Nurse Consultant Resume Samples

4.9 (106 votes) for Nurse Consultant Resume Samples

The Guide To Resume Tailoring

Guide the recruiter to the conclusion that you are the best candidate for the nurse consultant job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies

Tailor your resume & cover letter with wording that best fits for each job you apply

Resume Builder

Create a Resume in Minutes with Professional Resume Templates

Resume Builder
CHOOSE THE BEST TEMPLATE - Choose from 15 Leading Templates. No need to think about design details.
USE PRE-WRITTEN BULLET POINTS - Select from thousands of pre-written bullet points.
SAVE YOUR DOCUMENTS IN PDF FILES - Instantly download in PDF format or share a custom link.

Resume Builder

Create a Resume in Minutes with Professional Resume Templates

Create a Resume in Minutes
ZD
Z Durgan
Zita
Durgan
89844 Bernhard Estates
Houston
TX
+1 (555) 942 2090
89844 Bernhard Estates
Houston
TX
Phone
p +1 (555) 942 2090
Experience Experience
Detroit, MI
Nurse Consultant
Detroit, MI
Swift, Kunde and Boyle
Detroit, MI
Nurse Consultant
  • Performs case management through telephonic contact with all medical providers, employers, claims professionals and ancillary service providers
  • Meet with practices both virtually and onsite to engage practice with network and develop a plan to work towards the identified network goals
  • Assist specialists in resolving case management issues, develop action plans and provides screening, assessment and education
  • Assists in the development of continued care plans as necessary to include patient education and prevention programs
  • Develops goal-focused return-to-work plans; addresses barriers for return to work
  • Manages assigned caseload of complex cases; applies specialized training/knowledge to the assessment of cases; provides technical insight and advice
  • Collaborates with members of the health care team to provide ongoing case management services
Detroit, MI
Senior Nurse Consultant
Detroit, MI
Friesen, Welch and Zboncak
Detroit, MI
Senior Nurse Consultant
  • Provides technical expertise to Stop-Loss senior management, claims adjudicators, underwriting, sales force, TPAs, and their case managers
  • Research and development of new evidenced-based clinical content or clinical program development
  • Provides information, cost savings, risk management reporting and cost containment strategies for assigned cases
  • Provide on - line bibliographic and consumer health information searches to support medical content review / development
  • Develop and maintain strong relationships with internal/external parties, vendors and case managers
  • Develop, maintain and monitor the yearly medical content review process and schedule
  • Consults with underwriters to assist in determining potential future medical risk
present
Boston, MA
Nurse Consultant Senior
Boston, MA
Welch-Kihn
present
Boston, MA
Nurse Consultant Senior
present
  • Manages medical rehabilitation programs within a payor setting to restore injured worker to maximum recovery and facilitate employee's return to work
  • Commutes to site visit with medical providers, injured worker, employers, referral source, and other agencies involved in worker's rehabilitation program to coordinate services and facilitate a prompt return-to-work
  • Communicates with physician, injured worker, employer, referral source, and any other resource involved in worker's rehabilitation program
  • Generates correspondence to referral source, medical providers, injured worker and other parties involved in the rehabilitation process
  • Anticipates and identifies problems and makes timely and practical decisions
  • Facilitates in-house staff education programs related to medical management
  • Documents case management observations, assessment, and plan in system
Education Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
New York University
Bachelor’s Degree in Nursing
Skills Skills
  • Intermediate oral and written communication skills demonstrating ability to share and impart knowledge
  • Good organizational skills, ability to multitask and prioritize workload
  • Ability to balance detail with departmental goals/objectives
  • Knowledge of workers' compensation and/or disability
  • Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions
  • Strong written and verbal communication skills
  • Excellent oral and written communication skills
  • Ability to meet or exceed Performance Competencies
  • Ability to put the team first
  • Ability to set goals, multitask and prioritize workload
Create a Resume in Minutes

15 Nurse Consultant resume templates

1

Managing Nurse Consultant Resume Examples & Samples

  • Provide Medicare management training services to clients
  • Collaborate with engagement team to meet client needs efficiently and effectively
  • Consult with clients to address reimbursement opportunities
  • Experience conducting MInimum Data Set (MDS) assesments
  • Excellent speaking/teaching presentation experience
  • Excellent writing skills including publications and resport writing
  • Medicare management training experience
2

Managing Long-term Care Nurse Consultant Resume Examples & Samples

  • Conduct Medicare and Medicaid management reviews in long-term care (LTC) facilities and/or hospital based skilled nursing units (SNUs)
  • Provide Medicare and Medicaid management training services to nursing facility providers
  • Collaborate with BKD nursing facility billers, CPAs and other consultants to meet client needs efficiently and effectively
  • Consult with LTC providers to address reimbursement opportunities
  • Write industry specific articles and perform presentations at state and national conferences
  • Working knowledge of Medicare Skilled Nursing Facility Prospective Payment System
  • Working knowledge of Medicaid RUG and other case mix reimbursement
  • Experience conducting and coding Minimum Data Set (MDS) assessments
  • Computer proficiency in Word, Excel and PowerPoint
  • Excellent writing skills including publications and report writing
  • Travel: 50% + (auto & air)
  • Excellent Time Management
  • Job type: Full-Time
  • RN with minimum of 7 to 10 years of combined experience in the following
3

Managing Nurse Consultant Resume Examples & Samples

  • Collaborate with BKD’s payment reform service team to provide consulting services to clients related to new payment models including
  • Registered Nurse with a strong clinical background preferred
  • Experience in both hands on patient care and clinical administration preferred
  • Working knowledge of Managed Care, Population Health Management, and principals of integrated healthcare
  • Experience in clinical process re-design
  • Proven project management, process improvement, and mapping skills
  • Computer proficiency in Microsoft Office Suite
  • Excellent writing skills including publications and reports writing
  • Moderate Travel (auto & air)
4

