RN, Care Manager Resume Samples

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F Smitham

Furman

Smitham

409 Flatley Pass

Phoenix

+1 (555) 363 7868

409 Flatley Pass

Phoenix

Phone

p +1 (555) 363 7868

Experience Experience

San Francisco, CA

RN Care Manager Emergency

San Francisco, CA

Predovic, Ledner and Muller

San Francisco, CA

RN Care Manager Emergency

Provides updates to the ED clinical team regarding Care Management involvement with the patient during the patient’s visit
Documents activities, including utilization review activities, statistics, clinical assessments and plans in a thorough and timely manner or per Care Management Department policy
Works with the ED team to achieve optimal patient flow/throughput to enhance continuity of care, smooth and safe transition, patient satisfaction, and patient safety
Performs other duties as assigned by Care Management leadership
Acts as a resource and provides staff and physician education related to resource utilization, medical necessity, and federal regulation and guidelines
Utilizes thorough knowledge of various computer/information systems to perform assigned duties
Thoroughly and efficiently provides information through documentation for continuity of care

Detroit, MI

RN Care Manager, Senior Care Options

Detroit, MI

Baumbach LLC

Detroit, MI

RN Care Manager, Senior Care Options

Maintain goals and objectives of Network Health in working with all enrollees for the coordination of services for the above member population
Maintain an active Massachusetts profession-specific license in good standing without restrictions
Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations
Perform assessment and/or care management interventions for the referred and identified population
Communicates with all providers, actively involved in the enrollee's care, regarding individualized care plan progress, specific program participation, and complex case management interventions
Facilitate communication between the care manager and the enrollee and the enrollee with their practitioners to promote empowering the enrollee to take an active role in managing their health
Work in close collaboration between the behavioral health care managers and social care mangers to provide integrated care for at-risk enrollees

present

San Francisco, CA

RN Care Manager Minnesota Senior Health Options

San Francisco, CA

Bogisich, Rodriguez and Thiel

present

San Francisco, CA

RN Care Manager Minnesota Senior Health Options

present

Maintains knowledge of, and complies with, all relevant laws, regulations and policies, procedures and standards
Actively participates in creating and implementing improvements to achieve clinical, satisfaction and/or efficiency outcomes
Knowledge of community service organizations, agencies, programs and funding sources
Knowledge of the referral/authorization process for recommended services
Evidence Based Practice: Evaluates and/or assists in the evaluation of practice in relation to existing evidence identifying opportunities for the generation and use of research
Nursing Process: Utilizes the nursing process to provide holistic, compassionate, safe, high quality, population based care
Patient Safety: Demonstrates practices that support safety with recognition of variations in populations served, preventing harm to patients, families, employees, and themselves

Education Education

Bachelor’s Degree in Nursing Preferred

North Carolina State University

Bachelor’s Degree in Nursing Preferred

Skills Skills

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
Able to concurrently perform multiple tasks
Excellent verbal and written communication skills
Adheres to departmental policies and procedures as approved by Office of the Medical Director (OMD) Quality Committee
Demonstrates a thorough understanding of the cost consequences resulting from Care Management decisions through utilization of reports and systems such as Health Plan Benefits, Division of Financial Responsibility (DOFR), utilization of metrics and CM reports
Discusses Durable Power of Attorney (DPoA) and advanced directive status with PCP when applicable
Works in coordination with the care team and demonstrates accountability with patient management and outcome
Oversees provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care
Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
Coordinates provisions for discharge from facilities including follow-up appointments, home health, social services, transportation, etc., in order to maintain continuity of care

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RN Care Manager for Post-partum Program Resume Examples & Samples

Proactive telephonic outreach to eligible Humana members and engage participation in Human At Home Post-Partum Care Management program
Active Registered Nurse (R.N.) licensed in the state of Florida and possesses the ability to be licensed as a registered nurse in multiple states without restrictions
Seasoned professional nurse with 3+ years of clinical nursing experience in obstetrics or post-partum
Able to work 40 hours per week between the hours of 8am- 8pm with occasional Saturdays
Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10-panel drug test
Bilingual in Spanish or Creole strongly preferred
Previous work with vulnerable adults or the geriatric population

