Case Manager Rn Resume Sample
Shayna Klein
501 Brayan Gateway,
Los Angeles,
CA
+1 (555) 440 6568
Work Experience
Case Manager, RN
06/2015
-
PRESENT
Phoenix, AZ
- Plans, develops, assesses & evaluates care provided to members
- Assesses high risk patients in need of post-hospital care planning
- Develops & coordinates the implementation of a discharge plan to meet patient's identified needs
- Acts as a liaison between in-patient facility & referral facilities/agencies & provides case management to patients referred
- Collaborates with physicians, other members of the multidisciplinary health care team and patient/family in the development, implementation and documentation of appropriate, individualized plans of care to ensure continuity, quality and appropriate resource use
- Develops and coordinates the implementation of a discharge plan to meet patient's identified needs; communicates the plan to physicians, patient, family/caregivers, staff and appropriate community agencies
- Participates in the Bed Huddles and carries out recommendations congruent with the patient's needs
- Acts as a liaison between in-patient facility and referral facilities/agencies and provides case management to patients referred
- Educates members of the healthcare team concerning their roles and responsibilities in the discharge planning process and appropriate use of resources
Case Manager / RN
09/2008
-
01/2015
Dallas, TX
- Per established protocols, reports any incidence of unusual occurrences related to quality, risk and/or patient safety which are identified during case review or other activities
- Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
- Implements and monitors current medical group care management programs within the policies and procedures set by the Care Management department
- Reviews patients’ clinical records of acute inpatient within 24 hours of notification
- Reviews patients’ clinical records within 48 hours of SNF admission
- Prioritizes patient care needs and meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan
- Participates actively in assigned Care Management Committee (CMC) meetings. Documents pertinent patient information, all communication and CMC decisions
- Ensures appropriate utilization of medical facilities and services within the parameters of the patients’ benefits and/or CMC decisions. This includes appropriate and timely movement of patients through the various levels of care
- Follows patients on ambulatory care management programs, including CHF and home health in order to optimize clinical outcomes
UR Case Manager RN
12/2005
-
03/2008
Los Angeles, CA
- Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- Registered Nurse (BSN), Rehabilitation Counseling (BRC), Occupational Therapy, or Physical Therapy
- Two years of experience in a medical insurance environment
- Acquire certification (CCM, CCP) within two years of date of hire
- Wpm and 10 key by touch required
- In close collaboration with the member/member's family, and the multidisciplinary Health Care Team (Primary Care Physicians, Specialty Physicians, and other members of the health plan, the network and the community), assesses the member's health status, functional limitations, psychological status, social support systems, resources, environmental factors, and response to treatment
- Ensures consistent and reliable documentation of case management activities in compliance with all organization and department standards. Practices within ethical and legal guidelines using established policies and procedures. Maintains confidentiality of patient records, information, and departmental activities involving patient information
Education
University of Phoenix - Oregon Campus
2001 - 2005
Bachelor's Degree in Nursing
Professional Skills
- Intermediate knowledge and skills of MS Office including Word and Outlook Express
- Five (5) years of recent acute care nursing or four (4) years recent clinical experience, and one year utilization review experience
- Clinical experience in a hospital setting, acute care, long term or skilled care facility
- Two to three year’s acute hospital experience, including one year of supervisory experience
- Current clinical experience with two (2) years clinical experience in an acute care hospital setting
- Clinical experience as a RN in a skilled nursing facility (SNF), long - term care facility, home health, hospice or nursing home
- Computer skills (Microsoft Office) and competency with electronic medical records
How to write Case Manager Rn Resume
Case Manager Rn role is responsible for software, medical, microsoft, negotiation, word, reporting, retail, training, procurement, compensation.
