Care Manager, RN Resume Samples

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B Schiller

Bridie

Schiller

122 Adeline Plain

Los Angeles

+1 (555) 744 8206

122 Adeline Plain

Los Angeles

Phone

p +1 (555) 744 8206

Experience Experience

Houston, TX

Care Manager Rn

Houston, TX

Rodriguez and Sons

Houston, TX

Care Manager Rn

Promotes a service orientation in the performance of position duties and responsibilities and in interactions with patients, hospital staff and visitors. (100%)
Utilizes outcomes data to improve ongoing care management services
Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships. Develops and sustains positive working relationships with internal and external customers
2 Implements all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promotes quality and efficiency in the delivery of care management services
Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care
Provides and updates referrals to facilities through online/software discharge planning tools
Enters and maintains pertinent clinical information in various medical management systems

San Francisco, CA

Complex Care Manager, RN

San Francisco, CA

Bradtke-Toy

San Francisco, CA

Complex Care Manager, RN

Demonstrates flexibility when performing assignments in order to meet organization goals
Performance-based rewards based on stellar individual and team contributions
Perform other duties and responsibilities as assigned or requested
Collaborates with other clinical and administrative staff in a positive, constructive manner
Dedication, above all, to caring for patients suffering from chronic kidney failure across the nation
A comprehensive benefits package designed to enhance your health, your financial well-being and your future
Educates patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or medications

present

Chicago, IL

Utilization Care Manager, RN

Chicago, IL

Lindgren-VonRueden

present

Chicago, IL

Utilization Care Manager, RN

present

Performs prospective, concurrent and retrospective utilization reviews, and first level determination approvals for members, using BSC evidenced based guidelines, policies and nationally recognized clinical criteria, across lines of business, or for a specific line of business, such as Medicare and FEP
Ensures diagnosis matches ICD9 codes
Conduct UM/care management (CM) review activities with delegated entities as necessary
Manages member treatment in order to meet Recommended Length of Stay
Determines discharge (DC) plan by assessing cognitive and physical status
Ensures quality, cost-effective DC planning
Develops and reviews member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards

Education Education

Bachelor’s Degree in Nursing

New York University

Bachelor’s Degree in Nursing

Skills Skills

Excellent Interpersonal skills and ability to work effectively and independently
Skilled in computer operation with proficiency in Microsoft Office Word
High level of understanding of community resources, treatment options, home health availability, funding options and special programs
Demonstrated ability to assess, evaluate and interpret medical information
Operates personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment
Exceptional written and oral communication skills
Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc
Thinking at work may include listening, learning, analyzing, evaluating, and the ability to interpret what is seen and/or heard, or to link information from one issue to the next
Constant computer usage including typing and/or eye strain
Constant repetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry)

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Care Manager, RN Resume Examples & Samples

Develop, enhance and maintain provider clinical relationships
Active RN license is designated state
Ability to be in the field as needed to manage team
Prior management (team leadership) experience

Care Manager RN Nationwide Resume Examples & Samples

Comply with performance and reporting standards as defined by Humana Corporation
Active Registered Nurse (R.N.) license without restriction Compact state RN license OR Multi state RN state licenses
Active RN license in at least 30 states
Desire to work on Remote Monitoring Team that supports members with conjestive heart failure

Care Manager RN Concurrent Review Sacramento Resume Examples & Samples

Must have and maintain current, valid and unrestricted that meets licensure requirement for the state in which you practice, i.e., Registered Nurse, Clinical Psychologist, or Licensed Clinical Social Worker
Internal candidates must have functioned as a Case Manager I and received a satisfactory score on the Advancement Exam
Demonstrated ability to assess, evaluate and interpret medical information

Senior Care Manager RN Sacramento Resume Examples & Samples

Provides Intensive Care Management for Managed Care beneficiaries
Identifies patients appropriate for this service by evaluating high risk cases, intensity and complexity of services, health care costs, non-compliance issues and other triggers per policy
Manages cases to ensure that the beneficiaries’ clinical needs are met at the most cost effective and clinically appropriate level
Coordinates care between multiple providers
Develops care plans in coordination with providers, patients, and families, as appropriate and assesses its effectiveness over time
Identifies Potential Quality Indicators using criteria established by the QM department
Coordinates with Medical Director when appropriate
Communicates with both internal and external customers. Educates providers, members and beneficiaries regarding benefits
Effectively analyzes complex cases; makes innovative use of available resources
Performs data entry of authorizations and review-related material
May act in a lead capacity
Must have and maintain current, valid and unrestricted Registered Nurse
Minimum five years care management or related experience
Demonstrated ability to assess, evaluate and integrate clinical data
Ability to function as a team with cooperation, flexibility and willingness to assist others
Knowledge of Managed Care benefits and eligibility in this program
Excellent planning, organizational and prioritization skills