RN Care Manager Lead Resume Examples & Samples

Development of tools and education to help promote informed and strategic care management activities for primary care
Work collaboratively with enterprise stakeholders to align care management efforts across multiple practices and locations
Develop expertise of enterprise electronic medical record (Epic) and related population health management tools to promote care management best practices
Utilize data and analytics to identify patient populations in highest-need of care management services
Perform individual needs assessments and assists with educating patients and families on available and necessary resources to access healthcare delivery systems
Conduct analysis to eliminate fragmentation, duplication, and gaps in treatment plans
Development of care plans working toward reduction of preventable hospital admissions, re-admissions, emergency department visits, and excessive therapies
Graduation from an accredited college or university with a master’s degree in Nursing, Psychology, Social Work or in a related field AND one year of professional clinical, case management and healthcare experience
Must possess and maintain a valid State of Colorado Driver’s License
Work experience in the health professional field specializing in clinical, case management and healthcare may substitute for the master’s degree on a year-for-year basis
Three or more years of experience working with faculty and staff in a higher education medical/clinical environment
Experience working with Home Care, Medicaid and Medicare populations, and related social/economic issues
Experience and knowledge of HIPAA rules and regulations
Knowledgeable with managed care, case management, and utilization management; prefer familiarity with registries, risk stratification modules and population health management tools
Must possess excellent written and verbal communication skills and have a working knowledge of fiscal responsibilities
Experience working with an electronic medical record system
Intermediate skills with word processing and developing spreadsheets using Microsoft Office such as Word, Access and Excel
Excellent interpersonal and organizational skills with the ability to prioritize, multitask and follow-up
Must be willing to manage light travel among multiple metro-Denver clinical practice sites managed by the University School of Medicine and University of Colorado Health System

RN Care Manager Bachelors Resume Examples & Samples

2+ YEARS
KNOWLEDGE OF CARE MANAGEMENT AND RESOURCE/UTILIZATION MANAGEMENT
SKILL IN CARE MANAGEMENT AND PATIENT ASSESSMENTS
ABILITY TO MONITOR, ASSESS AND RECORD PATIENT PROGRESS AGAINST A PLAN OF CARE
ABILITY TO FACILITATE PATIENT ACCESS TO COMMUNITY RESOURCES
ABILITY TO WORK COLLABORATIVELY WITH BOTH INTERNAL AND EXTERNAL MEDICAL STAFF AND EXTERNAL PARTNERS AND ORGANIZATIONS
ABILITY TO ASSESS, ADAPT, AND CALMLY RESPOND TO CHANGING AND/OR CRISIS ENVIRONMENT
ABILITY TO MAINTAIN CONFIDENTIALITY WITH ALL ASPECTS OF PATIENT INFORMATION IN ACCORDANCE WITH ALL APPLICABLE POLICIES AND REGULATIONS

Rn Care Manager Waco Resume Examples & Samples

Researches, evaluates and recommends resources to meet medical and non-medical needs of patients and families
Collaborates, refers, and communicates across all programs to ensure appropriate coordination of services
Acts as liaison to hospital, long-term care, specialists and home health representatives
Ability to assess, adapt, and calmly respond to changing and/or crisis environment

RN Care Manager BSN Resume Examples & Samples

Assesses plans, implements, documents, coordinates, monitors, evaluates, and updates the plan of care by collaborating with all members of the health care team to provide evidenced based care
Bachelors of Nursing Degree Required
At least 2 years of related experience
Staff and external partners and organizations

RN Care Manager, Post Service Review Resume Examples & Samples

Using professional judgement, independent analysis and critical-thinking skills applies clinical guidelines, policies, benefit plans, etc to complete case review and determinations
Five years clinical experience in a health care environment; including Managed care experience preferred
Skilled in computer operation with proficiency in Microsoft Office Word　
Excellent Interpersonal skills and ability to work effectively and independently　　
Ability to effectively analye, interpret, apply and communicate policies , procedures and regulations

RN, Care Manager Resume Examples & Samples

Must have a working knowledge of current treatments and their physical and psychosocial sequelae
Basic knowledge of applicable laws and regulations, and accreditation guidelines, e.g. CMS (HCFA) DOC, JCAHO, EMTALA is required
In-depth knowledge of geriatrics including common health & functional changes in the aged, and various chronic disease processes
Must have strong clinical assessment and critical thinking skills necessary to develop a comprehensive plan of care appropriate to patients with complex medical, emotional and social needs
Must have the ability to work in a high volume case load environment and deal effectively with rapidly changing priorities
Must be assertive and creative in problem solving, and system planning and management
Must have the ability to serve as a health coach to patients in all categories of patients: well but at risk due to lifestyle habits, newly diagnosed conditions, chronic disease and end of life

