Care Manager, RN Resume Sample
Rodrick Schowalter
49854 Cleta Rue,
San Francisco,
CA
+1 (555) 372 3479
Work Experience
Care Manager, RN
01/2017
-
PRESENT
New York, NY
- Based on travel schedule and individual member’s situation, conducts onsite and/or telephonic concurrent review of members in assigned facilities to validate medical necessity of facility admissions
- Complies with all health plan and facility based regulations regarding HIPAA and patient safety and security
- Utilizing clinical judgment, assesses and evaluates members at risk for complicated medical comorbidties, and/or repeat admissions potential, and determines individualized care plan for communication and interventions to promote successful discharge and post-acute care treatment plan
- Conducts patient interviews and clinical assessments through personal visits, and using clinical judgment, determines appropriate level of interventions and patient's need for follow up care
- Provides members with educational resources to enhance their ability to access health care services, including health plan contacts, primary care physician and other pertinent health care provider contacts
- Works to ensure patient’s coordinated care by collaborating and communicating with patient’s Medical Home and/or other health care providers
- Obtains authorizations for post SHC care and services as required by patient’s benefits, entitlement programs, or charitable resource
- Documents assessments, interventions, plans, and education in the patient’s electronic medical record
- Travels daily to assigned facilities to talk with members and physicians regarding the status and treatments within each case. Based on travel schedule and individual member’s situation, conducts onsite and/or telephonic concurrent review of members in assigned facilities to validate medical necessity of facility admissions
Utilization Care Manager, RN
09/2012
-
09/2016
Philadelphia, PA
- Knowledgeable of the health insurance plan policy and procedures, Medicare and Medicaid plan terms, CMS regulations, member eligibility requirements, utilization management, care coordination, protocols, regulatory and compliance
- Working knowledge of PC applications, required. Complete and remain current with training courses on various computer applications and assessment tools
- Ensures continuity of care for newly enrolled members
- Identifies and prioritizes the member?s needs and preferences. Develops quantifiable goals and desired outcomes, and promotes the member?s ability to self-manage to the greatest extent possible
- Develops, implements and monitors the Person Centered Service Plan, assisting members in obtaining reasonable accommodations when appropriate
- Manages case load, including risk stratification of members, monitoring reassessment needs and facilitating transitions of care settings
- Supports initiatives of the Quality Assessment and Performance Improvement Committee
- CA State licensed Registered Nurse (RN)
Onsite Inpatient Care Manager, RN
12/2005
-
04/2012
Boston, MA
- Two year's clinical work experience
- Meets with clients in their homes, work-sites, physician’s or hospital to provide management of services
- Demonstrates knowledge and competency in performing baseline nursing skills. Maintains
- Conducts clinical review and utilizes objective criteria to assign patient to the appropriate level
- Promotes accuracy and completeness of clinical documentation to reflect the appropriate
- Conducts clinical review and utilizes objective criteria to assign patient to the appropriate level of
- Assesses patient’s condition to understand illness or injury and evaluate ability to follow treatment plan
Education
Mountain State University - Orlando Campus
1999 - 2004
Bachelor's Degree in Nursing
Professional Skills
- Be a team player who possesses strong analytical and organizational skills
- Demonstrated and evolving competence in UM functions and understanding of BSC book of business
- Experience using Microsoft Excel with the ability to edit, search, sort, filter, and other Microsoft and PHI systems
- Utilize Interqual and other formats during the prior authorization process
- Cultural competence and konwledge of life experiences with target population
- Knowledge and experience with current community health practices for the frail adult population and cognitive impaired seniors
- Experience and knowledge of the relevant product line
How to write Care Manager, RN Resume
Care Manager, RN role is responsible for training, insurance, security, database, travel, regulatory, medical, health, transportation, clinical.
To write great resume for care manager, rn job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Care Manager, RN Resume
The section contact information is important in your care manager, rn resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Care Manager, RN Resume
The section work experience is an essential part of your care manager, rn resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous care manager, rn responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular care manager, rn position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Care Manager, RN resume experience can include:
- Experience managing member information in a shared network environment using paperless database
- Experience using Microsoft Excel with the ability to edit, search, sort/filter and other Microsoft and PHI systems
- Registered Nurse with New York State License in good standing (NYS RN)
- Manages cases to ensure that the beneficiaries’ clinical needs are met at the most cost effective and clinically appropriate level
- Valid driver’s license, without restrictions, is required
- Assisting providers in assuring documentation accurately reflects the plan of care, barriers to care ect..
