Rn Case Manager Resume Samples

The Guide To Resume Tailoring

Guide the recruiter to the conclusion that you are the best candidate for the rn case manager job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies

Tailor your resume & cover letter with wording that best fits for each job you apply

Resume Builder

Create a Resume in Minutes with Professional Resume Templates

CHOOSE THE BEST TEMPLATE - Choose from 15 Leading Templates. No need to think about design details.

USE PRE-WRITTEN BULLET POINTS - Select from thousands of pre-written bullet points.

SAVE YOUR DOCUMENTS IN PDF FILES - Instantly download in PDF format or share a custom link.

Create a Resume in Minutes

Z Weimann

Zoey

Weimann

69506 Auer Plain

San Francisco

+1 (555) 620 5977

69506 Auer Plain

San Francisco

Phone

p +1 (555) 620 5977

Experience Experience

Chicago, IL

Rn Case Manager

Chicago, IL

Kozey, Kessler and Moen

Chicago, IL

Rn Case Manager

Maintaining fiscal responsibility by utilizing resources wisely, taking care of equipment, and preventing lost charges
Educating members on disease processes
Making "welcome home" calls to ensure that discharged member receive the necessary services and resources
Encouraging members to make healthy lifestyle changes
Coordinating Claims processing with doctors, claimants and employers and providing recommendations on claims handling
Creating, reviewing and revising care plans and focusing on a holistic approach
Identifying early risk factors and conducting ongoing assessments and documenting in an electronic file

New York, NY

Rn-case Manager

New York, NY

Morar, Hessel and Hahn

New York, NY

Rn-case Manager

Provides plan of care updates to providers inside and outside of the hospital, working with patients and caregivers
Makes regular reports of progress toward goals associated with clinical documentation improvement opportunities and operational improvement plans
Participate in performance improvement plans to improve patient satisfaction
Actively supports care management plans and process to measure, assess and improve quality, patient outcomes and care management metrics
Collaborates with Performance Improvement staff
Performs on-call responsibilities and provides on-call service to patients/families, as assigned
Reports to work on time and as scheduled, completes work within designated time

present

Boston, MA

Telephonic RN Case Manager

Boston, MA

Mitchell, Moore and Towne

present

Boston, MA

Telephonic RN Case Manager

present

Provide patient education to assist with self management
Providing patient education to assist with self management
Provide Case Management for Workers Compensation beneficiaries
Assist the provider / team with inbound and outbound communications for members including telephonic assessments or acuity follow - ups
Create a member centric care plan utilizing information provided during health assessment calls to identify problems, interventions and goals
Assist the provider / team with various care coordination activities to support the role of the On Call Nurse Practitioner
Document all encounters with the customers, practitioners and providers

Education Education

Bachelor’s Degree in Nursing

University of Delaware

Bachelor’s Degree in Nursing

Skills Skills

Problem solving skills with the ability to look for root causes and implementable, workable solutions
Proficient in basic computer skills including Microsoft Windows (or its equivalent) along with the ability to access the internet to do research
Ability to work proficiently with Microsoft Word, Excel, and Power Point
Knowledge of Medicare, Medicaid, Island Peer Review Organization (IPRO) and other Third Party criteria and standards as applicable
Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
Ability to coordinate, analyze, observe, make decisions, and meet deadlines in a detail-oriented manner
Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department
Professional verbal and written communication skills, with the ability to clearly articulate thoughts and ideas
Successful completion of the basic proficiency in medication administration examination
Establish realistic measurable, observable goals consistent with the patient’s diagnosis

Create a Resume in Minutes

13 Rn Case Manager resume templates

Read our complete resume writing guides

Rn Case Manager Resume Examples & Samples

3+ years of clinical experience in nursing, preferably in hospital case management
Experience with InterQual and Milliman Care Guidelines
Knowledge of DRGs and GMLOS
Knowledge of regulatory guidelines governing hospitals
Knowledge of Medicare, Medicaid, Island Peer Review Organization (IPRO) and other Third Party criteria and standards as applicable
Experience with Managed Care and Regulatory Requirements

Rn Case Manager Resume Examples & Samples

RN license in NJ
Experience with both Adults and Pediatrics
Prior disease management experience

Rn Case Manager Resume Examples & Samples

Coordinating Claims processing with doctors, claimants and employers and providing recommendations on claims handling
Explaining injury-reporting requirements and communicating with doctors, injured workers and employers to collect and record pertinent information, resolve problems, expedite claims handling and limit liability when indicated
Working as a team member of the Early Intervention Program to ensure efficient and cost effective case management
3+ years of Clinical experience
New York State RN license
Some experience in case management
Familiarity with worker's compensation, utilization review, manager care, and CCM
Rehab and/or Ortho experience

Rn Case Manager Resume Examples & Samples

2+ years of nursing experience
Med-Surg experience
Homecare experience

RN Case Manager / Vitilization Management Resume Examples & Samples

Obtaining an accurate member history
Assessing clinical information to develop care plans including a member support system
Establishing short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements
Identifying members with potential for high risk complications and coordinating the appropriate treatment in conjunction with the member and the health care team
Documenting the effectiveness of case management services
Conducting skills assessment, planning, implementation, coordination, monitoring and evaluation
Any strong case management experience or VM experience
RN or LPN
Experience with managed care

Rn Case Manager Resume Examples & Samples

Assesses, evaluates and documents patients records to reflect current status of patient
Assessing, planning, implementing, coordinating monitors and evaluating options and services to meet an individual’s health needs
Devises health care plans
Reviews patient reports and retrieves the necessary information to make callbacks and follow up on any results
Performs all levels of nursing care for assigned ‘case load’ between patient admission and discharge
May provide emotional support and provide medical advice
Provides clinical direction to the support staff
Responds to emergencies as needed
Controls the purchase of health care resources as well as services for the patients
3+ years of experience as an RN Case Manager in a hospital or medical facility
Familiarity with utilization review and D/C planning
Self-motivating

Rn Case Manager Resume Examples & Samples

Case Management experience required
Proficient with Microsoft Office including Excel
Education: Associate or Bachelor's degree in Nursing
Previous Auditing experience a plus

Rn Case Manager Rn Resume Examples & Samples

This position is primarily Work At Home but minimal travel will be required to the Miramar, FL office 1-2 times a month and also possible 2-3 provider visits required per month in Treasure Coast area down to Palm Beach area
TB test require if hired
Bilingual preferred (Spanish/English)

Rn Case Manager Resume Examples & Samples

Completes a thorough assessment, develops and implements a case/disease management plan including goals based on the assessment
Monitors the case to its conclusion (making modifications as needed) while maintaining contact with all involved parties during all episodes of care no matter what the setting in order to meet the goals identified in the case/disease management plan
Acts as primary liaison with designated customers (employers), clients (patients), and providers for ongoing care management program operations
Participates in continued education in order to maintain active case management certification, clinical and case/disease management expertise through education courses, seminars, nursing literature and in-services provided by the company
Registered nurse with active and unrestricted license to practice in the State of Wisconsin
Bachelor of Science in Nursing or equivalent experience
Minimum three years nursing experience in an acute care or relevant setting with evidence of the ability to make sound nursing judgment
Case Management Certification; desirable
Minimum one year experience in a managed care setting; desirable
Performs all activities within the scope of licensure and certification
Acts within the scope of Federal and State Laws and programs

Rn Case Manager Resume Examples & Samples

Works with members to assess their care needs and assist in planning and implementation of interventions to meet those needs
Utilizes knowledge of benefit plan design and care alternatives available within the community and nationally in order to recommend services
Collaborates with Providers to reinforce treatment plans and ensure the plan of care aligns with that and the member’s personal health care goals
Performs duties consistent with all State and Federal regulatory requirements, accreditation organizational guidelines, and Humana guidelines

Rn Case Manager Resume Examples & Samples

Active Registered Nurse (RN) licensed in residential state with the ability to be licensed in the State of Florida and without restrictions for additional states
Bilingual (English/Spanish) or (English/Creole); speaking, reading, writing, interpreting and explaining documents in Spanish and English or Creole and English
At least 6 months working with Special Needs Population (SNP)

Rn Case Manager Resume Examples & Samples

Case Management experience
Experience working with computerized charting system
Bilingual is a plus - Spanish or Creole

OB Momsfirst RN Case Manager Resume Examples & Samples

Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10Mx1M
Education: BSN or Bachelors degree in a related field
Knowledge of MS Word, Excel and Outlook a plus

Rn Case Manager Resume Examples & Samples

Provides professional nursing care visits to patients in their home
Collaborates with the patient’s case manager and other members of the patient care team
Independently provides and documents patient visits
Instructs patients and caregiver's according to the plan of care
Makes nursing assessments and reports significant changes in the patient’s condition to the appropriate team members
Supervises and is responsible for Home Health Aides and Home Care Aides in the field and provides appropriate documentation

RN Case Manager PRN Resume Examples & Samples

Coordinates and facilitates patient care progression throughout the continuum
Works collaboratively and maintains active communication with physicians, nursing, and other members of the multidisciplinary team in order to effect timely, appropriate patient management. In partnership with the care team, proactively identifies and resolves delays and barriers to discharge
Participates in patient rounding activities such as daily caseload rounding to establish priorities for self, SW and high risk TCC, multidisciplinary care coordination and discharge planning rounds, hand off report to nursing staff, hand off report to post-acute facilities SCC and PCC, physician advisor rounds and weekly LOS rounds
Ensures compliance with CMS Conditions of Participation, standards of the accrediting bodies and the state mandated revised code
Minimum of three years of clinical nursing experience required
Minimum of two years of experience in Utilization Review, Quality, or Care Management preferred. Knowledge of acute care regulatory/accreditation requirements preferred

Field RN Case Manager Resume Examples & Samples

Delivering a holistic approach to coordinated care based on the member’s needs using a person centered approach
3 + years’ recent experience as a RN in case management, Home Health or clinical experience in acute, rehab or long term care setting
Strong computer proficiency to include the ability to use Microsoft Word, Outlook and Internet on a daily basis
Bachelor’s Degree or Higher

Field RN Case Manager Resume Examples & Samples

Determines member’s overall bio-psychosocial needs and develops individualized member service/care plan based on assessment data, member and caregiver/ stakeholder input, and cost-effective options for service delivery
Facilitates appropriate member referrals to special programs such as Behavioral Health, Advanced Illness
Maintains the confidentiality of all sensitive information
Current, unrestricted RN license in the state
Reliable transportation, valid and unrestricted driver’s license, proof of insurance and ability to travel to provider offices, member homes or other locations within service delivery area
1+ year of coding experience
Must be able to travel to provider offices within service area – may require up to 1 hour radius for travel
ICD-10 coding experience, preferred CMS Risk Adjustment scoring
Experience in intensive care (ICU) or emergency department (ER) nursing

Rn Case Manager Resume Examples & Samples

Conducts Chronic Care Model visits and reviews the patient’s informal and formal support systems, focusing on what patients want to improve and educating them about their chronic disease
Pulls tasking report from disease management database and conducts Chronic Care Model follow-up phone calls to eligible CCM enrolled members who have set self-management support goals within 2 weeks of date tasked
Ensures all delegated tasks are also completed within 2 weeks of date tasked
Tracks self-management goal outcomes and documents in disease management database
Maintains current knowledge regarding CHF, IHD, COPD / Asthma and Diabetes as well as treatments and medications related to each
Serves as a resource or consultant for LVN team members
Two or more years experience in a physician’s office, clinical or hospital setting
Ability to use fine motor skills to operate office equipment and / or machinery
Ability to receive and comprehend instructions verbally and / or in writing
Ability to use logical reasoning for simple and complex problem solving

Senior RN Case Manager Resume Examples & Samples

Applies case management standards of practice to focus on effective care of high risk / high need patients
Serves as a patient advocate and resource and provide critical information and recommendations to the rest of the care team
Determines best resource to send to the home for the initial visit / evaluation based on protocols and investigation
Evaluates findings from initial visit to determine plan of action
Follows patient through various transitions of care to ensure that gaps are identified and remedied, breaks down silos and promotes efficient health care delivery
Maintains strong knowledge of Case management, community resources and plan benefits to ensure improved outcomes
Works as an adjunct/support to primary care providing communication/documentation and updates on patients status
Assist clinicians in implementing best practices for chronic care and disease management
Follow standard protocols, processes and policies as well as all state and federal regulations
Assists with emergency room case management including coordination of transportation or transfer to another facility
This position will require flexibility and possible coverage of other shifts and / or working of every other weekend
RN licensure is required and must be active and unrestricted
2+ years experience as a case manager
5+ years experience as a RN (preferably in ER, Urgent Care or ICU, critical care, acute care and / or M / S)
Computer proficiency - must be able to use multiple systems and multiple screens

Telephonic RN Case Manager Resume Examples & Samples

Interacting with field based Nurse Practioners
Degree in Nursing or equivalent
2+ years experience in case management in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
2+ years of previous acute care experience
Ability to demonstrate clinical skills with good organizational skills and work in a fast-paced environment
Cooperative work attitude toward co-workers, management, patients, visitors, and physicians
Geriatric experience

Sign On Bonus Field RN Case Manager Resume Examples & Samples

Travel in assigned territory as needed to complete member assessments; the rest of the time will be spent working in a home-based office
Identifying early risk factors and conducting ongoing assessments and documenting in an electronic file
Bilingual (Spanish)

Provider Based RN Case Manager Resume Examples & Samples

Interacts with patients via telephone; Schedule appointments, Follow up calls to assess understanding of services, answer questions and ascertain that additional procedures have been completed
Assists the member to access community, Medicare, family and other third-party resources as appropriate
Identifies barriers to optimal care and outcomes or clinical concerns and communicate with members and providers to formulate action plan to address
3+ years of clinical experience as a Registered Nurse in a hospital, acute care, home health, direct care or case management

Field RN Case Manager Resume Examples & Samples

Manage targeted population daily census
Meeting with patients, caregivers and families while inpatient to establish relationship and engage in transitional case management process
Assess adequacy of discharge plan and risk associated with compliance
Develop care plan and interventions with patient and family input
Promote cost effective health care with aligned health system networks
Current, unrestricted RN license in the State of Utah
3+ years of clinical experience as a Registered Nurse in a hospital setting, acute care or direct care experience
Basic level of experience with Microsoft Word, with the ability to type and navigate a Windows environment

Onsite RN Case Manager Resume Examples & Samples

Identify those patients appropriate for face to face contact
Meet with patients and caregivers / families while inpatient to establish relationship and engage in transitional case management process
Complete assessments, address any identified barriers to compliance across the continuum
Coordination of post discharge care with primary care physician
Current, unrestricted RN license in your state of residence
5+ years of experience in a hospital setting, acute care, direct care
Home Health Care and/or Field Based Case Management experience

High Risk RN Case Manager Resume Examples & Samples

* This position is both a Field Based and Telephonic Case Management position (primarily telephonic) which may require travel throughout the Tri-Cities of East TN Sullivan, Carter, and Johnson Counties and Cumberland area of Middle TN including Cumberland, Fentress, Overton, Putnam Counties ***
Engaging members telephonically and in person (in their homes or facilities) to coordinate services, community resources, and treatment needs
Functioning as an advocate for members and decreasing unnecessary hospitalizations and emergency room visits
Travel in assigned territory as needed to complete patient assessments
Creating, reviewing and revising care plans and focusing on disease management
*If you do not have a current CCM, you will need to obtain one within 2 years of start date***
Current, unrestricted RN license in the State of Tennessee
Minimum of 1 year of home care/home health and/or other case management experience
Minimum of 3 years of clinical experience
Experience managing chronic and/or complex diseases
Experience working in a health plan or other managed care setting
Experience with community health and / or public health
Experience working with electronic medical records (EMR) systems

Onsite RN Case Manager Resume Examples & Samples

3+ years experience as a Registered Nurse in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
Ability to commute to the assigned facility/facilities to engage with members in timely fashion
Ability to obtain CCM in 30 months
Home Health Care and / or Field Based Case Management experience
Experience / exposure with discharge planning

Optumcare RN Case Manager Resume Examples & Samples

Benefit Determination:Assist the provider / team with benefit determination associated with Medicare part A, part B, and part D benefits. The RN is responsible for collaborating with the nursing facility / AL to identify and respond to patient Change in Condition. RN may assist the provider by completing DSTs, re-assessing the patient, and other activities to support BD, as delegated by the provider or the CSM
Therapy Coordination:Assist the provider / team with therapy coordination for patients including possible assessments or follow up on requests and communicate / collaborate with NP. The RN may perform interval check in on patient progress with therapy department . The RN may participate in facility based therapy discussion meetings
Team Support:Schedule and participate in family conferences, team meetings, and team case presentations. Assist in the coordination of N95 fit testing, CPR training / recertification, tracking compliance with infection control measures, tracking TAP data etc. Participate in facility partnership or Customer Relationship Management (CRM) meetings under the direction of the NP / CSM- the RN may assist in coordinating CRM meetings, and may participate in and contribute to the meetings
Current unrestricted Registered Nurse license in the state of Arizona
3+ years of experience in post- acute care, such as long term care or hospice and/or Case Management experience as an RN
Valid driver's license with appropriate insurance
BSN or Baccalaureate degree in healthcare

Senior RN Case Manager Resume Examples & Samples

Manage a caseload by coordinating services and collaborating with other health care professionals in the provision of health care services for injured workers
Exercise sound judgment in the diagnosis and treatment of potential health problem
Determine the necessity and appropriateness of health care services for patients
Complete various report and documentation
Possess and applies a broad knowledge of principles, practices, and procedures of particular field of specialization to the completion of difficult assignments
Perform all job functions with a high degree of discretion and confidentiality in compliance with all state and federal laws, as well as Sierra and departmental confidentiality guidelines
Active unrestricted RN license in the State of Nevada
Ability to obtain CA RN license within 4 months of start date
2+ years of case management experience
Intermediate to advanced computer skills
1+ years multi-state workers
Certified in Case Management (CCM) and Certified Occupational Health Nurse (COHN)

Rn Case Manager Resume Examples & Samples

Provide member education to assist with self- management goals
Educate members on disease process or acute condition
Takes on-call assignment as directed/if applicable
Maintains current knowledge of health plan benefits and provider network including inclusions and exclusions in contract terms
With the assistance of the Managed Care/UM teams, guides physicians in their awareness of preferred contracts and providers and facilities
Registered Nurse with current licensure to practice in the applicable state
1 or more years case management experience
Experience working with psychiatric and geriatric patient populations

Rn Case Manager Resume Examples & Samples

Current, unrestricted RN license in the State of MN
Minimum of 3 years recent experience in a clinical setting
Experience in medical/surgical, ICU, ER, home care or previous case management experience
Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required
Must be able to talk and type at the same time

RN Case Manager, Obstetrics & Pediatrics Resume Examples & Samples

Advocate for patients and families as needed to ensure the patient's needs and choices are fully represented and supported by the health care team
Utilize approved clinical criteria to assess and determine appropriate level of care for hospitalized members
High Risk OB and/or Pediatric experience
At least an intermediate level of proficiency with written and verbal communication skills
Must posses a valid Nevada driver's license and maintain personal auto insurance coverage

Rn Case Manager Resume Examples & Samples

Stratifies and / or validates patient level of risk and communicates during transition process with IDT
Provides assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member's home
Develops interventions and processes to assist the MA and other patients in meeting short and long term plan of care goals
Nurse Care Managers work with their supervisor to work their assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process
Confers with physician advisors on a regular basis regarding inpatient cases and participates in departmental conferencing
Plans patient transitions, with Utilization Management RNs, Care Coordinators, providers, patient and care givers
With the assistance of the UM team, guides physicians and hospital staff in their awareness of preferred contracts and providers as well as facilities
Experience using EMR and CM practice guidelines
Knowledge of discharge planning alternatives options and interdisciplinary approaches
Experience working with geriatric over 65 patient populations, individuals with multiple co-morbidities

RN Case Manager Emergency Department Variable Shift Resume Examples & Samples

Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at Directors discretion
Previous ED nursing and/or ED Case Management experience preferred
Experience utilizing electronic InterQual or other standardized criteria strongly preferred
Post-acute levels of care such as Home Health, Hospice, AIM, and Palliative Care, SNF, B&C, Assisted Living, Sub-acute, Acute Rehab
General Knowledge DRG assignment process preferred
Functions in a manner to promote quality patient care and assure a positive patient experience

