensuring continuous compliance with regulations.
Created customized care plans, working with hospital staff and families to assess and meet individual needs.
Spearheaded and implemented new projects to expand scope of engagement.
Managed pre-certifications and verified insurance coverage. Completed intake assessments.
Education
Bachelor of Science: , Expected in 06/2014 - St. Petersburg College - Clearwater, FL GPA: Status -
High School Diploma: , Expected in 06/2001 - Boca Ciega High School - Gulfport, FL GPA: Status -
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