Care Manager, RN Prior Authorization Oregon Resume Examples & Samples

Performs electronic review of prior authorization requests for appropriate care, following clinical guidelines, policies, EOC and Benefit Policy and approves services or forwards requests to a Medical Director for review. 　
Enters and maintains pertinent clinical information in various medical management systems
Must have and maintain current, valid and unrestricted RN License for Oregon
Minimum 3 years clinical experience in a health care environment
Previous Managed Care/Health Plan/Independent Physician Association experience in prior authorization is required
Must physically reside in Oregon or SW Washington
Exceptional written and oral communication skills　
Demonstrated ability to assess, evaluate and interpret medical information　
Skilled in PC based software programs
Excellent Interpersonal skills and ability to work effectively and independently

Care Manager RN State Health Prog Medi-cal Woodland Hills Resume Examples & Samples

Must have and maintain current valid and unrestricted RN License that meets licensure requirement for the state in which you practice
Five years clinical experience in a health care environment; including Care Coordination, Nurse Advice/Triage, Case or Disease Management. Managed care experience preferred　
Knowledge of California Children services (CCS) process DMHC, CMS and DHS regulations pertaining to their position　
Internal candidates must have functioned as a Case Manager II and received a satisfactory score on the Advancement Exam
Skilled in computer operation with proficiency in Microsoft Office Word
Excellent Interpersonal skills and ability to work effectively and independently

Care Manager, RN Resume Examples & Samples

Must have and maintain current, valid and unrestricted Registered Nurse License
Case Management Certified preferred
State Driver’s License

Care Manager RN- / Days Resume Examples & Samples

Appropriately identifies and refers cases to physician advisor to support timely progression of patients along the continuum. (100%)
As patient is transferred, communicates pertinent information to next Case Manager to transition the patient to the next level of care. (100%)
Adheres to standards, policies and procedures at both the hospital and Departmental level. (100%)
Previous case management or utilization management experience preferred

Case / Care Manager RN SNP Resume Examples & Samples

Five years clinical experience in a health care environment
Two years proven case management experience required
One year training or teaching experience preferred
Managed care experience desirable. Internal candidates must have functioned in the capacity of a Case/Care Manager I

Senior Care Manager / RN Resume Examples & Samples

Utilizing evidence based practice, managers focus on larger population for the purpose of improving clinical performance, patient care outcomes, and resource utilization
Analyzes and evaluates clinical data as it relates to clinical outcomes and resource utilization
Develops process improvement goals and strategies
Organizes and leads process improvement teams
Develops standards of care/clinical guidelines/protocols in collaboration with multidisciplinary groups
Serves as a clinical and systems expert resource
Communicates information/outcomes regarding system issues and/or patient populations to appropriate individual or groups
Provides direction to facilitate/coordinate the progress of patient groups along the continuum of care to achieve expected outcomes based on established guidelines or protocols
Focuses the activities of the healthcare team on the achievement of optimal outcomes, resource utilization, clinical expertise and improvement strategies
Incorporates population specific knowledge into practice area

Care Manager Rn Resume Examples & Samples

Membership in the Maryland Association of Chemical Dependency Nurses (MACDN) and certification encouraged
Advanced skills in PC/Word processing/database/spreadsheets and the ability to use the advanced skills to produce complex reports and documents. Possess computer skills and knowledge of Microsoft Office software
Must have and maintain a valid Maryland driver’s license
Must have and maintain up to date CPR certification

Care Manager RN Sign On Bonus Resume Examples & Samples

Conducts advanced and complicated clinical review for inpatient, outpatient and ancillary service requests, medical necessity appeals or claims review requests including high dollar claims after the delivery of services. Case reviews include determination of medical appropriateness and medical necessity using considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge of medical policies, clinical guidelines, benefit plans, product configuration and coding rules/convention. Makes first level approval determinations when appropriate. Conducts retrospective review of service requests, medical necessity appeals or claims submitted by contracted and non-contracted providers, delegated and non-delegated providers for all product lines
Reviews, triages, prioritizes and completes cases to meet required turnaround times including claims service standards
Using professional judgement, independent analysis and critical-thinking skills applies clinical guidelines, policies, benefit plans, etc. to complete case review and determinations
Recognizes potential quality care concerns and refers as appropriate
Ability to multi-task and prioritize work

