Case Manager Rn Resume Samples

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D Schimmel

Destinee

Schimmel

816 Russel Squares

San Francisco

+1 (555) 676 7480

816 Russel Squares

San Francisco

Phone

p +1 (555) 676 7480

Experience Experience

Philadelphia, PA

Case Manager Rn

Philadelphia, PA

Ward Group

Philadelphia, PA

Case Manager Rn

Provide patient education to assist with self management
Providing patient education to assist with self management
Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
Providing patient education to assist with self-management
Knowledge of utilization/case management, reimbursement methods (prospective payment, per diem, etc), and performance improvement principles
Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination
Provide treatment updates to providers outside of the hospital and family members for each assigned case

Dallas, TX

Case Manager, RN

Dallas, TX

Mayer-Schuster

Dallas, TX

Case Manager, RN

Provide patient education to assist with self-management
Develops and maintains relationships with both network and Out of Network hospital UM and ER staff
Works directly with AppleCare Hospitalists to develop and implements inpatient processes
Provides Vivitrol injections. May be asked to train practice nurses in providing the injection
Follow State and Federal guidelines in providing care to opioid dependent patients in collaboration with licensed, prescribing physicians and pharmacy
Outreaches to members telephonically and/or in-person and coordinates member's case management services
Requests consultation and diagnostic reports from network specialists

present

Houston, TX

Case Manager / RN

Houston, TX

Donnelly-Bednar

present

Houston, TX

Case Manager / RN

present

Work with team members to ensure discharge-planning goals and objectives are developed and discussed at the interdisciplinary team meetings
Assist with the completion of the MDS for managed care patients
Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs
Key communicator of discharge plans related to managed care patients
Provide concurrent review to third party payers
Perform all other duties, as assigned
Coordinate all services for each managed care patient, including in home and outside of the care center

Education Education

Bachelor’s Degree in Nursing

University of San Francisco

Bachelor’s Degree in Nursing

Skills Skills

Excellent computers skills and current knowledge of the electronic medical record
Ability to operate PC-based software programs including proficiency in Word, Excel, PowerPoint, Access and Project
Ability to be accurate, concise and detail oriented
Extensive knowledge of the management of chronic conditions
Ability to communicate both written and verbally across multiple levels
Ability to work independently
Demonstrates knowledge of patient rights, patient choice for post-acute services, “Important Message from Medicare” on the right to appeal discharge
Comprehensive health care, dental, vision, life and disability plans
Actively seeks ways to control costs without compromising patient safety, quality of care or the services delivered
Facilitates patient throughput with ongoing focus on quality and efficiency

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Nicu Case Manager Rn-work Resume Examples & Samples

Provide authorizations for inpatient stays
Inpatient care coordination
Outreach to the parents/families of NICU babies, and provide ongoing education, guidance and support
Discharge and Home Health coordination
Builds Trust: Consistently models and inspires high levels of integrity, lives up to commitments, and takes responsibility for the impact of one's actions
Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same
Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Simplifies complexity and integrates internal efforts to deliver an optimal customer experience
Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
Active RN license in the state(s) in which the nurse is required to practice
3 or more years of experience as an RN in a NICU setting
Ability to be licensed in multiple states without restrictions
3 years clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
Ability to work independently under general instructions and with a team
Valid drivers license and/or dependable transportation necessary (variable by region)
BSN or Bachelor’s degree in a related field
Health Plan experience
Previous Medicare/Medicaid Experience a plus
Call center or triage experience
Previous experience in utilization management, discharge planning and/or home health or rehab
Bilingual is a plus

Case Manager, RN Resume Examples & Samples

Applicant must live in Fresno, Kings, Tulare, or Madera County and may need to visit provider offices and will be required to attend meetings in the Fresno office
Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
Current, unrestricted California RN or LCSW license is required
Experience as a Case Manager or Utilization Manager is preferred
Discharge planning and prior authorization experience preferred
Experience in Skilled nursing, Rehabilitation or Home Health is required
Clinical experience in multiple care settings such as Acute, Long Term or Home Health and have worked with the Seniors and Persons with Disbilities population or public health is preferred
Knowledge of Medi-Cal benefits or managed care experience a plus
Must have excellent communication, computer and typing skills, work well independently, and proficiency in troubleshooting computer issues

Case Manager, RN Resume Examples & Samples

Outreaches to members telephonically and/or in-person and coordinates member's case management services
Requests consultation and diagnostic reports from network specialists
Some states and/or locations may require nurses to occasionally travel to facility or inpatient bedside to conduct assessments or face to face visits
Preferred 2+ years of experience in appropriate experience and qualifications required to assessing members individual needs
Preferred 2+ years of experience in physical health, aging and loss, appropriate support services in the community, frequently used medications and their potential side effects, depression, challenging behaviors, Alzheimer's disease and other disease related dementias, behavioral health, and issues related to accessing and using durable medical equipment, as appropriate
Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
Ability to effectively present information and respond to questions from peers and management
Required Intermediate knowledge and skills of MS Office including Word and Outlook Express
Required Beginner Healthcare Management Systems (Generic)

Case Manager, Rn-cypress Resume Examples & Samples

In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives
Required An Associate's Degree in nursing or graduation from Diploma Nursing School
Intermediate Ability to drive multiple projects a plus

Case Manager Rn Resume Examples & Samples

Make referrals to outside sources
Make welcome home calls to ensure that discharged member receive the necessary services and resources
Current, unrestricted RN license in the New York
2+ years of experience in a hospital setting, acute care, direct care experience or experience as a Case Manager

Telephonic Case Manager Rn-future Telecommute Potential Resume Examples & Samples

Active, unrestricted RN license your state of residence
This role will require multiple state licensures beyond your home state license
Positive attitude and solution-oriented
Ability to handle multiple tasks and function in a high volume environment
Ability to work well as part of an interdisciplinary team
Must live within a commutable distance (50 minutes or 50 miles) of our Atlanta, GA or Maryland Heights, MO or Greensboro, NC office locations

Case Manager, RN Resume Examples & Samples

Directly performs concurrent review
Coordinates, facilitates and documents comprehensive discharge planning
Ensures the appropriate utilization of capitated and contracted specialists, providers, facilities, and vendors according to region and risk
Attends inpatient review rounds and presents cases to medical director(s), health plans and ACMM management staff
Develops and maintains relationships with both network and Out of Network hospital UM and ER staff
Works directly with AppleCare Hospitalists to develop and implements inpatient processes
Active unrestricted California LVN or RN license
2+ years of clinical experience as an RN or LVN
Computer proficiency; can type, create, edit, search web browsers, toggle between multiple screens, use Word, Outlook, Internet and navigate in a Windows environment
Experience in an IPA or MSO
Knowledge of HMO and ACO structures and operations
Knowledge of standardized CMS, Medicare Advantage, HMO, and Medi-Cal benefits structures
Understanding of DRGs

Case Manager Rn-telecommute Resume Examples & Samples

Working with the complex care needs
Current, unrestricted RN license in the State of New Jersey
3+ years experience in a hospital setting, acute care, direct care experience as an RN and / or experience as a telephonic Case Manager for an insurance company
Ability to work Monday-Friday 10am-7pm
Certified Case Manager (CCM) or must be obtained within 24 months of hire
Bilingual (fluent in English and Spanish)
Ability to work on an auto-dialer call system
Experience working with chronic illness and complex care needs population

Oncology Case Manager RN, Sign On Bonus Resume Examples & Samples

Provide telephonic case management in a fast-paced, technology enabled, call center environment
Apply dynamic clinical expertise to support a wide range of medical conditions
Act as a consciously competent professional eager for feedback to continuously learn and grow in an ever changing environment
Use critical thinking skills to prioritize high impact behavior changes that maximize consumer’s ability to address gaps in treatment and successfully leverage the health care system
Excel in achieving business goals and metrics that you will be measured on every day in order to be successful and thrive in this environment
Care to act and be a transformational force in health care
1+ years Oncology experience
Basic level of experience with Microsoft Word and using the internet
Certified Case Manager (CCM)

Telephonic Case Manager Rn-coumadin Clinic Resume Examples & Samples

Responsible for the coordination and quality of care of Anticoagulation (Coumadin) Clinic patients
Collaborates with Primary Care Physician to ensure appropriate and safe anticoagulation therapy management
Ensure compliance with all SMA/SHS/HPN policies and procedures, state and federal regulations, and standards of practice
Understanding of change and ability to move members along the continuum of change
Able to work under pressure and appropriately prioritize responsibilities
Knowledge in anticoagulation management
Coaching and/or decision support experience
3 years or more of clinical RN experience
5 years or more of clinical RN experience
Experience in Hematology/Cardiology or Home Health preferred

Case Manager Rn Resume Examples & Samples

Work with a multi-disciplinary team, including a social worker and clinical administrative coordinators, to review, stratify and process referrals sent to the Care Coordination Unit from a large variety of internal and external sources
Assist member / provider with coordination of care needs such as obtaining prompt post discharge provider appointments, helping obtain durable medical equipment, and other ancillary care services (home infusion, physical therapy, etc.)
Communicate with internal and external partners as needed to resolve member concerns (Customer Service, pharmacy, providers, facilities, etc.)
Assess intensity of member’s needs in order to determine need for follow-up calls/referrals for further support and case management / care coordination assistance
Make referrals to internal and external partner programs for ongoing psychosocial and / or medical needs requiring interaction with a Care Coordinator, Nurse Case Manager or other health care professionals
Timely and accurate data entry into designated care management applications
Registered Nurse with a current, unrestricted license to practice in the state of Arizona
3+ years of fast paced background in acute care, home health, hospice, geriatric and / or hospital settings
Proficient knowledge of chronic diseases, especially COPD / asthma, diabetes, CHF, depression, PVD and CAD
Excellent verbal and written communication skills; ability to use active listening skills effectively in order to accurately understand member and provider needs
Self-directed; ability to work independently and to collaborate productively within a multidisciplinary team environment / strong resolution and decision making skills
Strong computer skills, including proficiency in Microsoft Office and Outlook
Proficient in managing an ever-changing technology / computer environment, and performing documentation, while using telephonic, e-mail and instant messaging technology
Knowledge of discharge planning options and interdisciplinary approaches to decreasing post-discharge complications and avoidable readmissions to the acute care setting for a geriatric population
One of the following certifications: ACM, CCM, CCP, CMC, and / or CMCN
If not certified in Case Management, required within 3 years of employment
Experience working with geriatric population and individuals with multiple co-morbidities
Experience working with Centers for Medicare and Medicaid Services, especially Medicare and Medicare Advantage programs
Telephonic case management/triage experience

Nicu Case Manager Rn-colorado Resume Examples & Samples

Educating and supporting the family unit through telephonic assessment and expert clinical interventions
Evaluating delays in care, facilitating discharge planning, and arranging for alternative care services to facilitate timely and appropriate discharge
Coordinating care for members

Telephonic Case Manager Rn-cardiac Resume Examples & Samples

Current, unrestricted RN license in the state of Missouri
2+ years of nursing experience in a Cardiac setting to include ICU, ER or Step Down
Ability to work the listed schedule: Monday - Friday. 8:00am - 4:30pm for 3 days/week, 10:30am - 7:00pm for 1 day/week, 11:30am - 8pm for 1 days/week
Reside within commutable distance (50 miles or 50 minutes) of Maryland Heights, MO

Telephonic Case Manager, RN Resume Examples & Samples

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
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
Accountable to understand role and how it affects utilization management benchmarks and quality outcomes
2+ years of varied clinical experience in a hospital or clinical setting with an emphasis on case management or utilization management
High School diploma and/or equivalent
Must possess an active unrestricted Nevada RN license
Must possess reliable transportation
Available one day of weekend - Saturday or Sunday
Experience working with seniors
Experience in a managed care organization as well as case management experience

Case Manager Rn-telecommuting Potential Resume Examples & Samples

Making outbound calls and service inbound calls to assess members' current health status
Identifying gaps or barriers in treatment plans and partner with member to develop an effective care plan
Providing patient education to assist with self-management of their medical condition or disease processes
Collaborate with Medical Directors on high clinical and financial risk cases
Collaborate with Pharmacist regarding medication reconciliation, including lower cost alternatives, medication interactions
Holistic multi-disciplinary coordination of care for members, including partnering with Inpatient Case Manager, Physicians, Ancillary providers, Social Workers and other internal and external clinical programs
Facilitating referrals to Health programs and additional approved resources to assist members in managing their health more effectively
Empower members to actively participate in their health care including healthy lifestyle changes
Graduate of an Accredited RN program
3+ years recent clinical experience as an RN ( Acute care, Case or Disease management within a hospital setting or Home Health Care/Hospice) or experience as a telephonic Case Manager for an insurance company
Multiple state licensure (in addition to Compact License if applicable) OR ability to obtain multiple state nursing licenses required
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)
Experience or knowledge of utilization review, concurrent review and / or risk management
Strong communication skills and open to constructive feedback as well as Open Coaching dialogue

Case Manager Rn-kent & Sussex Counties Resume Examples & Samples

Working with children with special needs
Interacting with Medical Directors on challenging case
Educating members on disease processes
Current, unrestricted RN license in the State of Delaware
Minimum 3 years’ experience in a hospital setting, acute care, direct care experience as an RN and/or experience as a telephonic Case Manager for an insurance company
Experience working with special needs population

Case Manager Rn-outpatient Resume Examples & Samples

Education required: 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
Current, unrestricted RN license required, specific to the state of employment
Five or more years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
Two or more years of managed care and / or case management experience in on / more settings: hospital, acute rehab facility, skilled nursing facility
Medical-surgical clinical nursing experience
Knowledge of utilization management, quality improvement, discharge planning, and cost management
Ability to solve practical problems and deal with a variety of variables
Independent problem identification / resolution and decision making skills
This position requires AHCA level II background checks (fingerprinting) by the state of FL for all clinicians that have face to face contact with members or employees who have access to confidential patient data and will require renewal every five years

Home Health Case Manager RN Resume Examples & Samples

This position requires a minimum of one year experience in acute care or community setting. Home Health experience preferred
Current licensure as a California RN, must obtain Oregon licensure within 6 months of hire; BLS – Health care provider; Valid CA Drivers license, access to reliable auto with proof of insurance
Graduate of an accredited school of nursing; BS in nursing preferred
Must have demonstrated knowledge of the nursing process and community health care. Must have a working knowledge of applicable legal, regulatory and accrediting standards. Demonstrates knowledge of the concepts of death and dying, utilizing the AIM/End of life philosophy. Requires strong patient assessment skills as well as patient/caregiver education skills
Requires excellent organization, prioritization and communication skills. Requires effective English verbal and written communication skills. Must work well independently, without significant supervision or direction
Skilled in the following clinical interventions: central venous line management, pain management , wound management including NPWT devices, venipuncture, blood glucose monitoring and management of related medications and diet, coagulation testing and management of related medications and diet, bladder catheter insertion
Competent in functions of Case Management, including effective delegation skills
Sees 4-5 visits per eight hour day, including all Case Management duties (order follow-up, completes IDT case notes, POC’s reviewed/finalized timely, etc.)