RN Clinical Quality Nurse Consultant Resume Examples & Samples

  • Develop market business plans to motivate providers to engage in improving Stars measures to be 4 STARS or higher
  • Provide analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups
  • Be the primary go to person for all STARS related activities within their assigned market(s) working within a matrix relationship which includes Quality corporate operations and Regional/Market operations
  • Assist in developing of training and analytical materials for Stars and HEDIS
  • Lead Weekly, Monthly, Bi-monthly, Quarterly and / or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership
  • Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies
  • Identify and assess decision makers and other key provider group personnel with a focus on identifying barriers to achieving targeted outcomes
  • Focus communications and efforts accordingly
  • Develop solution-based, user friendly initiatives to support practice success
  • Registered Nurse with Undergraduate degree or equivalent experience
  • 1 years of HEDIS/Stars experience
  • 3+ years associated business experience with health care industry
  • Professional experience persuading changes in behavior
  • Strong knowledge of the Medicare market, products and competitors
  • Knowledge base of clinical standards of care, preventative health, and Star measures
  • Experience in managed care working with network and provider relations
  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
  • Microsoft Office specialist with exceptional attention to detail
  • Strong communication and presentation skills
  • Strong relationship building skills with clinical and non-clinical personnel
  • Demonstrated ability to interact with medical staff, peers, and internal company staff at all levels
  • Ability to solve process problems crossing multiple functional areas and business units
  • Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
  • Good business acumen, especially as it relates to Medicare
  • Medical/clinical background highly desirable
  • Undergraduate degree preferred, post graduate degree highly preferred
5

Occupational Nurse Consultant Resume Examples & Samples

  • Successful communication, decision making, interpersonal skills, leadership, planning and program management skills
  • Knowledge and application of standards of medical practice, medical records, medical procedures and ethics, pharmaceuticals, and current clinical practice guidelines, e.g., M&R, URAC, InterQual, and JCAHO to assess appropriateness of care or requested services
  • Knowledge and application of methods and practice of evidence gathering and processing, interviewing, and confidentiality
  • Knowledge and ability to conduct literature reviews and apply evidence-based medicine principles in clinical decision making
  • Ability to analyze data and medical records, applying utilization review principles to determine how medical practices affect client health and safety and whether the request meets accepted clinical practice guidelines to make authorization determinations
  • Demonstrate clear, concise, accurate and effective oral and written communication of clinical facts and emendations directed to healthcare providers, professional and para-professional staff in government and non-government organizations, and the public
  • Demonstrate competent program management skills,
  • Ability to exercise professional judgment, work independently with minimal supervision, and utilize time effectively
  • Ability to establish and maintain effective relationships with providers and staff at HCA and other agencies,
  • Ability to work effectively in a team, with peers, managers, health care providers and others
  • Knowledge and ability to use computer software programs, e.g., Word, Excel, MMIS, HWT, Hayes, MDConsult
  • Ability to facilitate meetings effectively with interdisciplinary groups, and provide education or training when needed
6

Senior Nurse Consultant Resume Examples & Samples

  • Works directly w/Member Srvs organization & other clinical & admin leadership to investigate & facilitate resolution of complex & high profile member requests & appeals
  • Provides/gathers clinical expertise for areas of compliance which involve medical necessity &/or quality concerns. Interprets clinical cases (grievances & appeals including lab values, medical records & interpretation) & presents appropriate clinical material for Physician review
  • Reviews member complaints to identify potential quality issues that should be referred to the local Quality Depts
  • Provides direct support & consultation on corrective actions developed by Depts for areas of non-compliance to ensure the compliance issue(s) is adequately addressed
  • Utilizes clinical expertise to conduct investigations & seek input from other clinical professionals as required
  • Acts as a liaison, problem-solver, & negotiator to achieve resolution on member requests & appeals. Leads &/or represents Regulatory Compliance at routine & ad hoc meetings on specific compliance areas relating to DMHC regulations
  • Maintains database & provides all user groups timely notice of updates & implementation timeframes according to the regulations
  • Works w/KFHP/KFH, Medical Group Depts & Sr Leadership at divisional, regional, & local levels as consultant on Dept of Managed Health Care (DMHC), Center of Medicare & Medicaid Srvs (CMS), Nat’l Committee for Quality Assurance (NCQA),& Dept of Health Srvs (DHS) compliance & develops, implements, tracks, & reports on work plans for correction
  • Participates in the development & implementation of internal audits for DMHC, CMS, NCQA, DHS, & State Programs compliance
  • Coordinates the audit process, including reviewing, analyzing, & reporting findings internally to the Dir, Sr Leadership, & to KFHP quality committees
  • Assists in the development of appropriate policies relating to compliance. Participates in the development & implementation of necessary educational programs to ensure all appropriate parties are knowledgeable about their compliance responsibilities on an on-going basis
  • Minimum eight (8) years of experience and knowledge in subject matter area of expertise
  • BSN or bachelor's degree in health related field preferred
7

RN Clinical Quality Nurse Consultant Resume Examples & Samples

  • 1 years of HEDIS / Stars experience
  • Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
  • Undergraduate degree preferred, post graduate degree
8

L&I Occupational Nurse Consultant Resume Examples & Samples

  • Organize, prioritize, and complete your work,
  • Critically assess and analyze complex healthcare policy topics,
  • Take initiative to contribute to creative problem solving,
  • Work autonomously and collaboratively with a team of professionals,
  • Learn how the workers' compensation system works,
  • Communicate effectively with diverse groups of people, and
  • Build constructive relationships
  • Bachelor's degree in public health, science, math, nursing or related field, including college level courses in statistics and research methods
  • A current active Registered Nurse license in Washington State OR the ability to get one within 6 months of starting the position
  • Minimum of 2 years' experience in a clinical setting
  • Minimum of 3 years' experience in public health, policy development, administration or supervision, teaching, research, or case management
  • Likes to engage in critical thinking and informed analysis,
  • Is able to occasionally work in excess of 40 hours per week and/or to adjust normally scheduled hours; may include evenings and weekends to meet program needs and critical deadlines
  • Is able to travel (mostly to Seattle) performing the duties of this job
  • Demonstrates basic professional or academic writing skills
  • Ability to work with people who have diverse backgrounds, perspectives, and skills, and build constructive professional relationships with them
  • Ability to effectively search scientific literature databases and other information sources for specific health care topics; understand the peer review process in scientific literature
  • Ability to organize, plan, lead, and implement multi-faceted healthcare related projects and assess how they will impact clinical care
  • Proficiency in writing complex policy documents e.g. analytical reports with figures and tables, executive summaries, newsletters, etc
  • Enthusiasm and/or passion for learning and developing public policy leadership skills
  • Interest in helping injured workers heal and return to work
  • Self-authored professional or academic writing sample on a healthcare related topic
9

Occupational Nurse Consultant Resume Examples & Samples

  • Provide consultative services and apply current concepts in nursing and utilization review, combined with clinical knowledge and skills to assure clients receive medically necessary, quality care
  • Review and evaluate available scientific evidence to apply evidence based clinical policy when making utilization review determinations meeting requirements of WAC 182-501-0165
  • Graduation from an accredited school of nursing and two years' experience working with low-income individuals and families
  • Knowledge and application of standards of medical practice, medical records, medical procedures and ethics, pharmaceuticals, and current clinical practice guidelines
  • Bachelor of Science Degree in Nursing or Bachelor's in closely allied field
  • Working knowledge of the Affordable Care Act (ACA) and Medicaid rules and regulations
  • Knowledge of coding principles/rules for ICD-10
10

