Care Manager Nurse Resume Samples

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H Quitzon

Hattie

Quitzon

99751 Jesse Mountains

Boston

+1 (555) 523 2512

99751 Jesse Mountains

Boston

Phone

p +1 (555) 523 2512

Experience Experience

Dallas, TX

Nurse Manager, Care Management

Dallas, TX

Roberts-McClure

Dallas, TX

Nurse Manager, Care Management

Manage unit Nurse Reviewer, Care Coordination and office support staff, including hiring, firing, orienting, training, supervising their activities, and imposing disciplinary action, if necessary
Oversee nursing reviews and care coordination and ensure that reviews are conducted in accordance with established regulations and standards of practice
Oversee assignment and monitoring of other related work, such as report development and writing; analysis of utilization patterns to inform policy development and to detect possible fraud, waste, or abuse; and formulation of responses to inquiries
Establish and monitor quality assurance functions, correct deficiencies, investigate related incidences and complaints, prepare follow-up reports, and implement corrective action and raise issues with Client or Senior Management for resolution
Responsible for managing and updating program contractual and service agreements and assuring that the unit is meeting the stipulations of these contractual obligations
Collaborate with Client and Clinical Analytics team to develop metrics and standard reports to assess productivity, utilization, cost trends and cost savings/ROI associated with the program
Work with data analysts to extract data from claims and other data sources to describe the population, to assess provider performance and to identify quality improvement opportunities in patient/member care

Boston, MA

Nurse Manager Ambulatory Care Services

Boston, MA

Hickle-Grimes

Boston, MA

Nurse Manager Ambulatory Care Services

Recruit, hire, manage, supervise and coordinate nursing staff for several ACUs, including the Northville Health Center (Medical Procedure Unit, Infusion Clinic, Adult Clinic, Women's & Children's Clinic, Musculoskeletal Clinic and call center), Livonia Center for Specialty Care, Livonia Health Center and Canton Health Center and Infusion Center
Provide leadership for the development, implementation and evaluation of standards of nursing practice and for interdisciplinary clinical guidelines, using best evidence
Work collaboratively with medical directors and administrative managers to identify and resolve unit operational problems and process improvements
Counsel, develop and evaluate the performance and clinical practice of staff
Plan, coordinate and evaluate LEAN initiatives and other quality improvement activities
Plan, assign and review the work of nursing and support staff
Evaluate and manage clinical equipment and recommend necessary expenditures

present

Phoenix, AZ

Nurse Care Manager Central FL Region

Phoenix, AZ

Kub-Haag

present

Phoenix, AZ

Nurse Care Manager Central FL Region

present

Adheres to established standards of practice including activities and behavior that characterize professional status
Assists FHCC team in efforts to promote care coordination
Provides leadership for other team members
Proficiency in Word, Excel, Outlook, PowerPoint and Access
Formulates a plan of care based on assessment, diagnosis, age, Health Risk Assessment and patient profile
Collaborates a plan of care based on assessment, diagnosis, age, Health Risk Assessment and patient profile
Conducts a medication reconciliation as part of the patient evaluation/re-evaluation process

Education Education

Bachelor’s Degree in Nursing

Johnson & Wales University

Bachelor’s Degree in Nursing

Skills Skills

Knowledge and skill in the applications of the techniques and practices of the nursing profession
Ability to learn and understand appropriate Federal, State, and local regulations
Ability to perform Care management
Ability to explain medical instructions to patients and their families
Ability to travel locally at times for coverage of Care Managers at Clinic locations
Ability to interact and deal tactfully with the public
Ability to read, write, speak and understand the English language fluently
Ability to communicate effectively, establish and maintain an effective working relationship with patients and staff and deal effectively and professionally under pressure

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15 Care Manager Nurse resume templates

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Care Manager Nurse Resume Examples & Samples

Active RN license is designated state
Experience in utilization or case management
Strong computer and communication skills
CCM
Health Plan experience highly desired
Prior management (team leadership) experience
Previous Medicare/Medicaid experience

Nurse Care Manager Mltc Resume Examples & Samples

Prior experience in a supervisor role necessary
Experience with case management in managed care setting a must
Managed Long Term Care experience required
Bilingual Spanish or Russian required