To write great resume for case manager rn job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Case Manager Rn Resume
The section contact information is important in your case manager rn resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Case Manager Rn Resume
The section work experience is an essential part of your case manager rn resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous case manager rn responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular case manager rn position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Case Manager Rn resume experience can include:
- Develops, implements, and manages case finding and screening processes to identify candidates for case management and to define the appropriate level of case management for members
- Actively participates in the referral processes, including eligibility verification, compliance with medical necessity guidelines, and evaluation of outcomes, ensuring that the appropriate information is entered into all relevant data systems
- Experience in communicating and building relationships with members/providers/employers both telephonically as well as live
- Experience with influencing and motivating individuals to change health behaviors
- Experience in two or more of the following: home health care, utilization review, discharge planning, disease/ case management
- Advanced training and experience in cognitive behavioral therapy (CBT), motivational interviewing or dialectical behavior therapy (DBT)
Education on a Case Manager Rn Resume
Make sure to make education a priority on your case manager rn resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your case manager rn experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Case Manager Rn Resume
When listing skills on your case manager rn resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical case manager rn skills:
- Excellence: Demonstrates competence in continuous improvement, continuous learning, accountability,and teamwork
- Work experience working with diabetic population
- Two (2) years clinical experience in an acute care hospital setting
- One (1) year current experience in an inpatient or outpatient case management setting
- Two (2) years of clinical experience as an RN in an acute care setting required
- Five (5) years of recent acute care nursing or four (4) years recent clinical experience, and one year utilization
List of Typical Experience For a Case Manager Rn Resume
1
Experience For Case Manager, RN Resume
- Knowledge and/or experience with population health
- Basic to intermediate experience in MS Word, Excel, tablet and/or smartphone
- Functions as a liaison to promote effective working relationships with providers and other agencies and resources
- Prioritize large volume of member activities
- Assists Social Services in planning setting that is most appropriate to meet the patient’s needs
- Provides education and consulting services to members, families and caregivers, members of the healthcare team, the health plan staff, and the community
- 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
2
Experience For Case Manager / RN Resume
- Facilitate care for high risk members across the continuum of the health care experience, including care transitions, coordination of community and social service and coordinating with other value-based organizations, providers as needed
- Collaborate with Member, Member’s Physicians, Plan Medical Directors, Managers, Local, Regional and Specialty team members as well as other functional areas to assist the member to meet their health care goals
- Promote healthy lifestyles, assist in strengthening the patient-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
- Assist Members and their physicians to navigate through the health continuum, educate regarding benefits, identify candidates for Care Programs and provide information pertaining to the network and network access
- Experience working with Managed Care products, benefits and services
- Instructs clients, family members and primary care givers as needed to ensure the maintenance of or acquisition of optimal functioning level for each client
- Provides input for formulation or modification of agency policies, procedures, and practices pertaining to client services
- Performs periodic supervisory visits for aides with a written evaluation regarding service delivery
3
Experience For Case Manager Rn-telecommute Resume
- Assist in planning the services required in the resident’s discharge plan as necessary
- When applicable, retrieves Tar, enters on TAR Log, and forwards to TAR Manager the first working day after discharge
- Coordinate discharge planning needs with facility, health services providers and member
- Confers with physician regarding referrals for Physical Therapy, nutrition, speech and swallow
- Works with on-site screeners in transitioning patients to appropriate post discharge settings
- Ensures that patient meets acute care criteria during each in-patient day
- In concert with attending physician, places patient on alternate level of care (ALC) status when appropriate
- Identifies and collects quality data including pre-established quality screens, NYPORTS and core measures
- Documents timely and appropriately in the medical record regarding the case management process
4
Experience For UR Case Manager RN Resume
- Provides summary note at time of discharge synthesizing the discharge plan and follow-up care needs
- Completes all other relevant documents including Patient Transfer Form
- Documents on-going case management progress notes in the medical record
- Current Florida RN license (or receives a Florida RN license within 1 month of hire)
- Experience in planning, implementing coordinating and monitoring activities that focus on acute and non-acute services, outpatient services and/or community resources for all lines of business