Care Manager, RN Sign on Bonus Resume Examples & Samples

Evaluates complex provider agreements, delegation arrangements and division of financial responsibility agreements. Interprets agreements/arrangements and applies interpretation to case review and determinations
Researches original medical necessity review determination and rationale for medical necessity appeals cases
Summarizes cases including analysis of medical records and appropriate application of all applicable policies, guidelines and benefit plans
Documents all activities as per unit practice including entry into automated systems
Ability to effectively analyze, interprets, apply and communicate policies, procedures and regulations

Onsite Inpatient Care Manager, RN Resume Examples & Samples

Travels daily to assigned facilities to talk with members and physicians regarding the status and treatments within each case
Based on travel schedule and individual member’s situation, conducts onsite and/or telephonic concurrent review of members in assigned facilities to validate medical necessity of facility admissions
Provides authorization to facilities using standard clinical criteria guidelines in conjunction with clinical judgment to determine the needed care required within the patient's individualized created care plan
Initiates and continues direct communication with health care providers involved in the care of members, including treating physicians, IPA and/or hospitals, to share information and collaboratively establish acute and post-acute treatment plans for hospitalized members
Utilizing clinical judgment, assesses and evaluates members at risk for complicated medical comorbidties, and/or repeat admissions potential and determines individualized care plan for communication and interventions to promote successful discharge and post-acute care treatment plan
Coordinates authorization and/or delivery of post-acute care services, including, but not limited to referrals to case and disease management, home health, medical equipment, skilled nursing facilities and other community based services
Provides members with educational resources to enhance their ability to access health care services, including healthplan contacts, primary care physician and other pertinent health care provider contacts
Facilitates referrals for post-discharge follow up with appropriate professional providers and support services (i.e. transportation) to ensure that members are able to access medically necessary services after discharge
Frequent travel required to regional healthplan office
Valid driver’s license, without restrictions, is required
Bachelor's Degree in a related field Health Services or Nursing is preferred
3+ years of experience in general nursing with exposure in the following: E/R critical care, discharge planning, bedside care, and/or acute care facility is required
3+ years of experience in applying nursing judgment to make clinical decisions with minimal supervisory or oversight is required
1+ year of experience in Managed Care is preferred
Ability to analyze information and covert related activities into a comprehensive work plan
Microsoft Outlook is required

Care Manager Rn-plainview Resume Examples & Samples

Conducts clinical review and utilizes objective criteria to assign patient to the appropriate level of care; identifies clinical resources required to achieve optimal patient outcomes and appropriate reimbursement for the organization. (100%)
Utilizes high risk screening criteria to initiate appropriate referral to the Social Worker regarding psychosocial and financial aspects of plan of care, community service options and barriers impacting arrangement of post-acute services. (100%)
Coordinates the plan of care with the interdisciplinary team to ensure all critical elements have been communicated to the patient/family. (100%)

Care Manager Rn Resume Examples & Samples

Works in conjunction with physicians, nurses, Care Management Team and others to assess, plan and initiate patient plan of care
Reviews patient charts daily or as needed
Utilizes MSW Care Manager for appropriate referrals: patient/families with complex psychosocial, on-going medical discharge planning issues, continuing care needs and end of life issues
Attends focus of care rounds per unit policy
Communicates targets and identified standards of care through collaboration with multidisciplinary team to reduce LOS and resource consumption
Collaborates with patients, families and other members of the interdisciplinary team as needed
Insures that all critical elements of the care and discharge plan have been communicated to multi-disciplinary team, patient and family including expediting teaching needs
Demonstrates competency in accessing and documentation in approved programs, which currently include Midas, Cerner, eDischarge and email system

Hospice Care Manager RN- / Days Resume Examples & Samples

Administers all medications and treatments according to agency policy and procedure, accepted standards of care and agency guidelines. (85%)
Communicates effectively with patients, families, caregivers, and physicians. (90%)
Provides coverage to ensure patient care, including on-call rotation, patient referrals, assessments, admissions and complaints
Completes and submits documentation timely and accurately according to Agency policy
Possesses adequate knowledge of the Medicare COPs and state regulations to ensure quality of patient care and regulatory compliance
One or more years experience in hospice