Occupational Nurse Consultant Resume Examples & Samples

  • Evaluate the adequacy, appropriateness, and conformance with nationally recognized utilization review standards used to measure medical necessity and appropriate level of care; as well as compliance with agency, department, state and federal policies, rules and regulations
  • Exercise professional judgment, work independently with minimal supervision, and utilize time and resources effectively
  • Apply clinical theory and practice of hospital-based care as well as pertinent agency, state, and federal codes, rules, regulations, policies, guidelines, publications and patient care standards when conducting retrospective clinical review
  • Analyze documentation in healthcare records to determine if diagnosis and procedure coding is accurate and make referral to coding staff for further evaluation as appropriate
  • Analyze documentation in healthcare records to verify services billed were ordered and provided
  • Refer cases identified as having potential fraud and abuse to the Medicaid Fraud Control Unit (MFCU) and/or other law enforcement entity for further investigation
  • Refer cases identified as having potential quality of care or licensing issues to the agency's Quality Management Team and/or Department of Health (DOH)
  • Support peers by coaching and mentoring clinical review protocols and through the inter-rater reliability review process
  • Accurately document determinations on appropriate review sheets, case tracking logs, and/or in the audit module
  • Respond timely and accurately to written and/or oral questions regarding retrospective clinical review findings and/or the retrospective clinical review process
  • Participate in provider dispute resolution process and administrative hearing process, including providing evidence and/or testimony in support of retrospective clinical review findings
  • Provide recommendations to executive and program management to prevent vulnerabilities and strengthen program policies and procedures
  • Participate in and provide feedback to internal and external workgroups and steering committees
  • Collaborate with non-clinical medical and hospital audit staff on audits and potential fraud cases, providing clinical expertise as requested
  • Facilitate and/or participate in meetings with intra-agency, inter-agency, contractors, and/or provider groups, and provide education or training when needed
  • Use creative and innovative approaches to achieve results and resolve problems
  • Evaluate hospital stays for provider preventable conditions (PPC) and determine if those conditions affected the payment
  • Coordinate record requests for PPC reviews with other auditors in the clinical review unit
  • Working knowledge of clinical theory and practice of hospital-based care, with a focus in behavioral health
  • Working knowledge and ability to analyze inpatient and outpatient healthcare records for appropriate medical intervention; and make independent decisions about the adequacy, appropriateness, and conformance with nationally recognized standards and criteria used to evaluate medical necessity and level of care
  • Ability to learn and use applicable standards, criteria, software, databases, and tracking systems used in the retrospective clinical/utilization review process and in the identification of potential fraud and abuse
  • Ability to exercise professional judgment, work independently with minimal supervision, and utilize time and resources effectively
  • Knowledge of state and federal rules and regulation; agency rules, policies and procedures pertaining to Washington State's Medicaid and Medical Assistance programs
  • Knowledge of Health Insurance Portability and Accountability Act and Personal Health Information privacy rules, regulations, and policies
  • Knowledge of the ProviderOne payment system
  • Knowledge of the State's medical assistance program cost reimbursement methodologies and regulations
  • Knowledge and ability to recognize inappropriate ICD-9-CM and CPT coding
  • Written and verbal communication skills, to include public speaking and negotiation
  • Working knowledge of Microsoft Office products and Internet
  • Ability to work effectively in an adversarial environment
  • Knowledge of the Health Care Authority organization, mission and goals
  • Familiarity with and an understanding of audit standards established by the U. S. Government Accountability Office (GAO) in the publication Government Auditing Standards (GAS)
11

Occupational Nurse Consultant Resume Examples & Samples

  • A minimum of a Associate's Degree in Nursing required
  • Current Registered Nurse licensure in Washington State
  • State and federal laws, policies, regulations and procedures on Medicaid and healthcare
  • Contract terms and processes
  • Balanced Budget Act of 1997
  • Managed care operations, delivery systems, customer service activities and policy issues
  • Utilization management activities and programs
  • Program development, implementation and evaluation
  • Health home and other care coordination program models
  • Care needs of low income, vulnerable Medicaid recipients in Washington State
  • Ability to analyze and resolve complex problems related to managed care programs
  • Ability to independently manage competing timelines to meet critical deadlines and handle multiple projects at a time
  • Ability to write narrative analytical reports
  • Two (2) years' experience in quality assurance and improvement principles and approaches
  • Experience in managed care operations
  • Experience in Utilization Management
  • Current resume
12

Phone Nurse Consultant Resume Examples & Samples

  • Ability to interact positively with Cancer Patients via phone
  • In-depth understanding of Cancer Patient issues
  • Knowledge of Cancer Types
  • Knowledge of Cancer Treatment Medications, indications & AE’s
  • Ability to interact with Clinic Staff via Phone
  • Basic understanding & utilization of computer & E.H.R.s
  • Ability to set and achieve individual & team goals & objectives
  • Ability to set and achieve personal & team Goals and Objectives
  • Ability to be reasonably flexible concerning shift times and attendance (shifts may vary from 8 AM to 7 PM), 5 days a week, 8 hour shifts, Monday-Friday
  • Ability to complete day end assignments and complete computer backup procedures daily
  • Work with supervisory staff to continually develop and implement ideas for delivering high quality, cost effective services
  • Ability to work independently and demonstrate leadership in the practice of Nursing and Medication Therapy Management
  • Ability to supervise and train employees, which includes organizing, prioritizing, and scheduling work assignments
  • Skill in examining and re-engineering operations and procedures, developing and implementing new strategies and processes, including best practices
  • Using telephonic assessment skills, candidates for this position must have the ability to recognize physical and psychological aspects of care
  • Candidate must be able to prioritize and multi-task to ensure daily activities are completed in a timely manner
  • Provides education support to the patient and/or family on disease specific processes, treatment options, management of side effects, self care measures, community resources, and end of life or palliative care issues
13

Nurse Consultant Resume Examples & Samples

  • Communicates with physician, injured worker, employer, referral source, and any other resource involved in worker's rehabilitation program
  • Coordinates home care
  • Analyzes results of treatment and medical status and reviews incoming provider reports
  • Generates reports to referral source to communicate case status, findings, and recommendations
  • Participates in case conferences over the telephone, and participates in internal and external training to enhance and maintain medical proficiency
  • Worker's Compensation experience is preferred
  • Certification in related field preferred
14