- Non-traditional working hours to meet the member’s availability
- Travel up to 30% (subject to change) for on-site member/provider/employer meetings, events or manager requests with occasional overnight stays throughout the state of Florida
- Performs client intake assessments including submission of required documentation for prior authorization of client services as needed based on client's pay sources
5
Experience For Health Case Manager RN / RPN Resume
- Routinely reviews pertinent client medical data to determine the effectiveness of services in reaching maximum rehabilitation potential
- Develops a plan of care based on nursing diagnosis, client and physician input that includes medical interventions and measurable goals or outcomes
- Investigates and takes appropriate actions on client or employee concerns/complaints
- Ensures effective coordination of client home care services through the timely completion of required documentation as well as the timely transfer of pertinent medical data to the client's physician, therapists or other care givers
- Participates on the advisory board or other agency quality assurance committees as requested
6
Experience For Hospital Transitions Case Manager RN Resume
- Strong organizational and leadership skills. Strong interpersonal skills. Strong written and verbal communication skills. Ability to problem solve and prioritize using critical analysis skills. Ability to make highly competent professional judgments and decisions. Ability to function as a core member of an interdisciplinary team
- Ensures that aides are properly oriented and trained to meet the client's needs in accordance with agency policies and procedures
- Utilization management through evaluating and approving the medical necessity, appropriateness and efficiency of requested health care services, procedures and cancer treatments under the provisions of the applicable health benefits plan
- 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
- 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
- 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
- Evaluate and assess member’s with diabetes and coronary artery disease
7
Experience For Complex Case Manager RN Resume
- 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
- 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
- Meet with facility interdisciplinary team to coordinate services to ensure that the resident’s total regimen of care is maintained
- Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Administrator
- 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
- Master’s in Social Work
- Review continued need for inpatient days with authorized length of stay extensions, if appropriate, based on patient's acuity requiring acute, observation, skilled unit or rehabilitation stays
8
Experience For Ows-case Manager, Rn-weekend Resume
- Review cost and/or hospital stay data to determine stop-loss attachment level status
- Communication with other Health plan case managers for follow up needs with documentation in the Health Service's system
- Facilitate provider contact as needed to coordinate member's care needs
- Identify high risk members for case management and work with member, physician and other health care providers to establish a plan of care to meet the member's individual needs
- Conduct or oversee "Welcome Home" calls to members post discharge from inpatient or other levels of care and ensure documentation is kept current in the Health Services system
- Phone contact and/or face-to- face to instruct the member on how to access the program resources, suggest and/ or arrange follow-up including mailing of educational materials, contact with community resources, and physician follow up visits; document the contact into the Health Service's system
- Reviews all patients for severity of illness and intensity of service using InterQual IS/SI criteria
9
Experience For Nicu Case Manager Rn-work Resume
- Collaborates with Mental Health providers, including substance abuse and domestic violence staff, to coordinate appropriate services for patients
- Interact with Medical Directors or member’s PCP on challenging cases
- Document and tracking findings
- Conduct nursing assessments in foster homes located throughout Central Maryland
- Provide child-specific training to foster parents, respite providers, and birth family
10
Experience For Ssh Case Manager Rn Resume
- Provide after-hours phone consultation on a rotating basis
- Perform home visits, with verbal and documented permission from provider and member and/or caregiver, for member support, when appropriate
- Review the medical record to ensure medical necessity
- Prepare for and attend Local Physician Organization committee meetings as assigned
- Comply with Customer Service expectations as applicable to the Department and Health Plan
List of Typical Skills For a Case Manager Rn Resume
1
Skills For Case Manager, RN Resume
- Experience working with telephonic case management platforms
- Med/surg experience
- Experience as an RN
- Disease/complex case management experience
- Visiting and assessing children in their foster homes
- Making outbound calls to assess oncology patients’ current health status
- Providing patient education to assist with self - management of their medical condition or disease processes
2
Skills For Case Manager / RN Resume
- Visiting members in the hospital to prepare for transition home
- Making outbound calls to assess patient's current health status
- Using established criteria, reviews appropriateness of patient's admission, need for continued stay and discharge criteria
- Serves as an in-patient liaison – planning, assessing, implementing and evaluating patient in collaboration with the health care team