Rn Case Manager Resume Examples & Samples

Minimum of three (3) years in acute medical/surgical/ED/ or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED/ or critical care nursing area may be considered for employment at director's discretion
Experience utilizing electronic InteQual or other standardized criteria strongly preferred
A broad knowledge base of health care delivery and case management within a managed care environment
Must be able to effectively communicate with, and promote cooperation and collaboration between individuals including patients/families/caretakers, physicians, nurses and other ancillary partners
Must have excellent time management skills to develop organized work processes in a high-volume environment with rapidly changing priorities
Ability to interact effectively with key internal and external constituents using collaboration, and customer service skills that promote excellence in the patient experience

Ambulatory RN Case Manager Orthopedic Resume Examples & Samples

Active, unrestricted CA RN license , Current, unrestricted CA Drivers License
Current, BLS certification
Minimum of three (3) years acute care nursing experience
Case management, home care, or discharge planning experience required – minimum one year
Knowledge of orthopedic conditions and surgical treatment options and its effects on patients and caregivers
Computer skills including Microsoft Office. EPIC knowledge preferred
Knowledge of applicable NCQA standards, state and federal regulations
Knowledge of the health care financial environment and requirements for various payer types, e.g., Commercial, CMS, CCS for HMO and PPO cases, and ability to apply Managed Care concepts

Rn Case Manager Resume Examples & Samples

Will be assigned to selected areas of the Hospital based upon department staffing and coverage
Will collaborate with SW Care Coordinator as a team to meet the needs of the patients within unit assigned
Each staff member will participate in a departmental orientation focused on Case Management Standards of Practice
All staff will be cross-trained and oriented to the ED Case Management Practice
BSN preferred, lnterQual experience preferred
Recent experience in a case management role or related role
Excellent computer skills including managing work against performance metrics and reporting on key indicators important to the department
Strong computer skills with knowledge and proficiency with Microsoft Word, Excel and PowerPoint
Demonstrate data analytic skills
Demonstrated skills in organizing and facilitating interdisciplinary teams to ensure timely discharge
Evidence of continued professiona l development

Pediatric RN Case Manager Resume Examples & Samples

AA in Nursing degree is required; BSN preferred
Valid Maryland drivers' license and current auto insurance, working vehicle; agree to comply with Maryland law for mandatory seat belt use
Two or three years pediatric nursing experience, preferably critical care
Two year home care experience preferred

Rn Case Manager Resume Examples & Samples

Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third party information
Validates admission criteria with third party payers (including onsite and telephonic Case Managers) as well as attending physicians. Recommends alternative care settings when appropriate
Collaborates with third party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial
Retrospectively addresses denials by reviewing the patient record and case management notes and provides detailed and specific information to the Director of Performance Improvement to support the appeals process
Assess the patient/family for care needs during hospitalization to establish an effective discharge plan in collaboration with the multidisciplinary team
Communicates clinical information in a clear and timely way
Monitors the patient's progress and plan of care with the aid of internal and external utilization guidelines. Reports issues and system barriers to efficient and effective discharge planning to the Director of Performance Improvement
Completes the interventions necessary for discharges to home with self-care, home with services and short term skilled nursing facility placement. Assembles necessary referrals, discharge summary and pertinent information for placement prior to the day of discharge
Identifies high risk patients to promote coordination of services and to prevent readmissions or Emergency Department visits. Strategies with primary care physicians, attendings, specialists and payers to develop appropriate care delivery strategies for these patients
Documents in the patient record according to department policies and procedures
Promptly communicates with attending physicians when cases lack adequate documentation to support acute hospitalizations. Communicates unresolved issues of inadequate documentation to the Utilization Review Physician Advisor for follow up
Contacts the attending physician to notify him/her of all decisions to issue a notice of non coverage for all payers
Informs the patient and/or next of kin when Medicare coverage must be terminated for the current admission. Issues the termination letter for Medicare patients following QIO Guidelines
Educate staff and physicians about managed care principles, observation status, discharge planning, reimbursement rules and range of patient care settings beyond observation, intensive care and acute hospital levels
As a member of the case management team
Seeks and provides peer consultation about cases that are presenting problems and/or experiencing significant deviation from the plan of care
Participates in performance improvement and evaluation processes related to the case management practice
Participates in development of procedures, roles, systems and structures related to the case management practice
Provides input into the operational and capital budget process related to case management practice
Demonstrates the knowledge and skills necessary to provide care appropriate to the age of the patients served

Rn Case Manager Resume Examples & Samples

Visit members in their homes and / or other settings, including community centers, hospitals or providers' offices
Identify when supplemental assessments are needed and conduct supplemental assessments
Engage member to participate in the assessment process and collaboratively develop plan of care based on their individual needs, preferences, and objectives

Rn Case Manager Resume Examples & Samples

Provide medical support to patients and health care providers, including education on specific diseases and therapies
Telephone support (including maintenance calls and adherence support)
Prepare for and attend extensive, specialized training sessions for specific therapies provided by the pharmaceutical team
Work directly with the reimbursement specialist and the physician to secure funding for their patient’s therapies; assist with alternative funding searches when needed
Attend pharmaceutical sales meetings as required
Attend patient meetings, conferences as needed to educate patients, providers regarding disease/product information and case management services
Work with patient associations and advocacy groups
Establish and maintain partnerships with pharmaceutical team
Liaise with health care providers, pharmacies and infusion clinics, and other agencies as required, to coordinate infusions, drug delivery and resolve issues as they arise
Clear communication to the manager, team and the client regarding the management of patient cases
With the managers, participate in the training process of new nurse case managers, including but not limited to shadowing & call monitoring
Be available on call after hours and weekends (24/7) for periodic telephone consultation and emails as needed by the program
The Nurse Case Manager will also be assigned other duties and tasks as required from time to time
A Bachelor’s degree or registered nurse (RN) diploma, advanced degree or specific practice management experience preferred, with five (5) years of Nursing experience
Requires a minimum of two (2) years in public or private third party reimbursement arena or pharmaceutical industry in sales (not required, but an asset), managed care, or clinical support, or related experience
The preferred candidate is a nurse with healthcare and case management experience in medical or hospital practice or the insurance or bio-pharma industry
Bilingualism (French and English) strongly required
Experience in hematology and/or nephrology an asset
Internet-research and computer savy; has strong verbal and written communication skills, problem solving skills and is a team player
Strong phone etiquette
Demonstrate teamwork abilities

Hospice RN Case Manager Resume Examples & Samples

Conducting regular visits at home or nursing facilities for a caseload of hospice patients
Coordinating, assessing, and implementing patients' care
Participation in a rotating on call schedule which includes weeknights, weekends and holidays
Ability to participate in an on call rotation which currently includes 4-6 nights per week including weekends, weeknights and holidays
Hospice experience
Proficiency with electronic medical records (EMR) software

RN Case Manager for Transplant Services Resume Examples & Samples

Encourage members to make healthy lifestyle changes
Utilize Milliman criteria to determine if patients are in the correct hospital setting
Ability and willingness to obtain additional RN licensure, if necessary
1+ years Case Management experience
2+ years of clinical nursing experience in a hospital setting, acute care or direct care environment
Must have access to high speed internet services
Solid organ and / or bone marrow transplant experience

Rn Case Manager Resume Examples & Samples

Collaborates with Social work on the facilitation of transfers internally to SNF, ARF, LTACH, Home Care
Works collaboratively with physicians, nursing, and other members of the multidisciplinary team to maintain active communication in order provide effect timely, appropriate patient management
Proactively identifies and, in partnership with the care team, resolves delays and barriers to discharge
Participates in patient rounding activities such as daily caseload rounding to establish priorities for self, SW and high risk TCC, multidisciplinary care coordination/discharge planning rounds, hand off report to nursing staff, hand off report to post-acute facilities SCC and PCC, physician advisor rounds and weekly LOS rounds
Participates in various committee meetings as assigned
Addresses and resolves items impeding diagnostic or treatment progress. Participates in Data Collection and inputting (e.g., Avoidable Days, Readmissions, Important Message letter delivery, Condition Code 44, etc.)
Ensures compliance with CMS Conditions of Participation, standards of the accrediting bodies and the state mandated revised code. Other duties as assigned
Knowledge of acute care regulatory/accreditation requirements preferred
Discharge planning and/or Quality Improvement experience preferred

Optum Field Based Senior RN Case Manager Resume Examples & Samples

Nursing home chart reviews for ICD- 9 coding and medication reconciliation
Transcribe on-call logs into electronic medical record
Must travel to nursing home facilities daily throughout Colorado Springs, CO
Active and unrestricted RN license in the state of CO
3+ years RN experience
Long term care / nursing home experience Long-term care or geriatric experience

Hospice RN Case Manager Resume Examples & Samples

Participating in a required on call schedule that rotates throughout the team which includes weekends and holidays
RN licensure (current, unrestricted) in the state of Virginia
Palliative care experience

Rn Case Manager Resume Examples & Samples

The Care Coordinator promotes inter-professional synchronization throughout the acute episode, and completes effective handoff to the next level of care or community to ensure continuity of care
The role requires the successful completion of annual competency training, as assigned. Care coordinators are required to obtain certification by an approved entity within one year of eligibility
Knowledge of acute care regulatory/accreditation requirements preferred. Discharge planning and/or Quality Improvement experience preferred

Rn Case Manager Resume Examples & Samples

Audit cases for quality by reviewing assessments, documentation and service plans
Make outbound calls to assess members' current health status post hospitalization
Provide patient education to assist with self management -Coordinate care for members
Make “welcome home” calls to ensure that discharged member receive the necessary services and resources

Senior RN Case Manager Resume Examples & Samples

Identifying opportunities or barriers in treatment plans
Interacting with Medical Directors on challenging cases
2+ years of Case Management experience
Certified Case Manager (CCM) or able to obtain within two years

Rn Case Manager Resume Examples & Samples

Provide care management to appropriate members based on diagnosis and or condition as per department protocol in accordance with CMSA and CHES standards of practice
Maintains a high level of ethical conduct regarding confidentiality, dual-relationships, and professional stature
Maintains client and program records in accordance with applicable standards and regulations, etc
Participates in continuing education activities, remaining knowledgeable in area(s) of expertise
Licensed registered nurse (current and unrestricted)
Associate or Bachelor Degree in Nursing required; Bachelor Degree preferred
Certified Case Manager (CCM) preferred. Must be eligible to take the CCM exam within 2 years of date of hire if not currently certified

CRS Telephonic RN Case Manager Resume Examples & Samples

Educating and supporting the individual through telephonic assessment and expert clinical case management interventions
Assess and interprets beneficiary needs, gaps, and requirements related to his/her condition
Create care plans/ addressing gaps or barriers in care
Interacting with Medical Directors and community partners on challenging cases
Current licensure as an RN in the State of Arizona
2+ years Behavioral Health experience
Intermediate experience with Microsoft Word, including Excel, with the ability to navigate a Windows environment
Experience with provider services, billing and enrollment, member services, and claim processes and procedures
Mental health/behavioral health experience; working with Arizona’s Regional Behavioral Health Authorities (RBHA)

RN Case Manager Mental Health Resume Examples & Samples

RN with Master’s degree in psychiatric or mental health nursing: Recent (within last 3 years) nursing experience in acute treatment unit in psychiatric hospital, psychiatric home care, partial psychiatric hospitalization program, or other psychiatric services required
RN with Bachelor’s degree in nursing: One year of recent (within last 3 years) nursing experience in acute treatment unit in psychiatric hospital, psychiatric home care, partial psychiatric hospitalization program, or other psychiatric services required
RN with Associate degree in nursing or diploma: Two years of recent (within last 3 years) nursing experience in acute treatment unit in psychiatric hospital, psychiatric home care, partial psychiatric hospitalization program, or other psychiatric services required

Home Visit RN Case Manager Resume Examples & Samples

Identifying those patients appropriate for face to face contact
Proactive post discharge follow-up; telephonically or in home as appropriate
Available to be in the field at least 75% of the time
Utilization Management
Field-Based experience (i.e. home health)

Rn Case Manager Resume Examples & Samples

Minimum of three (3) years in acute medical/surgical/ED or critical care nursing area required. Masters of Nursing in Case Management in lieu of three (3) years in acute medical/surgical/ED or critical care area may be considered for employment at director's discretion
Experience utilizing electronic InteQrual or other standardized criteria strongly preferred
Comprehensive knowledge of Utilization Review, levels of care and observation status
Some awareness of healthcare reimbursement systems: HMO, PPO, PPS, CMS preferred
Post-acute levels of care such as Home Health, Hospice, AIM and Palliative Care. SNF, LTAC, B&C, Sub-acute, Acute rehab

Rn Case Manager Resume Examples & Samples

Recommends additional levels of care, therapy/rehabilitation when medically indicated as appropriate
Facilitates patients' return to normal daily activities by teaching and making appropriate referrals for outside services/continued care collaboratively
Ensures that the patient has a safe and appropriate discharge
Intervenes when there are quality issues surrounding the transfers
Participates in inter-disciplinary case conferences and consultations
Consults with the physician regarding the Senior metrics for the appropriate length of stay for the Skilled population
Contributes to medical and nursing staff education by giving periodic in-service presentations
Participates in review/evaluation of the quality, appropriateness and outcomes of diagnostic and therapeutic services and treatment programs

Field RN Case Manager Resume Examples & Samples

3 + years of recent experience as a RN in case management, Home Health or clinical experience in acute, rehab or long term care setting
Access to reliable transportation and willingness to travel throughout surrounding area on regular basis
MDCP (Medically Dependent Children's Program) experience highly preferred

Rn Case Manager Resume Examples & Samples

Current Colorado /RN license, BSN Preferred
Current BLS from the American Heart Association
Minimum Experience and/or Knowledge Required
4 years of clinical experience as a Registered Nurse
1 to 2 years experience in Case Mgmt., Utilization review and discharge planning in hospital setting, preferred
Knowledge of community resources used for discharge planning, hospital operations, excellent communication skills, knowledge of third party payment systems, Medicare/Medicaid programs
Ability to multi-task, set priorities and maintain organization
Needs basic computer skills

Onsite RN Case Manager Resume Examples & Samples

3+ years of experience as a Registered Nurse in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
Ability to spend at least 75% of the time at the hospitals (St. Luke's and St. Anthony's)
Reliable transportation that will enable you to travel to client and/or patient sites within a designated area
Ability to acquire CCM within 30 months, if not already obtained

Optum Field LTC RN Case Manager Supervisor Resume Examples & Samples

*Position requires 75-90% travel across the state: Quarterly (and PRN) face-to-face meetings with team members***
Registered Nurse (RN) with Bachelor’s Degree in Nursing (BSN)
8+ years clinical RN experience
3+ years Case Management (emphasis with Medicare-Medicaid regulations and insurance authorizations or inpatient acute case management)
3+ years Supervisory / management experience
Proven leadership experience that includes team building, motivation, communication, recruitment, and budgeting
Experience with Medicare-Medicaid regulations and insurance authorization
Master’s degree in Nursing (MSN)

Rn-case Manager Resume Examples & Samples

Documents on the day of admission, or within the first twenty four hours, a clinical assessment and anticipated discharge plan that addresses use of the full continuum of care
Provides plan of care updates to providers inside and outside of the hospital, working with patients and caregivers
Manages each patient’s plan of care and throughout the stay
Clinical practice with experience acquired in assigned specialty required
Computer skills required; must be able to document in medical records
Exercises knowledgeable, independent judgement on routine and non-routine matters
A minimum of 1 year of hospital case management experience
Acute hospital experience
Any certification great to have
Possible weekend and holiday rotation needed based upon staffing levels

RN Case Manager Lead-cardiac Speciality Services Resume Examples & Samples

Current Iowa registered nurse (RN) license
Bachelors degree in health-related field required although BSN preferred
Demonstrates competency within a specialized area of clinical practice with 4 years experience in that specialty
Demonstrates success in positions of leadership

Rn-case Manager Resume Examples & Samples

Exercises knowledgeable, independent judgment on routine and non-routine matters
Ability to work on a PRN basis - variable shifts mostly on the weekend from 9am - 4pm. Occasionally pick up shifts during the week due to vacation or PTO
Previous hospital Case Management experience specifically within an acute care setting

RN Case Manager, Home Health Resume Examples & Samples

Provides professional nursing care by utilizing all elements of nursing process
Assesses and evaluates patient's/client's status by: a. Reviewing and implementing the plan of care. Regularly re-evaluating patient/client needs. Revising the plan of care as necessary
Observes the patient/client for changes in condition, discusses changes with the patient/client or family/caregiver and reports changes, as necessary, to the attending physician
Assists the patient/client with the activities of daily living and facilitates the patient's/client's efforts toward self-sufficiency and independence
Currently licensed as an RN through the State Board of Nursing
Compliant with accepted professional standards and principles
Possess and maintain good physical stamina and mental health
Must be a licensed driver with an automobile that is insured in accordance with state and/or Organization requirements and is in good working order
Provide satisfactory references from nursing school, previous (or current) employers and/or professional peers
Self-directed with the ability to work with little supervision; excellent good organizational skills
Requires monthly weekend, on-call and holiday rotation

RN Case Manager Lead Resume Examples & Samples

Nursing Degree from an Accredited Nursing School
Minimum of 3 years acute care hospital experience required and 2 years recent acute care hospital case management, discharge planning and utiization management experience
3 - 5 years experience in acute care hospital Case Management, Utilization Management and Discharge Planning and 1 year hospital supervisory experience
Public speaking and adult education experience preferred
Current Registered Nurse Licensed in the State of Arizona
MIDAS, CuraSpan and InterQual Certified Instructor (IQCI) training with proficiency testing

RN, Case Manager Resume Examples & Samples

Current license as a Registered Nurse in the State of South Carolina
BSN or MSN preferred
Minimum of three (3) years of hospital-based clinical experience preferred
Previous Case Management, Utilization Review or Discharge Planning experience desirable
Requires effective communication with patients, families, nursing, medical staff, and ancillary departments
Ability to take initiative to resolve problems immediately and implement change in a timely basis
Must be self-directed and able to adapt to change

Rn Case Manager Resume Examples & Samples

Three years Case Management/UM experience in an acute care facility
Knowledge and experience with Medi-Cal preferred
Good communication skills and ability to work with others

Rn Case Manager Resume Examples & Samples

Population Health/Disease Management
Clinical assessment
Ability to lead and coordinate activities of a diverse group of people in a fast paced environment
Critical thinking and problem solving skills
Strong computer literacy
Licensed RN, LVN or LPN and willing to be licensed in multiple states as applicable
At least 2 years of acute care experience required
Case Management Certification and/or experience preferred

Rn Case Manager Days Bonus to Offer Resume Examples & Samples

Graduate of an accredited school of nursing
Current licensure by the Texas State Board of Nursing
Current BLS for health care providers
Accredited Case Manager (ACM) preferred
Acute hospital case management experience preferred
Excellent organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people
Demonstrated critical thinking and problem solving skills
Computer literate

RN Case Manager, Weekend Baylor Plan Resume Examples & Samples

Provide professional nursing care by utilizing all elements of nursing process. 3. Assess and evaluate patient's/client's status by: a. reviewing and implementing the plan of care, regularly re-evaluating patient/client needs, revising the plan of care as necessary
Administer medications and treatments as prescribed by the physician
Initiate and apply appropriate preventative, therapeutic and rehabilitative nursing procedures and techniques and maintain communication regarding patient/client care with the physician and supervisory personnel
Complete, maintain and submit accurate and relevant clinical notes regarding patients/clients condition and care provided
Observe the patient/client for changes in condition, discusses changes with the patient/client or family/caregiver and reports changes, as necessary, to the attending physician
Assist the patient/client with the activities of daily living and facilitate the patient's/client's efforts toward self-sufficiency and independence
Teach the patient/client and family/caregiver self-care techniques as appropriate. Provide medication, diet and other instructions as ordered by the physician and recognize and utilize opportunities for health counseling with patients/clients and families/caregivers
Provide and maintain a safe environment for the patient/client
Graduate of an accredited school of professional nursing, BSN preferred
Current licensure as an RN in Massachusetts through the State Board of Nursing
Minimum one year's general nursing experience, with current home health, clinical, med/surg/telemetry, or critical care experience
Comply with accepted professional standards and principles
Excellent observation, nursing judgment and oral and written communication skills
Monthly weekend and on-call rotation; and holiday rotation required