Nurse Manager of Care Coordination Resume Examples & Samples

5+ years of Care Coordination experience, along with proven leadership and team-building experience
Master’s Degree in a health related field/ Bachelor's Degree in Nursing (BSN)
Management experience in care coordination / care management
CCM certification (or other certification in case management)
PRI certification

Nurse Manager / Long Term Care-sardis Oaks Resume Examples & Samples

Coordinates the assessment, planning, implementation and evaluation for resident care. Ensures that residents' care plans are being implemented
Ensures that unit operation and team members are in compliance with the Nurse Practice Act, regulatory standards, policies and procedures
Manages aspects of team members' compensation and assumes responsibility in recruiting and retaining team members
Promotes team member development through education, performance and identification of goals that enhance professional growth

Nurse Manager Progressive Care Unit Resume Examples & Samples

Demonstrates excellent skills in planning, organizing, and managing personnel resources in a cost effective and productive manner for the operation of the nursing unit
Manages the practice of professional nursing and support positions within the unit to maintain quality patient care through implementation and evaluation of clinical practice standards
Cardiovascular step-down experience preferred

Telephonic Nurse Care Manager Resume Examples & Samples

Knowledgeable of evidence-based guidelines, treatment protocols and effective models of care for the treatment of the following chronic conditions: Asthma, Coronary Artery Disease, Chronic Obstructive Pulmonary Disease, Diabetes, Heart Failure and Hypertension
In partnership with Chief and Director of Population Care, Prevention&Health Promotion department, and the Manager of Care Management, assists in the development and standardization of outreach and documentation processes/ protocols
Based on KPGA regional Clinical Quality Strategy, outreaches to members on specific physician's panel to assist in gap closure, improve quality of care and clinical outcomes
Based on input from the physicians: plans, develops, assesses and evaluates treatment / care plan provided to chronic disease members in specifically defined patient populations
Communicates to member when the primary care physician is recommending a change in treatment plan (e.g. medication change/ adjustment)
Communicates with physician and/or caregiver regarding patient progress in clinical, functional and psychosocial status
Maintains appropriate documentation on Health Connect and tracks outreach activities according to the policy and procedure in the department of Population Care, Prevention and Health Promotion
Telephonically educates member and/or caregiver on disease process, changes in treatment plan and provides written patient education materials as needed
Contributes to medical and nursing staff education by giving periodic in-service presentations
Utilizes approved algorithms (e.g. Treat to Target) based on the physician's order
Arranges and monitors follow-up appointments to ensure member follows the treatment plan
Encourages and recommends enrollment in the appropriate Healthy Living classes, Health Coaching Program and additional KPGA Care Management Programs (e.g. CVD Management Program)
Identifies & recommends opportunities for medical cost savings & regional or inter-regional "Best Practices" resulting in improved quality of care
Assists patients & family to identify limitations ad barriers to self-management & to explore motivation ad confidence about making healthy behavior changes
This job description is not all encompassing
Minimum three (3) years of nursing experience with chronic disease management
Demonstrated knowledge and experience with behavior change, as well as, self-management and motivational interviewing techniques
Experience documenting in an Electronic Medical Record preferred
Master's degree in nursing preferred

Nurse Manager Ambulatory Care Services Resume Examples & Samples

Recruit, hire, manage, supervise and coordinate nursing staff for several ACUs, including the Northville Health Center (Medical Procedure Unit, Infusion Clinic, Adult Clinic, Women's & Children's Clinic, Musculoskeletal Clinic and call center), Livonia Center for Specialty Care, Livonia Health Center and Canton Health Center and Infusion Center
Plan, assign and review the work of nursing and support staff
In collaboration with other members of the ACU leadership teams, identify and plan for staffing consistent with the needs of the patient population and budgetary requirements, and appropriate to the scopes of a variety of roles
Participate in and coordinate the development, implementation and evaluation of multi-disciplinary patient care activities and programs
Work collaboratively with medical directors and administrative managers to identify and resolve unit operational problems and process improvements
Facilitate the education of health sciences students
Four or more years of progressively responsible nursing experience
Demonstrated leadership abilities, self-confidence and assertiveness in a variety of contexts
Demonstrated strong understanding of regulatory requirements for procedural sedation
Demonstrated strong analytical and problem solving skills, knowledge of basic accounting principles and budgetary practices
Creativity and a high level of energy
Two or more years of experience in an ambulatory care management position
Broad personnel, financial, and program management experience
Proficiency with the system applications used in University of Michigan Health System, such as MiChart, OneStaff, and Wolverine Access