Field Based Case Manager RN Resume Examples & Samples

Assist members with the transition from a care facility back to their home
Must travel to nursing home facilities daily throughout Akron, OH
3+ years clinical experience as a RN in a skilled nursing facility (SNF), long-term care facility, home health, hospice or nursing home
A background in managed care: medicaid, medicare, managed care experience

Case Manager Rn Resume Examples & Samples

Making outbound calls and taking inbound calls to assess members' current health status
Bilingual (Spanish / English) skills
Medical / Surgical, Home Health, Diabetes or Cardiac experience or certification
Computer proficiency, to include strong data entry skills and the ability to navigate a Windows environment

Case Manager, RN Resume Examples & Samples

Current, unrestricted RN license in MN
Experience or exposure with discharge planning
Experience in utilization review, concurrent review or risk management
Previous experience in a telephonic role

Case Manager, RN Required Resume Examples & Samples

Manages 60 to 80 active cases based on case intensity and acuity. Specialty Case Manager case loads may vary
Interacts continuously with member, family, physician(s) and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan
Maintains accurate records of case management activities in the EMMA System using clinical guidelines
Performs special projects as assigned
Required 1+ year of experience in current case management experience
Required Beginner Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express

Field Case Manager Rn-telecommute Resume Examples & Samples

Current and unrestricted RN licensure in state of Mississippi
Reside within 30 miles of the greater Jackson, MS area
Clinical nursing experience that includes Sickle Cell disease management, Hematology, and/or Oncology
CCM (Certified Case Manager)
Experience in home care

Optum Hospice Field Based Case Manager Rn-sign On Bonus Resume Examples & Samples

Providing telephonic triage to hospice patients and their families during on call hours
Ensuring visits are conducted in a timely manner
Ensuring documentation is updated to ensure continuity of care for the week day team
Managing referrals that come in over the weekend
Working with an interdisciplinary team
Providing education and support to patients and families / caregivers
Conducting patient visits as needed (admissions, routine, pronouncements, tuck-ins)
RN licensure (current, unrestricted) in the state of Colorado
2+ years clinical experience as a RN in a hospital, acute care, home health / hospice, or nursing home
Telephonic triage experience
Acute care experience
Experience in long-term
Home care and/or hospice care experience

Oncology Case Manager Rn-lisle Resume Examples & Samples

Making outbound calls to assess oncology patients’ current health status
A current, unrestricted RN license in the State of Illinois
3+ years experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Oncology Case Manager for another insurance company
OCN certification

Case Manager RN Rancho Cordova Resume Examples & Samples

Develops plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
·Works with the member/family, provider(s), and other members of the health care team to develop a plan of care that enhances the clinical outcome while maximizing the member's benefits
Performs evaluation in multiple environments including process and relationships, health care management, community resource and support, service delivery, psychosocial intervention and rehabilitation
Valid Registered Nurse, Clinical Psychologist, or Licensed Clinical Social Worker license
Extensive knowledge of the management of chronic conditions
Experience using standardized clinical guidelines required

Case Manager RN Sacramento Resume Examples & Samples

Identifies cases needing Medical Director review or input. Presents cases to Medical Director for potential review or determinations when needed
Maintains confidentiality of all PHI in compliance with state and federal law and Health Net Policy
Minimum three years clinical experience required
Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations

Case Manager RN, Oncology Resume Examples & Samples

Identifies and recommends opportunities for cost savings and improving the quality of care across the continuum
Develops and collects data, and trends utilization of health care resources
Experience in utilization management, discharge planning, or transfer coordination
Collaborate with members of the healthcare team to design and coordinate an evidenced based plan of care. Conduct initial and ongoing comprehensive needs assessments of patients and families. Evaluates results of care plan and readjusts priorities as patient status changes. Follows an intervention plan from the time of patient referral, coordinates care among team members, reviews patients' disposition for care, provides patient information and education, assists patients in obtaining a second opinion, follows patients during treatment, and evaluates care and changing priorities. Matches unmet needs with referrals to a social worker, dietician, genetic counselor, nurse practitioner, and community or outreach coordinator. Participates in patient education by assisting patients in understanding their diagnosis, treatment options, and available resource's. Provides emotional and educational support for patients and families

Regional Telephonic Case Manager RN Resume Examples & Samples

Guides, facilitates & expedites the care & maximum recovery for employees with work related illnesses or injuries through telephone and electronic communication with patients, carriers, employers, providers (internal&external), & Kaiser Permanente staff. Coordinates patient education & monitors & evaluates the options & services necessary to meet the individual patient's needs
Facilitates and assists physicians and disability case managers in return to work duties
Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning,&facilitates authorizations and approvals as needed for outside services for patients/families
Educates & informs patient & family regarding treatment plan & facilitates return to wellness. Evaluates variance from treatment guidelines caused and takes remedial actions. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services
Identifies & recommends opportunities for cost savings&improving the quality of care across the continuum
Develops & collects data, & trends relating to utilization of health care resources. Interprets regulations, health plan benefits, policies, & procedures for members, physicians, medical office staff,contract providers, and outside agencies
Coordinates transmission of clinical & benefit treatment to patients, families&outside agencies. Acts as liaison for outside agencies, nonplan facilities, & outside providers
Coordinates repatriation of patients & monitors their quality of care
Minimum two (2) years of working within an occupational health/industrial environment
Minimum four (4) years of ongoing experience evaluating patients & work processes from a variety of industries

Telephonic Case Manager Rn-future Telecommute Opportunity Resume Examples & Samples

Making “welcome home” calls to ensure that discharged member receive the necessary services and resources
Active, unrestricted RN license in North Carolina
Must live within a commutable distance (50 minutes or 50 miles) of our Greensboro, NC office location
Knowledge of disease processes for chronic illnesses in the senior population
Knowledge of Medicare guidelines and regulations

Senior Case Manager RN Rancho Cordova Resume Examples & Samples

Manages individual member cases by coordinating the provisions of services, assuring the cost-effective utilization of health care resources to meet individual members’ health care needs and promote positive health outcomes. Significant clinical judgment, independent analysis, critical-thinking, detailed knowledge of departmental procedures, clinical guidelines, community resources, contracting and community standards of care are applied during case management activities. The case manager/care coordinator acts as a member advocate and a liaison between providers, member and HN to seamlessly integrate complex services
Screens members for possible case management services
Expedites access to appropriate care for members with urgent or immediate needs using expedited review process
Performs comprehensive case assessment
Acquires appropriate clinical records, clinical guidelines, policies, EOC, Benefit Policy and coding guidelines. Performs research and analyzes on complex issues
Assesses the member’s current health status, resource utilization, past and present treatment plan and services; prognosis, short and long term goals, treatment and provider options
Using professional judgement, independent analysis and critical-thinking skills applies clinical guidelines, policies, benefit plans, etc to determine the appropriate level of care, intensity of service, length of stay and place of service
Identifies existing problems; anticipates potential problems and acts to avoid them
Develops plan of care based upon assessment with specific objectives, goals and interventions designed to meet member’s needs
Works with the member/family, provider(s), and other members of the health care team to develop a plan of care that enhances the clinical outcome while maximizing the member’s benefits
Applies evidence-based guidelines when available
Identifies appropriate health care resources based on member's medical needs, including but not limited to evaluating contracts and negotiating with facilities/vendors
Effectively utilizes community resources and care alternatives
Implements and coordinates interventions and other activities that lead to the accomplishment of goals established in the case management plan
Continually reassesses services delivered to the member to determine if the goals of the plan of care are being met, whether the goals continue to be appropriate and realistic, and what actions may be implemented to enhance positive outcomes
Performs prospective, concurrent and retrospective reviews and first level determination approvals for assigned members, as appropriate, or refers reviews to appropriate associate. Utilizes considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times and regulatory requirements
Actively participates in departmental evaluation, audit and improvement activities
Acts in an advisory role for the department
Must have and maintain a current, valid and unrestricted clinical license
Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
Ability to work well with all levels in the organization
Local Travel Required

Telephonic Case Manager Rn-st Louis, MO Resume Examples & Samples

Identifying gaps or barriers in treatment plans
Active, unrestricted RN license in Missouri
2+ years clinical experience (any setting)
Must live within a commutable distance (50 minutes or 50 miles) of our St. Louis, MO office
BSN or greater

Telephonic Case Manager Rn-telecommute Resume Examples & Samples

Current, unrestricted RN license in the state of Ohio
2+ years of nursing experience as an RN
Ability to work the listed schedule: Monday - Friday. Hours: 9:00am - 5:30pm for 2 days/week and 11:30am - 8pm for 3 days/week
Reside within commutable distance (50 miles or 50 minutes) of Blue Ash, OH
Experience in utilization review, concurrent review and / or risk management

Telephonic Senior Case Manager RN Telecommute Resume Examples & Samples

Identifies candidates for Case Management using available resources
Reviews the work of others and provides recommendation for improvement
Sought out as expert and key resource on complex and/or critical issues
Serves as a leader/mentor/trainer
Collaborates with specialists, physicians, and medical/clinical directors to provide the necessary care and cost efficient care for the customer
Develops care plan in collaboration with member/caregiver/provider addressing gaps and focusing on areas for maximum impact
Solves complex problems/analyses and develops innovative solutions
Delivers clinical support to members across a wide array of health topics and conditions
Support leadership initiatives
Motivates and inspires other team members
Understands the roles, responsibilities, and functions of clinical staff
Maximizes use of community services, support programs, and resources available to customer
Adheres to ethical, legal/regulatory and accreditation standards
Undergraduate degree or equivalent experience, including specialty experience where required
This role requires a valid, unrestricted, RN license
2-5 years of experience in a clinical setting (departments specific requirements may vary)
Computer skills and technical aptitude
Mandatory certifications: Organization approved Case Management certification
Clinical competence in understanding hopital care and care coordination
Self-directed worker
Business background and/or experience
Supervisor experience
Experience in home care and hospital setting
Excellent clinical skills and judgment appropriate to the situation
Team building and coaching skills
Customer service, communication and presentation skills
Monday to Friday 8-5pm in residence time zone
Microsoft Application proficiency ( Word, Excel, Power Point)

Case Manager Rn-east Valley Resume Examples & Samples

*This is a full time, Monday-Friday position. The RN must be able to travel within assigned territory / location - East Valley or as needed in order to conduct critical face to face assessments. Applicants must be willing to carry a diverse clinical caseload and visit the patient in their home, hospital, SNF and as needed in the PCP’s office. $1500 Sign On Bonus.***
Collaborates effectively with interdisciplinary team (IDT) to establish an individualized plan of care for members, goals including both short and long term
Works with the Utilization Management RNs, Care Coordinators and other providers to facilitate smooth care transitions
Serves as the primary clinical liaison with hospital, clinical and administrative staff for a smooth, seamless transition to the next level of care
Ensures standardized execution of workflow processes, such as increase in admissions, monthly audits, and referral to Care Coordinators
Coordinates and attends member visits with PCP and specialists as needed
Attends and participates in interdisciplinary team meetings as directed
Enters timely and accurate data into designated care management applications as needed to communicate patient needs and maintains audit scores of 92% or greater on a quarterly basis as well as to be determined patient satisfactory scores
3+ years of experience in an acute care, home health, hospice, geriatric and / or hospital setting
Experience with Microsoft Office applications including Word
Able to prioritize, plan, and handle multiple tasks/demands simultaneously
Experience with Excel and Power Point
Marketing, sales and business development

Case Manager RN PRN Resume Examples & Samples

Maintain current knowledge of community resources and associated legal processes that impact the discharge planning process, such as, but not limited to adult and child abuse reporting, guardianship laws and procedures, and protective custody laws
Seeks appropriate resources and consultation to help formulate ethical decisions. Consults in-house resources such as the Ethics Committee and other community resources as needed
Participates in the development and/or update of pathways and policies and procedures to reflect current professional practice