RN Case Manager PRN Resume Examples & Samples

State of Alaska Registered Nurse
A minimum of 3 years clinical experience in nursing required
Experience in Utilization Review, Discharge planning or Case Management preferred

Rn Case Manager Resume Examples & Samples

Alaska RN license
BLS Preferred
Minimum of 3 years clinical experience in nursing required

RN Case Manager PRN Resume Examples & Samples

Assumes a leadership role with the interdisciplinary team to manage care, through criteria driven processes, for the appropriate level of care, patient status and resource utilization for assigned case load
Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of care; patient selection should be criteria based and interventions will be documented
Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
1 year of Hospital Case Management experience preferred

RN Case Manager Days Resume Examples & Samples

Performs utilization review ensuring admissions meet criteria for appropriateness of care and medical necessity
Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient
Bachelor's of Science in Nursing preferred

RN Case Manager / Days Resume Examples & Samples

Financial Assessment and Coordination
Utilization Review, Quality and Compliance Monitoring
Customer Service: Demonstrates customer service skills with both internal and external customers
Performance Improvement: Performs, participates, implements and evaluates performance improvement activities at the department level
Job Specific: Clinical Case Manager RN
Demonstrate an understanding of HCA's "Patients First" safety initiative through strict compliance to all safety protocols and procedures
Recognizes that variables such as age, race, nationality, culture, disease-causing vulnerabilities, socio-economic factors affect the patient populations under their care. Uses interventions appropriate to these factors (e.g. interpreter, dietary preferences, social service consult, etc)

Rn Case Manager Resume Examples & Samples

Performs admission and concurrent reviews for all payors and maintains legible documentation as directed by the Utilization Management Plan
Review of patient notes identifying and addressing any conflict in medical orders or lack of management plan
Build a rapport by providing continuity of care with patients and acting as their advocate throughout their hospital stay
Collaborate between multiple care givers and foster communication between medical teams and nursing staff
Identifies and intervenes to coordinate care of trauma patients in relation to appropriateness of level of care, length of stay and resource utilization issues
Identifying barriers to discharge and contacting relevant personnel to overcome these
Initiates and monitors referral process of patients post discharge
Identifies, tracks, and records Avoidable Days [AD], intervening to prevent or decrease as appropriate
Initiates denial and appeal process in accordance with policy
Demonstrates awareness of current trends that influence health care practice and assures compliance with professional, regulatory, governmental and organization standards

Rn Case Manager Resume Examples & Samples

Identifies and resolves barriers that hinder effective patient care
Collaborates and consults with physicians on patient's progress and discharge planning needs
Must be detail-oriented with ability to sustain concentration over long periods of time
Must have critical thinking skills, decisive judgment and the ability to work with minimal supervision in a fast paced environment
Must be able to read and comprehend written instructions and follow verbal instructions
Must have the ability to handle multiple priorities

Rn Case Manager Resume Examples & Samples

Current State of Utah or Compact Registered Nurse License
Current BLS certification (available after hire)
3 or more years of previous experience in all aspects of pre-admission and discharge planning preferred

Rn Case Manager Resume Examples & Samples

Identifies which patients in the specialty care practice have ongoing care coordination needs for their specialty condition
Serves as primary patient contact for team related to condition and facilitates access to services
Educates about managing a specialty condition, including prevention and health maintenance tasks. Educates and connects to other care providers and community resources to enhance care

Rn Case Manager Resume Examples & Samples

The Case Manager serves as the telephonic clinical liaison with hospital clinical and administrative staff as well as providing expertise for clinical authorizations for inpatient care
Makes outbound calls to assess members' current health status
Performs case reviews telephonically for assigned inpatient facilities and skilled nursing facilities; advises supervisor of any potential problems as they become evident
Ensures that our members receive the proper levels of care, coordinating their care, and assesses and interprets needs and requirements, in addition to referring patients to disease or case management programs; makes "welcome home" calls to ensure that discharged member receive the necessary services and resources
Conduct Utilization Reviews (concurrent and retrospective reviews) using approved health plan guidelines such as Milliman Criteria and / or InterQual Criteria
Demonstrate knowledge of utilization management processes and current standards of care as a foundation for utilization review and discharge planning activities
Confer with physician advisors on regular basis regarding inpatient cases and participate in utilization departmental rounds. Plans member discharges with providers
Track ongoing status of all certification activity and maintain continuing certification (or denial)
Make initial assessments regarding patient treatment plans and establish collaborative relationships with physician advisors, clients, patients, and providers
Adhere to quality standards and state UR guidelines, as well as confidentiality of all information, policies, and procedures. Adheres to company policies, procedures, and reporting requirements
Maintain in-depth knowledge of all company products and services as well as customer issues and needs through ongoing training and self-directed research
Continuous professional development about issues and trends in utilization review
Negotiate price, level of care, intensity, and duration of services as appropriate
This position is located at WellMed Medical Management Corporate Office**
Education required
Case Management certification strongly desired
Proficient computer skills in Microsoft applications

Complex RN Case Manager Resume Examples & Samples

Engage members either face to face or over the phone to have a discussion about their health
Utilize interviewing techniques and active listening to collect and retain member information and incorporating responses as they are presented to complete assessment
Current, unrestricted RN license in California
Telephonic Home care / field based case management

RN Case Manager, Rehab Resume Examples & Samples

Excellent communication, negotiation, and team building skills
Demonstrates knowledge of community resources, the rehabilitation process, and disease process
Knowledge of financial payer systems and reimbursements
MPACT experience and knowledge

Telephonic RN Case Manager, Access Center Resume Examples & Samples

Provides health education and coaches consumers on treatment alternatives to assist them in best decision making
Manages utilization through education
Current and active Nevada RN license
Willing to obtain RN licensure in Utah, California and Arizona after 3 months in position (reimbursed)
4+ years clinical experience
Diploma in Nursing or higher
Excellent telephonic customer service skills with ability to negotiate with professionals and patient /family
Willing to work rotating weekends and holidays
Triage, discharge planning and/or case management
Milliman experience

Telephonic RN Case Manager Resume Examples & Samples

Current, unrestricted RN license in state of residence
3+ years of experience as a Registered Nurse in a hospital setting, acute care or direct care experience or as a Case Manager for an insurance company
Basic level of experience with Microsoft Word, with the ability to navigate a Windows based environment
Experience in home health

Rn-case Manager Clinical Resource Management Day Resume Examples & Samples

Bachelor of Science in Nursing (BSN) required within 5 years of date of hire
Equivalent combination of education, training, and experience may substitute for education requirements
Appropriate certification in Case Management preferred; for example, Commission for Case Manager Certification (CCMC)
Minimum three years’ experience in Hospital Case Management
Individual will have experience that would produce an understanding of insurance, workers compensation and/or medical management

Rn Case Manager Sign on Bonus Resume Examples & Samples

Medical necessity screening
Facilitating multi-disciplinary patient care conferences
Making the appropriate referrals to other departments (e.g., nutrition, PT/OT/ST)
Referring complex social issues to Social Service
Communicating with patients and their families about the plan of care
Collaborating with physicians, office staff and ancillary departments (e.g., lab, pharmacy)
Participating in weekly Complex Case Review
Arranging for post –discharge patient education
Clear, complete and concise documentation in eCCM
Maintaining accuracy of patient demographic and insurance information
Identifying and documenting potentially avoidable days
Identifying and reporting over and under utilization and other duties as assigned

Diabetes RN Case Manager Resume Examples & Samples

Making outbound calls to providers in the Diabetes Health Navigator program
Identifying gaps or barriers in treatment plans to close STARS gaps
Interacting with Medical Directors, Pharmacists, and Social Workers, Internal teams
3+ years of experience in any clinical setting
Clinical Diabetes treatment experience
Experience working with the Medicare guidelines and regulations

RN Case Manager, Nicu Resume Examples & Samples

Educating and supporting the family unit through onsite and telephonic assessment and expert clinical interventions
Coordinating services as needed (home health, DME, etc.)
Active, unrestricted RN license in the state of Tennessee
3+ years of high risk level II or level III NICU experience
Strong computer skills with the ability to use multiple platforms, navigate within a Windows environment, and a foundational knowledge for Microsoft Office and email (ability to create, copy, edit, save & send documents utilizing Word, Excel & email)
Must live within a commutable distance of Memphis, TN

Rn Case Manager Resume Examples & Samples

Coordinate and develop an individualized person centered plan of care through close communication with members via in-person or on-phone assessments and touchpoints
3+ years clinical experience in a home health/hospice
1 -2 years of direct care or case management
Advanced Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
Experience working with Frail Elderly, Physically Disabled, Traumatic Brain Injury and Nursing Home Waivers

RN Case Manager Telecommute Resume Examples & Samples

Current, unrestricted RN license in your state
5+ years clinical experience in obstetrics; in a hospital, acute care, home health/hospice, direct care or case management
Access to high speed internet from home
Work flex shift and 20 hours in the evening M - F
Clinical experience in Prenatal Care

Field Based Senior RN Case Manager Resume Examples & Samples

The Sr. RN Case Manager works in collaboration with members, providers and key stakeholders in coordinating health services and referrals
Advocates for patients / families and liaisons with key team member to ensure that patients’ healthcare needs are being addressed
5+ years clinical experience as a RN in a hospital, acute care, home health, hospice, or nursing home
Registered Nurse with active unrestricted license in the State of Rhode Island

Rn Case Manager Resume Examples & Samples

State of Alaska RN license required
Minimum of 3 years clinical experience in nursing
Experience in Utilization Review (UR), discharge planning or case management preferred

Mmcm-rn Case Manager Resume Examples & Samples

Minimum of three (3) years’ experience, as an RN, in direct patient care delivery and / or management. Preferred patient care areas would be the emergency department, ICU or telemetry or successful completion of MMC’s Clinical Nurse Resident (CNR) program for Case Management
Demonstrates basic knowledge of the role of UM, DC Planning and / or CM for patients within an acute hospital and / or ED setting and across the continuum of care. This will be assessed during the interview process and the candidates narrative answers to case scenarios
Ability to read, write, hear, and communicate verbally in English to the degree required to perform the job
Willingness to act and dress in a professional manner at all times. Proficient in using a computer to accurately enter and extract data, send and receive email, calendar appointments, and use task lists as will be using a variety of computer software programs. Must be able to travel in and out of Stanislaus County, including transcontinental travel. If MMC and/or own vehicle used on company business, must possess valid California Driver’s License and upon request proof of liability insurance
Bachelors of Science in Nursing (BSN)

Rn-case Manager, Days JFK Memorial Resume Examples & Samples

Current license as a Registered Nurse in California, or related health care professional
Three (3) years Case Management/UM experience in an acute care facility
Knowledge and experience with Medi-Cal - preferred

Oncology RN Case Manager Resume Examples & Samples

A current, unrestricted RN license in Georgia
3+ years of experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Case Manager for another insurance company
1+ years of clinical experience working with oncology patients
Must live within a commutable distance (50 miles or 50 minutes) of Atlanta, GA
Disease management experience

Telephonic RN Case Manager Resume Examples & Samples

Collaborate with member, provider, facility to obtain best outcome
Complete cost - benefit analysis as appropriate
Review cases with Medical Directors daily on challenging cases as needed
Current, unrestricted RN licensure in the state of Nevada
Nursing degree or equivalent
3+ years of Clinical RN acute experience, resulting in excellent clinical skills and judgment
2+ years of experience in case management in a managed care environment and / or utilization review experience in an acute/sub-acute setting
Critical thinking skills as a case manager and able to formulate innovative plan of care for complex cases
Strong knowledge of CMS and other regulatory agencies
Intermediate level of proficiency with written and verbal communication skills
Strong inbound and outbound telephonic skills, or ability to quickly learn

Telephonic RN Case Manager Resume Examples & Samples

Support members with diabetes and / or asthma condition education, medication reviews and connections to resources
Current, unrestricted RN license in the State of Nevada
Certified Asthma Educator and/or Certified Diabetic Educator
Certified case manager (CCM)

Palliative Care Rn-case Manager Resume Examples & Samples

Implement the individualized plan of care and recommend revisions to the plan as necessary
Ability to perform procedures, to include, but not limited to: Wound care and dressing changes, Phlebotomy, Injection (B12, vaccines)
Consults and educates the patient / family and other caregivers regarding the disease process, pain and symptom management, end of life care and processes for dealing with issues of ethical concern
Ensure continual assessment of patient and family needs from admission to Bridges in Complex Care throughout the course of care
Conducts telephonic nursing follow up and case management when necessary
Serves as a resource or consultant for LVN
Exhibits professionalism and is courteous with all patients, physicians and co-worker
Determines the scope and frequency of services needed based on acuity and patient / family needs
Coordinates all patient / family services and prioritization of needs with the members of the interdisciplinary team
Performs all other related nursing duties as assigned
Five or more years experience in a physician’s office, clinical, hospice or hospital setting

Palliative Care Rn-case Manager Resume Examples & Samples

Conducts medical home visits on established Bridges home based care patients performing a hands-on exam at each visit
Ability to perform procedures, to include, but not limited to: Wound care and dressing changes; Phlebotomy; Injection (B12, vaccines)
Collaborates with the providers to recommend policies, procedures and standards which affect the care of the Bridges home based care patient
Exhibits professionalism and is courteous with all patients, physicians and co-workers
Experience related to advanced care planning and discussions with patients regarding end-of- life wishes

Medicare High Risk RN Case Manager Resume Examples & Samples

Assist with transition of care from inpatient to home setting
3+ years of experience as a Registered Nurse in any clinical setting
Proficient level of experience with Microsoft Word and Excel, and the ability to navigate a Windows environment
Must live within a commutable distance of St. Louis or Maryland Heights, MO (50 minutes or 50 miles)
Must be able to work 9:00am to 6:00pm CST
Previous Case Management or other managed care experience
Bilingual Skills (fluency in Spanish / English)

Rn Case Manager Resume Examples & Samples

RN with an active / unrestricted license in the state of Florida
Minimum of 1 year clinical or case management experience
Basic level of proficiency in PC-based word processing and database documentation (Word, Excel, Internet, Outlook)

100

Ambulatory RN Case Manager Resume Examples & Samples

Supports consumers in selection of best physician and facility to maximize access, quality, and to manage heath care cost
Prepares individuals for physician visits
Assesses and triages immediate health concerns
Supports consumers in selection of best physician and facility to maximize access, quality, and to manage health care cost
Takes inbound calls and places outbound calls as dictated by consumer and business needs
2+ years of Clinical RN experience, resulting in excellent clinical skills and judgment

101

Rn Case Manager Resume Examples & Samples

Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking
Knowledge of healthcare financing, community and organizational resources, patient care processes, and data analysis
Knowledge of utilization management as it relates to third-party payers
Knowledge of post-acute care community resources
Demonstrates flexibility via an ability to adapt to changing priorities and regulations
An autonomous role that coordinates, negotiates, procures services and resources for, and manages the care of moderate to complex patients to facilitate achievement of quality and cost efficient patient outcomes
Looks for opportunities to reduce cost while ensuring the highest quality of care is maintained Works collaboratively with inter-disciplinary staff internal and external to the organization
Participates in quality improvement and evaluation processes related to the management of patient care
Meets mutually agreed upon performance goals / objectives
Associate’s or Bachelor’s degree in Nursing
Possesses Case Management Certification (CCM) or will obtain CCM Certification within first year of employment
1+ years of critical care experience in ICU / IMC / ER / PACU or Case Management
BLS and ACLS
2+ years of CM or QA experience in hospital setting

102

Rn Case Manager Resume Examples & Samples

*This position is telephonic working at 2716 N Tenaya***
Communicate with all stakeholders the required health related information to ensure quality coordinated care and services are provided expeditiously to all hospitalized members
Current unrestricted RN license in the state of Nevada
Obtain CCM within two years of employment
Long Term Acute Care and/or Sub Acute experience
Possess knowledge of utilization management in a managed care environment
Knowledge of InterQual or Milliman guidelines

103

Optum Office Based RN Case Manager Supervisor Resume Examples & Samples

Hire, manage, mentor, coach and develop staff to meet corporate and departmental goals
Support and develop care models that align with Optum values
Manage schedules and resources to ensure proper coverage and staffing ratios to support contractual requirements
Performs chart / performance audits; identifies and meets individual / team training needs
Creates efficiencies and process improvements
The position reports to the Director of Clinical Operations and coordinates, supervises and is accountable for the daily activities of a team of RN Case Managers, Patient Care Coordinators and Social Workers
Registered Nurse (RN) for the state of GA with Bachelor’s Degree in Nursing (BSN)
2+ years clinical RN experience
2+ years Case Management (emphasis with Medicare-Medicaid regulations and insurance authorizations or inpatient acute case management)
2+ years Supervisory / management experience
Demonstrated proficiency in MS Office, electronic medical records
Experience with Medicare - Medicaid regulations and insurance authorization and health benefit plan experience
HEDIS / Star Quality experience

104

RN Case Manager, Medical Office Resume Examples & Samples

General knowledge of common diagnoses and procedures is required
Knowledge of individual and family development over the life span is required
Knowledge of the influence of cultural and spiritual values on health care is required
Must know child, elder and dependent adult and domestic violence reporting requirements
General knowledge of available health care and community resources appropriate for populations served is required; broad/in-depth knowledge is preferred
Must have the abilities to work independently with a minimum of direction, anticipate and organize work flow, prioritize and follow through on responsibilities
Must have excellent oral and written communication, interpersonal, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills
Demonstrated skills in motivating, mentoring, coaching and redirecting clients in order to achieve compliance with various necessary medical, social and functional interventions
Leadership skills to delegate and provide direction/guidance to staff and hold others accountable are required
Strong attention to detail and accuracy is required
The demonstrated ability to work constructively with a broad spectrum of health care professionals is required

105

Rn Case Manager Resume Examples & Samples

Perform patient assessment of all major domains using evidence based criteria (physical, functional, financial and psychosocial)
Develop individualized discharge plans that involve provider, patient, and caregiver goals for successful transitions of care
Implement discharge plan involving health care resources across the continuum
Monitor and report variances that may challenge timely quality care
RN Case Manager will be on - site at various locations and RN Case Manager must be flexible to float and work in various locations around Las Vegas and Henderson area.**
Assists members in sorting through their benefits and making choices
Work completed in Sub - Acute facilities or Acute Hospital settings
Occasional driving up to one (1) hour daily for regular employees per diem employees will drive less than one hour daily and are not subject to the driving requirements
Must possess an active and current Nevada RN license
Associates degree or higher in Nursing
3+ years of varied clinical experience in a hospital setting with an emphasis on case management or utilization management (Med/Surg background is helpful and preferred)
Understand spectrum of alternate delivery system
Demonstrate initiative toward problem solving without direct supervision
Strong organizational and computer skills
Good problem-solving skills
Assess patient needs to coordinate appropriate level of care
Ability to negotiate with professionals, patients, and caregivers
Independent case management knowledge and skills to formulate plans of care without direct supervision
CCM preferred within 2+ years of employment
Knowledge of Interqual or Milliman guidelines preferred

106

Transplant RN Case Manager Resume Examples & Samples

Coordination of member's care through the health care continuum
Collaborate with internal members of the health care team, to include PCP, FHS, COC and Medical Director
Communicate / Develop / Implement ongoing plan of care in conjunction with member and providers
Act as resource to SMA and Network providers, contracted transplant facilities
Evaluate, measure and report on outcomes
Utilize written criteria to approve, pend, and / or send case to medical director for review
2+ years case management experience
2+ years of experience working in acute care
NCQA, CMS and other regulatory agencies
Knowledge of patient care delivery in a managed care environment
Completed preceptor training and the ability to mentor others
Proficiently demonstrates the skills of a Case Manager
Ability to contribute to the organization's efforts to eliminate racial and ethnic disparities in organizational performance
Recognizes others deficits and assists to train / motivate improvement in their skill sets
Transplant experience
UNOS experience

107

Rn Case Manager Home Health Resume Examples & Samples

Maintains up to date knowledge of Medicare/Medicaid/JCAHO standards thru in-services and work shop attendance
Observes patient's reactions to medications and reports significant incidents to the physicians
Delegates and supervises care given by CNA#s/LPN#s

