Rn-rn Case Manager Resume Samples
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Rn-rn Case Manager Resume Samples
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AJ
A Jast
Amie
Jast
5367 Schmidt Groves
Los Angeles
CA
+1 (555) 390 8957
5367 Schmidt Groves
Los Angeles
CA
Phone
p
+1 (555) 390 8957
Experience
Experience
Phoenix, AZ
RN Telephonic Case Manager
Phoenix, AZ
Weissnat, Fritsch and Kemmer
Phoenix, AZ
RN Telephonic Case Manager
- Providing patient education to assist with self-management
- Provide patient education to assist with self-management
- Providing patient education to assist with self - management
- Provide patient education to assist with self management
- Provide patient education to assist with self - management
- Review clinical information and make recommendations for eligible members to receive a Cardiac assist device
- Encourage members to make healthy lifestyle changes
Phoenix, AZ
Tricare RN Autism Case Manager
Phoenix, AZ
Willms-Huel
Phoenix, AZ
Tricare RN Autism Case Manager
- Registering, educating and supporting the Autism population and their families through telephonic assessment and expert clinical interventions
- Identifies and coordinates care with community resources as indicated
- Collaborating with the Primary Care Provider, Specialty Care Provider, Therapists, DME provider and other clinical service providers to enhance the quality and efficiency in healthcare delivery to the Autism population
- Identifies solutions to military unique, non-standard request and problems
- Solves moderately complex problems and/ or conducts moderately complex analyses
- Works with minimal guidance, seeks guidance on only the most complex tasks
- Translates concepts into practice
present
Boston, MA
Case Manager Lead-must be an RN
Boston, MA
Howell Group
present
Boston, MA
Case Manager Lead-must be an RN
present
- Coordinates various disciplines and services to improve patient and hospital outcomes. Provides clear communication to eliminate duplication of workload
- Tracks and trends clinical denial issues. Addresses concerns and provides initiatives to improve the overall denial rate
- Assists the DCM with leading an effective management process
- Develops and maintains an effective working relationship with hospital directors, administrative staff, medical staff and external agencies
- Screens cases for risk management, infection control or quality of care issues and reports as per hospital policy
- Based on PA/UM Committee determination that admission or continued stay is not medically necessary CM will provide written notification to patient via the Observation Letter and provide a copy in the medical record. Active member of the UM Committee
- The NCM will ensure there is an admission status order in the medical record. The NCM will ensure the admission status order follows CMS guidelines. Communicate all questions and concerns to the attending physician to provide clarification related to the admission status order
Education
Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
Central Michigan University
Bachelor’s Degree in Nursing
Skills
Skills
- This is a telecommute, work from home position
- Making outbound calls to assess members' current health status
- Identifying gaps or barriers in treatment plans
- Providing patient education to assist with self-management
- Interacting with Medical Directors on challenging cases
- Coordinating care for members
- Making referrals to outside sources
- Educating members on disease processes
- Encouraging members to make healthy lifestyle changes
- Documenting and tracking findings
13 Rn-rn Case Manager resume templates
Read our complete resume writing guides
1
RN Dedicated Case Manager Chattanooga Tennessee Area Resume Examples & Samples
- MD office practice or hospital experience
- Problem solving skills - ability to address and resolve clinical and social issues with members, members’ family/care giver and healthcare providers
- Knowledge of the health insurance industry
- Proficiency with Microsoft programs and a strong computer acumen
- Certified Case Manager
2
RN Telephonic Case Manager, Advanced Illness Resume Examples & Samples
- 3+ years clinical experience in a hospital, acute care, home health/hospice, direct care and/or case management
- Primary consideration will go to home care and/or hospice experience
- Must live within a commutable distance of either our Greensboro, NC or Maryland Heights, MO office locations
- Home care/Hospice case management
3
RN Telephonic Case Manager, Aarp, Telecommute Resume Examples & Samples
- *Candidates must be willing to work until 6:00pm Central Time for this position. This is a telecommute, work from home position***
- Must live within a commutable distance of office Maryland Heights, MO (50 minutes or 50 miles)
- Ability to perform in a fast paced, high demand environment
- Experience with chronic diseases / chronically ill patients
- AARP experience
4
RN Telephonic Case Manager Resume Examples & Samples
- Active, unrestricted RN license in your state of residence
- 2+ years of experience in a hospital, acute care, or direct care setting, or experience as a Telephonic Case Manager for an insurance company
- Experience with discharge planning
- RN license in a compact RN license state
5
Tricare RN Disease Case Manager Resume Examples & Samples
- Making referrals to outside sources
- Current, unrestricted RN license in the state of AZ
- 2+ years of experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
- Telephonic experience, i.e. phone triage, crisis line, disease management, case management
- United States Citizenship
- Previous experience with Diabetes, COPD, Asthma, or Heart Failure
6
Case Manager, Disease Management Program RN Resume Examples & Samples
- 3-5 years of direct patient care or patient education in an inpatient, outpatient, ambulatory or home health setting
- Hospital or ambulatory case management or disease management
- Team leadership in a clinical nursing environment
- Proficiency and clinical work within the areas of cardiac telemetry, treatment of arrhythmias Previous ICU experience a plus
- Strong familiarity with the etiology and current therapeutic modalities in the areas of cardiac, pulmonary and diabetic care
- Experience with electronic health records and computerized patient care systems – Epic experience desirable
- Previous clinical experience in more than one level of care, i.e.: Intensive Care, Med-Surg, ED, Home Health, etc., strongly preferred
- Previous case management experience is preferred
- Experience using InterQual is strongly preferred
- Broad acute clinical background (experience in more than one population and level of care) strongly preferred
- General knowledge of illnesses, current treatments and their physical and psychosocial sequelae
- Specific knowledge in the areas of cardiac diseases, COPD, congestive heart failure, diabetes, asthma, hyperlipidemia and hypertension
