Rn-case Management Resume Samples
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Rn-case Management Resume Samples
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LO
L O'Conner
Lyric
O'Conner
8154 Hyatt Well
Boston
MA
+1 (555) 737 8718
8154 Hyatt Well
Boston
MA
Phone
p
+1 (555) 737 8718
Experience
Experience
Dallas, TX
Inpatient RN Case Management
Dallas, TX
Schaden Inc
Dallas, TX
Inpatient RN Case Management
- Assist with providing direction for case that are complex or requiring out - of - network care
- Supervises Inpatient Clinical Services Nurses providing transition of care coordination for attributed members in the Acute Facility setting
- Performs supervisory on - call duties as scheduled on a rotating basis
- Conducts values and performance coaching which includes: annual reviews, corrective action plans, and recognition of employees
- Efficiently navigates and utilizes computer data entry programs including but, not limited to: Microsoft Office (Outlook, Word, and Excel)
- Expert knowledge of industry accepted criteria (e.g. MCG, InterQual), CMS and Health Plan guidelines and guideline application
- Follows established guidelines for reporting a significant medical error or unanticipated outcome in the patients care which results in patient harm
Dallas, TX
Manager, Field RN Case Management
Dallas, TX
Bradtke Inc
Dallas, TX
Manager, Field RN Case Management
- Understands and uses data to manage the team as well as individual performance
- Responsible for performance management of staff
- Networks / communicates with peers to facilitate operational standards and improvements
- Leads by coaching staff to higher levels of performance
- Articulates team performance and impact of services delivered during client meetings
- Identifies opportunities for continuous improvement
- Participates in continuous improvement as SME
present
Los Angeles, CA
RN Case Management Specialist
Los Angeles, CA
Rowe-Schumm
present
Los Angeles, CA
RN Case Management Specialist
present
- Performs other duties as assigned
- Negotiates and coordinates a prompt return to work with employer
- Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards
- Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data
- Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor
- Supports the organization's quality program(s)
- Performs admission certification screening for patients in accordance with Utilization Plan using ISD criteria, and performs concurrent stay reviews at least every 72 hours for medical necessity using ISD criteria. Maintains documentation on discharge planning notes and charts on patient’s record
Education
Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
Georgia Southern University
Bachelor’s Degree in Nursing
Skills
Skills
- Ability to meet or exceed Performance Competencies
- Ability to work in a team environment
- Excellent negotiation skills
- Knowledge of disease specific states, clinical and community resources
- Strong critical thinking and problem solving skills
- Ability to network, advocate, communicate assertively with all customers
- Excellent interpersonal skills
- Excellent communication skills
- Exceptional organizational skills especially while multitasking. Ability to drive multiple projects
- Ability to work in fast paced environment
15 Rn-case Management resume templates
Read our complete resume writing guides
1
Supervisor, Field RN Case Management Resume Examples & Samples
- Direct supervision of assigned staff
- Reviews work performed by others and provides recommendations for improvement
- Current, unrestricted RN license in the state of Texas
- 5+ years of clinical experience as an RN within hospital, acute care, home health, direct care and / or case management
- Ability to travel up to 75% in the Dallas / Fort Worth area
- Staff management experience
- Experience in Hospice, Home & Community based or Long Term Care services delivery
2
Supervisor, RN Case Management Resume Examples & Samples
- Current, unrestricted RN license in the state of Utah
- 5+ years of clinical experience as an RN within hospital, acute care, home health, direct care and/or case management
- Ability to travel up to 75% in the Salt Lake City area
- Ability to drive productivity
3
AIM Telesupport RN Case Management Resume Examples & Samples
- Assesses risk and determines client's service needs, promotes quality and utilization management in the ambulatory setting
- Promotes integration of physicians's plan of care and case management plan
- Monitors the plan of care and provides patients with self-management support
- Uses effective interpersonal and communication skills to promote customer service with internal and external customers
- Actively participates in ongoing department operations
- At least 1 year Case Managment, Hospice and/or Home health experience
4
Manager, RN Case Management Resume Examples & Samples
- Provides daily operational direction to the Inpatient Services Department including oversight and supervision of Inpatient Supervisors and Operations Managers, Supervisors, and Clinical Services nurses