108

Rn Case Manager Resume Examples & Samples

Associate Degree in Nursing; BSN preferred
One year of recent acute hospital case management experience required
Current FL RN License required; ACM or CCM preferred

109

Complex RN Case Manager Resume Examples & Samples

This position is office based at 2716 N Tenaya**
Communicate/Develop/Implement ongoing plan of care in conjunction with member and providers(s)
Act as resource to SMA and Network providers
Provide Health Education, coaching and treatment decision support for members
1+ year experience in Case Management
3+ years experience in a hospital setting, acute care, direct care experience
Knowledge of NCQA, CMS and other regulatory agencies
Demonstrates initiative toward problem solving skills and ability to mentor others
Basic computer skills, including experience with at least Microsoft Word, Excel and Outlook and ability to navigate in a Windows environment
Demonstrates excellence in case management skills
Critical Demonstrated critical thinking skills as a case manager and able to formulate innovative plan of care for complex cases
Experience working with diabetes, cancer, stroke, traumatic brain injury, heart disease, lung disease or related experience

110

Rn Case Manager Resume Examples & Samples

5+ years clinical experience in a hospital, acute care, home health / hospice, direct care or case management
2+ years of Clinical Experience in Cardiovascular Transplant or Cardio Operating Room, Congenital Heart Disease or Intensive Care Unit
Bilingual skills - Spanish

111

Rn-case Manager Resume Examples & Samples

Utilize regional population stratification information and processes to identify appropriate members for enrollment into case management in collaboration with clinicians and health care team members of the medical home
Independently and proactively complete chart reviews, screening calls and full assessments related to the anticipated level of care and document findings using standardized approved documentation tools
With the member/family and appropriate KP staff and providers, develop and document a patient-centered care plan that addresses short term goals that are specific, attainable and measurable
Provide care coordination and management services for members with identified needs: Creatively using available and appropriate resources, including KP staff and providers, to support the unique needs of each member; Facilitating access to internal and external services; Monitoring the effectiveness of the interventions; and Reinforcing the treatment plan through life-style, diet and medication adherence including support for Chronic Condition therapies and Opiate Therapy Plan adherence; and Advising and coaching patients and families; Succinctly document interventions in KP HealthConnect as needed by other providers to ensure coordination of care and services
Strengthen and improve Case Management Services: Establish strong relationships with clinicians and other health care team members. Communicate data on population case managed, utilization and outcomes. Education of staff/clinicians. Development and distribution of education, tools and materials for member coordination. Contributing to ongoing process improvement including related procedures, policies, patient support and documentation tools
Act as a liaison between the Medical Home and Regional Case Management
Minimum six (6) years of nursing experience in acute care or ambulatory care/clinic/extended setting within the last eight (8) years
Prefer at least two (2) years of experience in case management, care coordination, or population care
Microsoft Word, Excel,& HC experience

112

Rn Case Manager Resume Examples & Samples

Applies motivational interviewing in identifying impact on member engagement and setting goals
Medication: Member education, medication reconciliation and benefit management
Ensures follow up appointments and referrals to programs, both health plan and community are in place
Facilitate patient/family and provider communications as indicated and advocate for patient / family with healthcare team as needed
Communicate with stakeholders, appropriate health care related information to ensure timely coordination care and services for members currently receiving inpatient care. Identified point of contact for managing transitions of care
Utilizes approved clinical criteria to asses and determine appropriate level of care for members currently receiving inpatient care
Reevaluates transition of care needs at day 30 and coordinates transition to next level of case management or care coordination services
RN diploma or equivalent
Certification in Case Management (completed or obtained within one year of employment in position)
5+ years clinical experience in a hospital setting with an emphasis on case management or utilization management
Critical thinking skills and ability to oversee teams to meet expected goals
Self motivated for member and program success
Ability to contribute to the organization’s efforts to eliminate racial and ethnic disparities in organizational performance

113

Inpatient RN Case Manager Resume Examples & Samples

Performs concurrent and retrospective onsite or telephonic clinical review at the designated network or out - of - network facilities as needed / directed by the ICPS Management team (Director, Manager, and Supervisors) documenting medical necessity and appropriate level of care utilizing clinical guidelines (e.g. Milliman, Interqual)
Complies with CMS regulations and Health Plan requirements
Interacts daily with treating physicians regarding the Monarch HealthCare member’s plan of care and alternative care solutions
Consults the Monarch Medical Director / designee for unusual and complex cases
Documents and maintains a Continuity Plan of Care for the Monarch HealthCare member by assessing and identifying continued needs upon discharge to encompass; health services, durable medical equipment, hospice, follow - up physician appointments, skilled versus sub - acute versus custodial levels of care
Issues the appropriate denial letters based on Health Plan or CMS guidelines utilizing ICE language
Identifies Quality Improvement (QI) indicators and provides timely reporting to the QI department
Current unrestricted CA RN
2+ years of experience as an RN
1+ of recent acute care or managed care experience
Computer proficiency; can type, toggle between multiple screens, use MS Outlook, Word, Excel and navigate in a Windows environment
Must have reliable means of transportation to travel from office to facilities

114

Rn Case Manager Resume Examples & Samples

Completes a comprehensive assessment of patients clinical, psychological and financial needs utilizing all available resources
Recommends and coordinates timely transfers to appropriate levels of care as indicated by clinical needs and utilization criteria
Develops, implements, evaluates and revises, as necessary, a plan for discharge, including referrals to other health care and community organizations based on needs assessment
Communicates discharge care plan, and any changes in the plan to patient, family and all appropriate healthcare professionals
Assists physicians and hospital staff in appropriate utilization of resources through application of utilization criteria and facilitating timely discharge planning for patients
Coordinates services between hospital departments to facilitate timely patient discharge
Conducts concurrent review of patient records on admission to the hospital and as determined by the patient's clinical condition
Applies utilization criteria accurately in order to determine appropriate utilization of resources
Notifies designated internal and external contacts of utilization issues that may affect patient care and/or reimbursement
Facilitates patient transfers to other health care organizations in accordance with hospital policies and all-applicable state and federal guidelines and regulations
Acts as a resource/advisor to physicians regarding discharge planning, medical record documentation, and all issues that may affect resource utilization and reimbursement
Integrates and manages established pathways, where available, to enhance clinical effectiveness and clinical resource management
Maintains knowledge and understanding of CMS regulations, Medicare/Medicaid, managed care and other payer regulations and benefit limits
Acts as a resource and provides education for patients, their family members and all health care professionals regarding HCFA regulations, Medicare, Medicaid, managed care and other payers
Develops and maintains knowledge and understanding of hospital and community resources, and facilitates use of most appropriate level of care to conserve patient, hospital, and payer resources
Identifies opportunities to reduce cost of managing patient care without impacting quality or outcomes
Participates in collecting and recording data for utilization and Quality Improvement reporting
Works collaboratively and professionally with patients, family members, and physicians, hospital staff and other individuals and agencies involved in providing patient care
5 years experience in a variety of clinical settings (e,g. home health, inpatient, physician office, clinic) required
Experience with managed care and payer/provider requirements preferred
Current Oklahoma RN License required. BSN preferred
Excellent interpersonal communication and collaboration skills
Current Case Management Certification preferred, at minimum attained within one year of hire (INTEGRIS Certified Case Management only)
Current Driver's License issued by the state of Oklahoma

115

Rn Case Manager Resume Examples & Samples

Five years in a professional setting such as hospital, clinic setting, or Managed care Organization
Experience related to case management, utilization management, quality assurance, discharge planning or other cost management program preferred
Good organizational, time management, and prioritization skills
Critical thinking skills, excellent problem solving, and good decision making abilities
Demonstrate a professional appearance and demeanor with external customers
Proficiency with desk top and lap top computers, with experience in basic programs

116

Rn Case Manager Resume Examples & Samples

Plans, implements, manage, coordinates, and evaluates a comprehensive plan of care across the care continuum aimed at stabilized chronic or high risk medical conditions and ensuring appropriate use of medical services and resources. Effectively manages and coordinates assigned caseload consistent with established criteria
Coordinates, manages, and evaluates services to ensure that they are consistent with the comprehensive plan of care and are delivered in a manner that demonstrate high quality and cost effectiveness
Ensures consistent and reliable documentation of case management activities in compliance with all organization and departmental standards. Practices within ethical and legal guidelines using establishing policies and procedures. Maintains confidentiality of patient records, information, and departmental activities involving patient information
Analyzes patient and program outcomes to identify improvements in program, quality, and cost effectiveness of case management activities
Develops, implements, and manages case findings and screening processes to identify candidates for case management and to define the appropriate level of case management for members
Actively participates in the referral processes, including eligibility verification, compliance with medical necessity guidelines and evaluation of outcomes, ensuring that the appropriate information is entered into all relevant data systems
Provides education and consulting services to members, families, and caregivers, members of the healthcare team, the health plan staff, and the community
Three (3) years of clinical experience with two (2) years in case management experience is required
Additional years of relevant clinical experience may be substituted for the case management experience requirement
Required clinical experience must include at least one year in area of specialty as follows
Geriatric: One (1) year of recent experience with a geriatric and Medicare population is required. Experience with chronic and/or high-risk medical diseases is required,including but not limited to diabetes, CHF, Alzheimer's dementia, and CVA
Pediatric/Adolescent: One (1) year of recent experience with pediatric/adolescent population is required. Experience with chronic and high-risk medical diseases is preferred, including but not limited to asthma, cystic fibrosis, and cerebral palsy
Adult: One (1) year of recent primary care experience with an adult population is required. Experience with chronic and/or high-risk medical diseases is preferred, including but not limited to diabetes, CHF, COPD, and asthma
Prenatal: One (1) year of recent labor and delivery of predominately high-risk obstetrics is required. Four (4) years of labor and delivery experience in a high-risk setting is preferred. Certification in fetal monitoring is required. Demonstrated competence with medication management is required
Oncology: One (1) year of recent clinical oncology experience is required; hospice certification is preferred
Renal: One (1) year of recent nephrology nursing experience is required. Two (2) years of recent dialysis nursing is preferred
Demonstrated competence with vascular access management is required

117

Intake RN Case Manager Resume Examples & Samples

Performs Behavioral Health Needs Assessments with thorough clinical documentation
Facilitates appropriate dispositions
Facilitates pre-admission TDO requests
Completes initial pre-certification and/or authorization requirements
Completes admission and/or registration process, including entering data in applicable admission/registration computer programs and completing applicable forms
Manages and documents Connection to Care inquiry calls with compassion and excellent customer service, assesses safety concerns and provides clear direction to access behavioral healthcare
Establishes and maintains contacts with behavioral health professionals and/or organizations to expand knowledge base of behavioral health resources and to enhance opportunities for business development activities
Remote collection of behavioral health clinical data via audiovisual technology for patients off-site followed by telephonic review with the psychiatrist on-call for level of care determination
Collaboratively works with the Behavioral Health Unit to manage bed availability and determine best unit placement to meet clinical needs of the patient
Builds alliances among collaborative departments to achieve optimal patient outcomes. Embraces the organizational goal of optimal patient care delivery as well as any departmental goals
Assumes or assists with additional nursing assignments when maintaining Inpatient Standard of Care in the Intake area/and or on an inpatient unit when needed
Participates in quality initiatives and process improvement projects as indicated
Participates in performance improvement activities to provide optimal outcomes for patients through the enhanced role of the case manager
Assess and identify using an empirical evidence approach, patients in the emergency room requiring intervention in relation to appropriateness of level of care, social barriers and resource utilization concerns, developing a discharge plan in collaboration with the healthcare team
Demonstrates awareness of current trends that influence health care practice and assures compliance with professional, regulatory, governmental and organization standards. Applies research findings to the development of policies, procedures and guidelines for cost-effective/high quality practice
Minimum of three to five years Behavioral Health or Emergency Department clinical and/or management experience (required)
Recent experience in Behavioral Health and/or Emergency Department setting with working knowledge of managed care (preferred)

118

Wound & Ostomy RN Case Manager Resume Examples & Samples

Authorizes patients currently being cared/followed for ostomy and wound care supplies through the approved KP ostomy benefits program
Assesses individual patient needs and goals, and provides educational programs to physicians, nursing, and other paramedical professionals
Evaluates currently used products for ostomy and wound care
Conducts continuing educational programs for physicians and nursing personnel
May provide guidance and supervision to Staff RNs providing direct patient care to patients with ostomyrelated conditions
Pre-counsels patients for surgery and follow-up after surgery
Sees patients for appointments regarding problems concerning ostomy management, wound management and other related concerns, rather than making an appointment with their physician whom it is difficult to maintain total familiarity with new equipment and techniques being used in ostomy care
Schedules patients in the outpatient department for pressure sore and incontinence management
Clinical nursing experience in caring for patients with abdominal somas, draining wounds, fistulas, pressure sores and incontinence
CWON

119

Rn-case Manager, Care Coordination Resume Examples & Samples

Bachelor’s degree in Nursing, required. Master in nursing, case management or other health related field preferred
National Certification in Case Management (i.e. ACM, ANA RN-BC Case Management) upon hire or within 18 months of hire date for experienced case managers
Newly trained case managers: National certification as noted above, within 24 months of hire
Three or more year’s clinical experience in acute medical/surgical or critical care practice area
In lieu of 3 years clinical experience noted above, Masters degree in Case Management with clinical residency from acute medical/surgical practice area at a Sutter Health Affiliate

120

Rn Case Manager Resume Examples & Samples

Current California RN license; BSN preferred
A minimum of 2 years experience in case management or utilization review
Comprehensive knowledge of inpatient hospital care, case management, utilization, discharge planning and hospital social services
Ability to communicate effectively and tactfully with professional staff, patients and their families, and third party payers

121

Optum Office Based RN Case Manager Resume Examples & Samples

Interact with home visit Nurse Practitioners to coordinate care
Current, unrestricted RN license in the State of GA
2+ years’ experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company

122

Rn Case Manager Resume Examples & Samples

Current TX RN License or valid compact license
BSN required within 24 months
Clinical nursing experience in cardiology setting

123

Telephonic RN Case Manager Resume Examples & Samples

Create a member centric care plan utilizing information provided during health assessment calls to identify problems, interventions and goals
Provide general education to patients and families to make informed personal health care decisions and facilitate communication between member, physician, health plan, and community
Perform follow up phone calls to members discharged from a hospital and/or SNF within 1 to 2 business days to ensure discharge plan is being met and to identify any obstacles that could be cause for readmission
Input authorization for services
Identify members with status changes and notify immediate supervisor for field staff interventions
Work with the medical director in providing additional clinical for DME, Home Care and other specialize needs for their review
Solid computer skills including the ability to document case notes using the case management system

124

Field Disease Management RN Case Manager Resume Examples & Samples

Conduct face-to-face visits in member’s home, hospital or physician’s office to develop and implement treatment plans that address individual needs of the member, their benefit plan, and community resources
Conduct health assessment interviews with members or relatives to obtain social history relevant to medical problems and care planning
Provide education about self-care and lifestyle modifications to implement a single plan of care focused on improving the member’s quality of life and reducing the likelihood for complications
Understands and follows policies and procedures and produces and submits reports in a timely manner
Identify members with status changes and notify immediate supervisor for appropriate interventions
Strong disease management skills for multiple high risk diagnosis
Knowledge of Medicare and Medicaid healthcare practices and policies

125

Telephonic RN Case Manager Resume Examples & Samples

Outreach low to moderate risk customers for coordination of care, including HRA and internal referrals, and continuity of care management
Identify and address customer gaps in care, which may include primary care physician and specialist appointment scheduling
Provide clinical assessments, health education, and community resources to customers, as needed
Initiate contact with customer/caregiver/family, primary care physician, and health care providers/suppliers as needed
Develop customer’s individualized plan of care, as well as communicate the plan of care to the customer
Document all encounters with the customers, practitioners and providers
Resolve any immediate issues for customers after screening
Evaluate each case for quality of care, document and report quality issues to the appropriate team
Request medical records as needed, abstract records, and complete data entry
Registered Nurse with minimum 2 years clinical experience and/or experience in Case Management
Medicare and/or Medicaid experience with geriatric populations
Experience with community resource organizations
Experience handling confidential health care information, with care management software applications
Experience managing customers with complex medical and behavioral health concerns preferred
Excellent interpersonal and communications skills
Basic proficiency in Word, Outlook, PowerPoint, Excel
Spanish language ability is desirable

126

RN Case Manager Homecare Resume Examples & Samples

Automobile and automobile insurance
Two years’ experience within the last five years in a homecare agency, primary care clinic, or acute-care facility
One-year of supervisory experience and marketing skills are preferred
Knowledge of intravenous therapy, pediatric and/or ventilator management is preferred

127

RN Case Manager, Hospice Resume Examples & Samples

At least one year as an RN Home health experience preferred
Demonstrates ability to work with patients who are in the last stages of a terminal illness and their families
Understands philosophy of hospice and needs of the terminally ill

128

Rn-case Manager Resume Examples & Samples

Education:BSN required. Will consider an Associate’s degree in Nursing with equivalent experience
Experience:Must have a minimum of three years work experience
Licensure/Certification/Registration:Must have current TN RN or Compact State licensure

129

RN, Case Manager Resume Examples & Samples

Effectively using established operating systems to document activities and ensure consistent program clinical practices
Proficiency utilizing Microsoft Word, with the ability to navigate a Windows environment
Case Management experience is strongly preferred
Experience/exposure with discharge planning

130

Optum Field LTC RN Case Manager Supervisor Resume Examples & Samples

*Position requires 75-90% travel across the state: Quarterly (and PRN) face - to - face meetings with team members***
Registered Nurse (RN) with Bachelor’s Degree in Nursing (BSN) with 5 years clinical RN experience (1 year related to the elderly) or Registered Nurse (RN) with Master’s Degree in health or social science with 2 years clinical RN experience (1 year related to the elderly)
2+ years of Case Management experience (emphasis with Medicare - Medicaid regulations and insurance authorizations or inpatient acute case management)
1+ years Supervisory / management experience
Experience with Medicare - Medicaid regulations and insurance authorization

131

Telephonic Transplant RN Case Manager Resume Examples & Samples

3+ years of experience as a RN in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
Organ and/or bone marrow transplant experience
A dedicated workspace from home
Ability to work 2 evenings per month until 7pm
Experience working in an ICU, Post Op or Dialysis setting
A background in managed care (MCO) or insurance setting
Experience in utilization review, concurrent review and/or risk management

132

Senior Field RN Case Manager Resume Examples & Samples

Support members desires to live in the least restrictive setting as possible
Completes all initial and annual service planning activities, and verifies, authorizes, coordinates and monitors services
3 + years of recent experience as a RN in pediatrics including developmental challenges of the pediatric population
Bachelor's Degree or Higher

133

RN Case Manager Supervisor Resume Examples & Samples

Develops and supports best practice to assure compliance with Model of Care
Current unrestricted CA RN license
3+ years’ experience as RN
Familiarity with Medi - Cal population

134

Telephonic RN Case Manager Resume Examples & Samples

Provide patient education to assist with self management
Document and track findings
2+ years experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
Ability to navigate a Windows environment, utilize Outlook and the ability to create, edit, save and send documents utilizing Microsoft Word

135

Hospice RN Case Manager Resume Examples & Samples

Diploma, Associate or Bachelor Degree in Nursing
Hospice experience a plus
Strong organizational and communication skills

136

Rn Case Manager Resume Examples & Samples

Proactively identifies members that may qualify for potential case management services
Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs
Performs ongoing monitoring of the plan of care to evaluate effectiveness and suggests changes accordingly
Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care
1-3 years in case management, LTAC

137

Rn Case Manager Resume Examples & Samples

Current registration and licensure with the Board of Nurse Examiners for the state or a Compact state
Three to five years’ recent experience in Case Management in a hospital setting
Knowledge of The Joint Commission regulations and Medicare, Medicaid, and Commercial insurance standards and requirements
Competent application of InterQual criteria, knowledge of Milliman criteria
Possess the ability to handle multiple projects simultaneously and to make independent decisions
Experience using healthcare software systems