- Applicable laws and regulations regarding government and commercial insurance benefits including basic knowledge of governmental (Medicare, Medi-Cal, etc.) healthcare reimbursement systems is required, as well as advanced knowledge of healthcare reimbursement systems: HMO, PPO, Capitated agreements, PPS, etc., is preferred
- General knowledge of coding and DRG assignment process is preferred
- Motivational Interviewing or Shared Decision Making techniques
- Available health care and community resources appropriate for populations served
- Individual and family development over the life span and the influence of cultural and spiritual values in health care
- Data collection techniques and methods of analyzing and reporting data
- Ability to use clinical knowledge to identify potential quality of care issues, delays in service, and post-acute care needs required
- Intermediate level computer skills are required
- Must be able to effectively communicate with, and promote cooperation between, multiple people including: patients and their families; physicians, nurses, social workers, etc
- Ability to work independently with a minimum of direction, anticipate and organize workflow, prioritize and follow through on responsibilities
- Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs
- Interpersonal relationship development, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills
- Leadership skills to delegate provide direction/guidance to staff and hold others accountable
- Strong clinical assessment and critical thinking skills necessary to provide care-planning and medication adjustments based on algorithms appropriate to patients with complex medical, emotional and social needs
- Strong attention to detail and accuracy
- Must have the ability to work in a high-volume caseload environment and deal effectively with rapidly changing priorities
- A demonstrated ability to work constructively with a broad spectrum of health care professionals
- Assertive and creative in problem solving, system planning and management
- Advanced computer skills are required. Ability to work with databases, Microsoft Suite and EPIC
- Must have the ability to create and communicate clearly via written and oral communication using SBAR
7
RN Telephonic Case Manager Resume Examples & Samples
- Active RN license in the state of TX with no restrictions
- Reside in the state of TX
- Minumum 3 years adult acute care setting
- Experience in case or disease management, adult discharge planning or transitional care knowledge
- History of meeting or exceeding productivity metrics
8
Case Manager Inpatient RN Resume Examples & Samples
- Identifies potential TPL/COB cases, investigate TPL/COB issues and notify the appropriate internal departments
- Utilizes considerable clinical judgement, independent analysis, critical-thinking skills and detailed knowledge of medical policies, clinical guidelines and benefit plans to complete reviews and determinations within required turnaround times and regulatory requirements
- Must have and maintain active, valid and unrestricted Registered Nurse License for the state in which you practice
- Demonstrated ability for assessment, evaluation and interpretation of medical information, and care planning
- Team player who builds effective working relationships
9
Case Manager Utilization RN Resume Examples & Samples
- Collaborates with physicians, other members of the multidisciplinary health care team & patient/family in the development, implementation & documentation of appropriate, individualized plans of care to ensure continuity, quality & appropriate resource use
- Conducts daily clinical reviews for utilization/quality management activities based on guidelines/standards for patients in a variety of settings, including outpatient, emergency room, inpatient & non-KFH facilities
- Two (2) years clinical experience as an RN in an acute care setting required
10
Case Manager OHS, RN Resume Examples & Samples
- Assures that all OHS patients are case managed by: identifying the required level of case management and overseeing the deployment of the appropriate level of staff necessary to deliver service to the required level of management; development and implementation of an individualized case management plan and documentation of clinical resolution of care
- Manages all patients who have complex or catastrophic injuries by: monitoring and evaluating the treatment plan and identifying variances to the treating physician; assuring that the patient has access to care and moves through the OHS in an efficacious manner; monitoring, evaluating the achievement of patients' progress through comparison, guidelines and treatment plan and performing work site assessments when necessary
- Participates in the OHS Quality Management program by: data collection and analysis of clinical outcomes of care and customer satisfaction standards; participation on the OHS Practice Team in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service
- Acts as a medical liaison between employers, carriers and third party administrators and injured workers by: communicating frequently (as indicated by the customers' standards) with employers, carriers, TPA's concerning work restrictions, treatment plans and progress, issues and problems and focusing on continually improving service and relationship
- Acts as a patient advocate and educator to assure that the patient has the knowledge to care for his/her injury and the patient is educated/empowered to be responsible for participating in the plan of care
- Participates as an OHS Management team member in decision making and execution of strategies to achieve the predetermined cost, quality, and service outcomes
- Minimum two (2) years of experience as a case manager in Occupational Medicine or related area including knowledge of workers' compensation and laws
- Bachelor's degree in nursing or healthcare related field (preferred) OR current equivalent related work experience (4) four years
- Certified Occupational Health Nurse, preferred
11
Case Manager Spec RN PD Resume Examples & Samples
- Participates in the formulation and implementation/monitoring of action strategies and outcomes of care or customer service
- Cancer Program:Two (2) years clinical experience in Oncology
- Cancer Program: Two (2) years experience in Ambulatory Oncology preferred
12
Case Manager Outside Utilization Rn-pd Resume Examples & Samples
- Minimum two (2) years of clinical experience as an RN in Acute Care or case management required
- Recent inpatient nursing experience
- Specifically daily management of caseload
- Fluent in negotiating electronic health record (i.e., Health Connect), Access and Excel databases, and email skills
- Ability to function independently and as a member of an interdisciplinary team
- Recent SNP and PD call experience strongly preferred
13
Case Manager Utilization RN Resume Examples & Samples
- BSN or higher preferred
- Two plus (2+) years of leadership experience preferred (Charge Nurse, Clinical Supervisor, etc.)