Education on a Care Manager, RN Resume
Make sure to make education a priority on your care manager, rn resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your care manager, rn experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Care Manager, RN Resume
When listing skills on your care manager, rn resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical care manager, rn skills:
- Related, progressive clinical experience in the area of specialization. Grandfathered experience requirements effective August 2016
- Education, skills, knowledge and competencies as defined for the Int. UM Care Manager
- RN experience in any of the following areas: Medical Acute, Emergency Services, Trauma or Critical Care
- Manage team of Care Navigators working with PCP’s to identify care gaps prior to member appointments
- Knowledge of Coordination of Care, Medicare regulations, prior authorization, and level of care/length of stay criteria sets desirable
- Computer literate; experience with MS Office Suite (Outlook, Word, Excel)
List of Typical Experience For a Care Manager, RN Resume
1
Experience For Utilization Care Manager, RN Resume
- Assists in identifying opportunities for alternative care options based on member needs and assessments
- Reviews and completes all appropriate information accompanying patient facility
- Collaborates with provider doctors, social workers, discharge planners, and community based service providers to coordinate care accordingly
- Coordinates and facilitates with the multi-disciplinary health care team as necessary in order to ensure care plan goals are achieved and maximize member outcomes
- Evaluates service authorizations to ensure alignment and execution of the member’s care and physician treatment plan
2
Experience For Care Manager Rn Resume
- Documents all encounters with providers, members, and vendors in the appropriate system in accordance with internal and established documentation procedures; follows up as needed; and updates care plans based on member needs, as appropriate
- Occasional overtime as necessary
- Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Effectively function in accordance with applicable state, federal laws and regulatory compliance
- Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practice within the scope of ethical principles
- Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member
- Initiates discharge plan within 24 hours of admission
- Acts as a liaison between hospital and post acute facilities to facilitate returns/admissions
- Facilitates arrangements for time and mode of transportation to facilities for patients
- Assess members to determine care coordination and case management needs for all referred members
3
Experience For Onsite Inpatient Care Manager, RN Resume
- Completes comprehensive assessment of medical , psycho-social and environmental support needs
- Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress. Schedules follow up calls as necessary
- Implements actions to address member needs. Documents progress towards meeting goals and resolving problems
- Facilitates access to entitlement programs and or community resources
- Participates in work groups as requested
- Identifies and refers potential and actual quality issues to the quality management department
4
Experience For Care Manager Rn-care Management Resume
- Keeps up to date with case management initiatives
- Comply with HIPAA confidentiality requirements to protect member personal identifiable health information
- Ensures that required documentation is completed per Conditions of Participation such as but not limited to; IM; Choice letters (ROI), MOON and swing bed admission and discharge paper work
- Manages denials and appeals, peer to peer discussions, and high awareness of under and over utilization of services, managing concurrent denials, reviewing and assuring accurate status order is on the record, physician and peer education of levels of care
- Obtains or ensures acquisition of appropriate pre-certification authorizations from third party payers and placement to appropriate level of care level of care prior to hospitalization utilizing medical necessity criteria and third party payer guidelines. This includes all aspects of swing bed program
- Obtains or facilitates acquisition of urgent/emergent authorizations, continued stay authorizations, and authorizations for post-acute services as needed and within compliance with all regulatory and contractual requirements
- Documents, verifies, and validates specific data required to monitor and evaluate interventions and outcomes (such as readmissions)
5
Experience For Care Manager, RN Outpatient Clinic Resume
- Assumes roles in assessment physical, psychosocial, and economic needs for transition of care planning to a variety of levels of care
- Participate in the discharge planning activities to ensure timely coordination of clinical case management occurs
- Focuses on Length of Stay (LOS) management
- Functions as resource to all members of the health care team as well as the patient and/or family members regarding the care management/utilization review management function
- Integrates performance improvement principles and patient experience into all aspects of job responsibilities
- Facilitates coordinate consults for swing patients i.e. Social Work, Dental, Wound Management, etc
6
Experience For Senior Care Manager / RN Resume
- Collect, analyze and report relevant Utilization Review Management data/information to appropriate Committees
- Participate in the orientation of staff and physicians in the area of utilization review management and care management
- New York State Registered Nurse (NYS-RN)
- Utilizes Telehealth to enhance members' access to care and to improve clinical outcomes
- State Driver’s License
- Conduct community outreach
- NYS RN or
List of Typical Skills For a Care Manager, RN Resume
1
Skills For Utilization Care Manager, RN Resume
- Demonstrates organization and leadership abilities by effective use of time and personnel
- Related, progressive clinical experience in the area of specialization
- Relevant work experience preferably as a Care Manager
- Knowledge and experience with the current community health practices for the frail adult population and cognitive impaired seniors
- Related clinical/case management experience
- Knowledge and experience with the current community health practices for the frail adult population and cognitively-impaired seniors
- Three years clinical experience required
- Three (3) years of experience in chronic disease management, case management, care coordination, utilization management or acute clinical care
- Health Plan experience beneficial
2
Skills For Care Manager Rn Resume
- Screening for medical necessity upon admission, concurrently and retrospectively
- Constantrepetitive arm, wrist, hand and finger motions -- making repetitive movements (e.g. key boarding, filing, data entry)
- Constantcomputer usage including typing and/or eye strain
- Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
- Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars.
