rn case manager resume example with 18+ years of experience
JessicaClaire
Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
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Summary
Accomplished Board Certified Registered Nurse Case Manager with 8 years of experience in Case Management in both the Hospital and Home Health setting. Experienced at effectively and efficiently communicating and collaborating with all levels of the healthcare team including physicians, administrators and all stakeholders to ensure that all patients receive quality care. Offering excellent clinical knowledge as well as problem solving abilities in regards to managing dynamic and complex situations.
Skills
Planning, coordinating and management of care plans for individuals
Experience in Utilization Review/Management
Collaborate with Providers and other care team professionals for successful transition from hospital to home or Long term care Setting.
Clinical skills to include Cardiopulmonary Assessments, wound care, IV infusion therapy, medication management, catheter care, tracheostomy care, colostomy care, g-tube care
Knowledge of medicaid/medicare and private insurance guidelines
Prior Authorizations, Peer to Peer and Denials Management experience
Coordinating referrals for Skilled Nursing Care
Patient education and follow up calls
Patient Satisfaction and Process Improvement
Electronic Health Records Management
Proficient with EMR software platforms such as Meditech and Oasis
Proficient with Microsoft software such as Excel, Outlook, Word, Works
Proficient with utilization Management software such as Interqual and Milliman(MCG)
Experience
RN Case Manager, 01/2018 - Current Harrison County Hospital – Corydon, IN,
Conduct prospective, concurrent and retrospective Utilization Review to determine appropriate level of care by utilizing the Interqual and Milliman platforms
Obtain recommendations for inpatient or outpatient level of care by discussing cases with physician advisor.
Advocate for all patients by identifying insurance coverage, navigating care options, communicating care preferences to providers and verifying patient have met their treatment goals.
Collaborate and Coordinate a plan of care for patients with providers and multidisciplinary team members to help ensure patients get the care needed.
Support and educate nursing staff on clinical documentation needs to ensure patients obtain good quality care.
Coordinate home care, home infusion, and durable medical equipment, efficiently and effectively to reduce length of stay and reduce patient wait time.
Competent in writing Appeal Letters to overturn Insurance Denials in order to Control Hospital Cost and obtain payment.
Assisting with oversight of extended Stay outliers for Behavioral Health patients.
Utilization Review for Behavioral Health/Inpatient Detox (10 bed facility)
Intake Referral Management for SWING Bed Admissions
Track, monitor and report out Data for Utilization Review Committee per regulatory guidelines
Registered Nurse/Case Manager, 10/2013 - 12/2017 Health Services Of Northern NY – City, STATE,
Evaluate patient care needs, prioritize treatment and maintain quality care thru certification period
Perform all clinical tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
Collaborate and coordinate with multidisciplinary team to develop care plans and prevent re-hospitalization
Coordinate with insurance companies to obtain prior authorization for services in order to ensure coverage for care.
Skillfully perform procedures in the home to include, medication management, IV infusion therapy, blood draws, colostomy and urostomy care, catheter care, gastro enteral care, tracheostomy care, suture and staple removals.
Maintain patient charts and confidential files following HIPPA guidelines
Coordination and Oversight of staff such as RN's, LPN's and CNA's that provide care for my patients
Registered Nurse/ Nurse Program Manager, 10/2013 - 02/2014 CP Of The North Country – City, STATE,
Overseeing/ scheduling of direct care support
Coordinated the care for all the Residents in the IRA, following NYS regulations for OPWDD individuals
Create medication profiles specific to the patient
Create and facilitate examinations for employees to obtain medication administration certification
Train employees for SCIP-R and proper Hoyer Lift Techniques following the OPWDD guidelines
Create, modify and carryout behavior plans for individuals with developmental disabilities
Direct Care/ Habilitation Assistant, 02/2003 - 10/2013 St. Lawrence NySarc – City, STATE,
Provided direct care support to individuals with developmental disabilities
Administered Medications to the patients
Followed the plan of care created by nursing management
Facilitated consumer outings into the community
Education and Training
Bachelor of Science: Nursing, Expected in 12/2019 - WGU - Salt Lake City, UT, GPA: Status -
Associate of Applied Science: Nursing, Expected in 05/2013 - State University At Canton - Canton, NY GPA: Status -
High School Diploma: English major, Expected in 2002 - Norwood Norfolk Central School - Norwood , NY GPA: Status -
Activities and Honors
Linda Lahey Fay Award Recipient
WGU Loves Nurses Scholarship Recipient
Haun-Kalberer Scholarship Recipient
WGU's Excellence Award For Health Assessment
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