- Case Management certification highly preferred
- Superior communication skills required
14
Case Manager Lead-must be an RN Resume Examples & Samples
- Assists the Director of Case Management (DCM) with daily operational needs within the CM department
- Develops and maintains an effective working relationship with hospital directors, administrative staff, medical staff and external agencies
- Assists the DCM with leading an effective management process
- Provides UM activity on complex cases as requested, complex insurance needs
- Tracks and trends clinical denial issues. Addresses concerns and provides initiatives to improve the overall denial rate
- Works in collaboration with the Revenue Cycle Team to decrease clinical denials
- CBO
- Admitting
- Finance
- Coordinates various disciplines and services to improve patient and hospital outcomes. Provides clear communication to eliminate duplication of workload
- Based on PA/UM Committee determination that admission or continued stay is not medically necessary CM will provide written notification to patient via the Observation Letter and provide a copy in the medical record. Active member of the UM Committee
- Addresses issues and concerns and if needed will respond as intermediary to third party payors and the case managers
- Coordinates the integration of CM services required for patient care throughout each level of care required (ICU, Telemetry, GMF) using screening criteria to promote optimal use of healthcare resources through discharge
- The NCM will ensure there is an admission status order in the medical record. The NCM will ensure the admission status order follows CMS guidelines. Communicate all questions and concerns to the attending physician to provide clarification related to the admission status order
- The NCM using screening admission and concurrent criteria (InterQual) will
- Document the admission status order and contacts the attending physician with any questions or concerns
- Document the patient’s plan of care in Midas as per department policy
- Identify the patient’s insurance coverage or other source of payment for services
- Identify and addresses as appropriate the patient’s risk factors or obstacles to care
- Provides insurace updates as per department policy to the insurace companies
- Follows payor authorization process for admission and continued stay review established by the payor
- Screens cases for risk management, infection control or quality of care issues and reports as per hospital policy
- Screens for discharge planning needs and coordinates the transition of care with Social Services in collaboration with the attending physician and other members of the multidisciplinary team
- Performs admission, concurrent and discharge reviews, using approved UM criteria and secondary physician advisors as needed to screen admission and continued stay reviews for medical necessity. The reviews will be completed in accordance of department policy
- Contacts the attending physician to discuss any plans of care, questions and/or barriers
- Will refer all questionable cases to the internal physician advisor for guidance related to medical necessity and communicates results to the attending physician as needed
- Communicates and provides updated clinical to insurance companies and other third party payors as per department policy
- Documents the authorization/certification in Midas/MS4 as per department policy
- Will facilitate physician to physician communication regarding adverse insurance determinations or to external utilization review organizations
- Facilitates communication and coordination among stakeholders involving the patient in the decision-making process on order to minimize fragmentation of care
- Enhances professional growth and development through participation in educational programs, reading current literature and attending inservice meetings and workshops that are related to assigned areas of responsibility
- Integrates Westlake Hospital service standards and values into daily work decisions and actions. Exhibits behavior supportive of the service standards and Culture of Excellence
- Performs job functions considering the age-specific needs of the patient population served
- Participates in departmental and unit-based meetings, problem solving, goal setting, development of productivity standards, performance improvement projects, writing policies and procedures, managing resources cost-effectively, educating, evaluating and record keeping
- Holds self and others accountable for meeting patient service standards by anticipating service needs and proactively resolving issues
- Performs all activities in a safe manner, according to WSMC guidelines and policy
- Participates in quality improvement initiatives as assigned
- Participates on hospital committees relative to areas of practice as assigned
- Educates patient and all stakeholders on treatment options, community resources, insurance so timey decisions can be made
- Encourages appropriate use of healthcare services while striving to improve quality of care through patient throughput and maintaining cost effectiveness of cases
- Assists patients in safe transitions of care to the next most appropriate level
- Organizes and attends the weekly outlier meeting, TEMPO, Patient Care Conferences, as well as other meetings as appropriate to advocate for the patient regarding transitions of care, post-acute options and community resources
- Oversees compilation of data, data entry of information into computer database, computation of statistics and analysis of data for institutional and physician pattern/variation
- Utilizes data to identify patterns with trends that will positively impact WSMC excess days through quality initiatives to improve overall patient throughput
15
Case Manager Utilization RN, Palomar, PD Resume Examples & Samples
- Recommends alternative levels of care and ensures compliance with federal, state and local requirements
- Reviews, monitors, evaluates and coordinates the patient's hospital stay to assure that all appropriate and essential services are delivered timely and efficiently
