Rn Case Manager Resume Sample
Ambrose Kemmer
36226 Hallie Branch,
Boston,
MA
+1 (555) 921 1974
Work Experience
Rn-case Manager
08/2016
-
PRESENT
Boston, MA
- Current licensure as RN in Maryland
- Acts as a liaison among the individual/family, community, provider and physician as well as other health care team members
- Performs initial screening of all bedded patient for appropriate level of care, priority, payer status and high risk criteria
- 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 routine medical necessity reviews (daily for unit patients and care coordinated patients)
- Makes appropriate referrals to third party disease and case management programs for recurring patients and patients with chronic disease states
- Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
- Maintains up to date knowledge of Medicare/Medicaid/JCAHO standards thru in services and workshop attendance
- Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating linkage with appropriate services and resources when the member’s level of chronic pain risk/need changes
Rn Case Manager
07/2012
-
04/2016
San Francisco, CA
- Provides members with information and referral for alternative and complementary care, as needed and as provided in the member’s benefit plan
- Supports initiatives of the Quality Assessment and Performance Improvement Committee
- BSN or AS in nursing
- Meets deadlines and takes responsibility for accomplishing one’s own work
- Active/current agency health requirements
- Office Based role at 2716 N Tenaya
- Current nursing icensure in state and CPR certification
- Dependable transportation and the ability to drive an automobile in all types of weather conditions
- Experience in Medical/Surgical or Critical Care Nursing
Hospice RN Case Manager
05/2007
-
05/2012
Los Angeles, CA
- ACM or CCM Certification or obtained within 3 years of hire
- Knowledge of individual and family development over the life span
- Knowledge of cultural and spiritual values and the impact they have on health care decisions
- Strong knowledge of Medicare and Medi-Cal guidelines and benefit resources as applicable to hospitalization and transition planning
- General knowledge of commercial coverage plans and usually covered benefits. Strong understanding of various reimbursement models and impact to care delivery, patient management and reimbursements such as ACOs, DRGs, Full Risk, etc
- Strong understanding of the criteria, rules and regulations around Inpatient, Observation and Outpatient levels of patient management
- Strong knowledge of geriatrics and the impact to health and function in the aged as well as a working knowledge of chronic/progressive disease states such as CHF, COPD, Diabetes and End Stage Renal Disease, etc
- Clear understanding of the role of the inpatient Social Worker and Palliative Care Resources
- Plan, organize, manage time and prioritize work in collaboration with others
Education
Waynesburg University
2001 - 2006
Bachelor's Degree in Nursing
Professional Skills
- Excellent skills in using technology, proficient in keyboarding; knowledgeable in Microsoft applications, Outlook, iPhone
- Strong computer skills, including keyboarding and multiple Windows
- Demonstrates assertiveness and effective speaking skills
- Experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Case Manager for another insurance company
- Experience in a hospital setting, acute care, direct care experience and/or experience as a Case Manager
- Demonstrates exceptional communication skills and knowledge of conflict resolution
- Excellent skills in Microsoft applications, Outlook, iPhone
How to write Rn Case Manager Resume
Rn Case Manager role is responsible for computer, nursing, clinical, microsoft, health, case, software, windows, basic, training.