Case Manager RN PRN Resume Examples & Samples

Performs continuous assessments and evaluations to ensure patient is progressing towards desired outcomes
Current licensure as a registered nurse (RN)
Knowledge of CMS guidelines and experience working with payer specific guidelines and contractual rules preferred

Case Manager Rn Resume Examples & Samples

Current license to practice as an RN in Utah
Certification in Case Management, Nursing or Utilization Review preferred. Knowledge of InterQual Criteria a plus
Graduate of an accredited nursing program-diploma, associate degree or baccalaureate program
Minimum of seven (7) years of clinical nursing experience in the acute setting and a minimum of two (2) years Case Management experience

Lead Clinical Case Manager RN Resume Examples & Samples

The Lead Clinical Case Manager is responsible for leading the Case Management team in the daily clinical care coordination of the patient through their entire episode of illness within Research Psychiatric Center’s healthcare system
This includes denials management responsibility at RMC and BH division level, daily oversight of UR duties, developing, maintaining, and distributing monthly reports to division leaders, management of UR schedules and assistance with time edits as needed, coordination of daily operations meetings, oversight of the insurance authorization progress and notification for inpatient programs, oversight of the Bridge clinic, assistance with regulatory compliance for UR, including: Medicare certification, patient choice letter, and coordination of aftercare planning
RN, MSW or Master's Degree in a relevant clinical behavioral sciences field (social work, counseling, psychology, etc.) from an accredited university
Current Missouri R.N. or L.C.S.W. or L.P.C. Licensure
Demonstrated competency in NVCI required upon hire or within three months of hire
One year experience working in a mental health setting. Previous experience in mental health utilization or clinical case management preferred
Working knowledge of DSM preferred
Knowledge of Community Resources/Services required
Demonstrated knowledge or training in the developmental and emotional needs of patients in this age group

Case Manager Rn Resume Examples & Samples

Responds to supervisor & CFO requests for information & assistance in a cooperative manner & within appropriate time frame and comes prepared to weekly self-pay meeting
Gives list of anticipated discharge patients to the Charge Nurse daily at the end of every work day
Documents patient’s admission status in Support Services
Documents discharge disposition in Midas on the day of discharge
Places frequent updates on the Observation Tracker, throughout the day
Reviews written monthly policies & procedures and acknowledges understanding by sending a read receipt message to the Office Coordinator
Accurately performs admission certification of medical necessity within 24-36 hours of patient admission
After following the assessment of the patient the Case Manager will make appropriate referral to the Social Worker

Case Manager Rn Resume Examples & Samples

Minimum 5 years clinical experience in an acute care setting
ER experience a plus!
Previous Case Management/Utilization Review experience preferred
Knowledge of InterQual preferred
Established Leadership skills, with critical thinking ability
Ability to collect, organize, and analyze data
Proficient with Computer programs
Ability to communicate both written and verbally across multiple levels

Case Manager Rn-inland Resume Examples & Samples

Documents Milliman Guideline(s) on every inpatient case within 24 hours of receipt and updates guideline as hospitalization continues for Acute and weekly and as needed for SNF
Notifies patient's Primary Care Physician of admission, discharge and discharge plan within 24 hours of each event as appropriate
Explores care options to reduce cost, decrease length of stay, curtail readmission and influence quality outcomes
Manages cases according to delegation agreement requirements, including notifications regarding LOS >5 days
Meets all health plan contract compliance directives for utilization
Identifies and refers members to Case Management prior to discharge or as deemed appropriate through referral review
Reviews all requests for specialty care, elective surgeries, treatment plans and diagnostic studies in accordance with commercial and senior health plan and CMS timelines
Utilizes health plan, CMS, Milliman and Hayes as sources for documenting appropriateness and standard of care. Seeks consultation from IPA Medical Director when request for services does not meet health plan, CMS, Milliman or Hayes recommendations
Current unrestricted CA Licensed RN or LVN
2+ years clinical experience in acute care (i.e., ICU, CCU, ER, med-surg)
Experience with managed care referral process or case management onsite performing utilization management, discharge planning, or prior authorization
Proficiency in Microsoft Office: Outlook and Word
Travel 50 to 60% to different facilities to provide coverage

Case Manager Rn-offering Sign-on Bonus Resume Examples & Samples

Coordinates services and referrals to health programs
Identifies problems or gaps in care offering opportunity for intervention
Strong inbound and outbound telephonic skills
Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment

Case Manager RN SNP Resume Examples & Samples

Reviews, screens and prioritizes cases for possible case management services
Identifies potential reinsurance cases and notifies the appropriate department according to policy and procedure
Performs prospective, concurrent and retrospective reviews and first level determination approvals for assigned members, as appropriate, or refers reviews to appropriate associate
Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination
Must have and maintain active, valid and unrestricted license that meets licensure requirement for the state in which you practice, i.e., Registered Nurse, Clinical Psychologist, or Licensed Clinical Social Worker
Case Management certification preferred
Local travel required

Case Manager, RN Arizona Resume Examples & Samples

Collaboration and consulting with field community health workers
Possible hospital visits with members
Reside in the state of Arizona
Computer / typing proficiency to enter/retrieve data in electronic clinical records; experience with email, Internet research, use of online calendars and other software applications
Case Management experience including Certification in Case Management (CCM must be obtained within 30 months of employment)
Experience with navigating patients through a complicated health care system

Case Manager RN, Care Coordination Resume Examples & Samples

FL RN license required
Minimum of 1+ years clinical RN experience required
Certification in Utilization, Quality or Case management; or, commitment to pursue within 1 year
Capable of priority setting
Proficient in problem solving and the continuous improvement process. Data management, computer skills

Case Manager RN, Care Coordination, A Resume Examples & Samples

Minimum of 3 years clinical RN experience required
Utilization review experience preferred
Knowledge of managed care and reimbursement principles
Collaboration and negotiation skills
Effective time management

Case Manager Rn Resume Examples & Samples

Assesses the member's current health status, resource utilization, past and present treatment plan and services; prognosis, short and long term goals, treatment and provider options
Closes cases according to the defined case closure procedure in a timely manner, and in accordance with guidelines established
Refers potentially inappropriate resource utilization or quality related concerns to Medical Directors
Must have and maintain active, valid and unrestricted Registered Nurse or LCSW License for the state in which you practice

Telephonic Case Manager Rn-sign ON Bonus Resume Examples & Samples

Direct patient care and telephonic management of anticoagulation therapy for patients enrolled in the Anticoagulation (Coumadin) Clinic
Evaluate INR responses, identify risk factors, and facilitate brief interruptions in therapy across various disciplines and venues
Participate in the development and implementation of patient centered care plans
Expert conflict management skills
1 year or more of clinical RN experience
Case management or cardiology experience
Three years of clinical experience with case management or IMC, ICU experience

Case Manager Rn-telecommute Resume Examples & Samples

Take incoming calls from members
Current, unrestricted RN in your current state
2+ 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
2 + year’s work experience working with diabetic population

IDT Case Manager Rn-southwest Medical Resume Examples & Samples

Visit Medicaid members in settings, including community centers, hospitals or providers' offices
Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheel
Position will be responsible for the care management / care coordination of a panel of high risk high need patients (including coordination of in and out patient care)
Acts as the single point of contact for a panel of patients and their families as well as providers of care team
Assists care team in making informed decisions regarding patients in order to promote better outcomes and smooth transitions of care by maintaining records and data analysis related to the assigned panel of high - risk cases
Duties include but not limited to work directly with provider with daily clinical needs, case management (500 cases per site), reporting, tasks completion, direct interaction with internal and external customers, audits and regulatory compliance
Positions in this function require various nurse licensure and certification based on role and grade level
Licensure includes RN and LPN / LVN, depending on grade level, with current unrestricted licensure in applicable state
These roles identify, coordinate, or provide appropriate levels of care under the direct supervision of an RN or MD
Function is responsible for clinical operations and medical management activities across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
This includes case management, coordination of care, and medical management consulting. Function may also be responsible for providing health education, coaching and treatment decision support for members
Includes Health Coach, Health Educator, and Health Advocate roles that require an RN
3+ years clinical experience in a hospital, acute care, home health / hospice, direct patient care
Experience in MED/SURG
Discharge planning or case management
Experience working with the needs of vulnerable populations who have chronic or complex bio - psychosocial needs

Telephonic Case Manager, RN Resume Examples & Samples

Identify gaps or barriers in treatment plans
Make "welcome home" calls to ensure that discharged member receive the necessary services and resources
3+ years of experience in a hospital setting, acute care or direct care experience
Must be able to type and have the ability to navigate a Windows based environment
Willing and able to obtain, up to, an additional 15 RN licensures

Inpatient Emergency Room Case Manager RN Resume Examples & Samples

Recommends alternative levels of care & ensures compliance with federal, state & local requirements
Reviews, monitors, evaluates & coordinates the patient's hospital stay to assure that all appropriate & essential services are delivered timely & efficiently
Coordinates transfer of patients to appropriate facilities; maintains & provides required documentation
Adheres to internal & external regulatory & accreditation requirements & compliance guidelines

Telephonic Case Manager Rn-high Risk Ob-telecommute From Resume Examples & Samples

Assess for high-risk pregnancy via telephonic assessments and provide education for healthy pregnancy
Provide a complete continuum of quality care through close communication with members via phone interaction
Interact with providers’ offices regarding clinical updates and resource locating
2+ years of High Risk OB clinical nursing experience + current / prior position as a Case Manager OR 3+ years of High Risk OB clinical nursing experience
Current, unrestricted RN license in Arizona
Access to secure high speed Internet via cable / DSL in home
Ability to work Monday - Thursday, 11:30am - 8:00pm and Friday, 8:00am - 4:30pm in your local time zone
Reside within a 50 mile commute of Phoenix, AZ
Bilingual Spanish
Managed care experience / Insurance industry experience

Case Manager Rn-inpatient Resume Examples & Samples

Conducts initial assessments within designated timeframes on patients identified as having complex case management needs (assessment areas include clinical, behavioral, social, environment and financial)
Performs all duties for internal and external customers in a professional and responsible manner having fewer than two complaints per year
With the assistance of the Managed Care / UM teams, guides physicians in their awareness of preferred contracts and providers and facilities
Possess planning, organizing, conflict resolution, negotiating and interpersonal skills
InterQual experience or Milliman experience

Diabetes Case Manager Rn-lisle Resume Examples & Samples

Evaluate and assess member’s with diabetes and coronary artery disease
Proactively begin readmission prevention and discharging beginning with outreach to the member upon admission to the hospital and post-discharge to ensure the member has the appropriate services and resources in place for a successful recovery
Current, unrestricted RN license in the State of Illinois
1+ year of experience working with diabetic patients and diabetes complications
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)
1+ year of experience with coronary artery disease a plus
Certified Diabetic Educator
Disease Case Management experience
Experience with Asthma, Diabetes or Heart disease treatment
Ability to work in a faced-paced environment, adapt to change, strong organizational skills and multitasking abilities are keys to success
Independent, team player and critical thinking skills

Case Manager RN, Utilization Management, A Resume Examples & Samples

Must be licensed in the state of Florida as a Registered Nurse
Associates Degree in Nursing required. Graduate of an accredited school of Nursing; Bachelor of Science in Nursing (BSN) preferred
Minimum required experience: 1+ years

Telephonic Case Manager RN Resume Examples & Samples

Intermediate / proficient level of experience with MS Office applications
Must live within a commutable distance (50 minutes or 50 miles) of our Maryland Heights, MO office
Experience working with elderly / geriatric population

Case Manager Rn Resume Examples & Samples

**This is a work from home / telecommute position and will require Field work throughout the week to visit hospitals in the Knoxville, TN area. Candidates must live within 60 miles of the greater Knoxville, TN area.****
Visit Medicaid and Medicare members in the hospital or other settings including community centers, homes or provider’s offices
Provide a complete continuum of quality care through close communication with members via in-person and/or on-phone interaction
Assist members with the transition from a care facility back to their home, coordinate care such as MD follow up appointments, home health services, medication reconciliation, etc
Assess for gaps in care and provide assistance with closing those gaps
Support members with condition education, connections to community resources such as Meals on Wheels, The Choices Program, utility assistance, etc
Current, unrestricted RN license in the State of TN and residence in W. Tennessee ( Memphis or surrounding areas )
Reliable transportation to travel to hospitals/facilities or other locations within service delivery area
Experience in Home & Community based or Long Term Care services delivery

Case Manager RN Per Diem-new Pueblo Medicine Resume Examples & Samples

Calling members with chronic conditions to help improve their self management skills
Reviewing population management reports and performing charts reviews to determine gaps in care
Suggesting interventions or referrals
Seeing patients with diabetes and teaching self-management skills such as insulin use, proper diet and exercise routines and glucometer use
The chosen candidate must be an RN with a current, unrestricted license in their state of residence, along with strong clinical experience
Associate’s or Bachelor’s degree
Computer proficiency is key
A disease management focus
Experience in a managed care environment
Certified Diabetic Educator or ACLS (Advanced Cardiac Life Saving) certification

Case Manager Rn Resume Examples & Samples

Interacting with Medical Directors/Pharmacists on challenging cases
Coordinating care for members i.e. Partnering with internal and external vendors including, Behavioral Health, Wellness, Social Workers, EAP
Communication with customers and/or account management teams
Collaboration with Primary Care and Specialty Providers
Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses within 12 months