- Provides patients with education to assist with their discharge and help them cope with psychological problems related to acute and chronic illness
16
RN Telephonic Case Manager Resume Examples & Samples
- Visit with Medicare members on the phone
- Provide a complete continuum of quality care through close communication with members via on-phone interaction
- Willingness to obtain CCM designation within two years of being hired, if not a credential already held
- Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
- Access to high speed internet from home (broadband cable or DSL)
- Dedicated workspace from home
- Home care or Hospice case management
- Bilingual skills
17
Tricare RN Autism Case Manager Resume Examples & Samples
- Registering, educating and supporting the Autism population and their families through telephonic assessment and expert clinical interventions
- Evaluating health care needs that qualify for the Autism benefit and arranging for services and supplies to support the beneficiary’s condition
- Collaborating with the Primary Care Provider, Specialty Care Provider, Therapists, DME provider and other clinical service providers to enhance the quality and efficiency in healthcare delivery to the Autism population
- Document all clinical information in accordance with United Healthcare Military & Veterans policies and procedures in the member's electronic medical record
- Assess and interprets the Autism population’s health care needs, gaps and requirements and provides referral to other Military and Veteran Case Management programs as indicated
- Provides assessment, coaching, teaching and referral to the Autism population’s family members and caregivers as required
- Identifies and coordinates care with community resources as indicated
- Identifies solutions to military unique, non-standard request and problems
- Solves moderately complex problems and/ or conducts moderately complex analyses
- Develops benefit focused care plan in collaboration with family, other Case Managers, Primary Care Provider, Specialty Providers, other service providers as needed to assure Autism benefit managed according to DoD guidance
- Translates concepts into practice
- Collaborates with specialists, physicians and medical directors to provide the necessary care and cost efficient care for the beneficiary and family
- Assesses the effectiveness and quality of services provided related to clinical, functional and outcomes
- Coordinates authorizations of services as needed
- Unrestricted RN license
- 2+ years of experience in a clinical setting
- Intermediate level of skills with Microsoft Word & Excel and has computer / technical aptitude
- Approved Case Management certification
18
RN Telephonic Case Manager Resume Examples & Samples
- Interact with Medical Directors on challenging cases
- Coordinate care for members
- Educate members on transplant processes
- Ability to speak, read and write Spanish fluently
- Proven proficiency utilizing Microsoft Word, with the ability to navigate a Windows environment, Excel (trainable) and Outlook
- Previous organ and/or bone marrow transplant experience
- Residence in Pacific or Mountain Time Zones
19
RN, Depression Case Manager Resume Examples & Samples
- Minimum three (3) years of mental health experience
- Minimum two (2) years of experience in case management, care coordination, or population care
- Experience with managing medications per protocol, especially SSRIs
- Background in Disease Management and/or Case Management
20
RN, Regional Case Manager Resume Examples & Samples
- Minimum three (3) years of experience in the behavioral health field, working with populations impacted by mental illness, inpatient/intensive outpatient psychiatric treatment, dual diagnosis and/or addiction medicine
- Minimum five (5) years of experience working with dual diagnosis populations; members who have chronic medical conditions AND mental illness, including Axis II disorders
- Minimum one (1) year of experience providing Case Management or Care Coordination, focusing on appropriate Emergency Department utilization
- Microsoft Word, Excel, and Health Connect experience
21
RN Continuum Case Manager Resume Examples & Samples
- Recent Continuum care experience is required, two of the last five years preferred Substantial
- Recent experience in utilization review and/or Ambulatory in an acute care setting is strongly preferred Broad clinical background strongly preferred
- Must have the abilities to work independently with a minimum of direction, anticipate and organize workflow, prioritize and follow through on responsibilities
- Leadership skills to delegate provide direction/guidance to staff and hold others accountable are required
- Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/ Continuum services appropriate to patients with complex medical, emotional and social needs
- Must have the ability to work in a high volume caseload environment and deal effectively with rapidly changing priorities
- Must have the ability to complete thorough, accurate and timely cost/benefits analyses and draft processes/policies
- Must be effective both as a team member and leader
22
RN Telephonic Case Manager Kidney Resource Services Resume Examples & Samples
- *The schedule for this position includes some evening hours where you will be expected to work until approximately 8pm, based on member availability. For example: 11am-8pm OR a split shift 8am-2pm and then 5pm-8pm***
- Coordinating care for members and services as needed (home health, DME, etc.)
- Making "welcome home" calls to ensure that discharged member receive the necessary services and resources
- Computer proficiency utilizing MS Office (Word, Excel, PowerPoint and Outlook), including the ability to type and talk at the same time while navigating a Windows environment
- Attention to detail, organizational skills and multitasking abilities
- Chronic Kidney disease experience
23
Case Manager Utilization Rn-pd Resume Examples & Samples
- Critical Care experience strongly preferred (ED, ICU, etc.)