- Initiates discharge planning by assessing the patient's needs and documenting the assessment on the interdisciplinary care team
3
Skills For Case Manager Rn-telecommute Resume
- Ensures patient and/or family are given information regarding their choices regarding transfer to another level of care according to regulatory standards
- Initiates discharge planning by assessing the patient’s needs and documenting the assessment on the interdisciplinary care team
- Communicates between the health center site to educate and promote effecting working relationships to avoid duplication of services
- Generate ongoing health protocols and training flow charts for each child on caseload
- Involves patient and/or family in discussion and planning for anticipated need for care following discharge
- Ensures that all continuing care services including transportation, durable medical equipment, etc. are appropriately arranged for and financially approved
- The Case Manager also coordinates the hospital activities concerned with case management and discharge planning
- Collaborates with team to ensure patient benefits are adhered to and are within the scope of coverage for planning patient needs at discharge
- Utilize applicable sources of information to identify, assess, and enroll patients requiring case management
4
Skills For UR Case Manager RN Resume
- Assesses, plans, implements, documents, coordinates, monitors, and evaluates the plan of care by collaborating with the physician, health care team and patient
- Serves as a liaison to patient, family, admitting, primary care physician, health care team, and hospital departments
- 2 - East Polk County, East Winter Haven Area
- Documents clearly, concisely and timely all contacts and information of the patient’s case management process on the appropriate chart forms
- Organize assessment data for accuracy, completeness and confidentiality. Record assessment data in an orderly fashion and communicate, revise and verbalize pertinent information to other health care team members. Complete in an accurate manner all admission nursing chart forms
- Assist physician with wound therapy. Implement wound care and HBO protocols when clinically indicated
- Continued assessment of compliance to the clinical pathway and be instrumental in bringing to the attention of the physician or health care team missing components. Document a plan of care accurately for all assigned patients
- Participate in team case reviews to assign appropriate primary care coordinator, identify aspects of the case that require the expertise of other iCMP team members. and provide consultative services to other role groups in the iCMP team
5
Skills For Health Case Manager RN / RPN Resume
- 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
- 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
- >>>>>>>>>>Five (5) years of recent acute care nursing or four (4) years recent clinical experience, and one year utilization
- Five (5) years of recent acute care nursing or four (4) years recent clinical experience, and one year utilization review
- Current, unrestricted license to practice nursing in the State of South Carolina
- >>>>>>Current, unrestricted license to practice nursing in the State of South Carolina. /> /> /> /> /> />
- Maybe asked to travel to Kaiser Kramer Medical Center for coverage
- 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
6
Skills For Hospital Transitions Case Manager RN Resume
- Bilingual skills (Russian or Spanish)
- Currently licensed registered nurse in the state of Tennessee or compact state in goodstanding
- 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
- Assures personal compliance with departmental documentation and timeliness of the same, i.e.: initial assessments, advanced directives, team conference reports. Conducts chart audits on a regular basis to maintain compliance, as requested by manager
- Coordinates with other departments, i.e.: Pre-Admissions, Admissions, Patient Accounts, Utilization Review, PPS Coordinator, etc., to assure positive fiscal management outcomes for the patient
- Strong working experience with Diabetes population
- Diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
7
Skills For Complex Case Manager RN Resume
- Experience as an RN
- Managed care and / or case management experience
- Medicaid and/or managed care experience
- Case management, discharge planning, or utilization management experience in the acute, sub-acute, home health setting or managed care environment
- Experience working with pediatric patients and case management
- Experience as an RN in a clinical setting
- Experience with discharge planning or transitional care services
8
Skills For Ows-case Manager, Rn-weekend Resume
- Valid nursing license in state of work
- Valid nursing license in MA
- Valid New York state ID for system access
- Proficient level of experience with MS Office applications (Word, Excel, Outlook and PowerPoint)
- Willing to do up to 25% travel in the Houston market
- Multiple state license (in addition to Compact License if applicable) or ability to obtain multiple state nursing license
- Computer/typing proficiency with Word, Outlook, Excel, and Internet
- Proof of all required educational levels due at time of hire
9
Skills For Nicu Case Manager Rn-work Resume
- Bilingual in Russian / English
- Bilingual in Spanish / Russian
- Current, unrestricted RN license in the State of residency
- Talk and type simultaneously
- Any combination of clinical, case management and/or disease/condition management experience, provider operations and / or health insurance experience
10
Skills For Ssh Case Manager Rn Resume
- Proficient working with and navigating through computer programs such as WebEx, Sharepoint, Microsoft Suite, and Internet