RN Care Manager Per Diem Resume Examples & Samples

Provides case management coordination to ensure that patients receive the appropriate level of care based on medical needs. This may include facilitating patient transfer from inpatient settings to other more appropriate care settings such as a post-acute care facility, or home care with monitoring by qualified medical staff. This may also include facilitating outpatient skilled services or the provision of durable medical equipment as needed
Uses professional judgment and departmental guidelines to refer cases to physician advisors
Ensures compliance with HIPAA and other applicable company policies and procedures as well as regulatory requirements
Maintain effective communication with management regarding development within areas of assigned responsibilities and performs special projects as required
Required- Three (3) years of previous job related experience in a healthcare environment
PC proficient; ability to communicate and interact professionally with co-workers, management patients, and Providers; ability to counsel and/or consult; working knowledge of HMO’s, PPO’s, Medicare, Medicaid, and insurance plans; knowledge of CPT4/ICD 9 & 10/HCPCS codes

Rn-care Manager Adult Partial Hospitalization Days CHI Health Immanuel Resume Examples & Samples

Relates to people in an open, friendly, accepting manner; shows sincere interest in others and their concerns; initiates and develops relationships with others as a key priority
Serves as an advocate and liaison between patient/family and physician, hospital staff, members of the health care team, community resources, and third party payers as necessary
Develops positive working relationships with the multi disciplinary team within the CHI Health and the Alegent Creighton Health Physician/Hospital Organization physician reviewers and refers cases in a timely manner to expedite certification decision and/or physician‑to‑physician communication
Collaborates with all disciplines to establish, collect, analyze, and monitor clinical outcome data of the identified population, which in turn will be used to improve patient care and demarcate service delivery mechanisms in need of revision. Participates in the development of patient protocols, maps, algorhythims and reports individual variances from established plans (e.g. CareMaps) which deleteriously effects patient care and/or length of stay of stay. Assists with the development of resources based in part on research findings (both internal and scholarly) for utilization throughout the System

Rn-care Manager Clinical Resource Management Days CHI Health Lakeside Resume Examples & Samples

Develops effective give and take relationships with others; understands the agendas and perspectives of others; recognizes and effectively balances the interests and needs of one’s own group with those of the broader organization
Speaks clearly and expresses self well in groups and in one to one conversation
Consistently evaluates the appropriateness of levels of care, diagnostic testing and clinical procedures, quality and clinical risk issues, and provides timely, accurate and complete medical record documentation and data collection which includes delay days

LPN / RN Care Manager Resume Examples & Samples

Assist in the assessment of clinic operations and make recommendations as necessary
Preferred: Previous care management, utilization review or discharge planning experience
Must have consistent, punctual and reliable attendance

RN, Care Manager Resume Examples & Samples

Performs duties of RN I and II
Evaluates nursing competencies and decisions according to current nursing practices
Functions as a resource and serves as a liaison between administration, clinicians, staff and other departments

Rn-care Manager Patient Aligned Care Team West Valley Clinic Resume Examples & Samples

Bachelor's Degree in Nursing (BSN) AND one (1) year RN nursing experience OR
Associate's Degree in Nursing (ADN) AND two (2) years RN nursing experience at Veterans Affairs Salt Lake City Healthcare System OR
Associate's Degree in Nursing (ADN) AND three (3) years RN nursing experience OR

Rn-care Manager, Denials Management Resume Examples & Samples

Facilitates coordination of a multidisciplinary plan of care to guide patient progress to promote the achievement of optimal clinical, quality, and cost effective outcomes
Completes documentation responsibilities in keeping with hospital and department policy
Performs evaluation of patient’s care and progress for the episode of care and/or across the continuum for the identified population
Graduation from an accredited school of nursing plus three years of recent clinical work experience in the specialty area or related clinical specialty in a hospital setting within the past five years that demonstrates attainment of the requisite job knowledge skills/abilities. Experience with utilization management, discharge planning and/or case management is preferred

RN Care Manager BSN Resume Examples & Samples

Assists patients with self-management through education, visits and telephonic engagement; encourages and supports patient adherence to their care plans
Ability to work collaboratively with both internal and external medical staff and external partners and organizations
Location/Facility – Baylor Medical Center at Waxahachie
2 years of experience
Driver’s License