138

Rn Case Manager Case Management Days Resume Examples & Samples

RN (minimum of BSN preferred)
Current licensure by the Texas State Board of Nursing
Current BLS for health care providers
At least 5 year’s bedside experience or LVN with 10 years bedside experience
Excellent organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people
Demonstrated critical thinking and problem solving skills
Computer literate

139

Tricare Echo RN Case Manager Resume Examples & Samples

*Must be flexible to work anytime between 7:00 am and 6:00 pm***
Registering, educating and supporting the ECHO population and their families through telephonic assessment and expert clinical interventions
Evaluating health care needs that qualify for the ECHO benefit, and arranging for services and supplies to support the beneficiary’s condition
Collaborating with the Primary Care Provider, Specialty Care Provider, Therapists, DME provider, and other clinical service providers to enhance the quality and efficiency in healthcare delivery to the ECHO population
Managing the ECHO financial benefit in coordination with the beneficiary / family / Primary & Specialty Health Care Provider in order to maximize the benefit and provide enhanced quality of life
Assess and interprets the ECHO population’s health care needs, gaps, and requirements and provides referral to other Military and Veteran Case Management programs as indicated
Provides assessment, coaching, teaching and referral to the ECHO population’s family members and caregivers as required
Identifies solutions to military unique, non - standard request and problems
Develops benefit focused care plan in collaboration with family, other Case Managers, Primary Care Provider, Specialty Providers, other service providers as needed to assure ECHO benefit managed according to DoD guidance
Collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiary and family
Coordinates authorizations of services as needed (home health, DME, etc.)
2+ years of Special Needs or Pediatrics experience
2+ years of case management program experience
2+ years of experience in a hospital setting, acute care, direct care, home care services OR experience as a telephonic Case Manager managing complex conditions patients
United States citizenship
Ability to obtain favorable adjudication following submission of Department of Defense form SF86 NAC form SF86
Prior telephonic Case Management experience
Bachelor’s Degree in Nursing or higher
Case management Certification (CCM)
Experience managing financial benefits
Strong organizational skills and ability to multi - task
Prior military case management program experience

140

Rn Case Manager Resume Examples & Samples

Registered Nurse with current licensure to practice professional nursing in Wisconsin
Current valid driver's license
Preferred experience in public health, home care or Hospice nursing
Ability to organize and prioritize workload independently

141

RN Case Manager Ambulatory Resume Examples & Samples

Takes in-bound calls and places out-bound calls as dictated by consumer and business needs
Special projects, initiatives, and other job duties as assigned
3 or more years of Clinical RN experience, resulting in excellent clinical skills and judgment
Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment and the ability to create, edit, save and send documents utilizing Microsoft Word
Bilingual preferred Spanish/Vietnamese/Farsi/Korean
Preferred experience working with Medi/Medi

142

RN Case Manager Spine & Joint Telecommute Resume Examples & Samples

Provide information to members to facilitate an improved care experience which includes illustrating cost savings, highest quality pairing of a center of excellence and surgeon, and ensuring a seamless administrative experience
Telephonic Case Management which includes assessments in the pre-operative and post-operative phases of Orthopedic surgery to ensure positive outcomes
Identifying gaps in treatment plans and coordinate ongoing care with providers
Provide patient education to encourage self-management and healthy lifestyle changes
5 or more years of experience in a hospital setting managing medical/surgical patients, ICU, Orthopedic patients, or complex case management experience
Computer proficiency including the ability to type and talk at the same time and to navigate within Microsoft Windows
Must be willing to obtain and maintain multiple state licenses as needed
Previous Orthopedic experience
A background in Managed Care
BSN and or other Baccalaureate Degree

143

Home Health RN Case Manager Resume Examples & Samples

Minimum of two years clinical home care experience
Knowledge of state and federal home health agency regulations/Conditions of Participation and Compliance standards and regulations
OASIS certified or will be required to obtain OASIS certification within one year of hire
Strong organization, communication and human relations skills

144

RN Case Manager Outpatient Services Resume Examples & Samples

Prioritize care needs, set goals and develop an initial plan of care that also addresses gaps and / or barriers to care and uses evidence-based practice as the foundation
Enters timely and accurate data into designated care management applications and maintains audit scores of 90% or better on a quarterly basis
Takes on-call assignment as directed
Attends educational offering to keep abreast of change and comply with licensing requirements and assists in the growth and development of associates by sharing knowledge with others
Participates in the development of appropriate QI processes, establishing and monitoring indicators
Education: Bachelor’s degree in Nursing, or Associate’s degree in Nursing and Bachelor’s degree in related field, or Associate’s degree in Nursing combined with four or more years of experience
Diverse clinical experience with three or more years experience in caring for the acutely ill patients with multiple disease conditions
One or more years case management experience
Ability to solve complex problems; critical thinking skills
Certified Diabetes Educator, or Certified Case Manager
Case Management Certification (CCM) or ability to obtain CCM within one year of employment

145

Tricare RN Case Manager Resume Examples & Samples

*Candidate must be able to work Monday- Friday, 8:00-4:30 Mountain Standard Time***
Educating and supporting the individual and family unit through telephonic assessment and expert clinical interventions Identifying gaps or barriers in treatment plans
Leads efforts to provide specialized case management services to beneficiaries identified with very complex conditions or diseases requiring intensive and extensive coordination of resources including accessing Centers of Excellence with specialty hospitals, multiple specialists and sub-specialists, DME, home care and therapy providers
Develops plan of care in collaboration with beneficiary/caregiver/provider
Works with minimal guidance, seeks guidance on only the most complex tasks
Collaborates with specialists, physicians, and medical directors to provide the necessary care and cost efficient care for the beneficiary
Assesses the effectiveness and quality of services provided related to clinical, functional, and financial impact and outcomes
Maximizes use of community services, support programs, and resources available to beneficiary
Current, unrestricted RN license in the state in which you reside
3+ years clinical experience in acute care, direct care, ER or hospital setting
1-2 years of Case Management experience
Previous experience working with Tricare, Military and Veterans

146

Rn Case Manager Resume Examples & Samples

Case Management and Supervision
Coordinates the patient’s and families care and services including those of the team, social worker, chaplain, home health aide, volunteer and physician
Responds necessary information to the senior case manager
Monitors the re-certification / re-authorization process
Participates in Interdisciplinary Team Meetings as indicated
Ensures and documents appropriate use of the medications, durable medical equipment and supplies
Educates patients, families and other caregivers
Provides skilled nursing as determined by the interdisciplinary plan of care
Appropriately utilizes the skills and resources of contract personnel such as PT, OT, Dietary, Speech and Pharmacy
Provides appropriate care plan and integrates care plans as needed
Performs on site evaluations of HHAs and volunteers
Participates in the on-call rotation and weekends
Quality Improvement
Integrates QI results into the established plan of care
Participates in QI assessment routinely
Participates in proactive patient calls
Participates in routine chart reviews
Participates in the orientation of new team members as assigned by the Team Manager
Develops and achieves professional growth goals and objectives and reviews with the Team Manager
Represents professional nursing
Maintain a safe and productive working environment following established protocols
Promotes and supports a teamwork culture and environment internally and externally
Ensure interactions remain positive and professional with all persons with whom you interact in the course of your work both internally and externally
Other duties as assigned or determined appropriate
Reliable transportation with adequate insurance coverage for driver and passengers
Private phone in home
Registered Nurse in the state of California
Three years Hospice Nurse experience
Requires full range of body motion including manual and finger dexterity and hand-eye coordination
Requires standing and walking for extensive periods of time
Requires corrected vision and hearing to normal range
Requires the ability to work successfully with our software applications on a computer and/or a laptop, and /or a blackberry for extended periods
May require going to other locations
Require the ability to work successfully under sometimes stressful conditions
Requires willingness to be flexible in changing job responsibilities, assignments and workload
Requires patience, compassion, and the ability to work successfully with a variety of persons internally and/or externally
May require critical thinking skills and the ability to work successfully independently or in a team with positive interactions

147

Rn Case Manager Resume Examples & Samples

RN with current Florida license Required
Previous acute care nursing experience Required
Minimum two years Case Management experience Required
Bachelor’s degree Preferred

148

RN Case Manager New Castle & Sussex Counties Resume Examples & Samples

Occasional field visits to members
Strong Pediatrics and Adult clinical background
Behavioral Health Experience

149

Rn Case Manager Lead Sign on Bonus Resume Examples & Samples

Accurate medical necessity screening and submission for Physician Advisor review
Care coordination
Transition planning assessment and reassessment
Implementation or oversight of implementation of the transition plan
Leading and facilitating multi-disciplinary patient care conferences
Managing concurrent disputes
Making appropriate referrals to other departments
Identifying and referring complex patients to Social Work Services
Communicating with patients and families about the plan of care
Collaborating with physicians, office staff and ancillary departments
Leading and facilitating Complex Case Review
Assuring patient education is completed to support post-acute needs
Timely complete and concise documentation in Case Management documentation system
Maintenance of accurate patient demographic and insurance information
Identification and documentation of potentially avoidable days
Identification and reporting over and underutilization

150

Rn Case Manager Resume Examples & Samples

Utilize clinical decision making when applying the nursing process to care of patients in their homes
Apply case/care management, communication, and collaboration principles and skills to provide care in the home health setting
Obtain and implement physicians’ orders accurately and promptly
Develop patient goals and discharge plans and make revisions based on the changes in patient condition
Provide patient education and counseling so that the patient and caregiver have the knowledge, skills and abilities to achieve their maximum level of independence. Document all patient teaching and the patient/caregiver’s level of understanding
Treats employees, patients, and business partners with respect. Fosters teamwork by trusting and supporting each other while encouraging collaboration at all levels of the organization. Embraces diversity and demonstrates the ability to work together
Organizes workload to complete responsibilities in an appropriate and timely manner
Requirement for Pediatric and IV cases only

151

Behavioral Health RN Case Manager Resume Examples & Samples

Perform appropriate documentation to maintain the standards set by the Agency, Federal, State & Local regulations, and/ or Fiscal intermediary
Initiate, develop, implement and revise the patient’s plan of care (POC) and ensure that it adheres to the recommended frequencies of the Healing Pathways. Responsible for continuous review and management of all aspects of the patient’s care, including: Appropriate utilization of services (Healing Pathways recommended frequencies); Monitor visit frequency and duration by reviewing physicians’ orders and comparing to the Plan of Care and documentation; Monitor authorization status and initiating request in a timely manner; Ensure continued skilled need; Evaluate homebound status; Accurate, thorough, timely documentation in the patient’s medical record; Communicate with the interdisciplinary team involved in the Plan of Care; Communicate with the patient’s Primary Care Physician; Case conference with Clinical Supervisor biweekly or as frequently as the patient’s condition requires to discuss changes in the POC
Compare assessment data to baseline assessment to monitor patient’s progress. Recognize alterations in function, including life-threatening situations. Intervene and document appropriately
Prioritize the work day assignment based on the patient’s health status and anticipated needs
Places needs of the patient first at all times. Care management and service delivery are developed with the goals of the patient’s healing and support in mind. Strives to deliver lasting value to our patients in the comfort of their home
Strives to make a difference in the lives of our employees, patients, and community
Adheres to departmental and agency dress codes as observed by supervisor

152

Rn Case Manager Resume Examples & Samples

Registered Nurse in the state(s) of practice and must possess a valid license in the state(s) of Kentucky
Minimum of one year's experience as a Registered Nurse
Previous experience in home care preferred
Familiarity with Medicaid programs and community resources preferred
Excellent organizational and problem solving skills
Ability to multi task and coordinate many activities at once
Ability to transfer, maneuver, and lift incapacitated clients in the home setting
Enjoys working with senior and/or disabled population

153

Rn Case Manager Resume Examples & Samples

Demonstrated ability to perform Case Management activities; strong clinical knowledge and capacity for continued learning
Knowledge of UM and plan benefit design
Strong verbal and written skills. Competent with MS office and other practice management systems or possess the ability to continue learning new applications
3+ years of direct patient nursing care with a focus on discharge planning or case management. CCM certification preferred
Proficient in Critical Thinking nursing skills of RN Case Manager. Ability to organize and prioritize tasks for self and patients
Registered nurse with active unrestricted license in the State of Nevada
1+ years of experience as a RN
Bachelor's Degree in healthcare or related field or working towards a Bachelor's Degree
Possess a valid Nevada Driver's licenses and maintain personal auto insurance coverage
Home health

154

Telephonic RN Case Manager Resume Examples & Samples

Provide Case Management for Workers Compensation beneficiaries
Follow up calls and patient assessments telephonically
BSN preferred but not required
2-5 years of Workers Comp Case Management experience preferred
Background working telephonically
Computer proficiency required, must be able to use multiple programs and toggle between them

155

RN, Case Manager Resume Examples & Samples

Coordinates clinical care services to ensure consistent standards of care and appropriate use of resources; and to prevent unnecessary delays
Facilitates psychosocial care coordination to ensure timely identification and resolution of psychosocial issues impacting patient throughput
Effectively manages resource utilization to ensure efficiency and appropriate reimbursement
Proactively initiates discharge planning and placement to facilitate timely patient transition to the next level of care
Collaborates with medical staff members to promote complete and accurate physician documentation in the medical record
Integrates clinical, financial, ethical, compliance, and other variables in complex decision making
Actively participates in projects designed to reduce costs, capture lost revenue, or enhance efficiency
Educates medical staff and others regarding documentation, medical necessity, available resources, and reimbursement issues
Develops and maintains a working knowledge of current reimbursement methods and regulations pertinent to RN case management practice

156

Rn Case Manager Resume Examples & Samples

This RN role provides telephone contact and kp.org to defined high risk OBGYN patients. The medical advice contacts are based on the clinical acuity of the patient and plan of care established by evidence based medicine and KPNW Nursing protocols, member feedback and provider direction. Responsibilities include nursing assessment, analysis, planning, and implementation of interventions; the monitoring and evaluation of the effectiveness of the plan of care; and facilitating changes in the plan of care; fully documents nursing assessment, treatment, and member response in the electronic medical record per protocols. As part of the patient management, establishes collaborative partnership with PNS clinicians, support staff and other pertinent members of OBGYN in the management of assigned patients. Maintains close communication with clinician and other team members through internal technology and in person. Participates in care conferences for patients in assigned group so that health care outcomes are achieved. The case/care manager role is accountable to PNS for direction and workload management
PNS Operational Support. Supports medical operations; including high risk case care management and other support for PNS operations. Included: Outreach training of RN personnel who work with preterm birth prevention member enrollment; implement staff education tools and methods; accountable for individual productivity; maintains quality management plans; participation in activities which will facilitate the ability of PNS to successfully meet requirements. First trimester screening and NST backfill support
Provides program development, quality management and implementation. Establishes, implement, maintain, and insure applications of standards of care and practice; the standards will be clinical Nursing practice and administrative. Includes key functions: prepare educational materials for members and RNs who work with selected high risk members. Ensuring program quality management by developing, implementing, and evaluating a program plan; ensuring self and team participation; collection and analysis of date and information. Assessment, planning and development of necessary materials, resources, systems and services to ensure care is clinically appropriate, cost effective, and in a manner satisfying to the member. Department activities completed: includes coordination of activities with other departments; develop, compile, analyze statistics and reports; information sharing and problem solving with other departments and stakeholders; meeting regulatory and safety standards applicable to the program. Performs other PNS duties as requested: Non-stress testing including limited ultrasound, first trimester screening and other medical advice as needed to support the PNS health care delivery
Minimum of six (6) years recent Ob-GYN nursing experience including antepartum, post-partum, non-stress testing including limited ultrasound and two (2) years high risk Ob-GYN nursing
Previous phone advice and triage nursing experience
Experience in providing group and individual education including educational presentations
Experience in developing educational materials and curriculums
Bachelor's of nursing or equivalent knowledge and experience (equivalent knowledge and experience being four (4) years of RN experience)
Diabetic Educator

157

RN Case Manager PRN Resume Examples & Samples

Reviews patient population for appropriate disposition and communicates with ED/primary physician
Collaborates with Bachelor’s Social Worker in cases where their intervention is indicated
Monitors plan of care to ensure timely and cost-effective use of resources
Maintains liaison with hospital department managers and other individuals to ensure continuity of care and effective communication of plan of care
Five (5) years case management experience preferred

158

Rn Case Manager Resume Examples & Samples

Assesses patient from clinical, social, financial perspective and coordinates post-discharge needs with care team
Functions as a clinical and financial resource for patients and interdisciplinary team members
Assists in clinical data collection utilizing established criteria and the InterQual system
Proactively performs utilization review; communicates coverage information with third party payers, medical staff and clinical providers
Five (5) years experience in a variety of clinical settings (i.e., home health, inpatient, physician office, clinic) required

159

High Risk RN Case Manager Resume Examples & Samples

This is a telecommute position requiring up to 25% travel in assigned region. We have one opportunity covering Jackson County MO and one opportunity covering St. Louis County, MO.**
Will serve as the primary contact for staff, health care providers and caregivers for children in the custody of the Jackson County Office of the Missouri Children’s Division
This designee will participate in and attend medical oversight meetings and cooperate with the Medical Care Management Agency to secure medical histories and provide medical records
Review and revise plan of care as needed based upon the needs of the member
Work collaboratively with service providers, families and Social Service worker to identify and access resources to meet the needs of members and support stable placements and permanency planning
Work with Social Service worker and network providers to ensure timely access to services following discharge from hospitalization or residential treatment
3 + years recent experience as a case manager, home care RN , foster care system and/or social service coordination
Foster Care experience highly preferred
Experience with Medicare and/or Medicaid
Experience with the Department of Social Services, Children’s and MO HealthNet Divisions

160

Rn Case Manager Resume Examples & Samples

Ability to work independently and exercise sound judgment in interactions with physicians, payors, patients and their families
Current AHA CPR for Healthcare Providers certification
Profession certification as a Case Manager is preferred

161

Rn Case Manager, Days Resume Examples & Samples

Identifies the provision of inappropriate or untimely services
Facilitates timely and appropriate discharges from the hospital. Identifies opportunities for improvements in patient care
Provides documentations of all functions, as required by regulatory agencies
Associate’s Degree (or Diploma) in Nursing is required; Bachelor’s Degree in Nursing is preferred
A minimum of one (1) to three (3) years of nursing experience required. Case management experience preferred

162

Rn Case Manager Resume Examples & Samples

Bachelors' Nursing or health related field Required
Master's degree in Nursing, Case management, or related field Preferred
Knowledgeable in child, adolescent, adult and geriatric psychopathology as well as psychiatric interventions
Must be knowledgeable with psychiatric psychosocial and legal issues and chemical dependency assessment and treatment, understanding of current insurance benefits and restrictions in the area of mental health
Knowledgeable of available community resources and of discharge planning policies
Must obtain and maintain current certification in Management of Assualtive Behavior and CPR within 30 days of hire
BLS-HCP
National certification in Case Management
Prior work experience in clinical social work position is required; preference for mental health experience
Demonstrates ability to plan, organize, set and accomplish objectives
Demonstrate sound clinical judgment, problem solving and decision making skills
Must exhibit excellent communication skills
Must be able to express ideas verbally in an articulate manner
Must be able to perceive the nature of objects by sight and sound. Incumbent must have manual dexterity of fingers on either or both hands

163

Onsite RN Case Manager Resume Examples & Samples

3+ years of experience in a hospital, acute care, or direct care setting
Access to reliable transportation and ability to travel to the required facilities/sites within the service delivery area
Previous case management or other managed care experience
Experience working with the geriatric patient population

164

RN Case Manager Med Surg Resume Examples & Samples

Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions
Compiles, evaluates, and reports statistics to members of the team and utilizes the information to facilitate process improvement activities
Adult Med Surg RN experience
Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred

165

Rn-case Manager Resume Examples & Samples

Current unrestricted license by the State of Tennessee as a registered nurse
Bachelor of Science in Nursing required; Masters of Science in Nursing preferred
Five years of clinical and case management/health coach experience required
Clinic/Physician office, home care, public health and/or social service experience preferred
Experience in patient education preferred
Must have strong organizational (time management) skills, strong interpersonal skills and the ability to handle multiple priorities
Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost) for individual users of health care and patient populations
Certification as Healthcare Coach or obtained within three years of hire
Certification in case management (CCM), public health and/or community health preferred
Ability to work autonomously within matrix environment without direct supervision or support
Demonstrates a wide theory base and sound clinical skills to function as a nurse generalist