- Navigate a Windows environment, utilize Outlook, and the ability to create, edit, save and send documents utilizing Microsoft Word
- Active CA clinical licensure is required (RN, PT, OT, SLP, LCSW)
- Current CCM® or ACM certification required at time of hire or within 2 years of hire
- RN with a BSN
- PALS certification within 6 months of hire, CDE within 18 - 24 months of hire
- Current, unrestricted RN license in the State of PA
List of Typical Responsibilities For a Case Manager Rn Resume
1
Responsibilities For Case Manager, RN Resume
- Prioritizes data according to the patient’s immediate conditions and needs
- Using high-risk criteria, makes referrals to social work as identified through the high risk screening process
- Responsible for having a clear and thorough knowledge of the Community Living Assistance and
- Support Services provider manual, including periodic manual updates
- Discusses estimated length of stay, treatment and discharge plan with the attending physician, as indicated
- Identifies and assists in removing any barriers to patient care (variances) and resolves these issues with appropriate departments and personnel
- Coordinates and facilitates any transitional planning needs through the acute care continuum
- Consults with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed
- Collaboration with member's Providers to get all information required to approve requested item
2
Responsibilities For Case Manager / RN Resume
- Take calls from members and providers and give them appropriate information to help expedite services
- Screens patients and conducts individualized clinical assessments of patient’s health concerns and needs
- Conducts concurrent stay review to ensure patient continues to meet criteria
- Initiates referrals to Physician Advisor on questions of appropriate admissions, continued stay, and quality of care. Discusses cases with PA’s and contacts attending physician with result of the review
- Works closely with attending physicians to insure appropriate documentation
- Support members with condition education, medication reviews and connection to resources
- Work with members who were hospitalized and are at risk for re-admission
- Conduct post-hospitalization assessments telephonically
3
Responsibilities For Case Manager Rn-telecommute Resume
- Identify member needs and formulate plans of care
- Manage caseload in the CLASS program to include home visits, telephone contact and written communication with clients on a monthly basis
- 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
- Pro-actively identifies problems and possible solutions
- Complies with the BPHC HIV/AIDS Medical Case Management Program Protocols
- Maintains current clinical knowledge base
- Develops collaborative relationship with community pharmacists
- Maintain oversight over specified panel of members by performing ongoing assessment of members’ health management needs, identifying the right clinical interventions to address member needs and/or training members to appropriate resources for additional support
4
Responsibilities For UR Case Manager RN Resume
- Create care plans to address members’ identified needs, for assigned case load. Remove barriers to care, identify resources, and conduct a number of other activities to help improve the health outcomes of members; care plans include both long and short term goals and plan of regular contacts for re-assessment
- Visit members in the hospital to engage in post hospital program
- Make concerted effort to find members post hospital that are difficult to reach
- Make initial post hospital call within 3 days of discharge to ensure that discharged member receive the necessary services and resources
- Coordinate care and services for members
- Adapt to regular process changes as new program evolves
5
Responsibilities For Health Case Manager RN / RPN Resume
- Utilization management through evaluating appropriateness and efficiency of requested health care services, procedures, and cancer treatments under the provisions of the applicable health benefits plan
- Serve as a Care Plan team member
- Monitor foster parent compliance with MARs and seizure logs
- Provide support and education to our staff of social workers
- Collaborates with and provides feedback to the primary care physician and multidisciplinary team regarding patient's status with regard to length of stay, utilization of resources and discharge status
- Ensures managed care reviews are up to date and accurately reflect patient's clinical progress and acute needs
- 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
- Documents on-going processes of patients' hospitalization
6
Responsibilities For Hospital Transitions Case Manager RN Resume
- Functions as a clinical resource/consultant/educator for interdisciplinary health care team on an ongoing basis in order to maximize quality of patient care and effectively manage length of stay by promoting a timely, cost-effective, efficient and safe discharge plan to include extended care, long-term care or home health services
- Assumes a leadership role in the interdisciplinary health care team in order to manage patient care with clients and their families, as well as the coordination thereof, to ensure high quality patient care throughout the hospital stay and upon discharge and documents interventions in the medical record
- Maintains regular contact with patient, family and interdisciplinary health care team to achieve clinical pathway and case management goals and ensures instruction to same based on individual learning needs
- Participates in team meetings and interdisciplinary rounds and incorporates recommendations and/or services of interdisciplinary team members in plan of care. Provides presentations and educational offerings to interdisciplinary health care team as it relates to case management