Complex Care Manager, RN Resume Examples & Samples

Conducts prospective, concurrent, and retrospective review of active patient care telephonically, with possible on-site visits when assigned. Consult with other care management members where needed for patients with complex cardiac and pulmonary issues
Demonstrates flexibility when performing assignments in order to meet organization goals
Current RN license in Pennsylvania; additional license in New Jersey preferred
Minimum one year of recent clinical experience, preferably in ICU or CCU floors; 3 -5 years preferred
Minimum of 3-5 year of case management, disease management, transition of care experience required

Onsite Inpatient Care Manager, RN Resume Examples & Samples

Identifies quality of care issues, and reports to appropriate health plan Quality department representative
Nurse will be based out of home, with travel required daily to assigned hospitals and facilities; Frequent travel required to regional health plan office
Licensed Registered Nurse (RN) is required

Care Manager Rn-care Management Resume Examples & Samples

Assessment - The care manager will collect in-depth information about a person’s situation and functioning to identify individual needs in order to develop a comprehensive care management plan that will address those needs
Planning – The care manager will determine specific objectives, goals, and actions as identified through the assessment process. The plan should be action oriented and time specific
Implementation – The care manager will execute specific intervention that will lead to accomplishing the goals established in the care management plan
Coordination – The care manager will organize, integrate, and modify the resources necessary to accomplish the goals established in the care management plan
Monitoring – The care manager will gather sufficient information from all relevant sources in order to determine the effectiveness of the care management plan
Evaluation – At appropriate and repeated intervals, the care manager will determine the plan’s effectiveness in reaching desired outcomes and goals. This process might lead to a modification or change in the care management plan in its entirety or in any of its component parts
Graduate from an accredited Associate’s or Bachelor’s of science degree program; BSN preferred
Licensed to practice as a Registered Nurse in the Commonwealth of Massachusetts
CCM or related certification attained within 24 months from the hire date is preferred
3-5 years of diversified acute clinical experience is required, surgical experience preferred
A minimum of 2 years of previous experience involving judgment and decision making, required in a utilization management/case management position
Coordination and Service Delivery – The care manager will understand confidentiality and the legal and ethical issues pertaining to it; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with team and referral sources; develop treatment plans
Physical and Psychological Factors – The care manager will understand methods for assessing an individual’s level of physical/mental impairment; understand the physical and psychological characteristics of illness; be able to assist individuals with the development of short- and long-term health goals
Benefit Systems and Cost Benefit Analysis – The care manager will understand the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings
Case Management Concepts – The care manager will understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities
Community Resources – The care manager will understand how to access and evaluate the available resources to meet a client’s needs; will be able to develop new resources

Care Manager, RN Outpatient Clinic Resume Examples & Samples

Perform Intake assessments of new patients at initial visit or by phone prior to first appointment, based on stratification criteria
Provides discharge/transition assessments, identifying barriers that affect length of stay, identifying barriers to successful clinical outcomes, developing plan of care, facilitates interventions and evaluates adherence to treatment plan through proactive patient engagement for care transitions across the care continuum
Obtains authorizations for post SHC care and services as required by patient’s benefits, entitlement programs, or charitable resource
Works with providers, patient/family to facilitate medication management/adherence through proactive follow-up
Assessment for financial barriers to adherence and discusses patient/family financial obligations for post SHC care and services
Assures patients/family have knowledge to manage care, manage health, prevent secondary disabilities and are empowered to be responsible for participating in plan of care
Documents assessments, interventions, plans, and education in the patient’s electronic medical record
Obtains/evaluates/synthesizes new knowledge that is applicable to practice and leads others in applying it
Increases knowledge through participation in professional associations, presentations, publications, literature review and educational opportunities and shares information freely with others
Participates in system wide development of clinical best practice pathways, patient education materials, order sets and implements successfully
ASN Degree required
BSN Degree strongly preferred or 15+ years of clinical experience preferred if candidate does not possess the BSN
3-5 years of clinical experience in one or more of the hospital’s service lines (SCI, Pediatric orthopedics, Burn care, Cleft lip and palate) preferred
Current California Registered Nursing License. In good standing required
Current PALS certification required

Care Manager, RN Resume Examples & Samples

Current knowledge of nursing care management
Expertise in chronic disease management
Management of a caseload of patients of varying complexities
Postion may sit in either Grand Rapids or Southfield

