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Workers Compensation Case Manager Resume Example

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WORKERS COMPENSATION CASE MANAGER
Professional Summary

Telephonic Nurse Case Manager acts as intermediary to drive appropriate and cost-effective healthcare services for injured workers by developing patient-centered case management plans. Leverages effective, independent nursing judgment and skills and evidence-based clinical decision-making criteria to optimize and improve clinical outcome for injured workers across care continuum. Demonstrated experience in management of acute injury complicated by chronic disease process, utilizing nursing process and collaborative care planning resulting in cost- effective, quality driven injury resolution.

Skills
  • Strong clinical background/judgement
  • Skilled cost- effective, guideline driven Utilization review
  • Ability to multi- task, prioritize
  • Case management
  • Former Business owner (M. Thornton Legal Nurse Consulting)
  • Account management
  • Managed Care
  • Insurance Knowledge
  • Health Education
  • Successful completion of leadership program
  • Development and presentation of “Teamwork “model”
  • Consulting
  • Conduit, Team , Microsoft proficient
Work History
06/2007 to CurrentWorkers Compensation Case ManagerCompany Name | City, State
  • Primary RN- assigned to oversee and directly manage lost time and complicated claims for all of DAS Mental health facilities (claims) in State of Ohio.
  • Ongoing daily collaboration with facilities, injured workers, caregivers, providers as well as Intra-company departments and teams.
  • Gold standard care and exceptional injured worker/employer outcomes are primary focus of care delivery.
  • Ongoing coaching, mentoring and supporting other team members
  • Utilization review – reviewed, approved, denied care based upon Official disability guidelines, cost effective basis as well as appropriate medical guidelines.
  • Reviewed questionable claims by conducting agent and claimant interviews to correct omissions and errors.
  • Reviewed police reports, medical treatment records and physical property damage to determine extent of liability.
01/2006 to 06/2007Workers Compensation Case ManagerCompany Name | City, State
  • Primary RN – Medical case management of assigned employer's injured workers with focus on injury resolution and eventual, timely, cost effective medical management resulting in return to work.
  • Ongoing daily collaboration with facilities, injured workers, caregivers, providers as well as Intra-company departments and teams.
  • Reduced care costs without sacrificing quality through effective service coordination and multidisciplinary collaboration.
  • Consulted with clinicians to devise and manage effective ongoing care plans for at-risk patients.
  • Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations and procedural costs.
01/2005 to 06/2007Thornton Legal Nurse Consulting (owner), RN Legal Nurse ConsultantCompany Name | City, State
  • Medical record review/analysis to identify standard of care deviations.
  • Compile and organize medical summations of medical records.
  • Locate /interview expert witnesses.
  • Depositional experience.
  • Business development and Management.
  • Consultant assisted with achievement of large out of court medical malpractice settlement
01/1997 to 01/2003Telemetry/ICU/ERCompany Name | City, State
  • RN Telemetry/ICU/ER- Performed patient care in busy Intensive care and Emergency room environments.
  • Monitored patient vital signs and notified attending physicians of changes. Assisted physicians with emergent situations.
  • Administered IV, oral, and injections of medications as directed.
  • Educated family members on patient conditions in compassionate way. Assisted with conflict resolution in tense situations.
  • Documented procedures, patient conditions, and medication administration with 100% accuracy.
  • Participated in team project to review and improve ICU process guidelines. ( Ventilator weaning committee resulting in planning extubation when ventilation initiated).
  • Worked with patients and families to provide in-hospital and after-hospital follow-up through teaching and referrals
Education
12/2015Bachelor of Science | NursingChamberlain College Of Nursing , City
06/1997Associate of Science | NursingCharles County Community College, City
06/1987License | Vocational NurseMira Costa College, City
Certifications
  • CRRN - Certified Rehabilitation Registered Nurse
  • CPC - Certified Professional Coder
Additional Information

1997-2003 RN Telemetry/ICU/ER clinical background

19987-1997 Licensed Vocational nurse Unit management- Facility Supervisor

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Resume Overview

School Attended

  • Chamberlain College Of Nursing
  • Charles County Community College
  • Mira Costa College

Job Titles Held:

  • Workers Compensation Case Manager
  • Thornton Legal Nurse Consulting (owner), RN Legal Nurse Consultant
  • Telemetry/ICU/ER

Degrees

  • 12/2015 Bachelor of Science | Nursing
    06/1997 Associate of Science | Nursing
    06/1987 License | Vocational Nurse

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