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senior nurse case manager analyst resume example with 6+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Professional Summary

Compassionate Nurse Case Manager offering 8 years of experience working with patients and families to facilitate smooth transitions following discharge from medical facilities. Committed to working collaboratively with health plan, leadership and department coordinators to achieve highest quality of patient satisfaction. Well-versed in developing individualized care plans and advocating patient welfare. Skilled in creating and implementing processes to improve patient care and cultivate support teams.

Skills
  • Medicare Compliance
  • HEDIS
  • HIPAA Guidelines
  • Discharge Planning
  • Disease Education
  • Identify Community Resources
  • Care Plan
  • Assessments
Work History
Senior Nurse Case Manager Analyst, 042020 - Current
Providence Life Services Merrillville, IN,
  • Collaborated with healthcare leaders and physicians to support and offer resources in performance of duties to maintain high-quality and efficient patient care.
  • Developed and modified patient care plans and assisted interdisciplinary team in identifying client needs and goals to determine priorities of care.
  • Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
  • Implemented aspects of patient care under physician orders and sought clarification when needed to promote safety, quality and cost-efficient care.
  • Educated Medicare/Medicaid patients and caregivers on healthcare protocols and processes.
  • Analyzed patient responses to medications, therapies and variances in plans of care.
  • Managed support services and fostered communication among social workers, therapists, hospital staff and patients.
  • Completed initial assessments of patients and family to determine and address individual home care needs. ·
  • Abstracted and input HEDIS data into computer programs and filing systems.
  • Maintained accuracy, completeness and security for medical records and health information.
  • Reviewed medical records for completeness and filed records in alphabetic and numeric order.
  • Maintained 95% Accuracy record
RN Case Manager, 012019 - 042021
United Healthcare Group City, STATE,
  • Completed initial assessments of patients and family to determine and address individual home care needs. ·
  • Effectively communicated with physicians regarding patient needs, performance, medications and changes.
  • Participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
  • Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans as needed.
  • Coordinated with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.
  • Developed care plans based on nursing diagnosis and incorporated therapeutic, preventive and rehabilitative nursing methods.
  • Liaised with physicians regarding patient needs, performance and changes.
  • Trained new nurses in proper techniques, care standards, operational procedures and safety protocols.
  • Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
  • Updated patient charts with data such as medications to keep records current and support accurate treatments.
  • Worked with suppliers and vendors on provision of medical equipment, items and services.
  • Authored clinical notes and updates to be reviewed by patient's primary physician.
  • Used EHR to maintain database of relevant information for practitioners to access and coordinate patient care.
  • Managed and streamlined referral queues of up to 40 cases per day by efficiently prioritizing patients and clearing insurance obstacles.
RN Call Center Supervisor, 012017 - 012019
United Healthcare Group City, STATE,
  • Monitored call quality and provided individual constructive feedback to enhance performance and address areas in need of improvement.
  • Trained team members on performance metrics and consumer behavior identification.
  • Increased efficiency and productivity through effective staff training regarding customer service protocols and call resolution techniques.
  • Oversaw employee performance to foster accurate prioritization and achievement of sales and productivity goals.
  • Executed Monthly Performance Plans with representatives to to identify production gaps.
  • Improved organizational efficiency by effectively recruiting new hires and supporting management with personnel decisions.
  • Reduced personnel turnover by developing and implementing performance evaluations to support corrective action planning.
  • Managed personnel, including scheduling for agents and product specialists to foster increased productivity.
  • Assessed personnel performance and implemented incentives and team-building events to boost morale.
  • Minimized workflow issues by cross-training staff on technical procedures, protocols and customer service practices.
  • Supervised 40+ nurse navigators in providing excellent customer service to callers requiring assistance for nurse trige and decision support ssues.
  • Established and oversaw performance targets for call center associates.
  • Developed quality employees within call center to take over leadership positions.
RN Nurse Advocate , 01/2015 - 01/2017
Optum City, STATE,
  • Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
  • Handled 25-40 calls daily
  • Assisted member with benefit interpretation, claims review and resubmission.
  • Reviewed Prior Authorization determinations
  • Nurse Triage line
  • Provided Health Education and Decision Support
  • Remote training of new hire classes as needed for 16 weeks
  • Mentored new hires seeking improved performance
  • Coordinated appropriate and efficient delivery of healthcare services to promote optimal outcomes by assessing and matching unmet needs with referrals and support services.
  • Scheduled appointments, educational meetings and follow-ups for patients and family members.
Education
Associate of Science: Nursing, Expected in 05/2013
-
Chattahoochee Valley Community College - Phenix City, AL
GPA:
Status -

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Resume Overview

School Attended

  • Chattahoochee Valley Community College

Job Titles Held:

  • Senior Nurse Case Manager Analyst
  • RN Case Manager
  • RN Call Center Supervisor
  • RN Nurse Advocate

Degrees

  • Associate of Science

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