Nurse Consultant Telephonic Case Management Resume Examples & Samples

  • Manage medical care in order to return injured employee to pre-injury status
  • Evaluates home care services and equipment and determines need for home modifications
  • Must maintain a case load to support at minimum 145 hours of billable or inventory of minimum of 72 files monthly with 95% Quality compliance expected
  • Associate's degree from an accredited school of nursing
  • Minimum of 3 years acute clinical experience in an acute care setting
  • Hold an active RN license within the state of practice
  • Worker's Compensation experience preferred
15

Nurse Consultant Utilization Review Resume Examples & Samples

  • Performs case management through telephonic contact with all medical providers, employers, claims professionals and ancillary service providers
  • Manage medical care in order to return injured employee to preinjury status
  • Reviews services of medical and rehabilitation providers and arranges for and coordinates appropriate evaluation, treatment, and counseling
  • Identifies suitable employment opportunities consistent with individual's medical limitations/capabilities, aptitudes, and interests to restore individual to maximum independence
  • Generates correspondence to referral source, medical providers, injured worker and other parties involved in the rehabilitation process
  • Associate's degree from an accredited school of nursing and a minimum of 3 years clinical experience in an acute care setting required
  • Active Registered Nursing license within the state of practice
  • Bachelor's degree preferred
16

UM Nurse Consultant Resume Examples & Samples

  • Confident in navigating multiple systems, multiple platforms, and being comfortable in switching between technology platforms
  • Flexibility working in a rapidly changing environment as the program evolves and develops to meet our customers and members expectations (leveraging the same bullet from the above role)
  • Manage multiple priorities and adapt in a fast paced environment. Being responsible for production and quality metrics
  • Confident in oral discussion with external providers to obtain and document clinical information
17

UM Nurse Consultant Resume Examples & Samples

  • Must have Utilization Review experience from a provider (i.e. health care system, independent review company) or managed care environment
  • Experience in the use of clinical guidelines (Interqual or MCG)
  • Clinical Experience (hospital) 3 to 5 years
  • Experience with Microsoft Suite and use of various search engines
  • Must be able to type and moderate to advance computer skills
  • Good written and oral communication skills
  • Proficient in processing information from various system/several software programs
  • Ability to multi task and work in an office/desk environment
18

Remote Telephonic Utilization Nurse Consultant Resume Examples & Samples

  • Perform utilization management, utilization review or concurrent review (inpatient care management) Determine medical appropriateness of inpatient and outpatient services by evaluating medical guidelines, benefit determination and compliance with state mandated regulations
  • Assess member’s needs Collaborate with staff, physicians, care/service coordinators, plan Medical Director, members and their families to coordinate and provide the level of care necessary to meet member’s health needs
  • Identify solutions to problems and non-standard requests
  • Maintain courteous, professional attitude
19

Case Manager, Nurse Consultant Resume Examples & Samples

  • Previous Utilization Review, Quality Assessment, Discharge Planning in Provider setting Knowledge of both Milliman Criteria (MCG) and Interqual -
  • Proficiency in software applications including, but not limited to, Microsoft Word, Microsoft Excel, Microsoft PowerPoint and Outlook
  • Excellent Verbal and Communication Skills
20

UM Nurse Consultant Resume Examples & Samples

  • Managed Care experience preferred
  • 3-5 years of clinical experience required
  • Utilization Management experience preferred
  • Excellent Computer Skills
  • Excellent Time Management Skills
21

Phone Nurse Consultant Resume Examples & Samples

  • 100%
  • Ability to interact successfully with Cancer, Critically ill, or Chronic Disease Patients and family members
  • Basic computer skills (Word, Excel, Power Point, etc.)
  • Basic understanding of Electronic Health Information and Records Programs (i.e. IKnowMed)
  • Experience in Nursing
  • Specialized area of Nursing
22

Nurse Consultant Resume Examples & Samples

  • Manages assigned caseload of complex cases; applies specialized training/knowledge to the assessment of cases; provides technical insight and advice
  • Reviews, records, and analyzes medical records and treatment plans data to make claims settlement determination
  • Compares duration control guidelines and clarifies functional inconsistencies
  • Provides recommendations to team regarding employee's current or potential functional abilities
  • Develops goal-focused return-to-work plans; addresses barriers for return to work
  • Facilitates communication between employee, physician and employer and partners with all parties to achieve a positive outcome
  • Follows established claim policies and practices to resolve claims and issues
  • May provide guidance to junior staff members
  • Bachelor's degree or equivalent business experience
  • Current Nursing designation
  • 5+ years of insurance claims experience
23

Nurse Consultant Resume Examples & Samples

  • Reviews assigned or escalated cases, to determine if Life or Disability insurance should be approved, declined, or pended for further medical review
  • Responsible for training, mentoring, and coaching 8-12 nurse temps each year during peak season
  • Acts as the lead nurse to oversee the underwriting team and help manage the nurse queues
  • Compiles, reviews, records, and analyzes data to make underwriting decisions
  • Follows established Statement of Health policies and practices to resolve issues
  • Must be willing to handle escalated phone calls with customers, applicants, brokers, etc
  • Participate or lead smaller-scale projects within team
  • High school Diploma with current RN License & current state license
  • In order to post for this position, you need the proper work authorization to work in the country where the position is located and not require relocation assistance
  • 2+ years of Insurance claims experience
  • Training background
24

Nurse Consultant Resume Examples & Samples

  • Ensure cost effective direct case management services for specialized cases. Communicate with all involved parties to determine client’s (patient’s) status and needs and to coordinate with reinsured health plans and insurance companies
  • Assist specialists in resolving case management issues, develop action plans and provides screening, assessment and education
  • Evaluate and assess quality of case management procedures. Ensure compliance with any federal and/or state regulations
  • Work with staff to improve service to customers and manage the customer relationship. Present appropriate information to prospective customers in sales presentations. Communicate, market, and educate current and prospective clients about program services available
  • Associate, Diploma, or Bachelor’s Degree in Nursing, with 3-5 years of clinical experience in the specialty field
  • Maintain current nursing licensure in states per direction of manager
  • Knowledge and expertise in specialty area of perinatal or neonatal nursing care
  • Ability to be flexible when needed, take initiative, and demonstrate accountability
  • Intermediate oral and written communication skills demonstrating ability to share and impart knowledge
  • Ability to quickly adapt to new methods, work under tight deadlines and stressful conditions
  • Ability to set goals, multitask and prioritize workload
  • Intermediate level of investigative, analytical and problem solving skills
  • Ability to work well within a team environment and participate in department/team projects
  • Ability to balance detail with departmental goals/objectives
  • Intermediate interpersonal skills
  • Ability to translate business needs and problems into viable/accepted solutions
  • Ability to foster customer service as needed
  • Ability to liaise with individuals across a wide variety of operational, functional, and technical disciplines and work well with all levels of management
  • Ability to travel 5-10%
  • General business knowledge
25

