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rn case manager resume example with 12+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Summary

Experienced Clinical Case Manager with 12+ years of experience as a Registered Nurse. Compassionate and efficient with a reputation for designing care plans that meet patients' needs and available resources. Highly proficient in care coordination and attention to detail.

Skills
  • Patient Care Planning
  • Needs Assessment
  • Community Program Referrals
  • Care Coordination
  • Clear Patient Communication
  • Critical Thinking
  • Preventive Healthcare
  • Compassionate and Caring
  • Chronic Disease Management
  • Problem Solving
  • Working Collaboratively
  • Microsoft Office
Experience
RN Case Manager, 01/2020 to Current
Reid Hospital & Health Care ServicesLiberty, IN,
  • Completed overall patient health assessments and evaluations of Dual Special Needs Plan (DSNP) members.
  • Incorporated appropriate nursing methods to create individualized care plans.
  • Determined and coordinated appropriate level of care to meet individual patient needs.
  • Advocated for patients by identifying insurance coverage, communicating care preferences to practitioners and verifying interventions met patients' treatment goals.
  • Helped patients navigate healthcare system and care options by educating on relevant subject areas and answering questions throughout treatment process.
  • Collaborated with physicians on patient medications, medical needs and performance.
Telephonic Nurse Case Manager, 03/2017 to 12/2019
Icw GroupLos Angeles, CA,
  • Resolved patients' inquiries, questions and concerns to consistently offer quality service and meet performance benchmarks.
  • Collaborated with interdisciplinary team of professionals as well as patients and families to determine appropriate treatment options.
  • Gathered community resources and coordinated referrals to obtain services.
  • Provided education and support to patients' family members.
  • Performed psychosocial assessments and evaluations of current needs.
  • Performed psychosocial assessments to identify barriers in patients to obtain or use medications.
Utilization Management Nurse, 09/2015 to 03/2017
HcaBarrington, NH,
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
  • Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
Field Nurse Case Manager, 09/2014 to 09/2015
Sedgwick Claims Management Services, Inc.Santa Rosa, CA,
  • Helped patients and families feel comfortable during challenging and stressful situations, promoting recovery and reducing compliance issues.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Coordinated with healthcare team to establish, enact and evaluate patient care plans.
  • Monitored diet, physical activity, behaviors and other patient factors to assess conditions and adjust treatment plans.
School Nurse, 08/2013 to 09/2014
North Monterey County UnifiedMoss Landing, CA,
  • Coordinated with families, school personnel and healthcare professionals on behalf of students to advocate for healthcare needs and provide medical information to appropriate parties.
  • Evaluated students with health concerns or injuries to develop plan of care or provide reference to appropriate healthcare providers.
  • Assisted in development of school safety plans that targeted problem areas
  • Interacted effectively by email, phone and in person with students, parents and staff members.
Home Health Nurse Case Manager, 12/2012 to 08/2014
CignaKirkland, WA,
  • Completed initial assessments of patients and family to determine and address individual home care needs.
  • Conducted regular re-evaluations to address changes in needs and conditions, and introduced revisions to care plans.
  • Administered prescribed medications and started intravenous fluids to address patient symptoms and underlying etiologies.
  • Collected biological samples for routine laboratory testing to assist diagnostic processes.
Community Health Nurse & Case Manager, 08/2010 to 11/2012
Kids Peace Mesabi AcademiesSchnecksville, PA,
  • Advised patients on preventive, therapeutic and rehabilitative therapies available, addressing benefits and drawbacks and suggesting treatments appropriate for unique situations.
  • Developed and revised patient care plans through regular assessment and evaluation of patient conditions and changes over time to improve prognosis in collaboration with clinic physicians.
  • Performed preliminary evaluations of patient conditions, administering physical examinations and asking questions regarding mental health and lifestyle factors to report to physicians.
  • Held consultations with patients and families to provide detailed information about diagnosed medical conditions, answering questions and advising on effective treatment methods.
RN Staff Nurse, 07/2009 to 07/2011
Pu'uwai 'O Makaha Rehab & NursingCity, STATE,
  • Evaluated patients suffering from both chronic conditions like diabetes or acute conditions such as injuries related to falls.
  • Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
  • Administered oral, IV and intra-muscular medications and monitored patient reactions.
  • Recorded patients' medical history, vital statistics and test results in electronic medical records.
Education and Training
Bachelor of Science: Nursing, Expected in 06/2009
Hawaii Pacific University - Honolulu, HI
GPA:
Associate of Arts: Liberal Arts, Expected in 05/2006
Leeward Community College - Pearl City, HI
GPA:
Licensure & Certifications
  • Registered Nurse (RN) - Licensed in Colorado and Washington
  • Certified Case Manager (CCM)

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Resume Overview

School Attended

  • Hawaii Pacific University
  • Leeward Community College

Job Titles Held:

  • RN Case Manager
  • Telephonic Nurse Case Manager
  • Utilization Management Nurse
  • Field Nurse Case Manager
  • School Nurse
  • Home Health Nurse Case Manager
  • Community Health Nurse & Case Manager
  • RN Staff Nurse

Degrees

  • Bachelor of Science
  • Associate of Arts

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