To write great resume for rn case manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Rn Case Manager Resume
The section contact information is important in your rn case manager 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 Rn Case Manager Resume
The section work experience is an essential part of your rn case manager 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 rn case manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular rn case manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Rn Case Manager resume experience can include:
- Effective multi-tasking skills in a high-volume, fast-paced, team-oriented environment
- Experience as a Registered Nurse in a hospital setting, acute care, direct care experience and/or experience as a Case Manager
- Manages assigned case load in an efficient and effective manner utilizing time management skills
- Experience in nursing or home health with excellent communication skill
- Leadership skills to delegate and provide effective direction/guidance to staff, ability to hold others accountable
- Be organized, detail-oriented, and possess effective written and oral communication skills
Education on a Rn Case Manager Resume
Make sure to make education a priority on your rn case manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your rn case manager 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 Rn Case Manager Resume
When listing skills on your rn case manager 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 rn case manager skills:
- Demonstrates ability to work within a decentralized model of patient-care delivery. Demonstrates proficient intermediate nursing skills and specialty skills
- Excellent interpersonal and written communication skills to collaborate/interact effectively and confidentially with internal and external contacts
- Shows strong ability to organize and prioritize workload independently; nursing skills per competency checklist
- Experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
- Formulate innovative plan of care for complex cases and demonstrates critical thinking skills
- Demonstrate a proficiency in computer skills including Microsoft Word, Microsoft Excel and In with the ability to navigate a Windows environment
List of Typical Experience For a Rn Case Manager Resume
1
Experience For Rn-case Manager Resume
- Strong discharge planning skills. Ability to commincate with other disciplines effectively
- Experience in nursing or home health with excellent communication skills
- Current obstetrical hospital experience required, including experience in fetal monitoring and cervical examinations
- Recent experience as a RN in case management, Home Health or clinical experience in acute, rehab or long term care setting
- Documenting and tracking progress throughout the fertility experience
- Demonstrates positive professional customer service being respectful of all patients, coworkers and providers, treating all equally/
- Maintains professional conduct and good working relationships with co-workers, supervisors and other employees
2
Experience For Telephonic RN Case Manager Resume
- Demonstrates professional judgment concerning patient care delivery
- Performs initial screening of identified patients for appropriate level of care, priority, payer status and high risk criteria
- Care is evaluated on an on-going bases for effectiveness and appropriate utilization of resources
- Integrates factors related to quality, efficiency and cost-effectiveness in managing care and makes appropriate referrals
- Demonstrates initiative in problem-solving
- Uses good judgment in referring inquires to other office personnel, supervisor and Medical director
- Demonstrates proficiency in the assessment, ongoing evaluation, coordination and timely/accurate documentation of the hospice patient care
3
Experience For Hospice RN Case Manager Resume
- Demonstrates knowledge of the regulatory requirements for providing care to
- Mental health / behavioral health experience; working with Arizona’s Regional Behavioral Health Authorities (RBHA)
- Hands-on clinical RN experience, preferably in ambulatory or inpatient setting
- Experience working in complex care, managed care
- Clinical experience in a hospital, acute care, home health/hospice, direct care or case management setting
- State of Arizona RN license in good standing
4
Experience For RN, Case Manager Resume
- 2+years clinical experience in acute setting
- Provider interfacing experience
- Experience working with diabetes patients
- Experience in Maternity, Labor & Delivery, NICU, and/or High Risk Maternity in a clinical setting
- Case Management experience including Certification in Case Management and / or complex disease management
- Demonstrates willingness to become certified in Managed Care Nursing or another appropriate professional specialty
- Experience: Microsoft Office Suite, including Work and Excel
- Demonstrates ability to exercise independent decision making capability
- Utilization review experience in an acute/sub-acute setting
5
Experience For RN Case Manager PRN Resume
- Assess the effectiveness of nursing care