- Nursing Leadership experience strongly preferred (i.e. Charge RN and/or supervisory experience)
- Masters degree preferred
24
RN Telephonic Case Manager Kidney Resource Service Resume Examples & Samples
- Diabetic educator experience
- Renal or Dialysis Care experience
- Telephonic case management experience
- Bilingual Skills (fluency in Spanish, Mandarin, Chinese, etc.)
25
RN Audits & Denials Case Manager Resume Examples & Samples
- Serves as liaison and point of contact for audits, clinical denials, and appeal inquiries
- Continually stretches oneself and expands comfort zone, not only for personal development but also for the betterment of the department in cross-training of employees
- Enters required canned text in MEDITECH from the: (a) point of assignment for clinical review by PFS, (b) appeal process, and (c) clinical review completion resulting with final appeal outcome
- Proactively shares knowledge, processes, and procedures within the team in the cross-training effort
- Maintains current knowledge base for regulations and appeal timeframes: state, federal, and commercial payors
- Communicates with multiple levels, in and out, of the organization (e.g. managers, physicians, clinical and support staff, and payors) to positively affect clinical and financial outcomes, in a courteous manner
- Identifies and resolves difficulties in a timely manner or brings them to the attention of management, gathers and analyzes information skillfully and efficiently, develops alternative solutions, and uses reason even when dealing with emotional topics
- Demonstrates accuracy and thoroughness, is highly detail-oriented, looks for ways to improve and promote quality, applies feedback to improve performance, and monitors own work to ensure excellence
- Conveys issues and barriers to manager for resolution
- Informs release of information vendor about missing or insufficient medical record documentation
- Performs clinical quality check on medical records for completion prior to submission to audit contractor/payor
- Will perform and maintain the standard essential functions of the RN Case Manager related to taking call and working holidays, as needed
- Proficient in all clinical software systems used to gather, report, and analyze data, as well as all other software applications necessary to carry out job functions
- Excellent assessment, cognitive, and critical thinking skills a must
- Ability to make complex decisions, with decisive judgment, and act in situations that are moderately to extremely difficult
- Familiarity with hospital billing and reimbursement, including but not limited to Claim Adjustment Reason Codes, Remittance Advice Remark Codes, Revenue Codes, Medicare Code 44-inpatient to outpatient, billable outpatient in a bed services; Medicare traditional IPPS 2 Midnight Rule as it relates to case review requirements and hospital reimbursement for services rendered
- Excellent verbal and written communication skills, strong listening skills, problem- solving skills, organizational skills, effective time management, ability to set priorities, and the willingness to adapt quickly to changing priorities, if necessary
- Ability to read, understand and abstract information from handwritten patient medical records
- Ability to maintain confidentiality according to HIPAA regulations is required
- BS in Nursing and licensed as Registered Nurse in the State of Texas required
- Certification as an Accredited Case Manager (ACM) or Certified Case Manager (CCM) or willingness to obtain within two years
- Significant experience in the healthcare field, including a minimum of three to five years of Utilization Review/Case Management experience in an acute care or managed care setting
- Two to three years of experience in the denial management process preferred
- Experience in the application of medical necessity screening criteria tools (MCG and/or InterQual)
26
Case Manager Outside Utilization Rn-pd Resume Examples & Samples
- Monitors/evaluates patient progress and modifies treatment plan as appropriate in collaboration with the Multidisciplinary team
- Recommended to be present at the inpatient UM staff meetings
- Minimum two (2) years of clinical experience as an RN in an acute care setting required
- Caseload will include patients placed at the SNF for skilled and custodial care, and will also include case management and care coordination for patients placed out of area on LOAs
- Recent inpatient case management or skilled nursing experience preferred
- Knowledge of Inpt. Quality Management and Continuing Care Quality Management preferred
- Demonstrated experience in coordinating care for patients across the continuum is preferred. of care is preferred
- Position will work closely with a paired physician on a daily basis
- Candidates who are outcome orientated, performance driven, self-motivated with great time management skills who can multi-task is ideal
27
Case Manager Utilization RN Resume Examples & Samples
- A minimum of 2-3 years inpatient Case Management experience
- 12-hour variable shifts, primarily in the Emergency Department and Short-Stay Observation Unit
- House Supervisor experience highly desired
- Shifts may rotate (evening/night)
28
Tricare RN Autism Case Manager Resume Examples & Samples
- Evaluating health care needs that qualify for the Autism benefit, and arranging for services and supplies to support the beneficiary’s condition
- Collaborating with the Primary Care Provider, Specialty Care Provider, Therapists, DME provider, and other clinical service providers to enhance the quality and efficiency in healthcare delivery to the Autism population
- Assess and interprets the Autism population’s health care needs, gaps, and requirements and provides referral to other Military and Veteran Case Management programs as indicated
- Assesses the effectiveness and quality of services provided related to clinical, functional, and outcomes
29
RN Telephonic Case Manager Resume Examples & Samples
- Intermediate / proficient level of experience with MS Office applications Word, Outlook, and Excel
- Must be willing / able to obtain CCM within 2 years of employment
- Must live within a commutable distance of our Greensboro, NC office location
- Experience in managed care, case management and / or disease management
- Triage experience
30
RN Telephonic Case Manager Resume Examples & Samples
- *This employee is required to work the hours of 10:00am to 7:00pm CST***
- *This is a telecommute, work from home position***
- Managing the members holistically
- Active, unrestricted RN licensure in state of Missouri
- Multiple state licensure (in addition to Compact License if applicable) or ability to obtain multiple state nursing licenses required (Application fees and filing costs paid for by UHG)
- Must live within a commutable distance of our Maryland Heights, MO office location (50 minutes or 50 miles)
- Must be able to work 10:00am to 7:00pm CST
- Adapts well to frequent change in process
- Home health/hospice experience
- Experience working with the Medicare patient population
31
RN Telephonic Case Manager Resume Examples & Samples
- Active, unrestricted RN licensure in state of North Carolina
- 1+ years of experience working with diabetes patients
- Must live within a commutable distance of Greensboro, NC office (50 min or 50 miles)
32
RN Telephonic Case Manager Resume Examples & Samples
- 3+ years experience in a hospital, acute care, or direct care setting
- 1+ years of recent oncology experience in an acute or outpatient setting (infusion, oncology office, etc.)