Case Manager RN Picc RN Resume Examples & Samples

Responds to requests for PICC line insertion
Assists with trouble shooting lines
Documents in the medical record and ensures patient plan of care is updated
Collects data for quality monitoring
Mentors new staff in the department
Resource for members of nursing and medical staff
PICC line management experience preferred (25 successful insertions in prior year)

Embedded Case Manager, Rn-st Louis Resume Examples & Samples

Current RN license in the state in which the nurse will be required to practice
Valid drivers license and/or dependable transportation necessary (variable)
Medicaid/Medicare experience

Case Manager Rn Resume Examples & Samples

Minimum five years of clinical e experience in an acute care setting
Previous case management and/or utilization management/utilization review experience preferred
Established leadership skills
Proven critical thinking skills
Innovative and creative approach to work
Ability to work independently and in stressful situations
Ability to demonstrate effective written and oral communication skills

Case Manager Rn Resume Examples & Samples

Associates Degree in Nursing required. Graduate of an accredited school of Nursing; Bachelor of Science in Nursing (BSN) strongly preferred
Excellent verbal and written communication skills and ability to work in a fast-paced, crisis-oriented environment
Prefer CCM or CPHM certifications

Case Manager RN PRN Resume Examples & Samples

Five (5) years of acute care clinical experience, intensive care nursing desired
Strong interpersonal/communication skills
Self motivated, can work autonomously and ability to work with an interdisciplinaryteam
Computer and statistical experience highly desired
Must be able to work in a fast paced, ever changing environment
Attention to detail and concentration

Case Manager RN PRN Resume Examples & Samples

At least 5 years of basic med/surg or psychiatric nursing or equivalent nursing experience
Experience in case management and utilization management preferred
Nursing experience at an acute care hospital preferred

Complex Case Manager, RN Telecommute Resume Examples & Samples

Conduct initial and follow-up assessments within designated timeframes on patients identified as having highest risk complex case management needs (assessment areas include clinical, behavioral, social, environmental and financial)
Assess the patient's current medical and social circumstances to identify any gaps or barriers that would impact compliance with the prescribed treatment plan
Engage patient, family, caregivers, and healthcare providers to assure that a well-coordinated treatment plan is established
Utilize holistic approaches to patient care and integrates patient's life and motivational goals into the treatment plan
Prioritize care needs, set goals and develop a treatment plan (or plan of care) that also addresses gaps and/or barriers to care and uses evidence-based practice as the foundation
Track the patient's health status and progress in achieving clinical and personal goals
Provide education, information, direction, and support related to care goals of patients
Communicate with patients, families, caregivers, physicians, and other service providers to coordinate the care needs for the patient
Work to facilitate patient compliance and to ensure continuity of care
Monitor and evaluate the patient's response to treatment(s)
Collaborates with internal Medical Directors to attain optimal outcomes and cost efficient services
Document assessments, interventions, and follow-up on Case Management activities
Regularly assess the effectiveness and quality of services provided to patients by analyzing outcomes (clinical, functional, and financial)
Maintain a focus on timely, quality customer service
Maintain a focus on the customer service through policy and program decisions and consider impact of these activities on the members
Facilitate problem resolution with members, providers, and other agencies or entities as needed
Promotes cost efficient health care consistent with adding value for consumers, customers and business
Serves as consumer advocate and maintains consumer's privacy, confidentiality and safety
Participates in special projects, initiatives, and other job duties as assigned
Registered Nurse (RN) with current active and unrestricted license in the State of residence
Willing and able to obtain additional State RN licensures, if necessary
3+ years of hands-on clinical experience in a hospital, acute care, inpatient, home health/hospice or direct care environment
Applicable certifications: NCQA approved Case Management certification within 30 months of assuming the position for those RN’s performing Complex Case Management who are not currently CCM certified
Experience in Managed Care
Bachelor’s Degree or higher strongly preferred
Transplant Case Management or Transplant nursing experience
Preferably live within a commutable distance to one of the following city and states: Richardson TX, Greensboro NC, Lisle IL, St. Louis MO, West Chester OH, Cincinnati OH, Phoenix AZ, & Eden Prairie MN

Case Manager Rn-east Valley Resume Examples & Samples

*This is a full time, Monday - Friday position. The RN must be able to travel within assigned territory / location - East Valley or as needed in order to conduct critical face to face assessments. Applicants must be willing to carry a diverse clinical caseload and visit the patient in their home, hospital, SNF and as needed in the PCP’s office. $1500 Sign On Bonus.***
Provides assessments of physical, psycho - social and transition needs in settings not limited to the PCP office, hospital, or member's home
Able to prioritize, plan, and handle multiple tasks / demands simultaneously
Experience working with geriatric over 65 patient populations, individuals with multiple co - morbidities

Case Manager, Rn-acute Care Resume Examples & Samples

Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient and non-KFH facilities
Coordinates transfer of patients to appropriate facilities; maintains and provides required documentation
Reviews, analyses and identifies utilization patterns and trends, problems or inappropriate utilization of resources and participates in the collection and analysis of data for special studies, projects, planning, or for routine utilization monitoring activities
Coordinates, participates and or facilitates care planning rounds and patient family conferences as needed

Duals Case Manager, RN Resume Examples & Samples

Reviews patients’ clinical records within 48 hours of SNF admission
Coordinates treatment plans and discharge expectations and discusses DPA and DNR status with attending physician
Demonstrates a thorough understanding of the cost consequences resulting from care management decisions through utilization of appropriate reports such as Health Plan Eligibility and Benefits, Division of Responsibility (DOR) and Bed Days

Inpatient Case Manager, RN Resume Examples & Samples

Prioritizes patient care needs and meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan
Coordinates provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
Maintains accurate and complete documentation of care rendered including LOC, CPT code, ICD-9, referral type and date

Utilization Review Per Diem Case Manager, RN Resume Examples & Samples

Reviews patients’ clinical records of acute inpatient within 24 hours of notification
Initiates and oversees data entry into IS systems of all patients within the parameters of care management policies and procedures
Manual dexterity to use/handle equipment and instruments

Field Based Case Manager RN Resume Examples & Samples

Must travel to nursing home facilities daily throughout Cleveland, OH
3+ years clinical experience as a RN in a hospital, acute care, home health / hospice, or nursing home
3+ years’ of Home care, long care or nursing home experience
Experienced in ICU or Med-serge clinical setting
UnitedHealth Group is working to create the health care system of tomorrow
Case Management experience including Certification in Case Management (CCM)

Case Manager, RN Resume Examples & Samples

B.S. Degree
Physical/emotional stamina
Communicates in a clear and understandable manner appropriate to the age/developmental stage of the patient or visitor
Demonstrates good interpersonal skills
Meets specific departmental criteria and/or certifications

Case Manager Rn-inpatient Resume Examples & Samples

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+ years of experience
Current, unrestricted RN license, specific to the state of employment
5+ years of diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
2+ years of managed care and / or case management experience
Proficient with Microsoft Office applications including Word, Excel, and PowerPoint

Case Manager Rn Resume Examples & Samples

Work in collaboration with the healthcare team in the coordination and management of care for patients to help ensure achievement of optimum outcomes
Utilize quality management tools to improve organizational performance relative to decreased costs, appropriate resource utilization and performance improvement
Clinical, managerial, and financial functions and includes these key components; communication, education, professional development, customer service, monitoring and evaluation, and systems management
Complete a psychological assessment with patient, family member, or both within the first twenty-four hours of the admission process
Document on the day of admission, or within the first twenty-four hours, a written discharge plan that addresses use of the full continuum of care
Provide treatment updates to providers outside of the hospital and family members for each assigned case
Manage each assigned client’s treatment plan throughout the patient’s stay
Revise plan of patient care as needed
Provide placement and related triage services for each assigned case as needed
Supervise nursing staff
Act as a liaison to patients and patient’s support system if patient feels care was unsatisfactory
Encourage nursing staff to provide best practices to improve patient experience and nurse’s productivity
Develop continuing education seminars for nursing staff
Document in a clear, timely and systematic fashion all actions taken with respect to each assigned case
Attend staff meetings and senior staff meetings
Facilitate nursing staff meetings
Graduate from an accredited school of nursing required
Master’s degree in Nursing preferred
Current RN State licensure
3 years Med Surg, or ICU nursing experience
4-5 years experience in health care environment as a case manager preferred
Proficient in use of medical coding software
Knowledge of utilization/case management, reimbursement methods (prospective payment, per diem, etc), and performance improvement principles
Proficient in Microsoft Office, Microsoft Project
Requires critical thinking skills, decisive judgment and the ability to work with minimal supervision. Must be able to work in a stressful environment and take appropriate action

Case Manager Rn-inpatient Rehab Resume Examples & Samples

BSN in Nursing required
Current state licensure as a Registered Nurse required
Previous experience in case management or related area required

Ows-case Manager, Rn-weekend Resume Examples & Samples

Manage in a case management system (EMR) using ongoing interaction with patients, physicians, and other health providers to meet designated clinical, operational, and financial outcomes for aggregate patient populations
Provides information to assist physicians, patients, families, staff and payors in providing care for patient populations that is appropriate, effective, and cost efficient
Attend and actively participate in all departmental and interdepartmental meeting relative to Case Management/ Psych/Social functions
Collaborates with payors and review organizations to ensure proper utilization of patient care resources
Documents clearly, concisely and timely all contacts and information of the patient’s case management process on the appropriate chart forms
Educates physicians and staff regarding appropriate level of care/utilization issues
Ability to work with diverse patient and staff populations with knowledge and sensitivity to cultural and spiritual influences impacting on patient care
Knowledge of the Continuum of Care and Utilization Review processes a MUST
Exhibit a positive attitude
Ability to document Case Management plans in a clear and concise manner
Knowledge of state and federal programs that provide medical care and financial support to individuals and community resources
Ability to work independently, with little direction
Perform other functions as needed
Maintains current knowledge of Case Management/Social Services, discharge planning, and nursing issues through continuing education
Suggests and introduces new methods and techniques
Participates in professional activities in order to continue their professional development and contribute to that of the profession
Minimum of three (3) years acute hospital nursing experience and two (2) to three (3) years acute
Hospital Case Management experience required
Valid New Jersey Registered Nurse License
Current BCLS required/ due at time of hire
Proof of all required License(s) and Certifications(s)

Case Manager Rn-outpatient Resume Examples & Samples

Perform comprehensive assessments and document findings in a concise / comprehensive manner that is compliant with documentation requirements and Center for Medicare and Medicaid Services (CMS) regulations
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
Travel

Complex Case Manager RN Resume Examples & Samples

Providing patient education to assist with self-management
Current, unrestricted RN license in the State of New York
Strong computer proficiency, must be able to talk and type in addition to navigating around a Windows environment and using multiple applications simultaneously
Must live within a commutable distance (50 miles or 50 minutes) of Kingston, NY
Oncology background

Case Manager Rn Resume Examples & Samples

Minimum of five (5) years of experience as an RN
Two (2) years of experience in a medical insurance environment
Acquire certification (CCM, CCP,) within two years of date of hire
Competent in use of Microsoft word, excel, and windows
Keyboarding skills and the ability to utilize computer equipment and software are required as is experience with other types of standard office equipment
45 wpm and 10 key by touch required
Familiar with multiple medical specialty procedures and diagnoses
RN License and BLS CPR
Previous experience in an ambulatory care setting or for specialized experience important to the function of the respective department
Previous care management or chronic care support experience
Familiarity with an electronic practice management system is preferred
Impact of Decisions: Serious impact on patient relationships, physician efficiency, and stewardship of clinic resources. Internal/External Contacts: Requires significant contact with insurance company representatives, physicians, clinical office staff and other support staff. Supervision: Does not directly supervise others

Case Manager, RN Resume Examples & Samples

Proactively collaborate and problem solves within internal (claims, prior authorizations) and external (providers, pharmacies, community) contacts to work through member issues on a case by case basis
Drive team consultation, research and collaboration to expand the skill set of the team in meeting the diverse needs of the special needs population
Proactively review new, in process, and closed cases to identify opportunities to provide guidance to members and the team
Escalate and articulate quality of care concerns to the Medical Director, and collaborate with involved parties to develop solutions and close communication to members
Identify and incorporate holistic environmental and cultural factors that impact the health and experience for our members and families
Identify priorities to address business and operational challenges interfering with the needs of the members
Ability to demonstrate active, empathetic listening to develop solutions with members, multidisciplinary providers and internal team
Ability to relay complex information across teams and to members in a plain, clear manner
Adaptability. This team is new and so roles will be morphing as we learn how the operation should function long - term
5+ years of experience working directly with complex pediatric patients and families
Current and unrestricted RN License in the state of MN
Active and unrestricted multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required (Application fees and filing costs paid for by UHG)
Proficient in multi - tasking and navigating multiple computer programs simultaneously while talking on the phone
Proficient with Microsoft Outlook, Word, and Excel
Experience providing care for children with special needs
Relationship management experience

Transplant Case Manager Rn-lisle Resume Examples & Samples

Provide patient education to assist with self-management
Making discharge calls to ensure that discharged member receive the necessary services and resources
1+ year Case Management experience
2+ years of Transplant clinical nursing experience (Solid organ and/or bone marrow transplant) in a hospital setting, acute care or direct care environment

Telephonic Case Manager RN Resume Examples & Samples

Must live within a commutable distance (50 miles or 50 minutes) of Greensboro, NC
Bachelor's Degree or greater
Cardiac nursing experience