Nurse Manager, Care Management Department Resume Examples & Samples

1) Supervision: Develops and maintains a work environment that fosters employee participation, recognition and respect, such that quality services are provided by a competent and committed staff
Develops, maintains, and continually improves the Care Management Program, encouraging and overseeing the Care Managers and Social Workers in the respective roles
Team Leader: Provides guidance and support to multidisciplinary patient care teams to coordinate and manage care across the continuum

Care Manager Nurse Resume Examples & Samples

Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements. Report findings to Medical Management, Medical Director and Center Administrator
Responsible for patient care management to assure appropriate care is provided; reinforce patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinate home health and DME requests and provide recommendations to the Center Medical Director
Assure compliance with HCFA guidelines and covered service guidelines
Evaluate and recommend health delivery network changes with the site Medical Director and Center Administrator
Participate in QI projects. Attend Care Management Meetings
Participate in patient satisfaction program as required and follow up on all inpatient/outpatient discharges
Assist the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans
3 to 5 years of recent clinical nursing experience
Preferred: Previous care management, utilization review or discharge planning experience
Ability to perform Care management
Ability to travel locally at times for coverage of Care Managers at Clinic locations
Knowledge and skill in the applications of the techniques and practices of the nursing profession
Ability to explain medical instructions to patients and their families
Ability to learn and understand appropriate Federal, State, and local regulations
Ability to read, write, speak and understand the English language fluently
Ability to communicate effectively, establish and maintain an effective working relationship with patients and staff and deal effectively and professionally under pressure

Nurse Manager Care Management Resume Examples & Samples

Must have excellent communication skills, (both oral and written) and understand organizational structure and human resource basics
Must be able to handle multiple tasks and remain flexible
Education level necessary to obtain required licensure and certifications Bachelor's or Master's Degree in related field preferred

Nurse Manager Progressive Care Resume Examples & Samples

Works with director on the hiring, evaluating, terminating, counseling, coaching and development of staff
Works with director to develop, interpret, inspect and review policies and procedures within the services provided
Serves as the patient and family advocate with respect to the patient’s right to privacy and protection of confidential information
Participates in planning and implementing patient care strategies and teaching based on a total assessment and the age of the patient
Evaluates and documents patient response, monitors and recognizes changes in physiological and psychological status, takes appropriate action based on assessment of the patient
Demonstrates knowledge of the occurrence reporting system. Uses system to report potential patient safety issues
Follows established guidelines for reporting a significant medical error or unanticipated outcome in the patient’s care which results in patient harm
2 years of Acute care experience as a RN is required

Nurse Care Manager / Case Manager Resume Examples & Samples

Ensures quality, cost-effective care in the appropriate setting and level of care
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
As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings
Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures
All other Nurse Care Manager duties as assigned

Nurse Manager Va Care Resume Examples & Samples

Prior management experience within past 2 years
Non-VA Care Coordination (NVCC) experience
SF-50 (must be most recent, non-award personnel action and reflect current federal status)
VA Form 10-2850a - Application for Nurses and Nurse Anesthetists. Available at the VA Forms website: http://www.va.gov/vaforms/search_action.asp?FormNo=10-2850&tkey=&Action=Search

Nurse Manager Rai Mds Restorative Care Perry Point & Loch Raven Md Resume Examples & Samples

50% or Greater
Travel will be required between Perry Point and Loch Raven Campus
Bachelor of Science in Nursing (BSN) is strongly preferred
Current Basic Life Support (BLS) certification is highly desired
Advanced experience in MDS, Restorative and SAIL
2-3 recent Nurse Manager or leadership experience
Advanced certification in related field
Proof of current Certification(s), Licensure(s) or Registration(s) (Required)
VA Form 10-2850a - Application for Nurses and Nurse Anesthetists (Highly Desired) Available at the VA Forms website: http://www.va.gov/vaforms/search_action.asp?FormNo=10-2850&tkey=&Action=Search
OF-306 - Declaration of Federal Employment - http://www.opm.gov/forms/pdf_fill/of0306.pdf (Highly Desired)
If prior military service, include all copies of your DD Forms 214 or proof of service (required). Applicants claiming preference based on service-connected disability, or based on being the spouse or mother of a disabled or deceased Veteran, must also complete and submit an SF 15, Application for 10-Point Veteran Preference - http://www.opm.gov/forms/pdf_fill/SF15.pdf
If currently employed in the VA system or another Government agency, include latest SF-50 - Notification of Personnel Action.(required)
Unofficial transcripts(s)–official college transcript(s) will be required before being hired; if applicable, supporting documentation from college or university will also be necessary to prove to the hiring agency that the required educational requirements (conferral) will be met in the near future