- Responsible for the Clinical Services Management Team in the areas of: Inpatient Clinical Services program development, implementation, and monitoring; Regulatory and Health Plan compliance
- Responsible for reviewing and participating in the analysis of inpatient data to determine trends where interventions are indicated and implements interventions that are identified
- Primary liaison between the Health Plans, contracted providers, and hospitals to ensure collaborative relationships
- Performs On-Call duties as scheduled on a rotating basis
- Graduate of an accredited School of Nursing (RN) with a BSN
- Current unrestricted RN license in CA
- 2+ years of experience coaching, mentoring, developing clinical teams
- 2+ years of inpatient utilization / case management experience
- 2+ years of inpatient care experience in an acute care setting
- Travel 50% to hospitals
- Proficient in use of Microsoft Office applications and possess a working knowledge of Excel and excellent knowledge of Word
5
RN Case Management PRN Resume Examples & Samples
- Develops, initiates, and coordinates individual patient case management plans to ensure appropriate level of care across the continuum. Ensures plan meets patient's clinical, psychological and discharge needs in collaboration with the attending physician and interdisciplinary team
- Evaluates patients educational needs concerning continuum of care and available services and provides information and materials regarding community resources, discharge options, and pre and post treatment options and costs to patient and patient families
- Minimum of three years recent acute clinical practice or related health care experience
- ER, ICU, or TELE background is strongly preferred
- Current Nevada State Registered Nurse license
- Critical thinking, service excellence and good interpersonal communication skills, ability to read/comprehend written instructions, ability to follow verbal instructions, PC skills, Demonstrates analytical and critical thinking abilities with pro-active decision-making and negotiation skills, strong knowledge of governmental and private organization and community resources
6
RN Case Management PRN Resume Examples & Samples
- Minimum of 5 years of clinical healthcare experience in an acute care hospital
- Minimum of 2 years of acute care case management experience preferred
- Knowledge of PC based computer software (ie Word, Excel, Access or similar system) preferred
7
Manager, Field RN Case Management Resume Examples & Samples
- Leads by coaching staff to higher levels of performance
- Creates an environment that is able to attract and retain staff
- Leads change
- Models accountability and expects the same from staff
- Communicates with staff in a clear and comprehensive manner
- Meets and / or exceeds customer expectations
- Collaborates with the provider services OH team, physicians, facilities and community resources
- Collaborates with sales, account management, product organization, and other stakeholders as applicable
- 3+ years of experience as a manager / supervisor
- Must be able to travel at least 75% of the time - a combination of local and overnight
8
RN Case Management Specialist Resume Examples & Samples
- Reviews data submitted through referral sources, applies the appropriate criteria and standards in screening patients for case management services
- Verifies eligibility for services
- Completes assessment of identified patients through review of past utilization, discussions with the primary care physician and specialists and evaluation of the patient
- Identifies member needs as well as barriers to care and available resources, maintaining the patient in the least restrictive, most cost/quality efficient environment possible
- RN Case Managers and LVN Case Managers both gather member data. The RN Case Manager Team leader provides oversight for interpretation and evaluation of the member’s clinical data
- RN Case Managers are responsible for creating and updating a plan of care and with the active involvement of the patient and their health care team including short and long term goals with timelines and priorities for achievement. LVN Case Managers work alongside and team with the RN Case Manager for documentation of the plan of care. Participates in specialty team meetings as required by Health Plans for individual groups of members and/or eligibility status (i.e. Special Needs Persons) preparing and completing the required documents
- Implements the agreed plan of care and coordinates services as necessary. Both RN and LVN Case Managers are responsible for implementing the plan of care
- Monitors and evaluates the services being provided with frequent updates to the care plan as necessary and coordination of care including the patient and healthcare team
- Implements cost management strategies as applicable
- Communicates with Inpatient Case Management Team as necessary during the acute hospital stay
- Identifies specific Health Education program needs and/or other community support services for patients