Field Based Case Manager Rn-east Resume Examples & Samples

Must travel to nursing home facilities daily throughout East Cleveland, OH
3+ years of clinical experience as a RN in a hospital, acute care, home health / hospice, or nursing home
3+ years of Home care, long care or nursing home experience
Experienced in ICU or Med - serge clinical setting

Case Manager, RN Resume Examples & Samples

Active licensed RN in state of employment
Case Management Certification (CCM) required
Three years clinical or managed care experience
Interqual (or Milliman) knowledge
Good communication skills, verbal and written
Bachelor’s degree in nursing or health related field
Two years case management experience

Field Based Case Manager RN Resume Examples & Samples

Facilitate Repatriation process by working closely with health partner, member and Transdisciplinary care team
Must travel to nursing home facilities daily throughout Dayton, OH
Background in managed care

Case Manager Rn Resume Examples & Samples

Evaluates appropriateness of patient for lines
Inserts line and provides patient/family education
Communicates to staff as necessary

Telephonic Case Manager Rn-california Resume Examples & Samples

Making Welcome Home calls to ensure that discharged member receive the necessary services and resources
Proficient level of experience with Microsoft Word, with the ability to navigate a Windows environment
Critical care experience

Case Manager, Rn-dual Bls-hepatology Hours Resume Examples & Samples

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 reinforces the treatment plan. Advising and coaching patients and families; Succinctly document interventions in KP HealthConnect as needed by other providers to ensure coordination of care and services
Two (2) years of experience working with bariatric surgical patients
Microsoft Word, Excel, and Health Connect experience preferred
Prior experience with care/case management, triage & advice for surgical population preferred
Prior experience and skill with telephonic patient assessment preferred
Experience working from standardized policies and procedures preferred
Certification in Case Management; Certification in Bariatric Nursing preferred

Telephonic Case Manager, RN Resume Examples & Samples

Assesses and interprets customer needs
Analyzes complex needs identified in [in-home] assessment
Works with minimal guidance; seeks guidance on complex situations
Plans and implements telephonic care conferences with clients and caregivers
Assist caregivers and care recipients in understanding changes in older adults health, abilities and functions, and helps finding solutions and making tough decisions
Develops a written care plan and summary and recommendation report from the assessment information that addresses needs and incorporates client and caregivers long and short term goals
Provides feedback and guidance to care recipients and caregivers
Serves as a resource and provides research on community services and programs
Provides education and referral sources
Independent Licensed Master's degree in Social Work or an RN
Must be able to treat individuals independently and without supervision
Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email and other software applications
5+ years clinical experience
2+ years of experience in case management of the geriatric population
1+ years of experience identifying resources and providing research on community resources and programs
Case Management experience including Certification in Case Management

Health Case Manager RN / RPN Resume Examples & Samples

The management of the assigned projects and/or cases
Adherence to the general HealthForward Inc. processes
Implementing call-centre programs including the provision of patient and healthcare professional bodies with telephone support. Current assistance lines focus on
Medical information
Disease management (including compliance, utilization, educational information on specific products/devices/delivery methods)
Compliance programs
Administer and adhere to case-management protocols, including clinical monitoring, data collection, on-going patient follow-up, compliance, therapy disruption/discontinuation monitoring, adverse event reporting and liaison with primary healthcare providers
All patient programs are based on casework methods and include a significant amount of out-bound calls
Document each activity in program specific database as required
Participate and attend on-going refresher training and in specialized training courses for specific products or programs as deemed appropriate by the manager
Support and collaborate with other staff in the development &implementation of disease management programs including
Determine and clarify clinical requirements
Write texts, manuals or patient pamphlets
Develop compliance program parameters, needs assessments and protocols
Provide feedback regarding current protocols, database, processes,inter-departmental relationships
Clear communication to manager, pod, and program trained colleagues regarding the management of cases during foreseen absences
With the managers, participate in the training process of new case workers, including but not limited to shadowing & call monitoring; and
The Health Case Manager will also be assigned other duties and tasks as required from time to time
Registered Nurse License for province of employment, or Registered Practical Nurse License for province of employment
Bilingualism (French and English) strongly preferred
0 to 5 years of nursing experience required
Professional / courteous / efficient telephone manner
Must be detailed-oriented and organized
Experience in customer service an asset

Field Based Case Manager RN Miami Dade Resume Examples & Samples

Assist members with the transition of care from home to ALS (Assisted Living Facility)
Current, unrestricted RN license for the state of Florida
Bilingual skills in Spanish

Senior Case Manager, RN Resume Examples & Samples

Receive, evaluate, accept and execute the initial patient intake process to assure that patient verification, assessment, teaching and ongoing scheduling of nursing services occur in timely manner
Assures timely communication with other company personnel and outside providers to assure the quality and continuity of patient care
RN license in New York
3+ years Infusion Therapy and home health experience
Knowledge of INS (Infusion Nursing Standards) and nursing process including assessment, problem identification of nursing diagnosis, planning and communicating, implementation and evaluation
Knowledge and experience with current state licensure requirements
Electronic medical records (EMR) experience
Knowledge and experience in HIPPA and OSHA regulations
Ability to work under pressure for clinical emergencies
Ability to work a flexible schedule as needed (including 2 Saturday’s per month)

Transplant Case Manager Rn-telecommuting Resume Examples & Samples

Making 'welcome home' calls to ensure that discharged member receive the necessary services and resources
Multiple state licensures (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required
Experience working with Milliman Care Guidelines (MCG)

Case Manager Rn-picc Resume Examples & Samples

Prioritizes placement of PICC lines according to patient needs
Maintains sterility during insertion and with dressing changes
Will communicate with MD if necessary to verify specifics of lines insertion or appropriateness
Minimum two (2) years of experience as an RN

Onsite Case Manager RN Resume Examples & Samples

Provide face to face condition management to NCR members that are referred for acute and chronic conditions; enroll them into the appropriate Optum program (Diabetes, CAD, Case Management, etc.)
Collaborate and integrate with onsite clinic to educate members on NCR’s available programs and resources, and provide both Case management and Lifestyle coaching to NCR members that are referred for conditions that could benefit from these programs
Make referrals as applicable to other NCR Health Direct Programs (i.e. Kidney Resource Services, Bariatric Resource Services, Cancer Support Services, Transplant Services, EAP/BH etc.)
Provide support and instruction to members on how to access the EAP benefit
Participate in presentations and market health programs at Health Fairs and Biometric Screenings to promote services offered through the NCR benefit programs
Possible 5% travel to other Atlanta offices (Duluth, Peachtree City, Columbus, Suwanee, etc.) for onsite biometric screenings to engage with membership
Understand the Onsite Clinic services in order to refer members if necessary
Collaborate with NCR Wellness Champion on staff to coordinate and promote wellness opportunities
1+ year of clinical experience dealing with adult patients

Case Manager / RN Resume Examples & Samples

Participate in the admission process including pre-admission assessment, rate negotiations, benefit verification, care needs and reporting
Communicate resident status, change in function and care plan either by phone or written report to payers
Include payer representative in interdisciplinary meeting if requested or deemed necessary to promote payer/provider relationship
Document all payer interactions regarding resident progress, expected outcomes and reporting capabilities including special instructions
Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs
Assist with the completion of the MDS for managed care patients
Negotiate all one-time payer agreements and LOA’s with the assistance of the Executive Director, District Director of Case Management, and Vice President of Managed Care & Professional Services
Coordinate all services for each managed care patient, including in home and outside of the care center
Approves all payer changes affiliated with managed care patients
Reviews all ancillary invoices with Executive Director and Business Office Manager
Key communicator of discharge plans related to managed care patients
Review and challenge documentation before sending to MCO
Maximize benefits by coordination of cost effective care, avoid fragmented care, duplication of services and ensure the appropriate level of care is provided in the most suitable setting
Meet with facility interdisciplinary team to coordinate services to ensure that the resident’s total regimen of care is maintained
Participate in all Medicare and managed care resident interdisciplinary meetings
Perform clinical assessments
Work with team members to ensure discharge-planning goals and objectives are developed and discussed at the interdisciplinary team meetings
Assist in planning the services required in the resident’s discharge plan as necessary
Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care and Medicare residents
Perform random chart reviews to ensure accurate and thorough documentation to support reimbursement of services rendered
Meet with residents, and/or family members, as necessary. Report problem areas to department directors
Agree not to disclose assigned user ID code and password or accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Executive Director
Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Administrator
Report any known or suspected unauthorized attempt to access facility’s information system
Assist with pre admissions evaluation of potential manage care patients, including cost-cut, insurance authorization and patient/insurance education as necessary
Embrace Consulate Health Care’s five core values of compassion, honesty, integrity, respect and passion, and incorporate them into one’s daily job function
Conduct oneself with the highest degree of honesty and integrity in every interaction
Demonstrate a passion for caring as evidenced by interaction with co- workers, residents, families and visitors
May be trained and assigned to perform the Customer Care Liaison duties as needed
Perform all other duties, as assigned
Develop and maintain a good rapport with interdepartmental personnel, as well as other departments within the facility to ensure that services can be maintained to meet the needs of the residents
Make appropriate reports to department supervisors as required or as may be necessary. Follow facility’s established procedures
Report known or suspected incidents of fraud to the Executive Director
Ensure that departmental computer workstations left unattended are properly logged off or the password protected automatic screen-saver activates within established facility policy guidelines
Ensure that appropriate supplies and equipment, etc., are available to meet the needs of assigned residents
Participate in the orientation of new resident/family members to the facility
Make rounds with physicians as necessary
Admit, transfer, and discharge Medicare and managed care residents as required
Report suspected or known incidence of fraud relative to false billings, cost reports, kickbacks, etc
Must have, as a minimum, three (3) year’s experience in a hospital, nursing care facility, or other related health care facility
Must have training in rehabilitative and restorative nursing practices
Must have a working knowledge of managed care rules, regulations, and guidelines
Must have knowledge of managed care and PPS systems

100

Field Case Manager RN 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 Post - Acute 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 and effectively communicates with members, their families and / or designated member representative to assess discharge needs and formulate discharge plan, provide Health Plan benefit information, and services available based on clinical need
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
Effectively communicates plan of care to facility staff, health plan partners, and Ambulatory Case Management (ACM) to ensure understanding treatment plan and clinical needs at time of transition to lower level of care
Efficiently navigates and utilizes computer data entry programs including, but not limited to: Microsoft Office (Outlook, Word, and Excel), RightFax, Adobe Reader for fax attachment process
Identifies and reports all institutionalized, ESRD and hospice patients, and appropriately refers members with special transition needs or disease management to ACM
Performs on call duties as scheduled on a rotating basis
Actively participates in the orientation and ongoing training of new employees as needed
Actively participates in the ongoing development of IPCS by participating in task forces for policy and procedure review / revision / development, staff meetings, and other departmental meetings / committees promoting Monarch HealthCare's core ideals and values
Regular and consistent attendance

101

Case Manager Rn-springfield Medical Center Resume Examples & Samples

Plans, implements, manages, coordinates and evaluates a comprehensive plan of care across the care continuum aimed at stabilizing 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
Develops, implements, and manages the patient's plan of care through use of comprehensive assessment tools, processes, clinical pathways, and clinical guidelines to evaluate patient's plan of care, including processes to identify and correct deviations from clinical pathways. Identifies and analyzes trends and barriers that may affect patient outcomes
Coordinates, manages, and evaluates services to ensure that they are consistent with the comprehensive plan of care and are delivered in a manner that demonstrates high quality and cost effectiveness
Analyzes patient and program outcomes to identify improvements in program, quality and cost effectiveness of case management activities
Promotes self-awareness and knowledge of current medical and case management standards in the community, recent innovations in patient care, and availability of alternative community, local, state, and federal resources

102

Case Manager, RN Telecommute Resume Examples & Samples

Current, unrestricted RN license in Louisiana
Dedicated work space from home
Bachelor’s degree or greater

103

Field Based Case Manager Rn-brown Deer, WI Resume Examples & Samples

Transcribe on - call logs into electronic medical record
Provide in - services to partnering nursing home staff for development and new home openings
Must travel to nursing home facilities daily throughout Brown Deer, WI (Milwaukee county)
Registered Nurse (RN) with an active and unrestricted license in WI

104

Case Manager Rn Resume Examples & Samples

Performs accurate identification in determining needs for cultural diversity, impaired vision and hearing
Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; documents plan in the medical record; communicates plan to appropriate clinical disciplines
Assumes a leadership role within the interdisciplinary team to manage care through criteria- driven processes, to achieve the appropriate level of care, patient status and resource utilization
Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement and assess the plan of care
Evaluates admission for medical necessity using approved criteria at defined intervals through the episode of care; escalates medical necessity and admission status issues through the established chain of command
Performs utilization management reviews and communicates information to third party payers
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 RN Care Coordinator services
Facilitates patient throughput with ongoing focus on quality and efficiency
Involves patient/family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
Directs activities to identify and provide for the needs of the under resourced patient population, to include patient education activities, patient assistance programs, and community based resources
Demonstrates knowledge of patient rights, patient choice for post-acute services, “Important Message from Medicare” on the right to appeal discharge
Follows through on securing Advance Directive documents/information
Escalates issues, as needed, through the established Chain of Command in a timely manner
Minimum 3 years’ experience in an acute care setting is required