- Acute care hospital nursing experience required
- Demonstrates ability to maintain professional demeanor in stressful situations
- Valid Registered Nurse (RN) license in the State of Florida, or appropriate multi-state license required
- Utilize both company and community based resources to establish a safe and effective case management plan for hospitalized members
- Making appropriate referrals to other departments, h ) identifying and referring complex patients to Social Work Services,
- Swing bed Activities program coordinator to ensure guidelines are being met set by CMS
- Ensuring and facilitating the achievement of quality clinical and cost outcomes
- Evaluating health care needs that qualify for the ECHO benefit, and arranging for services and supplies to support the beneficiary’s condition
6
Experience For Field RN Case Manager Resume
- Interacting with Medical Providers on challenging cases
- Leading and facilitating multi-disciplinary patient care conferences,
- Leading and facilitating Complex Case Review,
- Willing and able to travel throughout surrounding area on regular basis
- Establishing short and long term goals in collaboration with the member that meet the member’s needs and the referral source’s requirements
- Engaging members / families in person (in their homes or in a facility) to coordinate services, community resources and treatment needs
- Coordinating integrated care for members
- Making referrals to providers, and community resources
- Utilizing Milliman criteria to manage length of SNF stay
7
Experience For RN Case Manager, Home Health Resume
- Communicating with patients and families about the plan of care,
- Collaborating with physicians, office staff and ancillary departments,
- Assuring patient education is completed to support post-acute needs ,
- Managing concurrent disputes,
- Understanding of Federal and State program requirements
- Willing / able to obtain additional State RN licensures, if necessary
- Collaborates in developing, implementing and evaluating teaching/learning strategies for client/family
- Assists manager in determining appropriate staffing requirements and participates in the recruitment and hiring process
- Solves problems by gathering and/or reviewing facts and selecting the best solution from identified alternatives
8
Experience For Onsite RN Case Manager Resume
- Implement care such as negotiating and coordinating the delivery of durable medical equipment and nursing services
- Drive to various venues (SNFs, Board & Cares, patient homes) in order to do conduct patient visitsassessment, coaching and monitoring
- Participates in planning and presentation of continuing education programs, seminars and meetings
- Nursing - Medical/Surgical or Nursing - Critical Care - Required
- Evaluates and modifies plans according to changing patient needs and clinical data; documents and communicates plan to all team members
- Collaborates with physicians and Health care team in planning the care of patients and families within the acute setting and along the healthcare continuum
- Interacts daily with treating physicians regarding the Monarch HealthCare member’s plan of care and alternative care solutions
- Provides assessment, coaching, teaching and referral to the ECHO population’s family members and caregivers as required
9
Experience For Home Health RN Case Manager Resume
- Relevant data, including submission of clinical information to third party payers is communicated in a timely manner utilizing appropriate judgment
- Handles difficult and sensitive issues with tact, exercising judgement where necessary and consulting supervisor on major problems and issues
- Interact with providers’ offices regarding clinical updates and resource locating
- Collaboration and coordination with internal and external partners i.e. scheduling and conducting meetings
- Observation, recording, and reporting to the physician any reaction to treatment or changes in the client’s condition
- Care Coordination by demonstrating throughput efficiency while assuring care isthe right sequence and at appropriate level of care
- Patient care environment. Prolonged standing and walking
10
Experience For Complex RN Case Manager Resume
- Provides nursing care to clients according to physician orders and regulations
- Provides teaching and training to client / family / caregiver as appropriate
- Assist in the development, planning, coordination and administration of the activities of Utilization Review and Discharge Planning
- Assertive and creative in problem solving, and system planning and management
- Deals with a diversity of people in a broad range of circumstances discussing treatments, costs, equipment, discharge planning and individual treatment needs
- Displays regular and punctual attendance according to the Aultman Health Foundation Employee Handbook of departmental guidelines (excluding any FMLA)
List of Typical Skills For a Rn Case Manager Resume
1
Skills For Rn-case Manager Resume
- Demonstrated strong interpersonal, organizational, and time management skills required
- Exhibits sound decision making and organizational skills and has the ability to set priorities.