- Ability to work until 7:00 p.m. CST 1-2 times/week as needed
- Ability to obtain multiple state licensure (all fees paid by UHG)
- Previous Case Management or other managed care experience (utilization review, discharge planning, etc.)
- OCN (Oncology Certified Nurse)
- Residence within a commutable distance of one of our office locations
33
RN Telephonic Case Manager Resume Examples & Samples
- 3+ years clinical experience (any setting)
- Intermediate / proficient level of experience with MS Office applications: Word, Outlook, and Excel
- Must be willing / able to obtain CCM within 2 years of employment (fees paid for by UHG)
- Experience in case management, disease management or other managed care setting
34
RN / Lmsw Case Manager Resume Examples & Samples
- Completes face-to-face comprehensive assessments of members per regulated timelines
- Facilitates interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration
- 1 year experience working with population who receive waiver services
35
Case Manager, Ltss-rn / LSW / Lisw Resume Examples & Samples
- Promotes integration of services for members including behavioral health care and long term services and supports, home and community to enhance the continuity of care for Molina members
- Identifies critical incidents and develops prevention plans to assure member's health and welfare
- Note for RN's: May have additional duties, such as providing consultation, recommendations and education as appropriate to non-RN case managers; working cases with members who have complex medical conditions and medication regimens; and/or conducting medication reconciliation when needed
- At least 1 year of experience working with persons with disabilities/chronic conditions and Long Term Services & Supports
- Active, unrestricted State Nursing license (RN/LVN/LPN) OR Clinical Social Worker license in good standing
- Must have valid driver's license with good driving record and be able to drive within applicable state or locality with reliable transportation
36
Case Manager LVN / RN Resume Examples & Samples
- Collaborates with RN case managers/supervisors as needed or required
- Case managers in Behavioral Health and Social Science fields may provide consultation, resources and recommendations to peers as needed
- 3-5 years in case management, disease management, managed care or medical or behavioral health settings
37
Tricare RN Disease Case Manager Resume Examples & Samples
- Intermediate level of experience with Microsoft Word, with the ability to navigate a Windows environment
- Teamwork skills
- Detail oriented and highly organized
- Previous experience with Diabetes, COPD, Asthma or Heart Failure
38
Case Manager OS Utilis RN Resume Examples & Samples
- For positions in KP Reconnect & Transitional Care Case Management Program only (substitute first sentence above): Minimum two years clinical experience as an RN in Acute Care or case management required
- Has excellent service skills consistent with professional Customer Service regarding providing information and services to members, providers, ancillary support, vendors, etc
- Able to perform appropriate problem resolution, customer follow-up, and escalation to administration as required; while multi-tasking with various responsibilities such as phone activity and data entry
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RN Advantage Case Manager Resume Examples & Samples
- Assessment: Assess all referred “HMO/Advantage” members to determine case management needs by trigger diagnoses, disease management needs, high dollar cost, complex medical conditions or excessive length of stay. Conduct a comprehensive health care plan review that includes member contact and PCP contact. Assess the member's functional status, decision-making ability, and psycho-social needs. Enter identified “Advantage” members into Advantage Case Management with PCP and member consultation
- Planning: Plan a flexible care plan developed in conjunction with the member, PCP, health care team and other persons involved in the member's management. The plan should address the member’s health care needs identified in the assessment process. Community resources, psycho-social needs and end of life care are included in the plan of care
- Implementation and Coordination: Coordinate current treatment plans with the PCP and maximize benefits through in-Plan provider utilization. Utilize cost benefit analysis. Ensure communication of goals with all health care team members. Coordinate psychological care with in-Plan providers and with Behavioral Health Case Management Coordinators
- Documentation: Documentation follows current Paramount procedures. Has good knowledge of HMO/Advantage coverage, exclusions and Medicaid guidelines for appropriate system documentation. Demonstrates good skills in the required paper and electronic systems
- General: Act as a member advocate, maintain and ensure member privacy and confidentiality, adhere to ethical, legal and accreditation/regulatory standards for all Case Management activities/interventions. While most case management interaction is telephonic throughout the case management process as defined above, multidisciplinary face to face meetings with members and providers may be beneficial and necessary to effectively coordinate the member’s treatment plan of care
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RN Inpatient Case Manager Resume Examples & Samples
- Provide on-site and/or telephonic inpatient case management and concurrent review for identified hospitalized medical / surgical HealthPartners members
- Monitor medical necessity, appropriateness and efficiency of care using established inpatient guidelines, contacting Supervisor, Physician, Specialist, Hospitalist, and Medical Director as needed
- Participate in discussion of delays / barriers / progression of care at care coordination rounds or in 1:1 meetings with physicians, specialists and/or hospital staff
- Consistently apply HealthPartners organizational and department values (Mission / Vision / Initiatives) and continuous quality improvement in their daily work
- Be knowledgeable of patient’s available benefits / coverage / payor information
- Be knowledgeable of community programs and resources available to patients within their benefit plan