105

Hospital Transitions Case Manager RN Resume Examples & Samples

Contact members by phone to schedule in home post hospital assessment
Review hospitalization notes and reviews
Conduct in home post hospital assessment according to policy and procedure
Follow up on any identified member needs in a timely manner reaching out to member’s ongoing CM as needed
Provide member / caregiver / responsible party education related to disease process for which member was hospitalized. For example: Diabetes, COPD, CHF, etc
Reconcile member’s medications with current list of medications in the member record making sure member has member has filled medications prescribed upon discharge from the hospital
Educate member on medications as appropriate
Contact Plan PharmD with medication concerns. For example: member having difficulty filling medications-pharmacy not filling, duplication of medications, etc
Review member’s discharge instructions for DME needs, education needs, medications, etc
Assist member with scheduling of appointment with primary care physician within the week following hospital discharge unless appointment has already been made
Conduct 7 and 14 day post hospital phone calls with member to make sure appointments are kept and that no further issues have arisen
Schedule additional visits as deemed necessary
Keep ongoing CM informed of any needs or concerns that the member expresses, changes in environment, or changes of member’s informal support, etc
Participate in Quality Improvement process including recognition of quality of care issues and reporting the information to appropriate staff for review and resolution
Utilize software to document all telephonic and face to face contact with members and document in a timely manner
Organize work and develop strategies for adapting to a constantly changing workload or when confronted with unforeseen situations
Current registered nursing license (RN) in the state of Arizona
A minimum of two years case management, long term care or home health experience
Working knowledge of medical terminology
Experience with clinical coaching or teaching
Proficient computer skills (Word and Excel)
Ability to travel throughout the geographic service area to complete assessments
Working knowledge of Medicaid regulations
Experience with web based documentation systems (EMR)

106

Telephonic Case Manager RN, Telecommute Resume Examples & Samples

Active, unrestricted RN license in the state of New York
Must live within a commutable distance (50 minutes or 50 miles) of our New York, NY office locations
Experience in managed care (MCO)
Case management experience

107

Complex Case Manager RN Resume Examples & Samples

Strong clinical background preferably in acute care or home health
Must have working understanding of MS Outlook, Word and Excel and be capable of being trained in referral processing software
Three to five years experience in a managed care setting/utilization review/discharge planning/case management

108

Complex Case Manager RN Resume Examples & Samples

Bachelor’s required
California State Registered Nurse License
Two to three year’s acute hospital experience, including one year of supervisory experience
Strong leadership, supervision interpersonal and organizational skills
Excellent communication skills, both oral and written
Ability to plan, organize, prioritize, evaluate and document
Basic computer skills, Word, Excel, Access and PowerPoint
Knowledge regarding State and Federal regulations, HMO, PPO and Utilization processes
Knowledge of Discharge planning and Case Management
Knowledge of principles and practices of Utilization and Quality Management
Knowledge of CPT, IDC-9 Coding
Masters in health care related field preferred

109

Case Manager, RN Resume Examples & Samples

Performs a comprehensive nursing/psycho- social assessment on a targeted patient population
Develops and implements a care plan, in partnership with the patient’s PCP and other members of the pediatric iCMP team, that address the patient/family stated and clinical goals. Ensures psycho-social barriers are addressed and all elements of the plan have been assigned accountability, and communicated to the patient/family, members of the Interdisciplinary medical team and appropriate community partners
Engages the family and patient in their health management and care plan by addressing barriers to care the patient and family are experiencing and are hindering their engagement
Monitors the patient’s progress, intervening as necessary and appropriate to ensure that the plan of care and services provided are patient focused and friendly, high quality, efficient, and cost effective
Influences appropriate utilization of health care resources by coordinating patient care, encouraging involvement in disease and case management programs; conducts follow-up care prior to and post interaction with the broader health care system, including acute care admission, emergency department visits, specialist visits, and sub-acute care settings
Increase continuity of care by managing relationships with tertiary care providers, transitions of care, and referrals to both in- and out-of-network clinical providers ensuring the patient’s medical home is aware of all recommendations made by these parties and reconciles changes made in care, including medications
Attends patient/family Team meetings in medical, educational and community settings as needed, enlisting the help of other iCMP role groups as appropriate
Documents in the medical record all relevant encounters with the family and other agencies improving the health and well-being of the child
Provides consultation and education as necessary to other members of the iCMP care team regarding clinical matters, insurance benefit design and coverage, health care options, and available community resources that would improve the care of a particular patient
Participates in iCMP Team Meetings, Case Reviews with MGH Pedi ICMP team members, the MGH adult iCMP team and other Partners iCMP teams
Participate in practice-based Medical Management meetings, as appropriate
Participates in quality improvement activities of the iCMP program that may include PDSA, giving direct feedback and adjustments in responsibilities to improve the overall function of the program
RN with current license to practice in Massachusetts

110

Case Manager, RN With Weekend day Rotation Resume Examples & Samples

Identifies patients/families with complex psychosocial and non-medical discharge planning issues; refers to Social Services Department
In collaboration with multidisciplinary team, monitors the patient’s progress and plan of care with the aid of internal and external utilization and quality guidelines. Identifies, documents, and reports issues and system barriers
Coverage on weekends and holidays as per Case Management policy
Acute hospital experience preferred
Strong assessment and problem solving skills
Goal oriented and accountable
Demonstrated organizational skills
Demonstrated ability to work in a complex setting
Ability to work in an interdisciplinary team based environment
CM Certification desirable

111

Case Manager Rn Resume Examples & Samples

High level of clinical skills required
Familiar with Medicare MS-DRGs and Medicare PPS preferred
Performance Improvement (PI) experience preferred
Clinical leadership experience preferred
InterQual® ISD Acute Care Adult (IQ) or related medical review criteria experience preferred
Excellent computers skills and current knowledge of the electronic medical record
Certified Case Manager (CCM) certification preferred

112

Field Based Case Manager RN Resume Examples & Samples

Diagnosis reviews for coding accuracy
Monitor use of level 2 bed support surfaces to meet Medicare criteria
Must travel to nursing home facilities daily throughout Green Bay and Fox Valley, WI area
Background in managed care: medicaid, medicare, managed Care experience

113

Hiring Bonus Hospice Case Manager RN Resume Examples & Samples

Licensure for state of practice is required in Nursing or related field preferred
Basic ability to communicate and comprehend; ability to measure and comprehend certain quantities; knowledge of basic nursing skills, familiarity with the therapeutic effects and side effects of all medications administered
Must have or be able to obtain an Arizona Fingerprint Clearance card
Must be willing to rotate weekend, night, and holiday call with staff to facilitate adequate coverage for all patients
Ability to meet conditions of employment applicable to the agency
Ability to meet the physical and mental abilities of the job. (Reasonable accommodations for qualified disabilities will be considered by the employer on an individual basis as provided under the Americans with Disabilities Act)

114

Complex Case Manager RN Resume Examples & Samples

Registered Nurse with current unrestricted license in the State of Minnesota, BSN preferred. License free of history of restrictions and/or sanctions in the past 10 years in all states with current or past licensure
Demonstrated effective, independent nursing judgment and skills
Demonstrated skill and experience in effectively collaborating with care team members, using a high level of expertise in written, oral and interpersonal communication
Demonstrated working knowledge of quality improvement, utilization management, benefit plans, fiscal management, and various payment methodologies preferred. Understanding of healthcare and/or HMO industry

115

Case Manager Rn Resume Examples & Samples

Develops and maintains a unique patient specific care management plan with mutually agreed upon goals in collaboration with the Primary Care Physician (PCP), patient/family and treatment team; identifies gaps in care and barriers to care
Determines medical necessity, appropriateness of admission, continuing stay and level of care using a combination of clinical information, clinical criteria, and third party information. Intervenes when determinations are not in alignment with clinical information, clinical criteria or third party information to resolve the situation. Documents information in the current electronic system (such as MIDAS)
Validates admission and continuing stay criteria with third party payers as well as Primary Care and Attending Physicians. Recommends alternative care sites where appropriate
Collaborates with the third party payers to anticipate denial of payment and proactively addresses issues contributing to a potential denial. Intervenes to prevent the denial where possible. Supports the effective prevention and management of denials, including drafting appeal letters and/or providing information as part of the appeal process
Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge. Addresses actual and potential barriers to discharge

116

Case Manager Rn-field Based & Telephonic Resume Examples & Samples

Current, unrestricted RN license in the state of Alabama
Ability to travel to member homes or other locations within the greater Madison County, AL area
3+ years RN nursing experience in a hospital, acute care, home health/hospice, direct care or case management
Must live within a commutable distance (50 minutes or 50 miles) of the greater Madison County, AL area

117

Case Manager Rn-case Management Experienced RN Resume Examples & Samples

Contacts and interacts with third party payers to obtain approval of hospital days, pre-certification and post-discharge eligibility in relation to clinical course
Ensures compliance with current state, federal, and third party payer regulations
Identifies patients for Alternate Level Care (ALC) care list and notifies appropriate health team members
Communicates with insurance companies and physicians regarding utilization issues
Utilizes important message from Medicare (IMM) when appropriate
Ensures managed care reviews are up to date and accurately reflect patient’s clinical progress and acute needs
Participates in the quality management of patient care outcomes
Submits data to management regarding case management and/or quality initiatives
Participates in data collection regarding patient’s length of stay, utilization of clinical resources, IPRO citations including appropriate recommendations and re-admission within 30 days
Initiates appropriate discharge planning as supported by initial assessment at time of admission
Assesses each patient physically, psychosocially and financially
Documents the case management process in the medical record
Completes and documents a psychosocial assessment on the patient
Documents on-going processes of patients’ hospitalization
Documents finalized discharge plan and disposition
Completes applicable areas of the Patients Discharge Instruction Sheet and the Patient Transfer Sheet
Ensures case management sheet is current and accurate
Minimum of one (1) year related experience, required. Experience in case management and clinical pathways, variance analysis and trending, quality management/utilization review and home care/discharge planning, preferred

118

Case Manager Rn-per Diem Resume Examples & Samples

Minimum Education:Graduate from an Accredited Professional School of Nursing
Minimum Experience: Minimum of three (3) years experience in an acute hospital setting. Expertise in any of the following areas: Healthcare Management, Quality Assessment and Improvement, Continuous Quality Improvement, Utilization Review, Discharge Planning, Social Service, Infection Control, Risk Management
Req. Certification/Licensure: Current California RN License, American Heart Association (BLS) preferred

119

Case Manager RN, Hospice Resume Examples & Samples

Must be a graduate of an accredited school of nursing
Minimum of 3 years clinical nursing experience
One (1) year hospice experience preferred

120

Case Manager Rn-care Management Resume Examples & Samples

Demonstrates, through behavior, Florida Hospital’s core values of Integrity, Compassion, Balance, Excellence, Stewardship, and Teamwork
Coordinates the integration of social services/case management functions into the patient care, discharge planning processes in collaboration with other hospital departments, external service organizations, agencies and healthcare facilities
Performs initial case management assessment to determine care coordination and discharge planning needs. Conducts admission and concurrent medical record review using specific indicators and criteria in accordance with regulatory and contractual requirements as well as internal policy. Uses established medically necessity criteria as described by policy to conduct screening for appropriate-ness of admission (IP verses observation) and continued stay for intensity of service/severity of illness. Escalates cases as appropriate and per policy to Physician Advisor and Director. Collaborates with Bed Management to ensure appropriate bed placement based on level of care. Assimilates information obtained from information systems, service schedules, registration area, Bed Management, clinics, other facilities, and insurance companies to accurately assess patient clinical needs and treatment
Acts as patient advocate by negotiating for, and coordinating resources with payers, agencies and vendors during inpatient and transition phases
Identifies and communicates quality and risk issues to the appropriate staff/departments in a timely manner
Acts as a resource and provides staff and physician education related to resource utilization, discharge planning and psychosocial aspects of healthcare delivery
Reviews clinical and demographic information for accuracy and completeness and proactively interfaces with payer, where required, to ensure that hospital meets payer requirements for observation or inpatient services and in instances when insurance information/coverage seems unclear or unfamiliar. Ensures that the proper sequencing and scheduling of interventions, treatments and procedures are in accordance with the patient’s treatment plan, that care is expedited and that care delays and denials of payment are avoided
In collaboration with the patient/family, physicians and interdisciplinary team, the case manager ensures patient progression through the continuum in an efficient and cost-effective manner. The case manager is responsible for identifying, initiating and managing optimal patient flow/throughput to enhance continuity of care, smooth and safe transitions, patient satisfaction, patient safety and length of stay management. Independently identifies and communicates any problems or issues that affect patient flow or outcomes to the Director in appropriate timeframes. Identifies (internal or external) variances/obstacles to efficient or timely care and positive patient outcomes and intervenes with the healthcare team to overcome or eliminate these when possible. Identifies and participates in the development of strategies to reduce unnecessary LOS, resource consumption, implementing and documenting results. Mobilizes resources and interviews, as needed, to achieve expected goals and to assist in achieving desired clinical outcomes within the desired timeframe
Acts as a liaison between providers to optimize communication and facilitates a smooth transition through the healthcare system. Communicates effectively with physicians to obtain necessary information to complete all admission and concurrent reviews as required to prevent unnecessary delays and denials of service. Facilitates communication within the healthcare team to coordinate the patient’s treatment plan progress and ensures patient/family understanding of the treatment plan
Coordinates and implements the discharge plan for patients with post-care needs (i.e. home health, DME, transfers to SNF, etc.) in collaboration with the Social Worker. Identifies patients/families appropriate for referral to the Social Worker: those who would benefit from support that better enables them to deal with the impact of illness on individual family functioning and to achieve maximum benefits from healthcare services
Identifies and communicates relevant information to the care team related to patients frequently seen or frequently re-admitted
Issues Medicare Notices of Non-Coverage and assists in appealing insurance denials for assigned units. Partners and communicates with Finance department per department policy to support and ensure accurate billings, pro-active audit and denial management
Participates in the development of process/systems to measure/monitor clinical practice. Obtains reviews and analyzes LOS, resource utilization, outliers, readmissions denials and delayed days for assigned patients. In addition, will collect/input data or information into appropriate databases or collection tools, as indicated by Director. Utilizes thorough knowledge of various computer/ information systems to perform assigned duties
Documents activities, including utilization review activities, statistics, clinical assessments and plans in a thorough and timely manner or per department policy
Stays abreast of changing clinical trends, criteria, regulatory matters and third-party payer requirements related to clinical care, discharge planning and precertification of after-care benefits
Participates on committees or workgroups, as directed by Director
Performs other duties as assigned by the department Director