Nurse Care Manager, Facility Utilization Resume Examples & Samples

Act as the clinical coordinator collaborating with members, caregivers, providers, TPH multi-disciplinary team, and health care and community resources to evaluate member needs through a variety of assessments (care and utilization management) to identify areas of (medical, financial, environmental, health insurance benefit, psycho-social, caregiving) concern and potential gaps in care
Based on areas of concern, identify appropriate goals, strategies and interventions that may include referrals, authorizations, health education, activation of community based resources, life planning, or program/agency referrals
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
Work collaboratively with all stake holders to ensure knowledge of the action plan, including participation in telephonic and face-to-face case conferences when appropriate
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
Participate in delegation oversight and monitoring activities, as required
Research evidence-based guidelines, medical protocols, provider networks, and on-line resources in making coverage determinations and care management recommendations
Review and investigate member and provider requests to determine appropriate utilization of benefits and/or claim adjudication
Enter and maintain documentation in the TPH platform meeting defined timeframes and performance standards. Communicate authorization decisions and important benefit information to providers and members in accordance with applicable federal and state regulations, and NCQA and ConnectiCare standards
Maintain an understanding of TPH principles, program objectives and design, implementation, management, monitoring, and reporting
Identify quality, cost and efficiency trends and provide solution recommendations to Supervisor/Manager
Actively participate on assigned committees
Perform other related projects and duties as assigned
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
Prior case and/or utilization management/care coordination and managed care experience preferred
Certification in utilization or care management preferred
Strong oral and written communication, organizational, and interpersonal skills required. Trained in the use of Motivational Interviewing techniques a plus
Experience working in physician practice and/or with electronic medical records preferred
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
Strong cross-group collaboration, teamwork, problem solving, and decision making skills
Presentation, analytical and negotiation skills
Manage a flexible work schedule to meet member and/or caregiver and departmental scheduling needs
Utilization review of and/or experience working in a Sub Acute Rehab/Skilled Nursing Facility preferred
Knowledge of Medicare Utilization Management requirement and Medicare regulations preferred
Experience using InterQual software a plus
Experience working with Microsoft Outlook, Excel, and Word

Patient Care Director / Nurse Manager Resume Examples & Samples

Previous leadership and collaborative experience
Strong business acumen and communication
Previous Hematology / Oncology / BMT / Infusion experience
Oncology Certified Nurse (OCN) or Advanced Oncology (AOCN) certified
At least 3-5 years of RN experience
Current New York State RN license or willingness to obtain

Patient Care Director / Nurse Manager Resume Examples & Samples

At least 2-3 years of acute RN experience in Cardiothoracic Surgery
At least one year of management experience
At least 3 years of acute care RN experience in Cardiac

Nurse Manager, Operative Care Line Resume Examples & Samples

Demonstrates leadership in providing and improving the delivery of nursing care to surgical patients
Performs w/in the established standard of post-anesthesia & critical care and medical surgical nursing
Manages nursing care delivery and staff development to areas under direct supervision and responsibility
Executes proper use of equipment & supplies used in all areas of responsibility
Responsible to the Care Line Nurse Executive and Executive
Demonstrates competencies specific to management of clinical setting mainly in pre and post-operative nursing Care
Directs and implements practice according to established polices, standards of care and standards of practice to Operative Care Line
MSN with 2-3 years Management and/or Charge Nurse experience Preferred
2 years or more of recent acute surgical care experience within the last 5 years
Current ACLS

Nurse Manager of Care Coordination Resume Examples & Samples

Master’s degree in a health related field
Current New York State RN licensure (or willingness to obtain within 3 months)
At least five years of care coordination experience, along with proven leadership and team-building experience