166

Rn Case Manager Resume Examples & Samples

Based on standard operating procedures, verifies and communicates current, accurate and complete clinical information to payor from patient Pre-Admission through Concurrent Review using standard and plan review forms to justify clinical necessity according to payor review schedule. Ensures documentation is timely, accurate and complete in PCC and field file
Reviews Pre-Admission Review (PAR) and IRM Pre-Authorization assessment to identify costly treatments, supplies or services
Negotiates for appropriate continuation of length of stay or extension of services and appropriate Level of Care (what is covered/what is not covered) and associated rates
Facilitates obtaining payor authorization for recommended treatments, procedures, supplies, equipment and medications and all exclusions
Reviews Admission orders on all managed care patients for appropriateness. If necessary, re-negotiates Length of Service and Level of Care
Communicates contract terms for patient's stay to Interdisciplinary Team, e.g. Level of Care, Length of Service, Utilization of Services, Inclusions and Exclusions, Revenue Per Day, Network Providers, Rehab Treatments
Actively monitors patient case throughout stay to ensure utilization of services are in accordance with plan of care and minimize financial risk to patient and center
Acts as resource to Physicians, NPs and Treatment Team to identify alternate, cost-effective treatment options
Liaises with appropriate staff to gain or provide information, e.g. CRC, Unit Manager, Social Worker, Business Office, Rehab Program Manager
Reviews Rehab Optima (ROX) Documentation and clearly document current clinical and discharge planning information sent to payer and maintain in field file
Actively participates in weekly Utilization Meeting
Alerts appropriate staff and vendors of non-covered services
Alerts appropriate staff when duplicate services are ordered
Monitors changes in status that could lead to hospital readmission and report to nursing
Identifies overuse of resources such as rehabilitation therapy, diagnostic studies, non-formulary medications and medical supplies
Alerts Center Designee to last covered day of service. Requests Notice of Non-Coverage be delivered to patient/family for signature with copy of notification in Center Financial File
Assists Center in responding to denial of continued services by providing clinical information that substantiate medical necessity. Writes clinical appeals to insurance plans as needed
Prepares patient case for discharge/transition by ensuring network providers are known and securing all appropriate authorizations for a safe, coordinated discharge for patient/caregiver
Assesses patient/family risk factors as it relates to resource utilization: chronicity, complications and co-morbidity and identify barriers to a timely discharge
Consults Social Worker immediately for all social, customer/family problems that are identified as barriers to a timely, appropriate discharge
Maintains comprehensive case management records on all customers that reflect authorizations, extensions, levels of care, dates of service and rates approved by the payer to include name, phone and date of payer case manager's authorization
Manages relationships with 3rd party payors ensuring timely responses
Resolves issues promptly
Identifies service delivery and process improvements and communicates to supervisor

167

RN Case Manager, Home Health Resume Examples & Samples

Provide care utilizing infection control measures that protect both the staff and the patient
Monitor assigned cases to ensure compliance with requirements of their party payors
Perform on-call responsibilities

168

Rn Case Manager Resume Examples & Samples

Takes in - bound calls and places out - bound calls as dictated by consumer and business needs
3+ years of Clinical RN experience, preferably in ambulatory or inpatient setting
1+ year of Case Management experience
Ability to travel 30% of the time to our IPA / Vendor sites
Coaching and / or decision support - experience

169

RN Case Manager Care Coordinator Days Resume Examples & Samples

Current Texas Licensure as a Registered Nurse required
Bachelor of Science Degree in Nursing required
Three years of direct patient care nursing experience in an acute care setting preferred
Prior Case Management experience preferred
Ability to work at a fast pace and to prioritize multiple assignments/projects and respond to numerous requests
Ability to resolve conflicts among staff and to work collaboratively with department director, physicians and other members of the healthcare team
Ability to ensure operational efficiency
Ability to problem solve and make decisions

170

Onsite RN Case Manager Resume Examples & Samples

Proactive post discharge follow - up; telephonically or in home as appropriate
Interact in a collegial and collaborative fashion with hospital clinical staff to include: RNs, Social Workers, UR / UM, physicians, and non - clinical support staff
Access to reliable transportation and ability to travel to the required facilities / sites within the service delivery area
Experience in a critical care setting

171

Onsite RN Case Manager Resume Examples & Samples

Current, unrestricted RN license in the state of Florida
Access to reliable transportation and ability to travel to the required facilities/sites within the service delivery area as indicated
Previous case management or other managed care experience (disease management, utilization review, discharge planning, etc.)

172

Rn Case Manager Days Case Management Resume Examples & Samples

RN (BSN preferred)
Current licensure by the Texas State Board of Nursing
Current BLS for health care providers
Accredited Case Manager (ACM) preferred
At least 2 year’s acute hospital patient care experience
Acute hospital case management experience preferred
Excellent organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people
Demonstrated critical thinking and problem solving skills
Computer literate

173

Infertility RN Case Manager Nationwide Telecommute Resume Examples & Samples

Making outbound calls to assess members' health status
Identifying gaps or barriers in treatment plans and coordinate ongoing care with providers
Providing patient education to assist with self-management and healthy lifestyle changes
Documenting and tracking progress from initial assessment through post-operative care
3+ years of nursing experience in Infertility
Computer proficiency, including the ability to type and talk at the same time and to navigate within Microsoft Windows
Access to high speed internet form home
Dedicated work space

174

RN, Case Manager Home Health Resume Examples & Samples

Completion of three years of employment at the Staff Nurse II level with the last six months of employment completed at Dominican Hospital, or three years of employment at a comparable level at another acute care hospital, or completion of two years of employment at the Staff Nurse II level with the last six months of employment completed at Dominican Hospital (or comparable acute care hospital) and completion of a baccalaureate or masters degree in nursing or health related field
Meets criteria and performs Home Health Case Management duties
Performs relief charge nurse duties as needed

175

RN Case Manager Hospice Resume Examples & Samples

Actively engage in QAPI initiatives and compliance activities
Coordinate care with contracted facilities, discuss and initiate the written plan of care, and attend care conferences as scheduled
Promote efficiency in use of supplies and visit utilization including mileage
Is an ambassador for the agency in daily encounters with referral sources
One year recent clinical experience and at least one year of Hospice experience required

176

RN, Case Manager Resume Examples & Samples

Analyze data collected from the predictive modeling tools to identify eligible patients for the Case Management Program
Enroll and manage a case load of patients with complex medical needs, completing case management attestations and initial assessments in accordance with health plan requirements
Develop individualized case management plans with prioritized goals and appropriate interventions in compliance with the risk stratification level requirements. In addition, complete all documentation, member communications, and case closures per policies and procedures
Proficient in knowledge of current Case Management Standards
Coordinate Health Care Services with appropriate physicians and health care providers
Manage and provide a comprehensive summary and log of all active Case Management Cases as required by the UM/QA Committee and/or Health Plan
Act as a resource for MPAS Utilization Management Staff, physicians and Health Coaches and Patients
Assist with the evaluation and amendment of Case Management Policy and Procedures
Attend continuing education sessions and training relating to your job functions as required
Perform additional duties/tasks as assigned
Verbal Communication: Capable of interacting with, and relating to, people of varying educational levels and backgrounds, conveying information clearly and succinctly, applying listening, tact, responsiveness, empathy, and confidentiality. Effective in communicating verbally with other staff and departments related to the job responsibilities
Problem Sensitivity: Effective in identifying and analyzing problems
Computer Proficiency: Must be able to type 40 wpm on a keyboard-typing test required. Proficient in Microsoft Office
Minimum of 2 years' experience in managed care and case management

177

Rn-case Manager Resume Examples & Samples

Demonstrated ability to efficiently and independently manage own time and tasks with minimal supervision
Recent experience as an UM Coordinator and CM in DC Planning in an ED or acute care hospital setting
Knowledge of UM tools such as InterQual or Milliman criteria
Ability to use Microsoft Office Suite products (Outlook, Word, Excel, Power Point)

178

Pain Management RN Case Manager Resume Examples & Samples

Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating linkage with appropriate services and resources when the member’s level of chronic pain risk/need changes
Serves as the primary point of member contact. Assesses member needs, manages care and services, and ensures effective communication among members, caregivers, providers and community supports
Provides members with information and referral for alternative and complementary care, as needed and as provided in the member’s benefit plan
Maintains timely, complete and accurate documentation using both hard copy and technology-based solutions in compliance with regulatory policies and procedures

179

Rn Case Manager Resume Examples & Samples

Develops and implements a case management plan, including a waiver service plan, in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals and member's support network to address the member needs and goals
Assesses for medical necessity and authorize all appropriate waiver services
Evaluates covered benefits and advise appropriately regarding funding source
RNs provide consultation, recommendations and education as appropriate to non-RN case managers
RNs conduct medication reconciliation when needed

180

Rn-case Manager Resume Examples & Samples

Minimum – two years in acute care hospital
Preferred – experience in case management, discharge planning or utilization management role
Familiarity with case management role in health care setting
Knowledge of medical terminology, utilization management criteria, community resources, and health care reimbursement systems
Ability to analyze data, apply critical thinking process to problem-solving. Demonstrated capacity to work with inter-disciplinary team (especially physicians) and communicate effectively
Knowledge of InterQual and/or Milliman criteria is preferred
Moderate computer skills is required

181

Rn Case Manager Resume Examples & Samples

Communicate with all stakeholders the required health - related information to ensure quality coordinated care and services are provided expeditiously to all members
Licensed RN for the State of Tennessee
1 year of experience in hospital, long - term care, home health, hospice, public health or assisted living
Medicare, Medicaid or Medicaid Waiver experience
Experience with community based resources

182

Rn Case Manager Resume Examples & Samples

Complete initial and routine assessments for the purpose of identifying member care needs
Initiate care planning and implementation of a comprehensive care plan which is member-driven and addresses medical and / or behavioral health needs
Engage members routinely telephonically and in-person via home / facility visits to coordinate services, community resources, and provide health education
Identify early risk factors and targeted condition management interventions as necessary
Advocate for member needs and services and provide assistance to members in navigating the healthcare system
Current, unrestricted RN licensure in the State of Nebraska
1+ year of clinical or case management experience in a medical, long-term care, Native American population care management, or behavioral healthcare setting
Intermediate level of Excel to including spreadsheets and the ability to open, read and navigate Microsoft Office suite applications (Word, Outlook / Email, Internet), as well as the ability to type and talk at the same time and toggle between multiple applications
Do you have access to reliable transportation that will enable you to travel to client and / or patient sites within a designated area?
Access to high speed internet for home office set up
BSN or higher degree for Nurses, Master’s degree or higher for Behavioral Health Clinicians
Medicaid experience
Experience working with pediatric patients
Experience with electronic documentation methods and field-based technology use
Bilingual in Spanish

183

Rn-case Manager Resume Examples & Samples

Serve as the liaison to physicians and nurses, physicians and families, referring physicians, and surgeons
Assist physicians in monitoring EKG's, lab values and diagnostic procedures
Intercede calls for physicians from office or consults and hospitals
Perform patient assessment based on information provided by hospitals, physicians and nursing staff
Give appropriate verbal orders per protocol
Follow protocols for triaging calls, referring to on call physician when necessary
Prepare patient list of consults/patients received during previous night for incoming on all physicians
Available at all times during on call hours. Notify answering service of any contact information changes
Two or more years Med/Surg or internal medicine; ICU experience preferred

184

RN Case Manager New Jersey Resume Examples & Samples

Collaborate with Community Health Workers and Behavioral Health
Interact with Medical Directors on challenging cases including presenting at rounds
Current, unrestricted RN license in New Jersey
2+ years of experience in a hospital setting, acute care, direct care experience and/or experience as a Case Manager
Ability to navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word and Excel
Ability to talk and type proficiently at the same time
Experience working with populations with special needs
Bilingual – English/Spanish

185

Telephonic RN Case Manager Resume Examples & Samples

3 years experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
Ability to work 11:30am-8pm Monday-Friday
Willingness to obtain additional licensures as needed
Minimum of 5 years clinical RN background
Bilingual (Fluent in English and Spanish)

186

Rn-case Manager Resume Examples & Samples

Assesses for barriers to care, provides care coordination and assistance to member to address psycho/social, financial, and medical obstacles concerns
Facilitates comprehensive waiver enrollment and disenrollment processes
50-75% travel required

187

Rn Case Manager Resume Examples & Samples

Utilize regional population stratification information and processes to identify appropriate members for enrollment into case management in collaboration with clinicians and health care team
Triage findings from member assessments, identifying needs and issues, engage patients to define a plan of care and appropriate level of self management and interventions. Determine Level of Care
One (1) year of ambulatory oncology experience within the past three (3) years
One (1) year of telephone triage within the past three (3) years
Previous experience with population care/case management, triage and advice for surgical population preferred
ONCC Certification preferred

188

Rn Case Manager, Days Resume Examples & Samples

Current Utah Registered Nurse License
Three to five years experience in an acute care setting. Two years experience in Case Management and/or Discharge Planning preferred
Excellent public relation skills, knowledge of community resources, knowledge of regulatory agencies

189

High Risk OB RN Case Manager Resume Examples & Samples

*Office Based role at 2716 N Tenaya***
Collaborate with patient, family, and health care providers to develop an individualized plan of care that encompasses both acute care episode and post hospital discharge plan
Understand insurance products, benefits, coverage limitations, insurance and governmental regulations as it applies to the health plan
RN degree or equivalent
Previous case management experience

190

RN Case Manager PRN Resume Examples & Samples

Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs
Assumes a leadership role in the development, revision, and implementation of clinical protocols which transition patients across the continuum of care or discharge patients to an appropriate service level of care
Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely

191

Rn-case Manager Resume Examples & Samples

Care Management Plan
Actively supports care management plans and process to measure, assess and improve quality, patient outcomes and care management metrics
Collects data on variances from quality screening criteria approved by the appropriate committees, as needed
Reports to Care Management leadership, identification of avoidable days and other Care Management measures including but not limited to, readmission, saved days, core measure monitoring, interventions, and delays, to ensure data is accurately collected
Implements strategies in collaboration with the healthcare team to reduce length of stay (LOS) and resource utilization, never compromising quality or outcomes
Participates in quality improvement activities using information and creative thinking skills to promote positive health status and improved outcomes; resolve problems; establish benchmarks as needed; identify and adopt best practices
Implements action plans of identified improvements to resolve problems, increase effectiveness and efficiency, maximize resources and/or decrease cost and LOS as evidenced by dashboards
Participate in performance improvement plans to improve patient satisfaction
Acute Care Management
Provides the professional clinical component of the Acute Care Management model to ensure that department services support quality patient care and safety while coordinating patient throughput
Prioritizes patient needs for Care Management services based on: target/high volume Diagnosis-Related Group (DRG), high cost, outlier, LOS, frequent inpatient admission, unplanned readmission or significant variance
Supports the healthcare team with identifying decisions maker to ensure all plans and expectations are communicated in a timely manner including discharge plans and expected LOS outcomes and documents appropriately in the patient’s electronic health record
Identifies risk factors for potential crisis intervention needs related to clinical diagnosis, prognosis and/or patient/family dynamics
Coordinates the discharge planning process. Acts as a resource for discharge planning. Collaborates with the healthcare team to develop a discharge plan that includes the next step in the continuum (Post-acute services including Home Care, Durable Medical Equipment, Nursing Home Placement and/or other services) to identify patient needs relating to medical diagnosis, treatment, financial resources and psychosocial needs, assisting in transitioning patients to the appropriate Level of Care (LOC)
Ensures the multidisciplinary discharge plan is consistent with the patient’s clinical course, continuing care needs and covered services. Evaluates on an ongoing basis the patient’s status and progress toward reaching goals set forth in the plan of care. Revises and updates treatment plans as necessary and provides supportive documentation
Documents assessments, discharge plans and changes to discharge plans in the patient’s electronic health record
Participates in Touch Base Rounds in assigned areas and physician rounding on select patients
Works collaboratively with healthcare team on appropriate documentation to accurately reflect the severity of patient’s illness. Actively participates in the education of physicians and other healthcare team members on appropriate utilization of services and Level of Care (LOC) indicated by the clinical and/or socio economic situation to achieve optimal reimbursement
Conducts referrals to Care Management Leadership, Vice President of Medical Affairs, Ethics Committee, Risk Manager, and Legal Services as appropriate
Reviews daily admission and collaboratively creates a plan to positively impact desired outcomes
Professional Clinical Component
Provides the professional clinical component of the inpatient Care Management model to ensure that department services support quality patient communication, education and financial components while coordinating patient throughput
Facilitates all issues surrounding patient care in a compassionate manner
Supports the patient/family decision regarding advance directives or verifying a surrogate decision maker
Works collaboratively to assess for clinical, spiritual, financial, educational, functional and psychosocial baselines for patient/family to determine appropriate and realistic outcomes
Educates patient/family support system on the plan of care and expected outcomes. Improves patient/family understanding of and adjustment to the medical diagnosis/prognosis or other care issues
Refers patient to community resources. Supports Heart Failure Process as assigned
Ensures the negotiation for any benefit enhancements available to meet the discharge needs
Assist with fiscal management by identifying cost containment strategies regardless of limitations of policy/benefits available to patient; uses supplies and equipment efficiently
Issues patient notification for transfers of financial liability and counsels patients on utilization determinations when appropriate
Ensures patients are in the appropriate Level of Care (LOC) according to evidenced based, physician approved criteria and standards and prescribed plan of care. Provides accurate documentation for financial follow through
Obtains Discharge planning information from third party payer in a timely manner and per contractual agreements. Obtains authorizations in a timely manner for discharge planning needs
Oversees the effective coordination of patient care services including: fiscal processing and assurance through managed care systems, initial evaluation and assessment, plan of care development, patient/family education and follow through with post discharge services and needs in a timely manner
Performs reviews utilizing evidence based tool for reviews as necessary
Denial Management
Maintains knowledge of managed care and government appeal processes and timelines
Conducts through case reviews on all confirmed case denials including discussion with the appropriate Care Managers and Physician Advisors (PA)
Transitional Planning
Works with interdisciplinary team to coordinate needed services to ensure efficient continuity of care
Assesses need for services through collaboration with physicians and nursing staff
Plans for care needs with active involvement of patient, significant others, hospital staff involved in treatment process
Oversees implementation of transition plans with support from internal and external agents
Monitors patients’ progress and adequacy of planning process through regular communication with patients and service providers
Documents actions in medical record according to departmental guidelines and oversees process of exchange of information with other facilities/agencies adhering to legal mandates about confidentiality
Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g., overall length of stay, readmission rates, feedback from referral sources, etc.)
Identifies problems or gaps in community resources that impact outcomes and takes leadership role in efforts to effect changes
Behaviors
Exhibits behavior and adopts practices to ensure optimal risk management and financial stability
Identifies potential risk management or clinical quality issues and resolves them through intervention or collaboration with other members of the healthcare team as appropriate or refers the issue to the appropriate individual(s)
Observes Universal Precautions consistently. Wears proper Personal Protective Equipment when appropriate
Maintains knowledge of and adheres to current CHI-St. Vincent facility and Care Management Department policy and procedures
Demonstrates ethical behaviors and provides confidentiality in all Care Management interactions
Identifies and reports ethical situations to Care Management Leadership and Ethics Committee for resolution
Respects patients/guest/coworkers personal property
Maintains confidentially regarding personnel and strategic plans
Maintain confidential Care Management interaction with vendors, third party payers and patient/family at all times
Adheres to CHI-St. Vincent HIPPA policy and procedures
Advocacy for Quality Outcomes
Acts as a patient advocate for optimum care and a business partner to the physician
Participates as a team member to facilitate communication among all disciplines, identify barriers to meeting treatment goals, and determine ways to achieve best outcomes
Provides information and support to patients and families, helping them access needed resources within the medical center and community
Assists physicians in obtaining needed services for their patients and having access to all available data on best practice and financial outcomes
Cultivates collegial partnerships with physicians and other health care professionals and maintains high customer satisfaction ratings in dealing with patients and their significant others
Communicates Effectively
Resolves situations as appropriate within scope of job. Handles complaints/concerns in a prompt and courteous manner; assess and directs to appropriate person to deal with concerns as needed; makes attempt to solve issues with involved parties
Demonstrates tact, courtesy, sound judgment and a professional attitude when relating with patients, families, coworkers, physicians, and affiliated agencies
Gives and receives feedback in a positive manner
Communicates both verbally and in writing with physician and appropriate hospital staff regarding patient needs and progress of discharge plan
Meets with Care Management Leadership to discuss case specific issues
Actively participates in staff meetings, for information exchange, discussion of performance indicator results and action planning
Develops professional relationship with community partners
Care Management Education
Provides Care Management education to peers and consumers; participates in providing continuing educational activities
Assist with providing education of Care Management services, policies and procedures to physicians
Actively seeks to improve skills and knowledge base for personal and job development through literature review and participation in in-services and other educational programs
Consistently works toward standards of excellence to continually improve personal performance
Responsible for ensuring current licensure, Basic Life Support (BLS) certification, and other required certification as applicable
Responsible for documenting continuing education and mandatory in-service attendance and forwarding the information Care Management Leadership
Professional Public Image
Portrays a positive public image at all times
Acts as a role model for others
Recognizes, appreciates, accepts and values differences in people and treats all with dignity and respect
Attends and participates in CHI- St. Vincent facility committees as assigned
Wears clothing and CHI-St. Vincent identification badge consistent with dress code and attends to personal hygiene to maintain a clean, well groomed appearance
Maintains attractive, safe, and clean workspace
Meets CHI- St. Vincent facility attendance standards
Builds and maintains positive relationships with healthcare team, placing organizational/team goals first
Assumes responsibility, authority, and accountability for patient load, assisting other coworkers when requested or as the need arises
Meets deadlines and takes responsibility for accomplishing one’s own work
Takes feedback from coworkers and uses feedback to improve performance
Participates in peer evaluations
Identifies and actively participates in projects to assist with team self-actualization
Participates as a team member with department wide events/programs
Uses appropriate resources and methods to resolve conflicts with others in a positive and professional manner
Technology
Documents data accurately in the utilization management module to ensure data for tracking and trending is accurate
Uses technology for risk management, quality improvement activities, data collection, process improvement and evaluation of improvement interventions
Maintains technical knowledge and skills of computer systems (Interqual, Cerner, Star, and Email)
Consistently makes appropriate mandatory reports to appropriate agencies