121

Case Manager Rn-emergency Department Resume Examples & Samples

Master’s in Social Work
Flexibility in prioritization
Superior clinical skills to determine appropriate clinical and other information for medical necessity reviews and identify appropriate mechanism to address delays or variation for expected care practices. (preferred)
Minimum of five years recent acute care experience
Minimum of two years of experience in the ED (preferred)
Minimum of two years of utilization review/case management experience and a minimum of one year of experience in discharge planning in an acute care setting highly desirable

122

Cancer Survivorship Case Manager RN Resume Examples & Samples

Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment or hospitalization
Coordinates repatriation of patients and monitors their quality of care
Arranges and monitors follow-up appointments. Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy). Makes referrals to appropriate community services
The Cancer Survivorship Case Manager will partner with cancer care providers to ensure cancer survivors have the information, resources, and support they require to enjoy the highest possible quality of life with, though, and beyond their cancer diagnosis

123

Case Manager Rn Resume Examples & Samples

Engage Members telephonically or face to face at Florida Blue Retail Centers, hospitals, etc. with a focus on health coaching and member education. Facilitate access to care and resources to meet the member’s health care needs. Provide education and tools to promote self-management
Plan, implement, coordinate and monitor Case Management activities that may include acute and non-acute services, outpatient services and or community resources
Close gaps in care
Conduct Medication Reconciliation
Bachelor’s in related field

124

Case Manager, RN Resume Examples & Samples

Authorize services regarding the authorizations and implementation of approved services through Pre-cert, admissions, observation, concurrent review, and other outpatient services
Provide members with the support, education and assistance in the prevention and/or maintenance of their disease and/or health and wellness state (when appropriate); and
Improve collaborative coordination of care to affect waste and inefficiency
Reviews service requests submitted by physicians or facilities to include review of evidence/clinical documentation and its medical necessity
Communication with health plan care managers for follow up needs with documentation in the Care Management system
Facilitates provider contact as needed to coordinate member's care needs
May include phone contact with identified members or providers to explain the program, assess needs, educate regarding the disease as appropriate, instruct the member how to access the program resources, suggests and/ or arranges follow-up including mailing of educational materials, contact with community resources, facilitating physician visits etc., and documenting the re-contact into the web-based system depending on the needs assessment
Collaborates with Case Managers to assess as needed the discharge planning needs regarding Home Health and/or elective procedures. Coordinates with facilities, Medical Management staff, providers and members
Consults and works closely with the Medical Director regarding care that doesn't appear to meet medical necessity
Responsible for the documentation of all clinical decisions, to include the drafting and recording of denial letters to providers and members
Conducts daily tracking of caseload as assigned
Complies with all departmental policies and procedures. Participates in departmental and company in-services as appropriate
Complies with Customer Service expectations as applicable to the Department and Health Plan
Assists in retroactive reviews done for the Claims department
Takes calls from members and providers and give them appropriate information to help expedite services
Time management skills with the ability to prioritize and schedule daily activities for the most efficient use of time
Two years' utilization management or case management experience within a hospital, home health setting or managed care company preferred
Working experience with MCG or Interqual evidence based guidelines highly preferred
Bilingual and experience with geriatric population preferred
Maintains a valid driver's license for any required facility on-site visits

125

UR Case Manager RN Resume Examples & Samples

Reviews medical record and performs initial and concurrent review using established criteria for medical necessity for confirmed status
Submits clinical review to insurance companies and obtains authorization for services rendered
Completes required documentation for approvals, denials and communication with all parties
Demonstrates knowledge of regulatory requirements, HCA ethics and compliance policies and quality initiatives; monitors self-compliance and implements process change to ensure compliance as it relates to the provision of utilization review services
Demonstrates knowledge of electronic systems including MIDAS, Meditech, Microsoft Word, Excel and other systems relevant to UR
Communicates with case managers and other parties to advise of payer issues, potential denials and delays with progression of care
Manages time wisely and meets deadlines associated with work assignments
Tracks variances as assigned and develops action plans to improve processes
Works well in a team setting, but able to work independently and provide direction for others
Explores and implements strategies to reduce resource consumption and length of stay without compromising patient safety or quality of care
Maintains a calm, rational, professional demeanor when dealing with others, even in situations involving conflict or crisis
Adheres to established policies and procedures and standards of care
Demonstrates honesty, integrity and ethical behavior as outlined in the HCA Code of Conduct
Minimum three years nursing experience in acute care setting is required
Previous Case Management experience is strongly preferred

126

Complex Care Case Manager RN Resume Examples & Samples

RN graduate of an accredited school of nursing required
Current California RN license and American Heart Association BLS for Health Care Providers required
Strong clinical background preferably in acute care
Three to five years experience in a managed care setting/utilization review/discharge planning/case management/ patient education

127

Case Manager RN, Hospice Resume Examples & Samples

One (1) year hospice experience preferre
Licenses, Registrations, or Certifications
Current, unencumbered RN licensure in state of practice
CHPN preferred
Current driver's license with adequate transportation

128

Case Manager, RN Syracuse Resume Examples & Samples

Increase member compliance with treatment plans
Engage community resources to support the member's optimal functioning
Review evidence that discharge planning began at admission or start of services
Phone contact and/or face-to-face with identified members to explain the program, assess needs, educate member regarding the disease as appropriate
Consult and work closely with the Medical Director regarding care that doesn't appear to meet medical necessity
And all other duties assigned by the manager and/or supervisor
Experience working with the geriatric population is required
Two years of acute care and/or case management experience within a hospital, home health setting or managed care company

129

Case Manager, RN Houston Resume Examples & Samples

Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds
Required - Associates Degree in Health Services or Nursing or equivalent work experience
Preferred - 1+ year of experience in current case management
Preferred - Managed care experience
Required - Proficient using Microsoft Word, Excel, and Outlook

130

Case Manager Rn Resume Examples & Samples

>>>>>>>>>>>>>>>High level of clinical skills required. /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>Utilization management experience preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>Familiar with Medicare MS-DRGs and Medicare PPS preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Performance Improvement (PI) experience preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Clinical leadership experience preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>InterQual® ISD Acute Care Adult (IQ) or related medical review criteria experience preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Knowledge of acute care regulatory/accreditation requirements preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Excellent computers skills and current knowledge of the electronic medical record. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>Certified Case Manager (CCM) certification preferred. /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> /> />

131

Case Manager Rn-statewide Resume Examples & Samples

Bachelor’s degree in related field or equivalent work experience
Complex case management experience
Experience working with employer groups

132

Case Manager RN / , FTE / Dayshift Resume Examples & Samples

Current PA Registered Nurse license; or eligible for immediate state license
Three (3) years prior acute-care experience required
Excellent communication skills and ability to work collaboratively with all members of the health care team
Prior experience in UR or Case Management preferred

133

AHD Wound Care Center Case Manager, RN Resume Examples & Samples

Individualize care according to age specific population. In collaboration with the physician and other health care members (rehab, nutrition, diabetic education, home health, DME, nursing homes and other ancillary services), revise the plan of care and continuously reassess and evaluate until desired outcome is obtained. Complete the 4 week reviews in a timely manner and ensure all recommendations to the plan are activated in the physician orders. Participate in quality improvement/staff meetings
Develop and implement a teaching plan. Prioritize problems according to impact on health status. Formulate desired outcomes specific to patient's problems and wound care center protocols
Assess whether the plan of care is effective with the physician and is instrumental in initiating changes as necessary. Ensure desired outcomes that are mutually agreed upon by the patient, family (when appropriate) and the nurse. Formulate desired outcomes that are specific and measurable within a certain time frame and consistent with other health provider's expectations. Evaluate achievement or lack of achievement of desired outcomes. Participate in implementing planned changes and activities to improve care
Accurately complete the superbill and ensure that all orders and charges are initiated accurately
Prepare for clinic to enable accurate and complete updates to the physician. Triage telephone calls and assist with scheduling. Safely operate all clinical equipment in the clinic. Monitor condition of equipment and report malfunctions to Clinical Manager. Maintain appropriate infection control procedures. Maintain skills and knowledge through training and continuing education
Hold self and staff accountable for the delivery of quality nursing care. Promote harmonious relationships and favorable attitudes among the team members. Assist others within the clinic. Maintain an open, professional communication line with patients, physicians, and staff. Adhere to time and attendance policies

134

Case Manager Rn-per Diem / Variable Resume Examples & Samples

Current clinical experience with two (2) years clinical experience in an acute care hospital setting OR One (1) year current experience in an inpatient or outpatient case management setting OR Recent completion of a post-graduate level curriculum focusing on case management
Discharge planning, or utilization management experience in the acute, sub- acute, home health setting or managed care environment
CCM or ACM Case Management certification
Bilingual (English/Spanish)
Competent nursing assessment skills
Sensitivity to the needs and situations of a multi-cultural population from a variety of income levels
Strong organizational skills and ability to effectively present written and verbal information
Proficiency with computers and telecommunication devices, such as smart phones
Application of safety principles when performing duties
Demonstrates ability to maintain fiscal responsibility in service utilization
Ability to perform duties and responsibilities in an independent manner with little direct supervision, and complete job duties and responsibilities in a timely, accurate, thorough manner
Models professionalism through effective time management, efficiency and a positive team approach
Flexibility and an ability to adapt to changing and evolving hospital and departmental priorities

135

Case Manager Rn Resume Examples & Samples

Acts as a liaison between the hospital, the attending physician and third party physician advisors
Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan
Uses electronic systems to accurately document case coordination and discharge planning in the medical record, finance, review and referral systems

136

Palliative Case Manager RN Resume Examples & Samples

Provide a complete continuum of quality care through close communication with patients via in-person or phone interaction
Support patients with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
Visit patients in their homes to discuss goals and available resources
Use a team approach to address the needs of patients and their families, including bereavement counseling, if indicated
Offer a support system to help the family help during patients’ illness and in their own bereavement
Provide relief from pain and distressing symptoms
2+ years nursing experience as RN

137

Case Manager Rn Resume Examples & Samples

Assesses the needs of all patient admissions, and checks the status of each patient from admission to discharge
Serves as facilitator and member of health care team
Identifies all barriers encountered delaying patient discharge, e.g., testing, lab and x-ray results and facilitates same in order to expedite patient discharge
Communicates with patients, physicians, nurses and social workers to identify patients who may require post discharge services. Attends rounds on patient units to screen patients for ongoing care and services needed after discharge
Develops and documents a post discharge care plan in conjunction with other members of the health care team based on initial patient assessment
Identifies an appropriate agency for providing comprehensive patient care based on patient needs and available resources
Coordinates patient discharge with physician, managed care agency, social work services, patient and family
Collects data referencing patient's progress and follows up on changes in patient's plan of care
Contacts insurance company to assess coverage and the need for prior authorization for post-discharge care and advises patients of same
Provides information to managed care agencies to enable them to provide required services to patients discharged in their care
Identifies patient/family educational needs and arranges for those needs to be met prior to discharge
Knowledge of patient care management, theories, and practices as normally acquired through the completion of a Bachelor's Degree in Nursing or related field
PRI certification, preferred
Minimum of one (1) year utilization review/discharge planning and case management or related work experience to ensure familiarity with managed care services and federal/state regulations and trends in patient care
Strong organizational, communication and independent decision making skills required

138

Case Manager Rn Resume Examples & Samples

Conducts ongoing research to build a network of resources and alternative health care services that can better meet patient/family continuum of care needs
Collaborates with the performance improvement program by gathering sentinel events and target diagnosis data. Makes suggestions for improvement of current processes and practice trends based on research. Collaborates with physicians, nursing directors/clinical managers and department directors to improve practice issues that impact continuum of care needs of the patient
Participates in providing education support for newly hired staff persons within the department. Mentors interdisciplinary healthcare team in critical thinking processes essential to continuum of care issues. Coordinates patient education as needed. Collaborates with social worker to educate patients, families on discharge planning processes
Facilitates appropriate lengths of stay and reimbursement for all hospital admissions. Facilitates patient movement to the appropriate (acuity) level of care including observation status through collaboration with patient/family, multidisciplinary team and third party payors

139

Case Manager, RN License Req d Rocky Point Resume Examples & Samples

Coordinates community resources with emphasis on medical, behavioral and social services. Applies case management standards and maintains HIPAA standards and confidentiality of protected health information. Reports critical incidents and information regarding quality of care issues
Case load may differ by state and/or location based on contract requirements, membership, plan and/or operational best practice
Preferred 1+ year of experience in current case management experience
Required Beginner Microsoft Outlook