- Maintains a committed and cooperative attitude with staffing, promoting teamwork,
- Provides team-based case management services for medically underserved population with a goal of reducing chronic illnesses
- Seeks opportunities to meet learning needs through workshops and literature
3
Skills For Onsite Inpatient Care Manager, RN Resume
- Bachelors of Science in Nursing (BSN) highly desired
- Desire to work on Remote Monitoring Team that supports members with congestive heart failure
- Ensures discharge (DC) planning at levels of care appropriate for the member’s needs and acuity
- Flexibilty to work evenings and weekends
- Familiar with community resources and services
- Assumes responsibility for own professional growth and attendance to in-service educational opportunities
- Maintains knowledge of necessary QIO transmittal services to facilitate appropriate level of care and denial activities within the hospital
4
Skills For Care Manager Rn-care Management Resume
- Licensed Registered Nurse (RN) or Acute Care Nurse Practitioner (APRN) is required
- Proficient knowledge of NCQA, URAC, federal and state requirements
- Demonstrates professional judgment, and critical thinking, to promote the delivery of quality, cost-effective care. This judgment is based on medical necessity including intensity of service and severity of illness within contracted benefits and appropriate level of care
- Proficient in program operations and metrics
- Current Active CA RN License required
- RN (Registered Nurse) license
- Fluency in Spanish, Korean, Mandarin, or Cantonese
- Knowledge of Interqual and/or LOCADTR
- Strong interpersonal and assessment 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
5
Skills For Care Manager, RN Outpatient Clinic Resume
- Related, progressive clinical experience in the area of specialization
- NY State License as a Registered Nurse (RN)
- Knowledge of InterQual and LOCADTR
- Demonstrated ability to manage large caseloads and effectively work in a fast-paced environment - Proficient with simultaneously navigating the Internet and multi-tasking with multiple electronic documentation systems
- Work from Home and travel within NYC Metro Area to Nursing Homes (50%)
- New York State License (NYS) as a Registered Nurse (RN)
- Korean, Mandarin, or Cantonese fluency also in demand
6
Skills For Senior Care Manager / RN Resume
- LCSW, LMSW, LMFT, LMHC, LPC, licensed psychologist (any state)
- Experience in a clinical setting with general nursing exposure in the following: E/R critical care, discharge planning, bedside care, and/or acute care facility is required
- Recent acute care hospital experience
- BLS for Health Care Provider
- Current California RN License. BLS for Health Care Provider
- American Case Management (ACM) Certification or
7
Skills For Transition Care Manager, RN Resume
- Certified Case Manager (CCM) or
- Certified Professional Utilization Review (CPUR)
- Serve as the care team’s primary resource for patients with Congestive Heart Failure (CHF) & Chronic Obstructive Pulmonary Disease (COPD) related comorbidities
- Coordinates treatment plans, discharge expectations, and meets with patients and patients’ families to discuss care plans
- Coordinates provisions for discharge from facilities, including follow up appointments, coordination with patient’s specialists, transportation, etc., in order to maintain continuity of care and adherence to the patients’ treatment plan
8
Skills For Hospice Care Manager RN- / Days Resume
- Geriatric case management
- Home Internet hook-up for laptop
- Emphasis in geriatric case management
- Specialized knowledge for the population/culture served in the managed care program
- Appropriately identifies and refers cases to physician advisor to support timely progression of
- Utilizes considerable clinical judgment, 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.
- Maintains confidentiality of all PHI in compliance with state and federal law and Health Net policy.
- Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services.
- Contacts medical team members to discuss patient’s course of progress and needs.
9
Skills For Care Manager, RN Sign on Bonus Resume
- Implements care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline. Effectively functions in accordance with applicable state, federal laws and regulatory compliance
- Respects the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practices within the scope of ethical principles
- Identifies and refers members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions. Employs collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member
- Implement care management review processes that are consistent with established industry and corporate standards and are within the care manager’s professional discipline
- Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws
- Monitors and documents member's on going progress
- Function in accordance with applicable state, federal laws and regulatory compliance
- Employ collaborative interventions which focus, facilitate, and maximize the member’s health care outcomes. Is familiar with the various care options and provider resources available to the member
10
Skills For Care Manager RN Sign On Bonus Resume
- Develop and sustain positive working relationships with internal and external customers
- Advocates, informs, and educates beneficiaries on services, self-management techniques, and health benefits
- Conducts assessments to identify barriers and opportunities for intervention
- Develops care plans that align with the physician’s treatment plans and recommends interventions that align with proposed goals
- Generates referrals to providers, community-based resources, and appropriate services and other resources to assist in goal achievement
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