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Rn Practice Manager Resume Example

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Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
  • resumesample@example.com
Professional Summary

Professionally trained Registered Nurse with experience ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Career Objective  is to obtain a position as an Utilization Review Nurse where my special skills can be used to their fullest potential to help improve the standards of care.

Skills

•Determined medical necessity of the requested treatment.
•Communicated with requesting providers, service providers, claims adjusters and claimants via telephone and fax to request additional information.
•Coordinated care and provided verbal authorization for medical treatment per policy.
•Assisted in medical training for claims adjusters.
•Maintained ongoing compliance with federal, state or Federal laws, URAC standards.
•Ensured cost effective and quality patient care by appropriate utilization of medical resources.

Work History
RN Practice Manager, 10/2016 to 08/2017
ArchcareBronx, NY,
  • Oversee and managed 20 clinical and support staff in patient care activities while maintain a high level of staff and professionalism.
  • Perform administrative and managerial functions such as taking responsibility for staff, planning, and long-range goals.
  • NextGen EHR experience.
  • Work with individuals, groups, and families to plan and implement programs designed to improve the overall health of communities.
  • Instruct individuals, families, and other groups on topics such as health education, disease prevention and childbirth.
  • Interact with other caregivers and agencies regarding referrals for the total need of the patient including prior authorizations.
  • Operated clinical sessions in adult medicine, ob/gyn, and pediatrics with Licensed Practical Nurses and medical assistants.
  • Responsible for answering and responding to all nurse triage calls.
RN Unit Manager, 06/2015 to 06/2016
Summit Medical GroupMaynardville, TN, United States
  • Responsible for ensuring proper functioning of a Dementia unit.
  • Perform administrative and managerial functions such as taking responsibility for the unit's staff, planning, and long-range goals.
  • Complete staff performance reviews.
  • Responsible for disciplinary action for staff, write-ups.
  • Observe patients, charting in PCC, reporting changes in patient's' condition, and taking necessary actions.
  • Work as part of a healthcare team to assess patient needs, plan and modify care and implement interventions.
  • Evaluate nursing intervention outcomes, conferring with other health care team members as necessary.
  • Supervision of RN's, LPN's, and Nursing Assistants to ensure proper care is provided to patients on a consistent basis.
RN Site Manager, 01/2010 to 03/2015
Department Of Population MedicineBoston, MA,
  • Responsible for ensuring proper functioning of the entire clinic on a daily basis.
  • Perform administrative and managerial functions such as taking responsibility for a unit's staff, planning, and long-range goals.
  • NextGen EHR experience.
  • Work with individuals, groups, and families to plan and implement programs designed to improve the overall health of communities.
  • Instruct individuals, families, and other groups on topics such as health education, disease prevention and childbirth.
  • Interact with other caregivers and agencies regarding referrals for the total need of the patient including prior authorizations.
  • Operated clinical sessions in adult medicine, ob/gyn, and pediatrics with medical assistants.
  • Responsible for answering and responding to all nurse triage calls.
Utilization Review Nurse, 10/2017 to Current
Summit Medical GroupRockwood, TN,

Determined appropriateness and medical necessity of hospitalization and requested treatment (s) based on plan's guidelines, policies, Milliman, and medical director review, if needed. Also, includes observation status
Responsible for requesting clinical information for concurrent review with strict adherence to URAQ guidelines
Responsible for presenting, preparing, and submitting all recommendations for denial to the medical director and plan liaison, including arranging any peer-to-peer reviews, if requested by hospitalist, attending, or primary care physician
Assisted and/or provided facility interdisciplinary teams benefit information for in network providers/facilities, DME, home healthcare, acute, sub-acute rehab, skilled nursing facilities, and out-of-network benefits, if needed
Communicated frequently with assigned case managers for unplanned admissions, inpatient status, and discharge plan with orders
Collaborated with assigned case manager to identify members frequent hospital readmissions

RN Site Manager, 05/2009 to 10/2011
Winton Hills Med & Health CenterCity, STATE,
  • Responsible for the proper functioning of the entire clinic on a daily basis.
  • Perform administrative and managerial functions, such as taking responsibility for staff and schedules.
  • NextGen experience.
  • Interact with other caregivers and agencies in relation to the needs of the patient via referrals including prior authorizations.
  • Educated the patient's family in health care needs, conditions, options relates to care of the patient.
  • Operated clinical sessions in adult medicine, ob/gyn, and pediatrics with medical assistants.
  • Responsible for answering and responding to all nurse triage calls.
Education
Associate of Science: Nursing, Expected in April 2009
Galen College of Nursing - Cincinnati, Ohio
GPA:
Nursing
Certificate in Practical Nursing: LPN: , Expected in August 1995
Cincinnati Public School of Practical Nursing - Cincinnati, Ohio
GPA:
Skills
administrative, charts, disease prevention, EHR experience, health education, managerial, Nursing, ob/gyn, patient care, Observe patients, pediatrics, performance reviews, implement programs, reporting, Supervision, triage

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Resume Strength

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Resume Overview

School Attended
  • Galen College of Nursing
  • Cincinnati Public School of Practical Nursing
Job Titles Held:
  • RN Practice Manager
  • RN Unit Manager
  • RN Site Manager
  • Utilization Review Nurse
  • RN Site Manager
Degrees
  • Associate of Science
  • Certificate in Practical Nursing: LPN

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