Utilization Care Manager, RN Resume Examples & Samples

Performs prospective, concurrent and retrospective utilization reviews, and first level determination approvals for members, using BSC evidenced based guidelines, policies and nationally recognized clinical criteria, across lines of business, or for a specific line of business, such as Medicare and FEP
Ensures diagnosis matches ICD9 codes
Conduct UM/care management (CM) review activities with delegated entities as necessary
Manages member treatment in order to meet Recommended Length of Stay
Ensures discharge(DC) planning at levels of care appropriate for the members needs and acuity
Determines discharge (DC) plan by assessing cognitive and physical status
Determines post-acute needs of patient, levels of care, equipment, how event is going to impact patients status
Ensures quality, cost-effective DC planning
Triages and prioritizes cases to meet required turn-around times
Expedites access to appropriate care for members with urgent needs using expedited review process
Prepares and presents cases to Medical Director (MD) as required by law for medical necessity determination
Communicate determinations to providers and/or members to in compliance with state, federal and accreditation requirements
Develops and reviews member centered documentation and correspondence reflecting determinations in compliance with regulatory and accreditation standards
Identifies potential quality of care issues, service or treatment delays and intervenes or as clinically appropriate
Provides referrals to Case Management, Disease Management, Appeals and Grievance and Quality Departments as necessary
Identifies potential Third Party Liability and Coordination of Benefit cases and notifies appropriate internal departments
Manages multiple complex cases including lower level of care
Supports Lead UM Care manager including precepting, audits and special projects
Acts as resource and educator for colleagues
Monitors Clinical Support Coordinators (non-clinical) in the performance of UM support activities Quality assurance and regular performance audits
Training and mentoring backup to Lead as needed

Utilization Care Manager, RN Resume Examples & Samples

Performs prospective, concurrent and retrospective utilization reviews and first level determination approvals for members using BSC evidenced based guidelines, policies and nationally recognized clinical criteria, across lines of business, or for a specific line of business such as Medicare and FEP
Ensures discharge (DC) planning at levels of care appropriate for the member’s needs and acuity
Monitors Clinical Support Coordinators (non-clinical) in the performance of UM

Care Manager, RN Resume Examples & Samples

Bachelor's/Master's Degree preferred
Case Management certification preferred; eligible to sit for CCM required within 1 year of employment
1-3 years' case management experience
3-5 years' in a required clinical care specialty such as maternity, pediatrics, medical surgical, ICU, ER or other as required. Preferably in an acute care setting

Care Manager, RN Resume Examples & Samples

Unrestricted PA RN licensure and 3 years clinical practice experience in pediatrics
Managed care experience required with focus on Medicaid population preferred
Proficiency utilizing MS Office Suite, including Excel, Word, and Outlook. Familiarity utilizing electronic medical record and documentation programs
1-3 years case management experience
3-5 years clinical experience with a Pediatric population

Transition Care Manager, RN Resume Examples & Samples

Required Registered Nurse, graduated from an accredited Associates Degree or Bachelor’s Degree program
Required minimum of 3 years nursing experience, in related clinical setting
Required minimum of 2 years Discharge Planning Experience, or Case Management experience strongly preferred
Required valid drivers license and reliable automobile transportation for on-site assignments and off site work related activities
Preferred Managed Care experience
Preferred Emergency Department experience

Care Manager, RN Resume Examples & Samples

Advocates for the patient and his/her family while adhering to the overall treatment plan; UR/UM guidelines; policies and procedures of SHC; state, regulatory requirements and nursing and case management standards of practice
Work collaboratively with interdisciplinary team consisting of Social Worker, Resource Navigator, Patient Access, HIM, CDI/UM Specialist, UR Specialist, Corporate staff and others; to meet the overall goals of the organization and metrics specific to the assigned facility
Works to ensure patient’s coordinated care by collaborating and communicating with patient’s Medical Home and/or other health care providers
Discuss gaps in adherence with clinical team, and facilitate interventions
Facilitates co-management with the medical home for episodes of care
Ensures hand off communication with next level of care, post discharge and after exit from system
Reviews authorization for services, orders and documentation to support medical necessity and level of care, prior to and during encounters, in conjunction with CDI/UM specialists and patient access
Makes daily contact with inpatients and clinical care team to ensure timely care and services, identify needs and develop action plans
Provides anticipatory guidance about health care benefits to minimize over/under utilization and decrease fragmentation of care
Address gaps in care with external case management or primary care, and makes referrals as needed
Performs developmental touch point assessments for patients with children with medical complexity, based on stratification criteria
Discusses and documents agency and facility choices for post SHC services
5+ years of clinical experience in one or more of the hospital’s service lines (SCI, Pediatric orthopedics, Burn care, Cleft lip and palate) preferred
3-5 years Care Coordination/Case Management experience is preferred
Current Case Management Certification is preferred. If candidate is not currently certified in case management, certification by CCM or ACM will be required within 6 months of hire or upon eligibility
Current LA County Fire Card required
Pediatric, orthopedic, burn, or rehabilitation environment experience preferred
Bi-lingual English/Spanish strongly preferred