UM Nurse Consultant Resume Examples & Samples

  • Minimum of 3-5 years of clinical experience
  • RN License for state of NY
  • Ability to work until 9pm at least 1x/month as business needs dictate
  • Med/Surge background, ICU and Telemetry experience highly preferred
  • Benefits management experience
26

Telephonic Nurse Consultant Resume Examples & Samples

  • Works telephonically with workers’ compensation patients, employers, providers, and claims specialists to coordinate and assure proper delivery and oversight of medical and disability services. Initial contacts with all parties is conducted to outline TCM role and set expectations relative to treatment and return to work
  • Reviews treatment requests, and determines the causality and necessity for prescribed treatment by gathering relevant data and information through clinical interviews with the injured employee, provider(s), and the employer, and use of authoritative treatment/disability guidelines
  • Evaluates and coordinates medical diagnostic and rehabilitative services using cost containment programs and strategies. Maintains a proactive plan of action to address issues or barriers presented to effectuate the short term and long term outcomes. Action plans are addressed and adjusted accordingly
  • The TCM provides on-site assistance to the claim specialists’ staff to assist with medical management strategies to assist in facilitating optimal claim outcomes. The TCM will make recommendations as to the usage of medical management services, IMEs, Peer Reviews, UR, Radiology reviews, or other vendor services where indicated
  • Assists the injured worker by providing medical and disability education, conducts a job analysis, evaluates the need for work conditioning, determines and addresses functional capacities, and communicates and coordinates with physician and employer regarding same when indicated
  • Negotiates and assists employers with the development of transitional sedentary or modified job duties based on the injured employee’s functional capacity to ensure the injured employee’s safe and timely return to work
  • Participates in file review and conferencing with claim specialist, managers and/or other approved outside vendors on serious loss claims
  • Monitors, evaluates, and documents case management activities and outcomes including, but not limited to, case management approaches, over or under utilization, inappropriate care, effective treatment, permanent or temporary loss of function, failed or premature return to work, and non-compliance. Treatment guidelines are documented in every claim file and are updated as needed
  • Adheres to all appropriate privacy, security, confidentiality, and state or regulatory policies and procedures
  • Skilled in case management activities, and performing same consistent with the state mandatory regulations
  • Demonstrated proficiency to conduct medical research, and utilize medical treatment guidelines
  • Proven success in planning and coordinating medical care and treatment, as well as implementing creative return to work solutions
  • Very strong oral and written communication skills
  • Proficient in MS Office software suite, medical treatment guidelines, disability guidelines
  • Must be familiar with medical causality investigations
  • Demonstrated knowledge and practical application of conducting utilization review activities specific to state regulations
  • Bachelor’s degree in Nursing Science preferred
  • 5+ years of clinical experience in varied settings (i.e. Orthopedic, Neurology, Rehabilitation, Surgical, Emergency Room, Trauma, Critical Care, etc.)
  • Recent experience in telephonic case management of workers’ compensation claims
  • Case management experience should include knowledge and experience performing these services in multiple jurisdictions
  • Certification in Case Management (CCM) highly desired, would consider Certified Rehabilitation Registered Nurse (CRRN)
27

UM Nurse Consultant Resume Examples & Samples

  • Managed Care experience; Required
  • 3-5 years of clinical experience; Required
  • Certified Case Manager or NCQA; Preferred
  • 1- 2 years Medicare Experience; Highly Preferred
28

Occupational Nurse Consultant / Nurse Auditor Resume Examples & Samples

  • Conduct independent comprehensive review and analysis of inpatient and outpatient health care records
  • Communicate and collaborate effectively and respectfully with diverse populations, including internal and external customers/stakeholders
  • Working knowledge of clinical theory and practice of hospital-based care
  • Knowledge of Certified Public Expenditure (CPE) program
  • Knowledge of Medicaid rate settling and cost settlement
  • A cover letter
  • Three professional references
  • Persons under final consideration for initial appointment with HCA are subject to a background check*
29

Clinical Adherence Nurse Consultant Rn-telecommute Resume Examples & Samples

  • Acts in a consultative and supportive role in the management of process and clinical performance measurements/metrics
  • Effectively executes process steps in a continuous iterative infrastructure that promotes improvement, transparency and member advocacy
  • Communicate clinical adherence requirements, policies and procedures
  • Facilitates clinical process improvement activities
  • Perform qualitative reviews and analysis of clinical processes
  • Assists in designing performance metrics working closely with Complex Care Business Intelligence in the creation of reports and measurements
  • Assists in ensuring local clinical processes/operations, policies and procedures meet standards and are consistent with State and Federal guidelines
  • Current and unrestricted RN Licensure in state of residence
  • 2+ years of data analysis and/or audit experience within the healthcare industry
  • 2+ years of quality improvement experience or other relevant experience
  • Experience with interpreting contracts and regulatory requirements
  • Experience working with Medicaid and/or Medicare
  • Intermediate level of proficiency in tracking, trending and reporting on metrics
  • Intermediate or better level of proficiency in MS Word, MS Excel, and MS PowerPoint
  • Demonstrated ability to lead and influence in a large, matrix organization
  • Demonstrated ability to communicate ideas clearly and concisely both in verbal and written form
  • Ability to interface with strategic clients; experience with senior leadership level communication and presentation required
  • Excellent time management, organizational and prioritization skills and ability to balance multiple priorities
  • Ability to assess complex problems and recommend appropriate solutions
  • Demonstrated ability to think strategically and to proactively manage implementation of broad-based as well as specific initiatives
30

Virtual Nurse Consultant Resume Examples & Samples

  • BSN or associates degree in nursing with Bachelor’s in health care management
  • Basic life support training should be completed through the American Heart Association
  • Minimum of three years of pediatric nursing experience in a clinical setting that included physician interaction
  • Computer knowledge, specifically windows operating system. Ability to type a minimum of 40 wpm. Effective oral and written communication skills. Able to coordinate and complete assigned tasks, time management skills and motivated to seek continued education. Must be able to function well in a team environment with both direct and indirect reporting relationships
  • Nursing department environment with a considerable amount of background noise. Must be able to work a rotating schedule, including some weekends and holidays, as required to support adequate MKC coverage. Able to work well under pressure. Little physical effort required. Moderate amount of sitting with some stooping and bending. Extensive work at the computer with data entry. Extensive amount of time spent using the telephone. Job demands mental exertion including thinking, planning and problem solving
31