192

Inpatient RN Case Manager Resume Examples & Samples

Performs concurrent and retrospective onsite or telephonic clinical review at the designated network or out - of - network facilities as needed / directed by the ICPS Management team
Documenting medical necessity and appropriate level of care utilizing clinical guidelines (e.g. Milliman, Interqual). Complies with CMS regulations and Health Plan requirements
Efficiently navigates and utilizes computer data entry programs including, but not limited to: Microsoft Office (Outlook, Word, and Excel)
Provides guidance and benefits information for members and their families and facility discharge planners
2+ years of recent experience working inpatient hospital
1+ year of experience in utilization management
Efficiently navigate Microsoft Office (Word, Excel, Outlook)
1+ year of experience in case management
1+ years of experience in managed care

193

RN Case Manager, Home Health Resume Examples & Samples

At least one year as an RN in acute care setting or specialty area
Demonstrates ability to work within a decentralized model of patient-care delivery
Demonstrates proficient intermediate nursing skills and specialty skills
Current CPR certification and current California driver's license with proof of liability insurance for automobile

194

Rn Case Manager Resume Examples & Samples

Adhere to the scope of practice for Registered Professional Nurse per state regulatory guidelines
Demonstrate appropriate judgment skills to be able to make independent clinical decisions in routine patient care matters
Promote the level of clinical expertise required of staff to provide safe, high quality nursing care
Perform appropriate documentation to maintain the standards set by the Agency or Fiscal intermediary including timely recording of evaluation data, interventions, and client’s response to interventions
Review results of laboratory tests and other diagnostic procedures
Supervise and direct assigned LPN’s and Aides per Federal, State and Local regulations and Agency policy
Assume responsibility for maintaining compliance according to Federal, State and Local regulations and Agency policies and procedures
Identify significant clinical findings, make conclusions and intervene appropriately. Provide services requiring specialized nursing skills
Demonstrate the knowledge of the principles of growth and development over the life span and possess the ability to assess data reflective of the patient’s status
Provide the care needed as described in the Agency’s policies and procedures
Compare assessment data to baseline assessment to monitor patient’s progress. Recognize alterations in function, including life-threatening situations, and intervene and document appropriately informing physician and other team members of changes in client needs or services required
Initiate patient education based on identified learning needs of the patient and / or those providing care and document appropriately including disease process self care techniques and disease prevention strategies
Prioritize nursing visits based on the patient’s health status and anticipated needs
Demonstrate the skill and judgment necessary to implement physician orders, nursing procedures and nursing interventions
Assume on-call responsibilities as per on-call needs
Implement physicians orders accurately and promptly, using nursing judgment
If assigned as a field nurse, perform direct patient care as relates to the plan of care

195

Palliative Care RN Case Manager Resume Examples & Samples

Conducts urgent / acute visits on established Bridges home based care patients with the goal of keeping the patient out of the hospital in order to receive the best medical care at home
Ability to conduct an advanced care discussion with a patient and their family and properly document their wishes in the electronic medical record
Ensure continual assessment of patient and family needs from admission to Bridges home based care throughout the course of care
Attends the interdisciplinary meeting and is a crucial and vocal member of the team
Serves as a resource or consultant for LVN or LPN
Attends educational offerings to keep abreast of palliative care and complies with licensing requirements
Informs the provider of patient’s needs and outcomes of interventions as per standards
Determines the scope and frequency of services needed based on acuity and patient/family needs
Uses the case management approach and refers to other services as needed
Maintains a patient case load, daily visits and point of care documentation levels as per standards
Excellent verbal and written skills

196

Rn Case Manager Resume Examples & Samples

Current, unrestricted RN license in the State of Kansas
3+ years clinical experience in a home health / hospice
Advanced Computer / typing proficiency to enter / retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications

197

Healthy First Steps RN Case Manager Resume Examples & Samples

3+ years of experience in a hospital setting, doctors office, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
3 + years work experience including or similar to labor & delivery, OB, maternal / child, antepartum, postpartum, etc
Must be able to travel to providers offices and interact with providers and staff
Must be able to interact with members face to face in their homes
Must be located in the greater Tennessee area
Field based case management experience
A background in managed care (MCO)
Strong organizational skills and multitasking abilities will be keys to success

198

Healthy First Steps RN Case Manager Resume Examples & Samples

Current, unrestricted RN license in the State of Ohio
2 + years work experience including or similar to labor & delivery, OB, maternal / child, antepartum, postpartum, etc
Must be located in the greater Columbus, OH area
Reliable transportation to travel to provider offices within service delivery area
Maternal Child experience

199

RN Case Manager, Inpatient Services Resume Examples & Samples

Collaborates effectively with integrated care team (ICT) to establish an individualized plan of care for members. The interdisciplinary care team develops interventions to assist the member in meeting short and long term plan of care goals
Serves as the clinical liaison with hospital, clinical and administrative staff as well as provides expertise for clinical authorizations for inpatient care. based on utilized evidenced-based criteria
Performs concurrent and retrospective onsite or telephonic clinical reviews at the designated network or out of network facilities. Documents medical necessity and appropriate level of care utilizing national recognized clinical guidelines
Interacts and effectively communicates with facility staff, members and their families and/or designated representative to assess discharge needs and formulate discharge plan and provide health plan benefit information
Stratifies and / or validates patient level of risk and communicates during transition process with the Integrated Care Team
Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member’s home. Develops interventions and processes to assist the member in meeting short and long term plan of care goals
Manages assigned case load in an efficient and effective manner utilizing time management skills to facilitate the total work process directly monitoring assigned members
Education: Bachelor’s degree in Nursing, or Associate’s degree in Nursing and Bachelor’s degree in related field, or Associate’s degree in Nursing combined with 4 or more years of experience
Two or more years of managed care and / or case management experience
Ability to read, analyze and interpret information in medical records, health plan documents and financial reports
Must be able to prioritize, plan, and handle multiple tasks / demands simultaneously
Frequently required to stand, walk or sit for prolonged periods
Case Management Certification (CCM) or ability to obtain CCM within 6months after the first year of employment

200

RN Case Manager, Contingent Resume Examples & Samples

Minimum of three years RN clinical experience, preferred
Current working knowledge of discharge planning, utilization management, case management, performance improvement and managed care reimbursement, preferred
Performs duties in amanner to promote quality patient care and customer satisfaction, while promoting safety, cost efficiency, and a commitment to Continuous Quality Improvement process

201

RN Case Manager, / Rehab Resume Examples & Samples

Bachelors of Science in Nursing, required
Possess interpersonal communication and negotiation skills
Organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components with minimal supervision
Performs duties in a manner to promote quality patient care and customer satisfaction, while promoting safety, cost efficiency, and a commitment to Continuous Quality Improvement process
Current and valid license to practice as a Registered Nurse in the State of Michigan

202

Rn Case Manager Resume Examples & Samples

Participate in continuing education/professional development activities
Communicate and demonstrate a professional image/attitude for patients, families, clients, coworkers and others
Adhere to policies and practices of applicable professional organizations, client hospital and RehabCare Group
Contribute to client relations and marketing activities
Maintain competency, licenses/ certifications, and memberships in applicable professional organizations
Demonstrate use of effective case management skills to plan, coordinate and evaluate patient care and movement in the care continuum
Supports the team in the development of individualized care plans
Establishes and maintains a therapeutic relationship with patients and families

203

RN Case Manager, Weekend Baylor Plan Resume Examples & Samples

Completes, maintains and submits accurate and relevant clinical notes regarding patients/clients condition and care given
Uses supplies and equipment effectively and efficiently
Is a graduate of an accredited school of professional nursing. BSN preferred. 2. Is currently licensed as an RN through the State Board of Nursing
Has at least one year's general nursing experience, with current home health, clinical, surgical, or critical care experience
Has satisfactory references from nursing school, previous (or current) employers and/or professional peers

204

Rn Case Manager Prn Days Case Management Resume Examples & Samples

RN (minimum of BSN preferred)
Current licensure by the Texas State Board of Nursing
Current BLS for health care providers
At least 5 year’s bedside experience or LVN with 10 years bedside experience
Excellent organizational skills
Excellent verbal and written communication skills
Ability to lead and coordinate activities of a diverse group of people
Demonstrated critical thinking and problem solving skills
Computer literate

205

Rn Case Manager Resume Examples & Samples

Strong clinical background with 5+ years acute care nursing experience required
Relevant case management experience required
Audit and chart review experience required
Knowledge and understanding of Medicare IPPS rules and regulations
In-depth knowledge of case management, discharge planning, and utilization review practices and ability to incorporate current trends successfully
Knowledge and understanding of governmental and JCAHO regulations
Must have strong clinical, analytical, written, verbal and presentation skills
Ability to communicate effectively in oral, written and electronic formats
Ability to establish and maintain collaborative and effective working relationships with a focus on the importance of teamwork
Travel 40%

206

RN Case Manager / Discharge Planner Resume Examples & Samples

Interview resident/families to obtain social history
Communicate with patient and families in coordinating discharge planning
Involve the resident/family in planning social service programs when possible
Work closely with interdisciplinary team in determining expected discharge after rehab
Refer resident/families to appropriate social service agencies when the facility does not provide the services or needs of the resident
Provide information to resident/families as to Medicare/Medicaid, and other financial assistance programs available to the resident
Provide consultation to members of our staff, community agencies, etc., in efforts to solve the needs and problems of the resident through the development of social service programs

207

Utilization Review RN Case Manager Resume Examples & Samples

Must possess excellent customer service and communication skills
Must be organized and a self-starter, be able to utilize multiple resources to determine health plan requirements and benefits as applied to the utilization and case management process and clinical decision making
Three to five years experience preferred in a managed care setting/utilization review/discharge planning/case management

208

RN Case Manager / Franklin Hospital Resume Examples & Samples

Access to care and services
Bachelors Degree in Nursing, required. Masters Degree, preferred
Patient Review Instruments (PRI) Certification and Case Management Certification, preferred
Minimum of one (1) year related experience, required, Utilization Review/Discharge Planning experience, preferred, or completion of NSLIJ Care Coordination Extern Program, required
Demonstrates positive and professional written, verbal and non verbal communication skills
Knowledge of regulatory and survey standards (IPRO, Joint Commission, Department of Health, CMS)
PC literate. Knowledge of Microsoft Office, Excel spreadsheet management required

209

Rn Case Manager Resume Examples & Samples

Graduate from accredited school of Nursing
Current Registered Nurse licensure
Licensed as Registered Nurse in the State of Alaska at time of hire
Two (2) years experience as a Registered Nurse
Bachelors of Science in Nursing (BSN.)
Three (3) years of clinical nursing experience
One (1) year of experience as an RN in Utilization Management-review, Case Management and Discharge-planning experience
Prior experience with provider requirements for admissions, transfers and discharges
Experience with InterQual criteria, Medicare standards and COBRA regulations
Prior experience using Microsoft Office Suite

210

RN Case Manager, ACO Resume Examples & Samples

Basic Math Skills
Understanding of privacy and HIPAA standards
Flexibility and multi-tasking skills
Three years in acute care setting
Previous ACO Program preferred
Proficient computer use (includes typing, Internet, MS Office, Analytics Software)

211

Rn-case Manager LOA Resume Examples & Samples

Provide support to Leave of absence claims examiners and Return to work Specialists regarding medical documentation to support the need for the Leave
Assess adequacy and appropriateness of treatment and evaluate need for alternative treatment
Identify and resolve stated limitations inconsistent with medical documentation. Assess medical records to determine if claim for disability is caused or contributed to by a limited or excluded medical condition
Communicates effectively with handling claims examiner, client, claimant, attorney and supervisors
Assists employee-client in making informed choices, maintain client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards
Works with Managers and Return to work specialists so reasonable accommodation occurs for those employees with permanent restrictions within ADA guidelines and internal policy
Review Leave of Absence data to assist in analysis for strategies related to reducing lost work days
Provides high quality customer service by demonstrating diplomacy, compassion and professional competency
Ensures quality standards for case management are met. Implement Allina Health’s continuous quality improvement process whenever efficiencies or quality standards are not met
Participate in Metric creation for accuracy of Leave processing

212

RN Case Manager / PRN Resume Examples & Samples

Licensed RN in the State of Arizona, Bachelor’s degree preferred
Ability to work competently with computer based charting and other clinical and non-clinical software programs
Adaptability to change, good organizational skills
Working knowledge of criteria for Medicare, Medicaid, HMO, and private insurance companies and coverage details
Ability to advocate for patients
Ability to operate office equipment
Ability to effectively interact with insurance companies and communities healthcare resources
Ability to work what is sometimes a stressful, fast passed environment

213

Rn Case Manager Resume Examples & Samples

Technical, critical thinking and interpersonal skills relevant to clinical are in order to effectively communicate with patients and physicians
Ability to speak clearly enabling patients and the like easy comprehension
Ability to write and print legibly
Demonstration of customer focused skills

214

RN Case Manager, Home Health Resume Examples & Samples

Responsible to communicating with all disciplines involved in the patient’s care (i.e., Physical Therapy, Occupational Therapy, Speech Therapy, etc.)
Initiates and applies preventive and rehabilitative care techniques
Uses a systematic approach to plan, assess, implement, and evaluate consistency between the plan of care and the care plan
Communicates changes in the patient’s condition to the team leader, physician and the other team members
Ensures that arrangements for equipment, medication and other necessary items and services are available. Uses equipment and supplies effectively and efficiently
Performs duties in accordance of and under the direction/supervision as defined by the Agency’s organizational
Follows agency policies and procedures. Maintains confidentiality of patients and agency information
Attends in-service and education as required

215

Rn Case Manager Resume Examples & Samples

Seeks consultation from appropriate disciplines/departments as required to expedite care and facilitate discharge
Completion and reporting diagnostic testing
Modification of plan of care, as necessary, to meet the ongoing needs of the patient
Communication to third party payors and other relevant information to the care team
Assignment of appropriate levels of care
Identifies at-risk populations using approved screening tool and follows established reporting procedures
Monitors LOS and ancillary resource use on an ongoing basis. Takes actions to achieve continuous improvement in both areas
Refers cases and issues to Care Management Medical Director in compliance with Department procedures and follows up as indicated
Uses quality screens to identify potential issues and forwards information to Clinical Quality Review Department
Manages all aspects of discharge planning for assigned patients
Facilitates transfer to other facilities as appropriate
Actively participates in clinical performance improvement activities
Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team. Uses concurrent variance data to drive practice changes and positively impact outcomes
Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Outcomes Management
Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning). Uses pathway data in collaboration with other disciplines to ensure effective patient management concurrently
Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team. Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)

216

Rn Case Manager Resume Examples & Samples

Enters observation hours on the Observation Log in a timely manner
Avoidable days are documented appropriately in e/care
Holds PCC meetings, documents team note in chart and keeps a weekly team attendance sheet
Places a note re: the patient’s discharge plan in the multidisciplinary section at least every 3 days
Communicates as requested to insurance companies re: patients clinical status
Participates in the weekly Complex Case Review Meeting
Assist SW or D/C Planner with distributing the discharge copy of the MCL, completing admission assessments and working with patients and families to plan a safe and timely discharge
Notify the physician to facilitate discharge when patient does not meet admission or continued stay criteria

217

Coordinator, Emergency Dept RN Case Manager Resume Examples & Samples

Performs admission medical necessity reviews utilizing approved medical necessity criteria. Assists physicians in selecting the correct status for each patient
Actively builds relationships with the Emergency Department staff and physicians by participating in staff meetings and throughput initiatives as appropriate
Identifies patients that are at high risk for readmissions or is a readmission. Begins the discharge plan of care
Initiates alternative care settings for ED patients (when appropriate) to prevent avoidable readmissions
Knows and understands primary insurances accepted at the facility. Facilitates out of network transfers if necessary
Acts as an educator to ED staff on insurances issues, CMS regulations related to case management and appropriate inpatient/observation statuses
Education: Graduate of an accredited Associate’s or Baccalaureate Degree Nursing Program
Experience: 3 years RN experience in an acute care setting

218

Telephonic RN Case Manager Resume Examples & Samples

Current unrestricted Registered Nurse license in the states covered by the On Call team
4+ years of experience in post - acute care, such as long term care or hospice and / or case management experience as an RN
Baccalaureate degree preferred
Familiarity with the long term care business environment

219

Rn Case Manager Resume Examples & Samples

Graduate from an approved school of professional nursing and currently licensed to practice as a registered nurse in the state of agency operation
One (1) year experience as a RN
Has sufficient endurance to perform tasks over long periods of work hours
Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and is in good working order. Ability to travel to all business locations

220

Rn Case Manager Resume Examples & Samples

Graduate from an approved school of professional nursing and currently licensed to practice as a registered nurse in the state of agency operation
One (1) year experience as a RN
Must possess and maintain valid CPR certification while employed in a clinical role
Has sufficient endurance to perform tasks over long periods of work hours
Must be a licensed driver with an automobile that is insured in accordance with state and/or organization requirements and is in good working order. Ability to travel to all business locations

221

Rn Case Manager, Days Resume Examples & Samples

Current and valid license to practice as a Registered Nurse (ADN or BSN) in the state of Idaho; Bachelor’s Degree is preferred
One to three years of acute clinical experience. 3-5 years is preferred
Strong analytical, data management and PC skills
Strong organizational and time management skills, as evidenced by capacity to prioritize multiple tasks and role components
Understanding of pre-acute and post-acute venues of care and post-acute community resources
Professional certification as a Case Manager is preferred

222

Rn Case Manager Resume Examples & Samples

Candidates must have homecare experience
Working knowledge of OASIS-C documentation
Current State license, CPR certification
Must speak, read, and write the English language