- Participates in data collection and analysis by completing case manager's worksheet and inputting variances into a Microsoft Access Database. Completes variance and outcome tracking reports according to the clinical pathways and maintains pertinent documentation and case information in appropriate patient records, reports and files
7
Responsibilities For Complex Case Manager RN Resume
- Develops collaborative and professional relationships with patients/families, other departments, other members of interdisciplinary health care team, treatment providers and external health agencies to facilitate and support quality care
- Participates in the development, revision and effective utilization of the interdisciplinary clinical pathways for selected patient populations and other case management tools
- Collaborates with the Head Nurse in order to assist in the supervision, education and development of her/his staff involved in the care of patients, as necessary
- Participates in data collection and analysis by completing case manager’s worksheet and inputting variances into a Microsoft Access Database. Completes variance and outcome tracking reports according to the clinical pathways and maintains pertinent documentation and case information in appropriate patient records, reports and files
- Advocates for the patient and his/her family while adhering to the overall treatment plan, UR/UM guidelines, policies and procedures of Shriners Hospitals for Children, regulatory requirements, and nursing and case management standards of practice
- Performs assessments on assigned population and develops plans based on the needs of the patient/family
- Works collaboratively with the interdisciplinary team to promote high quality care provided in a timely and fiscally responsible manner. Ensures that the patient’s care is coordinated across the continuum by collaborating and communicating with the patient’s medical home and/or other healthcare providers
- Discusses with attending physician and/or physician advisor the appropriateness of resource utilization, consultation and treatment plan
- Identifies barriers that impact adherence to the plan of care and provides intervention or makes referrals as indicated
8
Responsibilities For Ows-case Manager, Rn-weekend Resume
- Provides clinical information as needed to assist in obtaining authorization for services; ensures admission, surgery, and designated level of care orders reflect medical necessity documentation. Obtains authorizations for post SHC care and services as required by patient’s benefits, entitlement programs, or charitable resources
- Provides guidance about health care benefits and assesses financial barriers; addresses gaps in healthcare coverage and makes referrals as needed
- Coordinates and facilitates patient care throughout hospitalization
- Performs a case management intake assessment
- Collaborates with all members of the interdisciplinary team to assess, plan, implement, coordinate and monitor services required to achieve quality patient care and resource management
- Coordinates and facilitates the discharge planning process
- Works collaboratively with the physician and interdisciplinary team to determine the patient's need for continuing care services
- Serves as a liaison between patients, families, physicians, payers and other members of the interdisciplinary care team
9
Responsibilities For Nicu Case Manager Rn-work Resume
- Ensures that the interdisciplinary care plan and the discharge plan are consistent with the patient's clinical course, continuing care needs and covered services
- Interviews patient or designated agent to assess discharge-planning needs
- Conducts a case management assessment, which includes the patient's physical, psychosocial and financial needs and issues
- Ensures that the discharge plan is safe and timely
- Completes all paperwork and/or ensures that all paperwork is completed and distributed in a timely fashion
- Performs concurrent utilization management
- Disseminates documents of non-coverage when appropriate
- Ensures compliance with current state, federal and third party payer regulations
- Works collaboratively with on-site reviewers to transition patients to appropriate discharge settings
10
Responsibilities For Ssh Case Manager Rn Resume
- Identifies quality issues and reports these to the Director of Case Management
- Documents on-going process of case management interventions and discharge planning including discharge assessment, planning with implementation, on-going evaluation, up-dates and case management outcomes
- Works collaboratively with the physician and interdisciplinary team to determine the patient’s need for continuing care services
- Completes appropriate portions of Patient Discharge Instruction Sheet
- Completes and facilitates the completion of the PRI with other disciplines
- Completes case management intake assessment form
- Strong clinical background and understanding of the preparation and post procedure monitoring requirements for diagnostic/radiological and/or surgical procedures. PC literate
- Knowledge of Microsoft Office, Excel, and spreadsheet management, required
- Ensures that the interdisciplinary care plan and the discharge plan are consistent with the patient’s clinical course, continuing care needs and covered services
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Work Experience
• Work usually performed in an office setting
• Significant time engaging customers in OR theatre and hospital or lab settings
• Develops, along with the Medical Director, departmental and team member goals and meets with team members on a periodic basis to review and assess as...
Professional Skills
• Strong consulting skills and ability to sh...
• Experience in current case or utilization ...
• + Proven ability to operate in a matrix or...