- Good computer skills are needed
- Three (3) years of clinical nursing experience in the acute care or medical setting OR ADN and 5 years of clinical experience
- Long term care / nursing home experience Long - term care or geriatric experience
2
Skills For Telephonic RN Case Manager Resume
- Recent experience as a case manager, home care RN or clinical RN experience in acute or rehab care setting
- At least five years HEDIS related experience and/or solid working knowledge of HEDIS measures
- Nursing experience in an infertility clinic (OBGYN experience doesn’t qualify)
- Five years of experience in one or a combination of the following: home healthcare, community health or public health, or outpatient facility experience
- Leadership skills to delegate and provide direction/guidance to staff and hold others accountable
3
Skills For Hospice RN Case Manager Resume
- Effectively communicates plan of care to facility staff, health plan partners, and ambulatory case management
- Proficient in phlebotomy and IV skills
- Demonstrates knowledge and skill in management of pain and symptoms including infusion therapies
- Valid driver's license and good driving record in compliance with CorVel's policies
- Bedside experience or LVN with 10 years bedside experience
- Computer skills to include Microsoft Work, Excel, data entry and Utilization Management Software
- Exceptional communication skills to enable communication and collaboration with physician, patients, families and ancillary staff
- Three to five years experience as an RN Case Manager in a managed care setting/utilization review/discharge planning/case management
4
Skills For RN, Case Manager Resume
- Clinical nursing experience with direct patient care in an acute care setting (preferably Critical Care, general ICU, ER)
- Previous experience in nursing and long-term care required
- Experience in Outpatient Clinical Nursing and Case Management
- Demonstrates competency in respiratory therapies including use of associated
- Demonstrates sound understanding of and commitment to the hospice philosophy of team and care
5
Skills For RN Case Manager PRN Resume
- Clinical nursing experience
- Experience with care/case management, triage & advice for surgical population (gender-affirming surgery)
- Experience working from standardized policies and procedures
- Experience in acute care clinical setting
- Experience working with Milliman and InterQual
- Serve as a liaison between the MCO and the skilled facility, ensuring all regulatory requirements are met in a timely manner
- Registered Nurse in good standing with required current state license
6
Skills For Field RN Case Manager Resume
- Develops and maintains effective working relationships with hospital staff and community agencies
- Experience with using an Electronic Medical Record
- Mental health/behavioral health experience; working with Arizona’s Regional Behavioral Health Authorities (RBHA)
- Experience triaging calls
- NICU nursing experience
- Clinical experience as a Registered Nurse in any setting
- Clinical experience dealing with maternity patients
- Experience in a physician’s office, clinical or hospital setting
- Acute hospital experience in one or more of the following areas: med-surg, ER, ICU or IMC
7
Skills For RN Case Manager, Home Health Resume
- Experience: Microsoft Office Suite, including Word, Outlook and Excel
- High risk OB clinical nursing experience
- Experienced in utilizing severity of illness/intensity of service criteria
- Experience in a hospital, acute care, home health/hospice or direct care setting
- Acute hospital experience in one or more of the following areas: med-surg, ER, ICU or IMC
- Diverse clinical experience in caring for the acutely ill patients with multiple disease conditions
- Experience in implementation of training and compliance process improvement activities and action plans
- Compliance or Auditing experience
8
Skills For Onsite RN Case Manager Resume
- Current North Carolina driver’s license in good standing required
- Clinical experience focusing on maternity patients
- Experience in rehabilitative and restorative nursing
- Experience working with chronic, complex diagnoses (CHF, COPD, diabetes, etc.)
- Case Management experience in a managed care setting
- Experience working in the homes of vulnerable populations who have chronic or complex bio - psychosocial needs
- Acute care hospital direct patient care nursing experience required
9
Skills For Home Health RN Case Manager Resume
- Provide admission, case management, and follow-up skilled nursing visits for hospice patients
- Two years experience in nursing required
- Active DE RN Licensure, in good standing
- Discharge planning experience is desired
- Three (3) of acute care hospital direct patient care nursing experience required
10
Skills For Complex RN Case Manager Resume
- Two years nursing experience in long term care, medical/surgical or rehabilitation
- : Long term care nursing experience
- Good working knowledge of benefit plans; HMO, Medicare, Medicaid, Employee, Commercial, Medicare Advantage, etc
- Assisted Living experience
- The position requires extensive, diverse and progressively responsible experience with adult/family populations in an outpatient clinical setting
- Experience providing care coordination to low income families
- Experience using Electronic Medical Records (EMR)
- Five years of experience in an acute care Medical/Surgical and/or ICU/CCU setting
List of Typical Responsibilities For a Rn Case Manager Resume
1
Responsibilities For Rn-case Manager Resume