223

Rn Case Manager Resume Examples & Samples

Attends work on a regular and predictable schedule in accordance with agency leave policy and performs other duties as assigned. 2. Monitors the health status of all persons served assigned to the RN Case Manager. Uses nursing skill and judgment and established procedures to assure that optimal nursing care is provided in an attempt to promote the optimal health of persons served. 3. Performs physical assessments in accordance with training and facility protocols. 4. Demonstrates thorough knowledge of the nursing process and nursing procedures. 5. Actively participates in meetings related to care of persons served in order to manage and coordinate health care to achieve optimal health. 6. Demonstrates knowledge of medications administered in order to identify desired effects or adverse reactions. 7. Reviews physician’s orders and Medication Administration Records to ascertain that medications/treatments are administered as ordered. 8. Demonstrates knowledge of safety and infection control practices to ensure a safe working environment. 9. Participates in competency-based training and continuing education activities and meetings in order to maintain competence in nursing best practice. Complies with state mandated continuing education to maintain licensure as a registered nurse. 10. Demonstrates compliance with time and attendance policy and assigned work hours. Observe Standards of Conduct of State Officers and Employees as defined in HHSC HR Manual. Adheres to professional standards of conduct and behavior. 11. Establishes and maintains professional work relationships with persons served, co-workers, supervisors, ancillary staff and visitors. Participates in proactive problem solving related to care of persons served and nursing processes and issues. 12. Follows information security protocols in order to maintain the accuracy and confidentiality of consumer records. 13. Participates in Quality Assurance, Peer Review practices and other activities related to the development/enhancement/refinement of nursing policy and procedure in order to evaluate and improve the quality of nursing care provided on campus. 14. Provide treatment to HHS employees injured in the course and scope of employment. Other duties as assigned include but are not limited to actively participating and/or serving in a supporting role to meet the agency’s obligations for disaster response and/or recovery or Continuity of Operations (COOP) activation. Such participation may require an alternate shift pattern assignment and/or location. Knowledge Skills Abilities
Licensed to practice as a registered nurse in the State of Texas (or a state that recognizes reciprocity through the Nurse Licensure Compact) 2. PLUS TWO (2) years of experience as a practicing nurse in a recognized health agency, hospital, or health-care facility. Initial Selection Criteria
Graduation from a college or university with a degree in nursing; 2. Licensed by the Texas Board of Nursing as a Registered Nurse or a state that recognizes reciprocity through the Nurse Licensure Compact. 3. Experience in assessment and documentation of health status 4. Two (2) years nursing experience 5. Previous experience working with persons with developmental disabilities preferred. 6. Documentation of computer skills. Additional Information

224

Rn Case Manager Resume Examples & Samples

Previous experience as a Case Manager, or minimum 3 years current clinical hospital experience, or Nursing Management experience, or current clinical experience working within the Care Management department
Current Case Manager Certification preferred
Ability to communicate effectively and diplomatically within a multi-functional team

225

RN Case Manager Wellmed Resume Examples & Samples

Works with the PCP and clinic staff to identify patients with high risk diagnoses such as CHF, IHD, COPD / Asthma and Diabetes and ensures clinical guidelines are being followed
Utilizes appropriate motivational interviewing techniques necessary for coaching and assisting the patient to complete self-management goal / action plans
Communicates these needs to the appropriate person (i.e. Social Worker, clinic staff, etc.) or addresses them per process
Decision making is usually based on prior practice or policy, with some interpretation. Applies individual reasoning to the solution of a problem devising or modifying processes and writing procedures
Attends educational offerings to keep abreast of change and complies with licensing requirements, ensures all patient educational materials are up-to-date, and maintains knowledge of specialty and ancillary provider contract contents, to include exclusions and contract terms
Collaborates with the nurse manager to recommend policies, procedures and standards which affect the care of the patient with high-risk chronic disease diagnoses such as CHF, IHD, COPD / Asthma and Diabetes
Ability to push or pull heavy objects using up to 100 pounds of force
Bilingual (English / Spanish) language proficiency
This position requires Tuberculosis screening as well as proof of immunity to Measles, Mumps, Rubella, Varicella, Tetanus, Diphtheria, and Pertussis through lab confirmation of immunity, documented evidence of vaccination, or a doctor’s diagnosis of disease

226

Telephonic RN Case Manager Resume Examples & Samples

Care Coordination for members
Conduct telephonic rounding and identify high risk patients or issues for the Nurse Practitioner to follow - up
6+ months on call experience as a nurse
Must be open to obtaining multi-state RN licensures upon hire

227

Maternity RN Case Manager Resume Examples & Samples

Making outbound calls to assess maternity members' current health status
1+ years of clinical experience dealing with maternity patients
Case or disease management experience

228

Rn Case Manager Resume Examples & Samples

Takes in-bound calls and places out - bound calls as dictated by consumer and business needs
3+ years of Clinical RN experience
1 year of Case Management experience resulting in excellent clinical skills and judgment
Ability to travel 70% of the time to our IPA / Vendor sites
Managed care or ambulatory care experience

229

Rn Case Manager Resume Examples & Samples

Graduate of an accredited professional nursing program required
Minimum of 1 year of acute care nursing, case management, or utilization management experience strongly preferred
Bachelor’s Degree in Nursing strongly preferred
Licensure to practice as a registered nurse in the state of employment
Professional certification in case management preferred

230

Rn Case Manager Resume Examples & Samples

Must be a registered nurse with a current state license
Must have current certification for CPR
Must have a minimum of 1-year general nursing experience with current Hospice, medical, surgical or critical care experience. Experience with providing pain management and IV skills preferred
Must demonstrate a commitment to the company's philosophy of care
Must have experience in providing services to terminally ill patients
Must be a licensed driver with a reliable automobile that is insured in accordance with state and/or organization requirements

231

Rn Case Manager Resume Examples & Samples

Identifies high-risk members appropriate for case management intervention
Initiates contact with patient/family, physician, and health care providers/suppliers to discuss current and alternative treatment plans
Coordinates the delivery of cost-effective, quality health care services for health plan members through the implementation of a care plan that address individual needs of the member
Interfaces with providers of medical services and equipment to facilitate effective communication, referrals, development of discharge planning and alternative treatment plan development
Facilitates communication between patient, physician, health plan, and community
Supervises other team members according to scope of practice guidelines
Monitors, evaluates, extends, revises or closes care plans as appropriate
Assists with the implementation of quality improvement initiatives, including but not limited to STARS measures and Quality Improvement Plans
Adheres to departmental policies and procedures
Serves as a professional resource to other Case Managers and members of the interdisciplinary team
Active and unrestricted licensure as a Registered Nurse (RN) in Florida
Two or more years of experience in a clinical and/or managed care setting as a RN or LPN

232

Nicu RN Case Manager Resume Examples & Samples

Collaborating with hospital staff and other clinical programs to enhance the quality and efficiency in healthcare delivery
3+ years of high risk level II or level III NICU care experience
Dedicated, distraction-free work space within the employee's home with access to high speed internet

233

Telephonic RN Case Manager Resume Examples & Samples

This is a telecommuter position but it does require that you live within the listed region*
Engaging members / families telephonically from the office to coordinate services, community resources, and treatment needs
RN License, must be current and unrestricted in state of Texas
3 + years recent experience as a case manager, home care RN, or clinical RN experience in acute or rehab care setting
MDCP (Medically Dependent Children’s Program)
Experience with complex populations

234

Rn Case Manager Resume Examples & Samples

Clinical Care Coordination -- coordinating multiple aspects of care to ensure the patient progresses
Transition Management -- transitioning of the patient to the appropriate level of care needed
Utilization/Financial Management -- managing resource utilization and reimbursement for services
Outcomes Management -- monitoring, and if needed, intervening to achieve desired goals and outcomes for both the patient and the hospital
Research & Practice Development -- Identifying practice improvements and using evidence based data to influence needed practice changes

235

Rn-case Manager Resume Examples & Samples

Job Satisfaction
Competitive Wages and Benefits
Career Growth
Performs on-call responsibilities and provides on-call service to patients/families, as assigned

236

Rn-case Manager Resume Examples & Samples

Graduate of National League for nursing accredited school of nursing
Minimum of one-year experience
Preferred experience in public health, home care or hospice nursing

237

Infertility RN Case Manager Resume Examples & Samples

Willing and able to obtain additional RN licensures, if necessary, in other states
3+ years of nursing experience in an infertility clinic
Compact state RN license
Strong organizational skills and the ability to multitask

238

Onsite Nicu RN Case Manager Resume Examples & Samples

3+ years experience as a RN with high risk level II or level III NICU focus
Dedicated space in the employee's home for a home office and access to high speed internet
Availability to travel between Newark Beth Israel and Jersey City Medical Centers on a daily basis
Proficiency using MS Excel

239

Rn-case Manager Resume Examples & Samples

Identifies primary diagnosis, reasons for home care, and problems based on assessment, which includes patient demonstration of functional status; then develops a plan of care that will best meet patient outcomes
Meets weekly with Clinical Supervisor to review patient caseloads, assessing the quality of care, coordination of all disciplines involved and appropriate allocation of resources
Responsible for reviewing all admission OASIS data (if SOC/ROC not done by primary clinician) and make changes as deemed appropriate
Triages patient visit needs through a combination of onsite visits and telephone triage
Plans and implements nursing intervention which includes all appropriate elements of nursing care and prescribed medical or other therapeutic regimens, including implementing disease management programs
Must be willing to work a minimum of one weekend per month, two holidays per calendar year and as department may require

240

Home Health RN Case Manager Resume Examples & Samples

Current CPR certification or ability to become certified in CPR within 180 days of hire
Knowledge of basic nursing skills
Basic ability to communicate and comprehend; ability to measure and comprehend certain quantities; knowledge and familiarity with the therapeutic effects and side effects of all medications administered
Must have a good driving record and be able to provide proof of current automobile insurance

241

Rn-case Manager Resume Examples & Samples

Plans patient care in collaboration with all members of the healthcare team
Arranges for home care equipment, healthcare needs
Assumes responsibility for timely completion of required case management reports for regulatory bodies, health plans, and reinsurance carriers
Documentation meets current standards and policies
Maintains optimal continuum of patient care through efficient and effective planning, assessing and coordination of healthcare services
Maintains current licensure
Wears identification while on duty, maintains neat, clean attire. Completes inservices and site audits, returning in timely fashion
Attends Utilization Management Committee, performance improvement and departmental meetings as appropriate
Understanding of healthcare/HMO industry
Knowledge of financial and/or statistical analysis

242

Rn-case Manager PRN Resume Examples & Samples

Performs intake assessment on patient within 24 hours of admission (patients meeting screening criteria)
Performs follow-up assessments per Case Management Plan and/or department policy
Utilizes clinical pathways whenever ordered by physician, to facilitate coordination of patient care
Keeps patient informed of progress and provides information related to disease progression
Coordinates specialties when appropriate for optimal patient care
Works with third party payers to validate need for patient care and home care environment needs
Educates patient and family on all aspects of patient's hospitalization and continuing care
Reviews patient care activities for occurrences and trends that affect the quality, cost effectiveness and delivery of services. Assures that the outcome of review is appropriately maintained in the computer database
Maintains a good working relationship both within the department and with other departments
Consults other departments, as appropriate, to collaborate in patient care and performance improvement activities. Collaborates with other departments to identify operational problems and develop solutions/resolution
Functions as a patient/family advocate
Assures patient returned from hospital to safe environment
Remains current on case management theory and practice, psychosocial issues current within the community and the healthcare environment
Maintains regulatory requirements
Reports to work on time and as scheduled, completes work within designated time

243

Rn Case Manager Resume Examples & Samples

Clinical Pediatric experience
Pediatric Case Management experience
AHCCCS health plan experience

244

RN Case Manager Stop Loss Resume Examples & Samples

Review policyholder data to identify claimants with catastrophic care needs and assess medical & claims information available to calculate potential risk. Provide written claimant assessments within established deadlines to the Underwriters/RGM’s to utilize when establishing rates for new and renewal business
Review potential stop loss claim notices to identify case management and cost containment opportunities to reduce potential excess loss claim expenses. Notify appropriate management and underwriters of potential claims involving significant risk. Work with Third Party Administrators (TPAs) and external Case Managers utilizing medical and claims management resources to facilitate clinical and financial outcomes for claimants with complex and catastrophic medical conditions. Maintain current claimant clinical status, cost containment activities and contact information in ESL
Act as a resource to internal and external customers by
Four or more years nurse clinical (preferably hospital based) experience and Two or more years case management experience
Two or more years of experience in health care or health insurance industry; stop loss or reinsurance preferred
Case Manager Certification (CCM)
Ability to use varying resources to research diagnoses, treatments and average costs
Ability to work independently and in team environment
Ability to develop unified internal and external working relationships
Ability to multi-task and adapt promptly to change
Strong prioritizing and organization skills
Ability to communicate effectively with others using the spoken word
Ability to communicate effectively in writing clearly and concisely
Ability to utilize available time to organize and complete work within given deadlines
Strong computer proficiency (MS Word, Outlook, Excel and PowerPoint)

245

Rn Case Manager Resume Examples & Samples

Collaborates with clients, families and providers by assessing patient needs, facilitating and implementing clinical care, planning, education, monitoring and evaluating specific services and advocating health care needs on an individual basis either by phone and/or by onsite visits
Utilizes clinical expertise and standards of practice in determining appropriate treatment options
Three (3) years clinical practice experience. Medical case management experience preferred

246

Rn Case Manager Resume Examples & Samples

Collaborates with clients, families and providers by assessing patient needs, facilitating clinical care, planning, education, monitoring and evaluating of specific services either by phone and/or by onsite visits
Utilizes clinical expertise and standards of practice in determining appropriate transitional plan of care
Three (3) to five (5) years clinical medical practice experience. Medical case management experience preferred
Ability to travel to various locations with access to own transportation for business use
Must be able to work flexible hours Technical Skills and Knowledge
Knowledge of medical terminology/coding and managed care processes
Personal Computer skills using Windows-based programs and applications, including Basic MS Office Skills
Knowledge of medical health conditions, levels of care, and discharge planning

247

Rn Case Manager Resume Examples & Samples

Appropriate delegation to LPN staff, patient condition change visits, and completion of OASIS time points. Accepts accountability for patient satisfaction scores and quality of care outcome measure results
Respects and supports patient and family's cultural beliefs and values, individual needs, health goals and treatment preferences
Manages episode of care in accordance with evolving nursing care needs and continued eligibility for services
Communicates with team LPN when delegating appropriate visits
Communicates with other community providers to coordinate the care plan (i.e. Insurance case managers, high risk case managers, elder services, protective service, etc.)
Identifies specific learning needs & goals and collaborates with nursing leadership in developing a plan to meet them

248

Rn Case Manager Resume Examples & Samples

Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families
Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement
Develops and maintains case management policies and procedures

249

Rn Case Manager Resume Examples & Samples

Confirm documentation of eligibility for beneficiaries
Utilize client’s claims system, claims listing, or HMS case management system to determine case
Value
Obtain additional claims from the client’s claim system for active and ongoing cases
Obtain required information to determine accident related claims
Conduct all case document review and updates as needed
Communicate with others to obtain required information to determine accident related claims for case value
Responsible for reviewing and confirming all related or un-related claims are identified for accident related health insurance claims to determine the accurate case value
Ensure production and quality standards are met to accurately determine case value
Prepare required correspondence, liens, claims and other related documents to progress the case to recovery
Perform basic and advanced levels of document review to identify current case status, legal research, and case management and ensure case progress through workflow
Compile, analyze and make conclusions about case information and status from multiple sources
Maintain records of legal documents as needed, distribute correspondence providing the lien/claim amounts to attorneys and ins. co. or other stakeholders as requested and scheduled
Interact (i.e. on incoming and outgoing calls and correspondence) with attorneys, insurance adjusters, medical providers, court staff, recipients and family members and client
Process all claim/lien disputes and review claims with attorneys and other stakeholders
Negotiate and compromise claim/lien settlement amounts per contract guidelines
Conduct outgoing periodic follow up on case status and payment
Maintain a daily system of providing timely and accurate information required to move cases through
The case management workflow
Effectively work, maintain and manage a variety of cases with current and accurate notes from
Creation to recovery
Prioritize case events and critical case payment/recovery issues, while meeting, various internal and legal deadlines that are revenue impacting
Responsible for accurately reviewing and confirming all required case information is documented in case management system, and updated as necessary
Meet department objective standards for Customer Service
Collaborate with internal Subrogation Operations team and OQA Department to improve case valuing quality
Ensure all processes meet HIPAA and Government security requirements with regards to sharing/storage/PHI (Personal Health Information)
May have some training responsibilities for subrogation staff members
Ability to work proficiently with Microsoft Word, Excel, and Power Point
Ability to analyze and evaluate medical and claims information
Ability to provide good customer service skills
Ability to perform well in team environment, with staff at all levels, to achieve business goals
Ability to function under pressure and with deadline oriented project demands as well as manage multiple initiatives
Ability to apply existing knowledge of health care marketplace including commercial and government insurance health plan organizations and HIPAA guidelines with their associated security requirements
Ability to work independently to meet predefined production and quality standards
Working knowledge in and successful application of medical and claims review
Strong understanding of state policies and procedures for determining accurate case value
Work Conditions and Physical Demands
Primarily sedentary work in a general office environment
Ability to communicate and exchange information
Ability to comprehend and interpret documents and data
Requires occasional standing, walking, lifting, and moving objects (up to 10 lbs.)
Requires manual dexterity to use computer, telephone and peripherals
May be required to work extended hours for special business needs
May be required to travel at least 10% of time based on business needs
Current, RN License required
3+ years’ experience with advanced coding, including the most complex; coding credentials preferred
Experience in supervising or training entry-level coders preferred
Experience in interpreting clinical codes for Specific TPL project(s) of similar size and scope required

250

Rn Case Manager Resume Examples & Samples

Current Washington State Registered Nurse License
Minimum of five (5) years clinical experience
CPR or BLS certification within 6 months of hire
Previous experience in utilization review/case management
Computer skills: typing, email, and word processing
Certified case manager
Ability to use an Electronic Medical Records (EMR) system

Download Rn Case Manager Resume Sample as Image file

Related Job Titles

Rn-rn Case Manager Resume Sample

Disability Case Manager Resume Sample

Case Manager Rn Resume Sample

Behavioral Health Case Manager Resume Sample

RN Program Coordinator Resume Sample

Case / Care Manager Resume Sample

Case Manager Specialty RN Resume Sample

Rn-med Resume Sample

Rn House Supervisor Resume Sample

Rn Center Resume Sample

Mental Health Case Manager Resume Sample

Manager RN Resume Sample

Browse More

Rn Case Manager Resume Samples

The Guide To Resume Tailoring

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies

Tailor your resume & cover letter with wording that best fits for each job you apply

Resume Builder

Resume Builder

13 Rn Case Manager resume templates

Read our complete resume writing guides

How to Tailor Your Resume

How to Make a Resume

How to Mention Achievements

Work Experience in Resume

50+ Skills to Put on a Resume

How and Why Put Hobbies

Top 22 Fonts for Your Resume

50 Best Resume Tips

200+ Action Words to Use

Internship Resume

Killer Resume Summary

Write a Resume Objective

What to Put on a Resume

How Long Should a Resume Be

The Best Resume Format

How to List Education

CV vs. Resume: The Difference

Include Contact Information

Resume Format PDF vs Word

How to Write a Student Resume

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

RN Case Manager / Vitilization Management Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Rn Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

OB Momsfirst RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

RN Case Manager PRN Resume Examples & Samples

Field RN Case Manager Resume Examples & Samples

Field RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Senior RN Case Manager Resume Examples & Samples

Telephonic RN Case Manager Resume Examples & Samples

Sign On Bonus Field RN Case Manager Resume Examples & Samples

Provider Based RN Case Manager Resume Examples & Samples

Field RN Case Manager Resume Examples & Samples

Onsite RN Case Manager Resume Examples & Samples

High Risk RN Case Manager Resume Examples & Samples

Onsite RN Case Manager Resume Examples & Samples

Optumcare RN Case Manager Resume Examples & Samples

Senior RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

RN Case Manager, Obstetrics & Pediatrics Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

RN Case Manager Emergency Department Variable Shift Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Ambulatory RN Case Manager Orthopedic Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Pediatric RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Hospice RN Case Manager Resume Examples & Samples

RN Case Manager for Transplant Services Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Optum Field Based Senior RN Case Manager Resume Examples & Samples

Hospice RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

Senior RN Case Manager Resume Examples & Samples

Rn Case Manager Resume Examples & Samples

CRS Telephonic RN Case Manager Resume Examples & Samples

RN Case Manager Mental Health Resume Examples & Samples

How to Make
a Resume

50 Best
Resume Tips

200+ Action
Words to Use

Internship
Resume