Nurse Manager, / Virtual Care / Days Resume Examples & Samples

Ensures unit operations and employees are in compliance with the Nursing Practice Act, regulatory agency standards, certifications, licensures and policies and procedures as defined by Carolinas HealthCare System
Partners with leadership and service lines in the development of virtual/tele ancillary care solutions and initiatives
Support existing and future tele-ICU facilities by recommending and fostering Critical Care Network and Virtual Critical Care evidence based best practices
Assists in development of policies, procedures and standards reflective of evidence based practice within a tele-ICU
Allocates resources to meet the unit needs. Responsible for budgetary oversight, and along with staff involvement, accountable to the organization for maintaining a cost effective unit

Nurse Manager Wound Care Center Resume Examples & Samples

Wound Care experience
ACLS certificate
Current National Wound Certificate (WCCN) required within 1 year of hire

Nurse Care Manager Central FL Region Resume Examples & Samples

BSN or Bachelor’s in Education OR
A minimum of three years of clinical healthcare experience
Insert bulleted requirement here (remove bullet points before copying)
Professional knowledge of mind-body medicine and current research within field
Proficiency in Word, Excel, Outlook, PowerPoint and Access
Ability to support departmental and organizational mission
Case management/chronic disease background (Preferred)
Current valid State of Florida RN license
Current valid State of Florida driver’s license, class E and driving record in accordance with Florida Hospital policy
Current valid auto insurance

Nurse Manager Progressive Care Resume Examples & Samples

Oversees the operations of the unit to ensure smooth and efficient patient care management
Completes daily Nurse Leader Rounding on patients and staff to ensure quality provision of care
Manages the unit to ensure patient and employee satisfaction while promoting safety and retention
Serves as a real-time resource and assists with clinical expertise for unit staff and physicians for problem-solving on patients, processes, and family issues
Coordinates quality initiatives and process improvement projects
Has strong financial management skills and is able to maintain fiscal unit goals
Develops and mentors’ leadership skills among staff including communication, decision-making problem-solving/critical thinking and employee engagement
Functions as a role model to encourages staff to participate in their own professional development
Facilitates unit meetings and shared governance / leadership efforts
Responsible for selection, orientation, on-boarding, and retention
Demonstrates leadership through coaching, performance evaluations, corrective actions, and development opportunities to create a culture of learning
Assists the Director with the development of the operational and capital budget, provides daily operational resource management including staff, supplies, and equipment, and ensures optimal productivity for the department
BSN Required, MSN preferred
Must possess at least 2 years of clinical experience relevant to Stepdown and post CABG patient population

Nurse Manager, Care Management Resume Examples & Samples

Manage unit Nurse Reviewer, Care Coordination and office support staff, including hiring, firing, orienting, training, supervising their activities, and imposing disciplinary action, if necessary
Oversee nursing reviews and care coordination and ensure that reviews are conducted in accordance with established regulations and standards of practice
Manage the performance evaluation process, including evaluation of the quality, productivity and inter-rater reliability of staff’s work product
Oversee assignment and monitoring of other related work, such as report development and writing; analysis of utilization patterns to inform policy development and to detect possible fraud, waste, or abuse; and formulation of responses to inquiries
Assess quality, continuity of care, and patient outcomes by hospital and use patterns of hospital behavior to provide feedback and technical assistance to aid hospitals in meeting regulatory or program requirements around admission, continued stay and discharge planning
Establish and monitor quality assurance functions, correct deficiencies, investigate related incidences and complaints, prepare follow-up reports, and implement corrective action and raise issues with Client or Senior Management for resolution
Responsible for managing and updating program contractual and service agreements and assuring that the unit is meeting the stipulations of these contractual obligations
Collaborate with Client and Clinical Analytics team to develop metrics and standard reports to assess productivity, utilization, cost trends and cost savings/ROI associated with the program
Work with data analysts to extract data from claims and other data sources to describe the population, to assess provider performance and to identify quality improvement opportunities in patient/member care
Collaborate with Senior Management in determining staffing mixes and levels needed to meet review timelines, reassign personnel and duties as required, oversee attendance records, and provide appropriate guidance when needed
Develop and manage standard operating procedures, unit policies and procedures, case report forms, and/or case report form completion guidelines
Assist in the design and implementation of the annual business plan
Participate in the development of the budget for assigned cost center; monitors, evaluates and recommends changes within personnel, supplies, and equipment for the unit
Manage unit funding sources by monitoring revenue and expenditure activity; adhere to university, state and funding agency regulations
Represent the unit at internal and external administrative meetings with, but not limited to, the Client, providers, stakeholders and UMMS, as needed
Perform other job related duties as required and assigned
Bachelor’s degree in nursing, or equivalent
Registered Nurse with current registration to practice nursing in the Commonwealth of Massachusetts
7 years of related experience including at least 3 years of nursing management and supervisory experience
Demonstrated communication skills, both oral and written, necessary to interact with all levels of staff and key stakeholders
Ability to travel within the state of Massachusetts, as necessary
Experience in using computer-based tools; ex. Word, Excel, Access, Outlook, PowerPoint
Master’s degree in Nursing or related degree
Prior work with populations comprising those with disabilities and/or long term care needs is highly desirable
Prior work in inpatient or outpatient rehabilitation, nursing facility, home care, or other long term care environment is highly desirable
Prior work in utilization management and/or care management