- Excellent clinical assessment and communication skills
- Excellent time management, organizational, research, analytical, customer service, communication (verbal and written) and interpersonal skills
- Demonstrates ability to effectively communicate with various customers
- Demonstrates ability to work independently, and effectively perform multi-tasks
- Possesses good interpersonal communication skills and works well with a diversity of co-workers
- Strong working experience with Diabetic patients
- Demonstrates skill and proficiency in assessing appropriate use of therapies for enteral and parenteral nutrition
- RN and prior Case Management experience or CM Certification
2
Responsibilities For Telephonic RN Case Manager Resume
- Experience and skill with telephonic patient assessment
- Intermediate computer skills (Microsoft Word, Outlook and Internet)
- Experience in Long term care skilled delivery services or Home care / field based case management
- Skills and ability to work collaboratively with all members of the health care team
- Effectively interact with insurance companies and communities healthcare resourses
- Strong telemetry/EKG experience (able to read and interpret cardiac telemetry rhythms)
3
Responsibilities For Hospice RN Case Manager Resume
- Demonstrates ability to prioritize assignments
- Nursing or case management experience
- Maintain logs, medical records and other documentation needed to demonstrate compliance with CMS, QIO, accrediting and other government regulatory bodies
- Clinical experience as a Registered Nurse(any setting)
- One year home health experience desired
- Apply case management standards of practice to focus on effective care of high risk high need patients at a specific site
- Maintains strong knowledge of UM, Case management, community resources and plan benefits to ensure improved outcomes
4
Responsibilities For RN, Case Manager Resume
- Review requests for goods and services to identify medical appropriateness
- Promotes and demonstrates professional standards to enhance the development of the department including
- Identifies priority patients requiring care management services
- Demonstrate initiative in problem solving; know when to seek counsel
- Demonstrates the ability to carry and manage a caseload of patient/family members and the integrity of the associated Plan of Care
- Demonstrates the ability to work as a team member and to coordinate care with IDT members
5
Responsibilities For RN Case Manager PRN Resume
- Demonstrates knowledge of costs related to care, hospice reimbursement and
- Experience with relevant systems; Excel, Word, EPIC, Allscripts, MCG, Sorian
- Experience as a Registered Nurse, in various settings
- MDCP (Medically Dependent Children's Program) experience
- One (1) year recent acute care hospital case management experience required
- Three or more year’s clinical experience in acute medical/surgical or critical care practice area
- Two years’ experience within the last five years in a homecare agency, primary care clinic, or acute-care facility
- Experience as RN
- Experience with the Department of Social Services, Children’s and MO HealthNet Divisions
6
Responsibilities For Field RN Case Manager Resume
- Acute hospital patient care experience
- Clinical experience in a hospital, acute care, home health / hospice, direct care or case management
- High Risk OB and / or Pediatric experience
- Cardiac, medical - surgical and / or critical care experience
- Direct care clinical experience in a hospital, acute care, home health / hospice
- RN experience
- Case Management/Care Coordination experience
- Recent experience in hospital, acute care, home health, hospice, case management, foster care system and/or social service coordination
- Home care and/or case Management experience
7
Responsibilities For RN Case Manager, Home Health Resume
- MDS or Case Management experience
- Experience in case management
- Experience in Obstetrical, Maternal or Newborn care
- Experience as a RN (preferably in ER, Urgent Care or ICU, critical care, acute care and/or MED/SURG
- Workers compensation case management experience
- Valid Registered Nurse (RN) license in the State of Florida, or appropriate multi-state license
- Workers compensation experience
- Experience as an RN with Ambulatory Case Management
8
Responsibilities For Onsite RN Case Manager Resume
- Strong knowledge of Managed Care Plans
- Experience with Medicaid or Medicare
- Clinical RN experience
- CCMLong Term Acute Care and / or Sub Acute experience
- Workers compensation experience
- At least one year related experience in a healthcare environment
- Recent acute hospital experience
9
Responsibilities For Home Health RN Case Manager Resume
- Acute clinical experience
- Demonstrate resourcefulness and critical judgement in emergency situations
- Clinical experience in a hospital, acute care, home health / hospice, direct care or case management
- Clinical experience as an RN in any setting
- Case management and / or disease management experience
10
Responsibilities For Complex RN Case Manager Resume
- Basic level of experience with Microsoft Word, Outlook and Internet
- Experience in area of clinical specialty
- Valid PA RN license
- Clinical experience in a hospital, acute care, home health / hospice, direct care or case management
- HCHB experience highly desireable!
- Experience as an RN
- Maternity Case Management experience
- Telephonic Member Management experience with the maternity population
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