RN Care Manager Pediatrics Resume Examples & Samples

Critical-thinking and problem-solving skills
Significant knowledge and understanding of availability of community and post-acute resources and related payer requirements (preferred)
Minimum of one year recent acute care experience
Associate of Science in Nursing Degree
Current active Florida State license as a Registered Nurse

RN Care Manager Minnesota Senior Health Options Resume Examples & Samples

Completes comprehensive health risk assessment of each members bio-psycho-social and environmental safety needs
Provides care management based upon results of the assessment to prevent hospital and nursing home admissions allowing member to remain in the community with all the necessary supports available
Develops Plan of Care based on a comprehensive health risk assessment maximizing the level of self-determination and member choice of services, service providers and living arrangements to meet identified needs
Communicates and manages plan of care needs with members/representatives, primary physicians and interdisciplinary team members to meet all identified needs of the member
Associate's degree in nursing from an accredited school of nursing required. Bachelor's degree in nursing preferred
3 to 5 years of experience working with health plans, clinic systems, or general health care environment with geriatric population focus preferred
Knowledge of and ability to utilize specific software to access and input information in Excel databases
Knowledge of Medicare, Medical Assistance and Federal waiver programs desirable
Knowledge of the MSHO and MSC+ care management model and Consumer Directed Services desirable
Knowledge of the referral/authorization process for recommended services
Assessment, Planning, Evaluation: Collects and analyses pertinent data and/or clinical findings. Incorporates clinical findings and scientific evidence in the development, coordination and implementation of an individualized plan of care to achieve desired outcomes. Evaluates progress towards goals and outcomes identifying opportunities for improvement and change
Nursing Process: Utilizes the nursing process to provide holistic, compassionate, safe, high quality, population based care

RN Care Manager Per Diem Resume Examples & Samples

Reviews Interqual Criteria applied by the central utilization team to screen the patient’s condition within 24-48 hours of arrival. Applies Interqual criteria to the Medicare population for screening, in the absence of 3 days thereafter
Collaborates with the multidisciplinary team to plan, implement and evaluate the patient’s plan of care via daily rounds
Collaborates with Business Office and Utilization Review staff to manage denial management processes and communicate with multidisciplinary team as appropriate

RN Care Manager, Managed Long Term Care Resume Examples & Samples

Communicate and reach out to patients, family, and other medical personnel to work together to achieve the optimal outcome; identify and breakdown roadblocks in communication and intervention to maintain a smooth flow
Assist the member in making appropriate applications for public assistance, Medicaid certification or recertification, housing, and other necessary entitlements
Create and manage electronic files to document patient records, progress, and outcomes
Attend educational workshops; review professional publications to stay abreast of current trends; establish personal networks and participate in professional societies to maintain professional and technical knowledge
Clinical experience; assess treatment needs and make recommendations that impact desired outcomes and quality of care
3 - 5 years preferred
Must be NYS licensed as a Registered Nurse or Social Worker

RN Care Manager K Sign on Bonus Resume Examples & Samples

Registered Nurse with current license in Nevada
BSN in Nursing preferred
One year of experience in utilization review, quality assurance, discharge planning or other cost management program required
Two years experience in hospital-based nursing required. Charge nurse or critical care experience preferred

RN Care Manager Emergency Resume Examples & Samples

Knowledge of and ability to utilize in-house and external resources
Masters degree in Nursing (Preferred)
Minimum of five years recent acute care experience (Preferred)
Minimum of an additional two years’ experience in the ED (Preferred)
Clear/Active Florida State License as a Registered Nurse

RN, Care Manager, Inpatient Resume Examples & Samples

Prioritizes patient care needs upon initial visit and addresses emerging issues
Consults with physician and other team members to ensure that care plan is successfully implemented
Uses protocols and pathways in line with established disease management and care management programs and approved by medical management in order to optimize clinical outcomes
Ability to type 25 wpm

Access RN Care Manager Resume Examples & Samples

Assesses and coordinates discharge planning needs with healthcare team members
Prepares statistical analysis and utilization review reports as necessary
Serves as lead to the Medical Staff and BH for the Care Management Program