140

Practice Case Manager Rn-westchester Health Resume Examples & Samples

Facilitates patient management post hospitalization or care in a skilled nursing facility
Serves as an in-patient liaison - planning, assessing, implementing and evaluating patient in collaboration with the health care team
Serves as a resource to the health care team regarding quality, utilization of clinical resources, payer, and reimbursement issues
Works with hospital or skilled nursing facility in transitioning patient to home setting or other appropriate post discharge setting
Collaborates with payers, providing all necessary clinical documentation for the maximization of benefits
Advocates, guides and intervenes on behalf of patients, their families and/or caregivers in concert with their primary care physician
Screens patients and conducts individualized clinical assessments of patient’s health concerns and needs
Supports patients in developing personalized condition specific action plans
Provides appropriate education
Evaluates patient progress in setting and meeting established goals and revises their individualized care plans accordingly
Performs medication reconciliation in supporting medication management
Participates in the quality management of patient care outcomes
Submits data to management regarding case management of patient care outcomes
Participates in data collection for trending analytics and benchmarking
Performs related duties, as required
Current license to practice as a Registered Professional Nurse in New York State, required. License to practice as a Registered Professional Nurse in Connecticut, required within 90 days of hire
Case Management Certification, preferred

141

Case Manager Rn Resume Examples & Samples

Performs telephonic assessments for data collection and provides disease-specific education to the member and/or family/caregiver(s)
Collects information related to the member’s strengths, problems, functional status, goals and need for specific services/resources, to assist with establishing care plan goals
Develops an individualized member care plan in collaboration with the member/member's family/caregiver(s), practitioners, and the interdisciplinary team members. Sets realistic goals for the member as the care plan is developed
Implements a disease management program, including utilizing the clinical support tools to track and monitor the care provided to the disease population
Refers individuals for case management and specific disease management programs as needed and works with practitioners and other professionals to evaluate the clinical appropriateness of the disease management program. Revises as needed with changes in clinical care and guidelines
Ensures that the disease management population is receiving the appropriate tracking, monitoring and outreach to assist that population to receive the care indicated by the disease management program
Promote healthy lifestyles, assist in strengthening the member-physician relationship, encourage behavior and lifestyle changes to realize a better quality of life, for individuals with identified chronic conditions, costly and/or catastrophic illnesses
Develops communications to physicians, other professionals and members about the program, including outreach activities, develops program activities, such as educational interventions, and incorporates community resources, when appropriate

142

Case Manager Rn Resume Examples & Samples

Collaborates with the performance improvement program by gathering sentinel events and target diagnosis data
Makes suggestions for improvement of current processes and practice trends based on research
Collaborates with physicians, nursing directors/clinical managers and department directors to improve practice issues that impact continuum of care needs of the patient
Participates in providing education support for newly hired staff persons within the department
Mentors interdisciplinary healthcare team in critical thinking processes essential to continuum of care issues
Coordinates patient education as needed
Collaborates with social worker to educate patients, families on discharge planning processes
Facilitates appropriate lengths of stay and reimbursement for all hospital admissions
Facilitates patient movement to the appropriate (acuity) level of care including observation status through collaboration with patient/family, multidisciplinary team and third party payors

143

UR Case Manager RN Resume Examples & Samples

Patient care experience in an acute care setting is required
Understanding of the unique needs associated with various age populations and the ability to provide age specific care and services
Effective communication skills, both orally and written is required
Computer literatcy is required
Experience with Interqual Criteria is required
Must possess the knowledge and skills necessary to effectively meet the needs of the patient/internal & external customers
Ability to perform comprehensive assessment of physical and psychosocial needs of patients
Knowledgeable about Medicare, Medicaid, TriCare and other third party payers
Knowledgeable about local, state, federal and community resources and the scope of services they provide
Direct experience with regulatory agencies and third party payers within the last two years
Experience in discharge planning and a working knowledge of alternative delivery systems including home health, durable medical equipment, rehabilitation, extended care facility and skilled nursing facilities, their scope of services and their criteria for care
Knowledgeable and experience in medical/legal aspects of care

144

Case Manager Rn Resume Examples & Samples

Coordinates the oversight of delivery of services based on level of care, intent of stay and prior level of function. May include facilitation of patient review meetings and / or chart reviews
Coordinates Resident Assessment & Planning Tools
Provides periodic assessment and summaries to insurers for continued authorization of care
Communicates with external Case Managers for Managed Care & commercial customers
Ensures documentation supports level of care, MDS & RUG
Ensures appropriate rate negotiations from point of admission & during stay
Valid State licensure as an LPN, LVN, or RN
Note: Other incumbents (job code 7065) may have specific training or education in the healthcare field (other than as a licensed nurse) to ensure proficiency in the requirements of the position (i.e., Registered Therapist)

145

Case Manager, Rn-telecommute Resume Examples & Samples

Provide a complete continuum of quality care through close communication with members via in-person or on - phone interaction
May require some field work- meeting members in homes, facilities if difficult to engage telephonically or at the request of management
3+ years clinical experience in a hospital, acute care, home health/hospice, direct care or case management
Must reside in Louisiana

146

Case Manager / RN Resume Examples & Samples

Registered Nurse with a current California license
Minimum of two years recent clinical experience
Assertive and creative in problem-solving and systems planning and management
Self-directed and able to work under pressure and constant change
Demonstrates positive, professional relationships with department staff, physicians, hospital personnel and others, thereby promoting teamwork

147

Ssh Case Manager Rn Resume Examples & Samples

Assesses all patients and identifies the patient's problems based on comprehensive assessment of the medical condition, adjustment, support systems, finances, housing, behavior and cognition, abuse factors, function and abilities, legal, and substance abuse factors and implements needed services and interventions for case management and discharge planning
Develops and maintains an effective professional working relationship with all patients, families, physicians and providers
Develops and implements a plan, in conjunction with the patient, family, and health care team, which addresses all problems and needs identified in the assessment
Knows and keeps up-to-date on community resources. Advocates for the patient/family's needs, including negotiation with internal/external resources and payers for needed services
Provides consultation services for other department staff
Coordinates regular meetings between families, SSH staff, and physicians to discuss course of treatment and discharge plans
Attendance at Interdisciplinary Team Meetings
Provides clear, concise, timely written documentation on the patient's medical record and on departmental records
Assigns accurate and complete closure codes, which are supported in the written documentation
Communicates with patients, families, and members of the health care team and others in a professional, diplomatic and empathetic manner
Participates in activities which support and advance the department and the SSH mission, vision and goals to improve outcomes and operations
Provides or arranges education for patients, families, physicians and other members of the health care team, to enhance patient care or improve department outcomes and operations
Performs utilization review. Communicates effectively with third party payers and reviewers and documents reviews' decision, length of stay and next review date
Participates in the planning, implementation and evaluation of quality improvement activities within department, health system and/or community
Participates in the accreditation process
Compliance with Infection Control Standards, including Standard/Universal Precautions, Hand Hygiene and Personal Protective Equipment (PPE)
Accountability for maintaining a Healthy Work Environment by adhering to the "Commitment to my Co-workers" principles
Compliance with mandatory job related requirements (i.e. staff meetings, in-services, annual competencies and TB testing)
Maintains knowledge of current trends in area of expertise and provides evidence of current competencies

148

Case Manager Rn-care Continuity Services Resume Examples & Samples

Current MO RN license
Bachelor's degree in nursing or demonstrated equivalent in combination of education and experience
3 years of RN experience in an acute care setting
Excellent partnership building and interpersonal skills with all levels of internal and external customers and the ability to perform effectively in team situations
Solid clinical knowledge base in Medical/Surgical nursing

149

Senior Case Manager RN Resume Examples & Samples

Work within both telephonic role and clinic to assess patients, coordinate additional communications and follow up
Triage referrals and support team on triage
Follow up with patients on a continuing basis
Serve as a key resource on complex and critical issues
1+ yrs. acute care RN experience
Microsoft Office and general computer proficiency
2+ yrs. acute care experience

150

Case Manager, RN Resume Examples & Samples

Initial assessment and intake obtaining social, medical, mental health, substance use disorders and medication history
Review intake assessment with primary care provider and establish appropriate plan of care for patient
Revise patient plan of care with the opioid treatment team as needed to address patient needs and issues
Review consents and treatment contracts with patients and significant others, obtaining signatures and giving patient a copy, and scanning a copy into the EPIC electronic medical record system
Assessment and monitoring of patients in the induction, stabilization, and maintenance phases of treatment
Collaboration, communication, and meetings with opioid treatment team as needed and required
Researches, evaluates and recommends resources to meet the medical and non-medical needs of patients. Initiates referrals to the appropriate agency or resource and conducts regular reassessment of patient needs and resources. Works closely with HIV/AIDS/HCV Nurse Medical Manger to refer patients as appropriate and share resources
Complies with the MDPH BSAS Office Based Opioid Treatment Program Policies and Protocols
Acts as a resource and consultant for the health center
Provides Vivitrol injections. May be asked to train practice nurses in providing the injection
Proactively performs needs assessment and collaborates with physicians/health care team to develop the plan of care
Collaborates and communicates with the health care team and other involved staff/agencies to ensure appropriate coordination of services, including coordinating supported referrals. Tracks services to ensure adherence to treatment plan, medications, and compliance with treatment planning in order to avoid duplication of effort
Collaborates with Mental Health providers, substance use disorders and domestic violence staff, to coordinate appropriate services for patients
Educates patients and families on specific disease management, positive prevention, harm reduction and community resources and capitalizes on opportunities for education and referral
Complies with confidentiality policies, HIPAA, JCAHO, and other regulatory requirements
Completes BSAS trainings offered by MDPH and attends MDPH meetings as required
Linkage to Addiction services and assisting patients at the MGH Health Centers to access the Methadone clinic with intake process
Assessment of signs and symptoms of opioid withdrawal using the COW (Clinical Opioid Withdrawal) scale
Ongoing education and support of patients in all phases of treatment including; nursing visits scheduled and random, urine toxicology screens, routine labs and as needed, medication teaching, monitoring, pill counts, observed dosing, and medication refills
Follow State and Federal guidelines in providing care to opioid dependent patients in collaboration with licensed, prescribing physicians and pharmacy
Complete appropriate documentation with excellent record keeping
Assesses the patient and family in a systematic and ongoing manner for both overt and covert signs and symptoms
Collects pertinent data using appropriate assessment techniques
Prioritizes data according to the patient’s immediate conditions and needs
Consistently uses clear concise and effective communication written/oral and comply with departmental policies when sharing/documenting relevant patient care data
Provides follow up care in person and via telephone when needed
Works with the pharmacy and the SUDS team in obtaining medication orders, prescriptions, refills, and communication as needed
Licensed to practice professional nursing as a registered nurse in the Commonwealth of Massachusetts required
Certified in related specialty areas preferred
Leadership experience with the ability to work autonomously
Minimum of five (5) years of nursing experience preferred
Addiction experience required
Experience in HIV/AIDS related medical/social issues preferred
Knowledge of community, and health resources, particularly addiction related resources and supports
Effective verbal, written, and interpersonal skills with ability to interact with providers and team members from various settings
Sensitivity to ethnic, cultural, gender; beliefs, and behaviors
Ability to work in a fast paced environment, with excellent communication skills, critical thinking, and problem solving abilities

151

Case Manager Rn Resume Examples & Samples

Will be responsible for state data collection analysis and reporting
Support members with condition education, medication reviews and connections to community resources Assist members with the transition from a care facility back to their home
Position is required to be onsite at health plan with ability to telecommute and participate in member and provider outreach at management discretion
Participate in clinical quality initiatives
Responsible for care management program evaluation
Reviewing and responding to appeals and general inquiries and state inquiries
Perform/Assist with provider and member outreach as needed
Monitor and facilitate care coordination activities through shared service partners

152

Case Manager Rn Resume Examples & Samples

Facilitate the care of patients during a disease/catastrophic episode by managing, coordinating and monitoring resources to achieve optimal clinical, utilization, service and financial outcomes
Demonstrate the knowledge and skills necessary to direct, plan and supervise activities of Case Management
Function as administrative representative in the absence of senior administrative staff
Experience: Prefer 3-5 years acute care experience & UR or case management experience preferred
Licensure/Certification: RN License in TN & Case Management Certification preferred

153

Case Manager, RN Resume Examples & Samples

Ensures the timely implementation of the plan of care
Documents in the medical record as appropriate, as part of the Interdisciplinary team in accordance with the MGH Case Management Documentation guidelines
Utilize a translator when appropriate and incorporate awareness of patients cultural needs that may impact the plan of care
Assesses patient/family continuing care needs in collaboration with the interdisciplinary team in the review/revision of the therapeutic plan to expedite and arrange non acute care
Complies with Case Management Standards of Practice, based on assignment
Evaluates, coordinates, manages and documents all activities related to clinical approval/denial processes and communicates relevant information to patients/families, members of the multidisciplinary team, hospital departments, and payers
Minimum five years Medical /Surgical experience, three of which must be related
Ability to work independently with minimal supervision

154

Case Manager Rn Resume Examples & Samples

Experience working with clients in the community setting
Demonstrate a proficiency in computer skills including Microsoft Word, with the ability to navigate a Windows environment
Live within a 25 mile radius within the established worksite location

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