- Maintains accurate and complete reports and records on all patients being case managed with regular reporting to administration
- Coordinates work with other departments and clinics of CMS, IPA providers, non-plan and outside contracted providers and contracted health plans
- Responsible to continue to improve customer service and telephone communications with all callers
- Attends all mandatory customer service and ethics training
- All other job related duties as it relates to the job function or as delegated by the management team
- 5 years acute care experience
- Two years managed care experience in medical management
- Computer skills: EZ-CAP, Word 7.0 and Excel required
9
Ubc-rn Case Management Resume Examples & Samples
- Adheres to principles as stipulated by program specific contractual agreements and company practices which may include
- Interact and build relationships with assigned patients throughout duration of program
- Provide patient centric education regarding treatment and disease states for assigned products
- Manage caseload including schedule maintenance and adherence, scheduled calls/interactions, updating program database per company protocols
- Coordinate meetings between patient and clinical partners
- Deliver customized interactions based on patient’s needs
- Participates in program specific customer meetings and training sessions
- Participates in program specific orientation meetings and demonstrates clinical and systems competency on tests
- Performs special projects and performs other duties as it pertains to specific contract performance
- Associate’s Degree and professional nursing license (current and valid) in state of practice
- 2-5 years relevant experience, case management experience preferred
10
Rn-case Management Resume Examples & Samples
- InterQual experience preferred
- Advanced knowledge of healthcare reimbursement systems: HMO, PPO, capitated agreements, PPS, etc., preferred
- Advanced knowledge of post-acute healthcare resources such as: SNF, Home Health, Hospice, AIM, etc., required
- General knowledge of coding and DRG assignment process preferred
- Able to orchestrate successful, complex discharge plans
11
Supervisor of RN Case Management Resume Examples & Samples
- Actively evaluates caseloads and appropriate distribution of work
- Achieve workflow modifications to maximize efficiency
- Supervise staffing needs as indicated by Clinical Manager
- Assist the Manager in developing and implementing and monitoring the quality assurance process
- Identify compliance and quality improvement opportunities and initiate corrective actions
- Assist in implementing procedures to provide excellent customer service to our clients through but not limited to communication, staffing, phone availability and service execution
- Identify issues, training needs, and develop processes within the Case Management departments
- Conduct performance reviews and evaluations of staff
- Willingness to assist with case management duties when needed
- Current RN license in the state of California
- 3+ years of Case Management experience
- 1 or more years of Managed Care/IPA/Health plan experience
- 1 or more years of Supervisory/Management experience
- Computer proficiency in MS Office: Outlook, Word, Excel, PowerPoint
- Ability to travel to IPA sites when needed
- Clinical experience with inpatient, hospital, ambulatory care, SNF, or home health
12
RN Case Management PRN Resume Examples & Samples
- Conducts initial and ongoing assessment of each individual patient with respect to clinical condition, level of care, and plan of care
- Assist the physician offices in obtaining necessary assessments prior to surgery, procedures, and/or admission
- Assist in the development and implementation of critical pathways
- Utilizes computer support and physician advisor to determine potential outliers (length of stay and changes in condition) in continued hospital stay
- Distinguishes between the levels of care available and interacts with the various benefit plans and their delivery systems to coordinate this care across the continuum
- Participates in IDT rounds
13
RN Case Management Specialist Resume Examples & Samples
- Experience in CM or other managed care environment
- Knowledge of disease specific states, clinical and community resources
- Ability to network, advocate, communicate assertively with all customers
- Exceptional organizational skills especially while multitasking. Ability to drive multiple projects a plus
- Works well independently as well as part of a team
- Strong commitment to help others
- Licensure: Licensure must be current and unrestricted in the appropriate jurisdiction
- Minimum Experience
- Licensure must be current and unrestricted in the appropriate jurisdiction
- Ability to travel
14
Inpatient RN Case Management Resume Examples & Samples
- Supervises Inpatient Clinical Services Nurses providing transition of care coordination for attributed members in the Acute Facility setting
- Expert knowledge of industry accepted criteria (e.g. MCG, InterQual), CMS and Health Plan guidelines and guideline application