- Prioritize daily workload to ensure efficiency in completing daily work (patient discharge needs are met, guidelines are followed with proactive discussion of delays / barriers to efficient care, data entry is completed)
- Facilitate communication between patient, family, physician, social services, and vendors to maintain continuity of care and appropriate use of resources
- Serve as a resource to patients, providers, and internal departments. Facilitate and comply with application of benefits processes as needed in close coordination with medical director and care team. Perform utilization management for HealthPartners members admitted to Out of Network Facilities, acute rehabilitation facilities, facilitating the approval/denial of services provided
- Coordinating transfer of patient to in network facilities when appropriate
- Assist in monitoring of annual financial goals for inpatient case management LOS, readmission’s, and denial rates, cost savings, patient/provider satisfaction and achievement of outcomes
- Remain current with knowledge and skills of case management and utilization management practices, application of guidelines, policies and procedures related to case management
- Remain current with knowledge to ensure compliance with government programs such as Medicare / Medicaid requirements and regulations
- Maintain confidentiality of information obtained in performance of duties as well as HealthPartners policies & procedures
- Discuss cases not meeting medical criteria and cases with utilization issues with physician, social worker, other care team members and medical director as needed
- Assist in monitoring of annual goals for case management LOS, referrals, readmissions, denial rates, cost savings, patient/provider satisfaction and achievement of outcomes
- Serve as a liaison to other agencies, departments, or community resources as needed to coordinate care in transition planning
- Participate in required educational programs and actively demonstrate self-directed learning and continuing education to enhance professional development in the area of case management
- Participate in staff development activities and staff meetings
- Identify and refer to manager and supervisor all cases involving potential high cost, sensitive or complex medical issues for review
- Record, monitor and report data such as clinical outcomes achieved, potentially avoidable and medically necessary variances, denials, length of stay, reviews completed and outcomes (savings and referrals), and discharge dispositions on a daily basis
- Work with the attending physician, hospitalists/rounders, specialists, hospital and social work staff to create an actionable plan of care and transition / discharge plan for each patient followed, as needed
- Demonstrate knowledge regarding transition criteria and level of care and use of appropriate community-based resources
- Review and assesses inpatient cases for eligibility, benefits and limits, medical necessity and ongoing appropriate level of care
- Function independently and as part of a team, working effectively with various departments, internal and external staff, facilities, patients, patients’ family, and physicians to facilitate quality and efficient patient care
- Provide services at sites throughout the metro area on an as needed basis, based on assignment / census
- Minimum 3 years’ experience as a Registered Nurse in a clinical setting, performing utilization review, case management or discharge planning
- Excellent problem identification and problem solving skills and follow through skills
- Excellent organizational skills and ability to prioritize workload
- Function independently and as part of a team, working effectively with various facilities, internal and external staff, patients, patients’ family, and physicians to facilitate patient care
- Able to work with individuals of diverse back grounds
- Ability to deal with change and ambiguous situations
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Case Manager, Chronic Conditions RN Resume Examples & Samples
- Registered Nurse with current license in the State of Minnesota, BSN preferred
- Health behavior change coaching experience
- Experience in effectively collaborating and problem solving with patients and health care team members
- Experience in use and management of automated medical management systems
- Ability to engage patients with various dispositions into programs
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RN Telephonic Case Manager Resume Examples & Samples
- Active, unrestricted RN license in the state of Florida
- Bilingual skills (fluency in Spanish/English); speak, read and write
- Must live within a commutable distance of our Miami, FL office location
- Experience working with heart failure patients
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Case Manager Utilization RN Resume Examples & Samples
- KP experience, recent telephonic case management experience, recent IP experience, recent experience with transitions in care, as well as recent experience with tele-monitoring preferred
- Experience in working with young adults, adults and older adults is critical given panel caseload
- Excellent verbal and written communication skills are essential, as are computer skills and the ability to navigate multiple computer programs, including the electronic health record
- Ability to prioritize deadlines, regional and local medical center initiatives while providing exceptional patient care is necessary
- Candidate must be proficient in using language assistance services
- Bilingual (English/Spanish)preferred
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Case Manager Outside Utilization RN Resume Examples & Samples
- Must have excellent prioritization skills, juggle multiple pt care issues requiring follow-up while addressing pt transition events (ED, IP, planned surgeries, SNF to home)
- Written/verbal communication skills; collaboration
- Recent experience in acute clinical, SNP and telephonic case mgmt. preferred
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RN Telephonic Case Manager Resume Examples & Samples
- Review clinical information and make recommendations for eligible members to receive a Cardiac assist device