Care Manager Rn-medicare Advantage Resume Examples & Samples

Implements care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Effectively functions in accordance with applicable state, federal laws and regulatory compliance
2 Implements all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies. Promotes quality and efficiency in the delivery of care management services
Identifies and refers members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employs collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member
Excellent computer and software knowledge and skills
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Hospice Care Manager RN Resume Examples & Samples

Addresses patient needs and problems, nursing intervention and patient response, safety interventions and education and teaching. (75%)
Documents patient status in an accurate, timely and concise manner in electronic medical record, as required by Agency policy. (50%)
Participates in case conferences/team meetings. (95%)
Makes visits as scheduled and participates in on-call rotation as required. (50%)
Certified Hospice and Palliative Nurse (CHPN)

Care Manager RN Per Diem Resume Examples & Samples

Ability to problem-solve
Excellent computer and IT system knowledge
Establishes and maintains a good rapport with physicians and interacts well with all internal and external customers in a professional and courteous manner

Per Diem Care Manager, RN Resume Examples & Samples

Assessment: The Care Manager will collect in-depth information about a persons’ situation and functional status to identify individual needs in order to develop a comprehensive plan of care that will address the patient’s needs. The Care Manager will identify both present and possible future needs of the patient and family, which may affect the plan of care and the patient’s well-being. This assessment will include age-specific physical, psychosocial, environmental, financial, and health status expectations
Implementation: Executes specific interventions that will lead to accomplishing the goals and timeframes of the shared plan of care, Works effectively with the healthcare team to determine the necessary steps to achieve the plan of care. Problem solving techniques will be applied to the implementation process
Additional requirements
Ability to work in an ambiguous environment; work effectively under pressure due to changes in priorities
Possesses the knowledge and skills necessary to communicate with third party payers

Transition Care Manager RN Pocono Mountain Area Resume Examples & Samples

Registered Nurse,accredited Diploma, Associates Degree or Bachelor’s Degree program
Minimum of 3 years nursing experience, in related clinical setting
Emergency Room or Acute Discharge Planning Experience Preferred
An unrestricted RN practice in the Plan’s state and any other state in which he/she works
Proficiency with Microsoft Office Suite (Word, Excel, Power Point). Access is a plus. Consistent word processing speed and accuracy of 50 or more words per minute

Onsite Inpatient Care Manager, RN Resume Examples & Samples

Travels daily to assigned facilities to talk with members and physicians regarding the status and treatments within each case. Based on travel schedule and individual member’s situation, conducts onsite and/or telephonic concurrent review of members in assigned facilities to validate medical necessity of facility admissions
Required 3+ years of experience in a clinical setting with general nursing exposure in the following: E/R critical care, discharge planning, bedside care, and/or acute care facility
Required 3+ years of experience in applying nursing judgment to make clinical decisions with minimal supervisory or oversight
Preferred 1+ year of experience in Managed Care

Msho Care Manager, Rn-fte Resume Examples & Samples

Licensed RN in the state of Minnesota
Strong computer skills in Microsoft Word, Excel, Access, and Outlook
Reliable Transportation for home visits

Care Manager Rn Resume Examples & Samples

Coordinates activities to progress the patient through the healthcare continuum; initiates referrals and recommends consults to facilitate readiness for discharge by the target date, performing basic discharge planning functions. Monitors patient progress toward discharge criteria, collaborating with the physician and healthcare team to modify the plan of care when patient progress is less than optimal or patient needs change. Anticipates and proactively works to prevent delays and barriers to efficient care delivery; collaborates with involved persons/departments to resolve barriers. (100%)
Provides ongoing communication to nursing staff and unit manager regarding complex patients, barriers to appropriate care delivery and progress of patients toward discharge/transfer. Functions as role model and serves as mentor to nursing staff. (100%)
Promotes accuracy and completeness of clinical documentation to reflect the appropriate severity of illness/intensity of service for all patients in collaboration with licensed staff and physician. (100%)
Promotes a service orientation in the performance of position duties and responsibilities and in interactions with patients, hospital staff and visitors. (100%)

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