- Assist with providing direction for case that are complex or requiring out - of - network care
- Adjust workflow and responsibilities according to business and operational needs
- Oversee to day - to - day operations of the Inpatient Acute Case Managers (i.e. ability to cover for illness, vacation, etc.) for the acute hospital settings (Short - term Acute, Long - term Acute and Acute Rehab)
- Conducts values and performance coaching which includes: annual reviews, corrective action plans, and recognition of employees
- Performs supervisory on - call duties as scheduled on a rotating basis
- 3+ years' of experience as Inpatient Case Manager
- Reliable means of transportation to and from work and the ability to travel to local hospitals as needed
15
RN Case Management PRN Resume Examples & Samples
- Assesses the health status of assigned patients by collecting and analyzing patient and family data, and expedites and coordinates the delivery of services to facilitate patient’s progression through the healthcare system
- Evaluates patients’ educational needs concerning continuum of care and available services and provides information and materials regarding community resources, discharge options, and pre and post treatment options and costs to patient and patient families
- Acts as an educational resource and provides consultation to hospital medical personnel regarding discharge planning process and applicable federal, state and local regulations; identify benefits, implications and limitations of home care as appropriate. Monitors and controls the use of healthcare resources to achieve desired patient outcomes, decrease length of stay, and decrease resource utilization. Identifies and documents delays in care and services and reports findings to department director
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems
16
RN Case Management Specialist Resume Examples & Samples
- Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client's situation for psychosocial needs, cultural implications and support systems in place
- Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives
- Evaluates need for alternative treatment
- Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards,
- Negotiates and coordinates a prompt return to work with employer
- Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data
- Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery
- Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor
- Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards
- Knowledge of workers' compensation laws and regulations
17
RN Case Management PRN Resume Examples & Samples
- Ensures all admissions and continued stays meet clinical criteria for appropriateness and medical necessity
- Develops, initiates, and coordinates individual patient case management plans to ensure appropriate level of care across the continuum
- Ensures plan meets patient's clinical, psychological and discharge needs in collaboration with the attending physician and interdisciplinary team
18
Discharge Planner, Rn-case Management Resume Examples & Samples
- Knowledge of the acute care provided to neonate, pediatric, adolescent, adult, and geriatric patients
- Ability to function successfully and independently in an extremely challenging environment
- Must be self-directed, flexible, committed to teamwork
- Must demonstrate initiative and willingness to learn
- Demonstrates leadership, communications, and the interpersonal skills necessary to interact effectively with physicians, management, staff, external agencies/customers and patients/families
- Must possess analytical, data management and computer skills
- Bachelor’s degree in Nursing (BSN)
- Utilization management and discharge planning experience for the acute care or post- acute care setting
19
RN Case Management PRN Resume Examples & Samples
- Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
- Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
- Evaluates admissions for medical necessity using approved criteria at defined intervals throughout 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 payors
- Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Three (3) years nursing experience in acute care setting required
20
Inpatient RN Case Management Resume Examples & Samples
- 3+ years of Inpatient Case Manager experience
- 1+ years of experience in lead / supervisory role
- 2+ years of experience in lead / supervisory role
21
Case Mgr Rn-case Management Bmcd Resume Examples & Samples
- Current RN licensure from the Maine State Board of Nursing required
- Bachelor Degree or currently matriculating preferred
- Five years of acute care clinical setting nursing experience preferred
- Is responsible for maintaining a current knowledge of the nursing practices contemporary to the legal framework of the Nurses Practice Act, and in accordance with regulatory requirements
- Knowledge and experience in discharge planning, case management and utilization review preferred
- Interest and experience in research through review and use of evidence-based practice preferred