- Communicate with staff at the transplant facility
- Verify eligibility information and conduct research in order to educate members on their benefits
- Conduct clinical case review and assist with discharge planning
- Work with members to conduct a post-surgical assessment and make referrals to a partner program as appropriate
- Maintain the confidentiality of sensitive and protected health information
- Computer proficiency, must be able to type and navigate around a Windows environment
- Excellent communication skills, written and verbal
- Bachelor’s in Nursing or higher level of education
- Compact State Licensure
- Previous experience working with VAD patients
- Previous transplant experience
- VAD Coordinator work experience
- Previous case management or managed care experience
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Case Manager Utiliz Rn-pd Resume Examples & Samples
- Coordinates the interdisciplinary approach to providing continuity of care, including Utilization management, Transfer coordination, Discharge planning, and obtaining all authorizations/approvals as needed for outside services for patients/families
- Refers patients to community resources to meet post hospital needs
- Adheres to internal and external regulatory and accreditation requirements and compliance guidelines including but not limited to: TJC, DHS, HCFA, CMS, DMHC, NCQA and DOL
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Case Manager / Service Coordinator, RN Resume Examples & Samples
- Requires a Nursing Diploma or Associates Degree in Nursing. Bachelor of Science in Nursing preferred
- Three years of clinical experience. Two (2) years of experience working with vulnerable populations and people with chronic or complex conditions
- Experience working for a managed care organization preferred
- Bilingual English and Spanish a plus
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Case Manager Utilization Rn-pd Resume Examples & Samples
- Bilingual abilities desirable
- Master’s degree desirable
- Clinical expertise in Critical Care/Emergency Medicine, Neurology, Cardiology/Telemetry, or Pediatrics a plus
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RN Telephonic Case Manager Resume Examples & Samples
- Current Registered Nurse (RN) license in the state of practice required
- Continuing education credits maintained as required by state of practice required
- Minimum of five (5) years’ experience in clinical nursing required
- Minimum of three (3) years’ experience in renal nursing preferred
- Demonstrated knowledge and understanding of data and managing to clinical, financial, and patient satisfaction outcomes
- Demonstrated experience and effectiveness in change agent role
- Demonstrated knowledge and understanding of CQI techniques
- Previous experience in healthcare performance coaching required
- Certified Nephrology Nurse (CNN) or Certified Case Manager (CCM) preferred
- Ability to modify personal practice patterns to adapt to new / electronic processes and increased productivity expectations as it pertains to Capella implementation
- Current driver’s license in state employed with positive driving record and able to meet requirements of insurance coverage required
- Functional proficiency with DaVita specific clinical software programs, including Capella, required within 90 days of employment
- Home office with internet connectivity at minimum of 1MB upload and 1MB download speed required
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RN Telephonic Case Manager Resume Examples & Samples
- Develop a comprehensive treatment/management plan to return the GE employee to health, work, and wellness in a timely and appropriate manner
- Support to provide telephonic health services to designated sites that include reviewing and assisting them with new injury/illness WC claims, case management of all work and personal disability claims, proper return to work and transitional work programs, return to work exams, surveillance exams, and collecting job profiles for all work areas
- Determine specific goals and objectives to meet the employee’s and GE needs using appropriate resources and benefits available to them
- Is the employee’s advocate and advisor to help facilitate quality and cost-effective care
- Communication is timely and ongoing with employees, providers, Disability Center/Sedgwick, and the business
- Knowledgeable of all GE Disability Programs, Pension Programs, and Social Security Benefits and appropriate phone numbers to refer the employee to
- Be familiar with the employee’s job by acquiring a Detailed Job Profile in order to determine with the business to see if there is work availability
- Document all employee phone calls in a timely and accurate manner
- Knowledgeable of GE medical computer programs and use regularly for all disability claims
- Collaborates with EHS and Operations at each site on what compliance exams/testing is required and assist with outside vendor to provide GE forms and policies in accordance to OSHA, State, and GE regulations
- Maintains and safeguards confidentiality of GE employee health information and records
- Provides health-related counseling for GE employees within scope of nursing knowledge and practice
- Works with onsite EHS and Operations at each site to collect statistical information pertaining to that site that are required for the GE HealthAhead Scorecard
- Minimum of 3-5 years of Case Management, Occupational Nursing, or Emergency Nursing experience
- RN with current Pennsylvania license
- Working knowledge of OSHA regulations
- Strong proficiency in computer skills
- Excellent oral and written communications skills; strong interpersonal skills
- Ability to effectively communicate with employees at all levels of the organization
- Experience communicating with medical professionals in the community
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Case Manager Utilization RN Resume Examples & Samples
- Preferred Experience in ED and Inpatient UM/Case Management
- Able to work in a team environment
- Strong and thorough interview and documentation skills preferred
- Have a strong understanding of the disease process and understand clinical pathways
- Comfortable at talking about end of life topics with patients and families