RN Care Manager Complete Care-telecommuter Resume Examples & Samples

Contributes to the development of patient-focused care and initiates the process in accordance with established guidelines
Conducts assessments, develops treatment plans, performs defined interventions, and generates referrals to providers, community-based resources and appropriate social services
Assesses member's physical, psychosocial and discharge planning needs through communication with appropriate hospital staff including attending practitioner, utilization review staff, discharge planners, social workers, and coordinates care accordingly
Functions as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care as well as effectively manage length utilization and coordination of resources
Assists in identifying opportunities for and facilitating alternative care options based on member needs and assessments
Evaluates and pre-authorizes request for inpatient/outpatient, specialty care, home care, Durable Medical Equipment, and transportation services from network and out-of-network providers in accordance with departmental guidelines
Performs pre-authorization, concurrent and retrospective reviews of Medicare/Medicaid/Commercial members to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter. Responsible for compliance, in practice, with regulatory mandates
Documents all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to ensure integrity of member services provided over the continuum of care and over time
Associate’s degree in Nursing from an accredited program
New York State Registered Professional Nurse license
Fluency in speaking Spanish or Mandarin/Cantonese
U.S. based work experience as a licensed Registered Nurse
Care management including the concepts and philosophy and relevant standards of patient care
Understanding of and sensitivity to cultural differences and needs of the community are essential. Adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Russian, Creole and Korean
Knowledgeable of the values offered with integrated care
Must possess excellent judgment in order to resolve any grievances and/or concerns about patient care and safety
Excellent interpersonal skills, especially the ability to relate well with seniors, their families and community care providers, along with demonstrated ability to handle rapidly changing crisis situations
Requires very accurate typing skills interacting through electronic documentation using multiple electronic PHI databases and security requirement tools such as encryption
Experience exercising independent thinking and problem solving
Ability to communicate on an individual basis as well as in a group setting. Adept at working in an environment with fast-past changing priorities while achieving departmental goals and objectives
As a representative of CompleteCare effective interpersonal skills must be demonstrated consistently while interacting with members/families/support staff for daily collaboration on care plans

RN Care Manager, Senior Care Options Resume Examples & Samples

Assist clinical disease management team with establishing and maintaining efficient and effective communication processes with vendors providing home interventions for Network Health membership
Facilitate communication between the care manager and the enrollee and the enrollee with their practitioners to promote empowering the enrollee to take an active role in managing their health
Communicates with all providers, actively involved in the enrollee's care, regarding individualized care plan progress, specific program participation, and complex case management interventions
Maintain goals and objectives of Network Health in working with all enrollees for the coordination of services for the above member population
Work in close collaboration between the behavioral health care managers and social care mangers to provide integrated care for at-risk enrollees
Continuously assesses the member's needs and upgrades the plan of care accordingly
Review inpatient admissions, continued stays, specialty referrals and specific ancillary services telephonically, or by other electronic means for LOS, medical necessity, discharge planning and care coordination for enrollees enrolled in care management
Participate with on-call coverage for enrollee and/or provider needs during after-hours and weekend coverage
Attend activities including clinical and other professional organizations as needed
Maintain professional growth and development through self-directed learning activities and involvement in professional, civic, and community organizations
Perform related duties as assigned
Advanced communication and interpersonal skills with all levels of internal and external customers
Knowledge of computer software applications
Certificate/License: RN with current MA license, CCM preferred

RN Care Manager, Total Population Health Resume Examples & Samples

With the member, caregiver, provider(s) and TPH multidisciplinary team, develop, communicate and evaluate medical management strategies and interventions including potential for alternative solutions to ensure high quality, cost effective continuum of care
Act as the member’s advocate and liaison by completing or facilitating interventions with providers and/or private, non-profit, and governmental agencies
Ensure that all TPH processes and reporting are compliant with all applicable federal and state regulations, and NCQA and ConnectiCare standards
Actively participate on assigned committees
For RNs: Associate’s degree or Bachelor’s degree in Nursing with 3 years of clinical nursing experience. Valid RN License in the State of CT without restriction
Strong oral and written communication, organizational, and interpersonal skills required. Trained in the use of Motivational Interviewing techniques a plus
Previous system user experience in a highly automated environment and strong personal computer literacy on Windows products required
Bilingual in English/Spanish or English/Polish a plus
Presentation, analytical and negotiation skills
Manage a flexible work schedule to meet member and/or caregiver and departmental scheduling needs

Per Diem SCO RN Care Manager, Cape Resume Examples & Samples

Timely completion of initial and ongoing geriatric assessments
Completion of the Minimum Data Set-Home Care (MDS-HC)
Participation in routine primary care team meetings
Management and coordination of all transitions of care, including
Bachelors of Science in Nursing (BSN) and Registered Nurse with current, unrestricted state license is required

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