UM Nurse Consultant Resume Examples & Samples

  • RN License active in state of NY required
  • Ability to work until 9pm as business needs dictate (approximately once every six weeks)
  • Med/Surge background, ICU & Telemetry experience HIGHLY preferred
32

Senior Nurse Consultant Resume Examples & Samples

  • Review, develop and / or maintain evidence based clinical content to include annual review / maintenance of 1000+ medical content items which include extensive medical reference research of evidenced based resources
  • Research and development of new evidenced-based clinical content or clinical program development
  • Support clinical services / clinical content medical projects
  • Medical review of vendor content and web resources
  • Provide on - line bibliographic and consumer health information searches to support medical content review / development
  • Develop, maintain and monitor the yearly medical content review process and schedule
  • Communications marketing medical content review and consistency checking
  • Interact with and support Physician Medical Reviewers with information sources as needed
  • Interact with staff nurses, training/education, quality or managers/supervisors concerning medical content purpose / usage to represent and support medical content interdepartmentally
  • Other special project medical review that require medical expertise (consistency of content)
  • Current RN license with at least 3 years nursing experience
  • Experience in telephone triage nursing
  • Experience working with medical content
  • Previous experience in the research, review and writing of medical content
  • Strong knowledge of Microsoft word, excel and use of the internet
  • Strong organizational and prioritization skills, capable of handling multiple responsibilities
  • Self-motivated with effective written/verbal communication and interpersonal skills
  • Ability to work independently, interdependently and meet deadlines
  • Ability to remain flexible and accept change as an on-going process
  • Ability to work with highly confidential materials
33

UM Nurse Consultant Resume Examples & Samples

  • Minimum of 3-5 years of clinical bedside nursing experience required
  • Flexibility to be on call every 5th weekend required
  • Active, unrestricted RN License for the State of Florida required
  • Concurrent Review nursing experience preferred
34

Nurse Consultant Resume Examples & Samples

  • Complete resume with relevant experience where you worked, job title, duties and accomplishments, employer's name and address, supervisor's name and phone number, starting and end dates (Mo/Yr), hours per week and salary. If you are a current or previous federal employee, provide your pay plan, series and grade level (e.g. GS-0201-09)
  • Complete assessment questionnaire https://apply.usastaffing.gov/ViewQuestionnaire/10008023
  • Supporting documentation
35

Disability Nurse Consultant Resume Examples & Samples

  • Perform clinical review of medical records and/or other documentation to determine restrictions and limitations supported by the medical record and expected duration
  • Proactively contact healthcare providers to obtain additional information as needed to support their conclusion in their clinical reviews and to provide information pertinent to clinically-based claim management
  • Perform clinical claim administration tasks within departmental metrics such as prescribed turn-around time, documentation, qualitative, quantitative, and customer service. Assist STD and LTD Case Managers, Critical Illness Specialists, Life Claim Specialists, and Waiver of Premium Specialists, as needed
  • Measure case management intervention to determine outcomes to include clinical, financial, quality of life, and customer satisfaction; maintain accurate records of costs, savings, and demographic data
  • Communicate effectively with internal and external partners. Fully collaborate in a team environment. May be called upon to effectively present clinical case management before a customer
  • Excellent customer service and collaboration skills required
  • Work efficiently and effectively with minimal supervision to ensure departmental metrics are met/exceeded
  • Exhibit effective communication skills (e.g., written, verbal and presentation skills)
  • Ability to work independently, and as a part of a team, to efficiently manage multiple priorities
  • Proficient in Microsoft Office/Internet/Internet navigation
  • Excellent interpersonal and negotiation skills
  • Excellent coaching skills
  • Ability to work in fast paced environment and manage multiple computer applications
36

Nurse Consultant Senior Resume Examples & Samples

  • Manages medical rehabilitation programs within a payor setting to restore injured worker to maximum recovery and facilitate employee's return to work
  • Evaluates services of medical and rehabilitation providers and arranges for and coordinates appropriate evaluation, treatment, and counseling
  • Coordinates home care and possible modifications with all parties involved. Estimates expenses related to the cost of rehabilitation and makes appropriate recommendations to referral source
  • Advises referral source of disability potential and cost factors on severe and high cost injuries
  • Commutes to site visit with medical providers, injured worker, employers, referral source, and other agencies involved in worker's rehabilitation program to coordinate services and facilitate a prompt return-to-work
  • Communicates with employers to determine job requirements of pre-injury occupation and to explore light-duty, modified, or alternate employment as necessary
  • Evaluates, reviews, and suggests changes where necessary in worker's medical treatment program
  • Anticipates and identifies problems and makes timely and practical decisions
  • Participates in case conferences in person and over the telephone, and participates in internal and external training to enhance and maintain proficiency
  • Advises referral source and injured worker of services available through community resources
  • Facilitates in-house staff education programs related to medical management
  • Documents case management observations, assessment, and plan in system
  • Associate's degree from an accredited school of nursing and a minimum of 5 years clinical experience in an acute care setting required
  • Must hold a valid license
  • Ability to maintain minimum of 145 billable hours and 90% quality for month required for full time employee
  • Must be working toward certification and must have minimum of 3 years in rehabilitation management
  • Must have valid drivers license and insurability
  • Additional experience accepted in lieu of degree, if candidate has an Active Registered Nursing License
37

Nurse Consultant Description Resume Examples & Samples

  • Skill in coordinating, developing of medical review programs
  • Skill in the application of a wide range of analytical and evaluation methods
  • Knowledge of project management and program/administrative analysis
  • Knowledge complex health care problems
  • Skill in written communication
  • Skill in oral communication
38

Nurse Consultant Resume Examples & Samples

  • Computer Skills ( Microsoft Word, Excel)
  • Writing Skills
  • Verbal and Written Communication Skills
39

Nurse Consultant Resume Examples & Samples

  • Identify attributed patients who benefit from care coordination and work with practice to effectively manage the high risk, high cost, and high utilizers
  • Assist with referring to appropriate ancillary services such as payer specific CM/DM programs, BH resources, pharmacist support, and other resources as identified
  • Assist and perform transitions of care on the identified populations
  • Meet with practices both virtually and onsite to engage practice with network and develop a plan to work towards the identified network goals
  • Case management experience preferred
  • Knowledge of primary care practice process preferred
40