Nurse Manager Wound Care Resume Examples & Samples

Responsible for driving patient experience within the department to the 75th percentile by working collaboratively with the staff and patient experience team
Responsible for hiring and retaining qualified personnel through effective job design, recruitment, retention, development, and performance management programs and processes
Responsible for budgetary planning and financial performance of the department, as set with Leadership
Responsible for driving employee engagement to above the 75th percentile
Responsible for maintaining department quality metrics and ensuring that all quality measures are completed in a timely manner
Responsible for working collaboratively within the team to support the vision of nursing
Responsible for ensuring that patient throughput within the organization is optimized
Responsible for reviewing payroll and time and attendance for each department weekly
Must have excellent customer service/ communication skills
Must have the ability to develop outstanding rapport and work well with the physicians & staff
Be focused on Patient Experience
Knowledge of regulatory standards ( Joint Commission, OSHA, Specialty Standards) strongly preferred
Ability to communicate effectively and present information to both large and small groups
Computer knowledge and skills. Cerner medical record experienced preferred
Maintain clinical competencies and is able to fully assist at the bedside
BSN degree required, or in school pursuing the degree
Two or more years of recent experience in a relevant unit (same or higher acuity of care as unit pursuing)
Charge experience, lead, clinical coordinator or nurse manager experience is highly preferred
LEAN Leadership Certification completed within two years – provided by the hospital
State of Florida license as Registered Nurse with clear/active status
ACLS, NRP, etc. as required for the unit assigned

NOC Nurse / Med Care Manager Resume Examples & Samples

High School diploma/GED accepted and may be required per state regulations
Medication Management certified
You must be able to make choices, decisions and act in the resident's best interest, have the ability to react and remain calm in difficult situations and possess written and verbal skills for effective communication and level of understanding

Optum Field Based Nurse Care Manager Resume Examples & Samples

Collaborates effectively with interdisciplinary team (IDT) members to complete an individualized comprehensive patient plan of care. Works with the utilization management nurses, care coordinators/social workers, primary care providers (PCPs) and other team members to facilitate smooth transitions of care
Serves as the clinical liaison with local hospitals, clinical and administrative staff and also works collaboratively with the SNF case managers as appropriate
Stratifies and/or validates patient level of risk and communicates with the medical management integrated team during weekly interdisciplinary team (IDT) meetings including the Medical Director
Provides assessments of physical, psycho-social and transition needs within the patient’s actual settings not limited to the PCP office, hospital, SNF and/or patient’s home. Develops interventions and processes to assist the patient and care givers in meeting short and long term goals
Coordinates and attends member visits with PCP and specialists as needed
Manages assigned caseload in an efficient and effective manner utilizing time management skills to facilitate the total work process
Confers with Medical Directors on a regular basis regarding inpatient cases and other patient issues in departmental IDT meetings and at other times as requested
Enters timely and accurate data into designated care management applications to capture clinical patient information. Complies with procedures around auditing of patient records and maintain a minimum of a 90% or better audit score on a quarterly basis
Problem solving by gathering and /or reviewing patient information and selecting the best solution from identified alternatives. Presents patients in the Medical Management Meeting which occurs once a month for input, resources and suggestions from the interdisciplinary team
Refers the Hospital Case Manager to OptumCare Arizona contracted providers and Premier SNF facilities
Arizona State current and unrestricted RN license
Must be able to obtain Case Management Certification within 3 years of hire date
3+ Years of hospital clinical experience
2+ years of case management experience including community based such as hospice, home health care, public health and hospital case management
Experience with Microsoft Office