TB Nurse Consultant Resume Examples & Samples

  • Experience working with tuberculosis highly preferred, but any nursing experience with other communicable diseases will be favorable
  • Experience in conducting professional level trainings
  • Experience working with other state agencies and or programs
  • Excellent ability to be a self-starter and independent thinker
  • Excellent prioritization skills
  • Ability to travel on short notice for disease investigations
  • Word, Excel, PowerPoint, Access
  • Proofreading, editing, attention to detail
41

Nurse Consultant Resume Examples & Samples

  • Ability to work well on a team and with partners
  • Cross cultural interest and/or experience
  • Good writing skills, oral communication, and presentation skills
  • Interest and ability to provide consultations, technical assistance, and adult education
  • Good organizational skills, ability to multitask and prioritize workload
  • Computer and data skills and experience; and
  • Strong interest in public health practice
  • Experience working in tuberculosis prevention and control
  • Infectious disease reporting, follow-up and investigation
  • Working knowledge of rural and remote health needs, services and systems, especially in Alaska
  • Public health preparedness
  • Electronic health records, syndromic or electronic surveillance, and/or electronic lab reporting systems; and
  • Project planning, implementation and evaluation
  • Tetanus, Diphtheria, Pertussis (Tdap)
  • Mumps, Measles, Rubella (MMR)
  • Varicella
42

Nurse Consultant Description Resume Examples & Samples

  • One-year probationary period may be required
  • Travel, transportation, and moving expenses will be paid: No
  • Bargaining Unit Position: No
  • Drug Screening Required: No
  • Recruitment Incentive may be authorized: No
  • Annual Leave for non-federal service authorized: No
  • Research position: No
  • Promotion potential: No
  • Supervisory position: No
  • Knowledge of public health and HIV prevention principles, practices and programs
  • Skill in working with a variety of international partners and country officials with different backgrounds
  • Ability to provide consultative assistance
43

Nurse Consultant Resume Examples & Samples

  • This position may require occasional travel
  • E-Verify: If you are selected for this position, the documentation that you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the DHS "E-Verify" System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant
  • All qualification requirements must be met by the closing date of the announcement
  • Financial disclosure statement may be required
  • One-year probationary period may be required
  • Travel, transportation, and relocation expenses will be paid: No
  • Bargaining Unit Position: May vary by Center
  • Drug Screening Required: No
  • Recruitment Bonus may be authorized: No
44

Nurse Consultant Resume Examples & Samples

  • 20% Ability to interact positively with Chronically ill patients via phone
  • 20% In-depth understanding of Disease State Management
  • 10% Knowledge of Chronic Disease Treatment Medications, indications & AE’s
  • 10% Ability to interact with Clinic Staff via Phone
  • 10% Basic understanding & utilization of computer & E.H.R.s
  • 15% Ability to work within a structured, process driven environment
  • 15% Ability to set and achieve individual & team goals & objectives
  • 3 years experience in Disease Specialty area preferred
  • Ability to interact successfully with Critically ill or Chronic Disease Patients and family members
  • Ability to work in a team setting
  • Ability to work within a structured, process driven environment
  • Current RN License in good standing in state of practice
  • Must have a valid driver’s license and maintain a driving record which meets company standards if required to drive
  • Other tasks as assigned by management
  • Physical Requirements: Must be able to stand, walk, sit, and reach outward on a frequent basis. The employee must be able to reach above shoulder, climb, and crawl, squat, kneel, and bend. The employee must be able to frequently push/pull up to 15 lbs. The employee must be able to lift/carry up to 15 lbs frequently and up to 35 lbs occasionally. Specific vision requirements and abilities include close vision, distance vision, peripheral vision and the ability to adjust focus
  • Responsible for the education and support of patients diagnosed with conditions that can be treated with oral chemotherapy agents
  • Provide regularly scheduled calls to evaluate learning and support needs, provide symptom management, and help to coordinate care with the prescribing physician’s health care team
  • Promote patient adherence to the prescribed regimen, and assist with control and treatment of side effects caused from these medications
45

Hypertension & Diabetes Nurse Consultant Resume Examples & Samples

  • Manages public health programs consistent with public health laws and regulations
  • Develops plans to implement policies, programs and educational offerings
  • Develop mechanisms to monitor and evaluate programs for their effectiveness
  • Develops strategies for continuous quality improvement
  • Considers the role of cultural, social, and behavioral factors the accessibility, availability, acceptability and delivery of public health services
  • Manages programs within current and forecasted budget constraints
  • Incorporates ethical standards of practice as the basis of all interactions with organizations, communities, and individuals
  • Promotes individual, team and organizational learning opportunities
  • Ability to adapt education to the public health setting
  • Ability to stay current with trends in diabetes care and evidence around hypertension and diabetes care
  • Ability to collaborate with the entire health care team
46

Perioperative Corporate Clinical Nurse Consultant Resume Examples & Samples

  • Masters of Science in Nursing, Adult Education, or other relevant specialty
  • Current state of Missouri license as a Registered Nurse. Current BCLS and ACLS provider/instructor status. Other instructor certification current status as applicable to area of specialty
  • Five to seven (5-7) years clinical experience in an area of specialty
  • Computer literacy to navigate electronic medical records and education records systems, Microsoft Windows, Word, Excel, Power Point and Outlook
  • Competent operating audiovisual equipment
  • Effective collaboration, problem-solving, negotiation, conflict resolution and written and verbal communication skills
  • Self-motivation to work independently
  • Flexibility to collaborate with colleagues and shift priorities as needed
  • Skilled at presentation and teaching/coordination of educational courses
47

UM Nurse Consultant Resume Examples & Samples

  • FL-Jacksonville
  • FL-Tampa
  • NC-Charlotte
  • SC-Columbia
  • TN-Nashville
  • TN-Chattanooga
  • GA-Atlanta
  • LA-Baton Rouge
  • LA-Metairie
  • NC-Morrisville
  • FL-Sunrise
  • RN Licensure
48

Nurse Consultant Resume Examples & Samples

  • Current permanent U.S. work authorization required
  • BS/BA degree in Nursing or a health-related field required
  • Certified Case Manager (CCM) certification
  • 7+ years’ experience in healthcare consulting and/or healthcare provider operations experience related to case management
  • 3+ years hospital Case Management Director level experience in assessing, designing, implementing and driving performance in areas that focus on the issues surrounding Length of Stay; Utilization & Case Management; Patient Throughput; and collaboration between Social Workers, RN Case Managers, and clinical staff
  • Master's degree in Nursing, Health or Hospital Administration is highly preferred
  • Hospital operational and management experience at the Director level or above, including exposure to Finance
  • Experience interacting and influencing physicians about the rationale for clinical decision making
  • Project Management experience including creating work plans, budgets, managing budget to actual, and goal setting/benchmarks
  • Experience supervising project teams and co-workers, and ability to coach and mentor staff
  • Ability to actively manage and deliver on client expectations around project activities, timelines, deliverables, outcomes, etc
  • Ability to provide targeted communication, both verbal and written, to internal and external constituents
  • Proven analytical and process redesign skills, including problem solving, quantitative reasoning, workflow process, etc
  • Exposure to a wide variety of process improvement methodologies (e.g., Lean) is highly preferred
  • Ability to work with a diverse group of professionals and personalities in a team environment
  • Possess the following skill sets
49

Nurse Consultant Resume Examples & Samples

  • Travel to customer sites for business meetings occasionally
  • 2+ years of Clinical Experience required
  • Nursing degree with RN license required
  • Disability claims experience preferred
  • Psychiatric Nursing experience preferred
50

UM Nurse Consultant Resume Examples & Samples

  • 3-5 years of clinical experience in a hospital setting; required
  • Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding; required
  • Effective communication skills, both verbal and written; required
51

Rn-site Review Nurse Consultant Resume Examples & Samples

  • Managed Care experience is preferred
  • Certified Site Reviewer would be a huge plus!
  • HEDIS experience is a plus!
  • Position requires proficiency with MS Office Suite and navigating multiple systems and keyboarding Effective communication skills, both verbal and written
52

Clinical Nurse Consultant Hartford Territory Resume Examples & Samples

  • Deliver disease state educational presentations to nurses, physicians and other health care providers
  • Maintain strong working relationships with brand teams and assist in the development of disease-state educational resources
  • Develop relationships with key nurse and advanced practice provider opinion leaders
  • Demonstrates knowledge of the hematology/oncology market
53

UM Nurse Consultant Resume Examples & Samples

  • 3-5 years of clinical experience (med/surg, ICU, acute care, long term care or previous hospital exp) required
  • Computer proficiency (Outlook, Excel, Word) required
  • Utilization Management preferred
54

UM Nurse Consultant Resume Examples & Samples

  • RN license required
  • 3-5 years of recent clinical (med/surg, ER, ICU, Acute) experience required
  • Rehab/Skilled Nursing Facility experience preferred
  • Inpatient Acute Care experience preferred
  • UM/UR experience preferred
55

Nurse Consultant Resume Examples & Samples

  • Assesses and analyzes injured worker's medical and vocational status
  • Develops progressive plan of care to facilitate medical recovery and progressive return to work
  • Manages one-time task assignment or full field case management referral to meet with attending physician, injured worker and/or employer to clarify medical and/or vocational claim related information which could not be obtained through correspondence or telephonic attempts by claims team
  • Collaborates with members of the health care team to provide ongoing case management services
  • Acts as liaison for involved parties in the worker's compensation injury by communicating in person and telephonically with the patient/caregiver, attorneys, employer, claims examiners, telephonic nurse case manager, return to work specialists, vocational rehabilitation supervisor, provider(s), ancillary provider(s) and health care team
  • Monitors injured employee's progress towards appropriately established outcomes through continued assessment and evaluation
  • Coordinates necessary referrals, consultations, and therapeutic services for the injured employee
  • Completes the interview process with the patient/caregiver in the home, worksite, ancillary location or physician's office for current and ongoing assessments and evaluations
  • Assists in the development of continued care plans as necessary to include patient education and prevention programs
  • Testifies as needed to substantiate relevant case work or reports
  • Confers with medical treating providers concerning the course of care and treatment per clinical guidelines
  • Educates medical providers on appropriate disability and treatment guidelines as necessary
  • Supports the total performance management initiative
  • Travels as required
  • Works from home as needed
  • Knowledge of laws and regulations pertaining to rehabilitation and HIPPA
  • Knowledge of workers' compensation and/or disability
  • Excellent oral and written communication skills
56

Appeals Nurse Consultant Resume Examples & Samples

  • Minimum 3 years varied clinical nursing experience and a minimum of 12 months of medical management/ utilization review experience required
  • Minimum 2 years of managed care experience, or experience with regulatory or accrediting body requirements (i.e., NCQA, URAC, EQRO, CMS) preferred
  • Excellent computer skills with direct experience in MS office, Word, PowerPoint, and Excel required. Must be able to pass Windows navigation test
  • The incumbent should demonstrate effective written and verbal communication skills, leadership qualifies, strong interpersonal and organizational skills, and be able to function independently as well as in cooperation with others
  • Must be self-motivated and able to manage multiple tasks and priorities within specified time frames
  • Must have excellent interpersonal skills, with the proven ability to lead, delegate, and follow-up and resolve conflict
  • Must have excellent logic, systematic and sequential reasoning and problem-solving skills as evidenced by previous successful implementations of complex projects
57

UM Nurse Consultant Resume Examples & Samples

  • 3-5 years of clinical experience required e.g., hospital setting, rehab, skilled nursing, alternative care setting such as home health or ambulatory care required
  • Medicare guidelines experience preferred
  • Registered nurse (RN) with unrestricted state license is required
58

UM Nurse Consultant Resume Examples & Samples

  • RN licensure required
  • Discharge planning experience preferred
  • Concurrent review experience preferred
  • Homecare experience preferred
59

Supervisory Nurse Consultant Resume Examples & Samples

  • 5% Domestic travel may be required
  • E-Verify: If you are selected for this position, the documentation you present for purposes of completing the Department of Homeland Security (DHS) Form I-9 will be verified through the E-Verify System. Federal law requires DHS to use the E-Verify System to verify employment eligibility of all new hires, and as a condition of continued employment obligates the new hire to take affirmative steps to resolve any discrepancies identified by the system. The U.S. Department of Health and Human Services is an E-Verify Participant
  • Direct Deposit: All Federal employees are required to have Federal salary payments made by direct deposit to a financial institution of their choosing
  • Pre-employment physical required:No
  • Drug testing required: No
  • License required: No
  • Mobility agreement required: No
  • Immunization required: No
  • A background investigation may be required
  • Incentives may be authorized; however, this is contingent upon funds availability. If authorized, certain incentives will require you to sign a service agreement to remain in the Federal government for a period of up to 3 years. Note: This statement does not imply nor guarantee an incentive will be offered and paid. Incentives include the following: moving expenses, recruitment or relocation incentive; student loan repayment, superior qualifications appointment, creditable service for annual leave for prior non-federal work experience or prior uniformed military service, etc
  • Bargaining Unit Position: No