Nurse Case Manager Resume Sample

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Kaitlin Beahan
42708 Veum Knoll,  Houston, TX
+1 (555) 857 9218

Work Experience

Nurse Case Manager
10/2017 - PRESENT
Boston, MA
  • Utilize community resources to support patient’s post hospital needs. Documents choice in available resources
  • Participates in department audit activities
  • Initiate and coordinate a multidisciplinary team approach to care management which includes patients, payors, and providers, across the care continuum
  • Evaluate patients’ comprehensive medical and social support and devise a comprehensive plan of care to support patients’ self-management of condition(s), arrange for services and ensure continuity of care at optimal levels
  • Design care plans which ensure seamless continuity of care, minimize the potential for duplication of services, and reduce fragmentation and gaps in care
  • Enhance and continuously improve communication and collaborative relationships with multi-disciplinary healthcare team members including payors and providers
  • Act as patient advocate protecting privacy and confidentiality issues
  • Provide patient education, monitor health needs, and coordinate community resources
  • Prevent adverse patient events to minimize poor outcomes
RN Nurse Case Manager
10/2011 - 09/2017
Dallas, TX
  • Maintain a comprehensive working knowledge of community resources, payor requirements, and network services available to the target population
  • Using clinical/nursing skills to help coordinate the individual’s treatment program while maximizing cost containment
  • Serving as an intermediary to interpret and educate the individual on his/her disability, and the treatment plan established by the case manager, physicians, and therapists
  • Facilitate treatment between providers and worker
  • Resource for claims personnel when needing providers in certain locales
  • Partner with employers determining modified work
  • Accurate and quality documentation meeting Best Practices timeframes
  • Reporting billing hours in accordance with case activity and billing practices
  • Following specific account instructions
Behavioral Health Nurse Case Manager
10/2008 - 07/2011
Detroit, MI
  • Demonstrates a level of professionalism within the work place and in dealing with injured workers reflects positively on the company as a whole
  • Coordinate effective, efficient & proactive completion of all utilization management activities that facilitate the member’s movement through the continuum of care
  • Monitoring and Evaluation. Gathers information and documentation from all relevant sources regarding the case management plan’s activities and/or services to determine the plan’s effectiveness in reaching desired outcomes and goals. Modifies or changes the case management plan, as needed
  • Monitors the admission and discharge process of the client into the program
  • Performs initial assessment and tailored plan to achieve the desired outcome for the client and leave transition and return to work
  • Evaluates effectiveness of care coordination needs across the continuum of care, revises plan as needed
  • Maintains communication with providers, inpatient care management as needed and third party payers
  • Assumes responsibility for care management of assigned population
  • Able to prioritizes schedule to accommodate needs of the patient


Ohio University - Zanesville Campus
2003 - 2007
Bachelor's Degree in Nursing

Professional Skills

  • Decision making with sound judgment, good organizational and time management skills, and excellent verbal and written communication skills
  • Strong clinical, interpersonal, analytical, priority setting, problem solving, and organizational skills
  • Problem solving skills and independent decision making skills is required
  • Strong interpersonal skills. Ability to work effectively with employees, management, medical providers, and vendors
  • Utilize available resources efficiently and effectively; good organizational skills and ability to prioritize work load
  • Effective decision-making /problem-solving skills, demonstration of creativity in problem-solving, influential leadership skill
  • Demonstrates highly effective problem-solving, planning and organizational skills

How to write Nurse Case Manager Resume

Nurse Case Manager role is responsible for case, health, nursing, organizational, computer, medical, interpersonal, education, training, customer.
To write great resume for nurse case manager job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Nurse Case Manager Resume

The section contact information is important in your nurse case manager resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Nurse Case Manager Resume

The section work experience is an essential part of your nurse case manager resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous nurse case manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular nurse case manager position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Nurse Case Manager resume experience can include:

  • Strong communication skills in order to effectively communicate with claimants, medical professionals, employers, claims staff and others
  • Utilizes clinical judgment, independent analysis, critical thinking skills, time management skills and detailed knowledge of case management program
  • Critical thinking, excellent verbal and written skills and ability to work in a team environment required
  • RN experience in a hospital setting, acute care, direct care experience and/or experience as a Case Manager
  • Strong problem solving skills and the ability to perform positively and efficiently in production driven environment
  • Clinical experience and/or case management, utilization review, and/or discharge planning experience in an acute care setting

Education on a Nurse Case Manager Resume

Make sure to make education a priority on your nurse case manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your nurse case manager experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Nurse Case Manager Resume

When listing skills on your nurse case manager resume, remember always to be honest about your level of ability. Include the Skills section after experience. Present the most important skills in your resume, there's a list of typical nurse case manager skills:

  • Effective interpersonal communication and writing skills
  • Utilizes excellent writing skills, and accurate and clear communication to relay findings to healthcare team
  • Strong interpersonal skills, including oral and written communications
  • Demonstrated accountability and skills in analysis, decision making and time management
  • Excellent analytical, communication, computer, interpersonal, and problem solving skills
  • Good problem solving skills and the ability to triage based on severity

List of Typical Experience For a Nurse Case Manager Resume


Experience For RN Nurse Case Manager Resume

  • Organizational skills with regard to time management, task prioritization, and integration of information from a variety of sources
  • Computer Skills, keyboard knowledge, Microsoft Office; Word, Excel
  • Effectively manages assigned caseload of medical/disability cases within company and regulatory guidelines
  • Demonstrates the ability to triage care and use risk stratification to establish daily work-flow
  • Case Management or Utilization Review experience for at least 1 year
  • Understanding of IMMS holistic approach to medical management
  • Understanding of legislative acts, such as the ADA
  • Complete program specific tracking and reporting based on contractual and departmental KPIs and benchmarks

Experience For Field Nurse Case Manager Resume

  • Basic understanding of CMS, OIG, RAC, MIC and CERT auditing and regulations
  • Assists the practice to develop a process for managing the patient population using best practices for preventative care and disease management
  • Resource Management and Discharge Planning
  • Per approved scripting, conduct telephonic patient interviews and document responses
  • Consult with/refer patient to program pharmacist for medication counseling as needed
  • Ensure timely follow up on all outstanding reports

Experience For Behavioral Health Nurse Case Manager Resume

  • Competency using email, attachments
  • Apply principles of adult learning to provide educate to staff, patients and families
  • Works closely with the ACO team to include other nurse case managers, social workers, medical directors and outreach assistant
  • The contractor shall possess demonstrated knowledge of patient education principles and management of complex medical, psychosocial, and financial problems in order to enhance patient adherence to individualized treatment plans and train peers and staff
  • The contractor shall possess the ability to seek feedback from peers, professional colleagues, clients, and outcomes research, in order to expand clinical knowledge, enhance role performance, and increase knowledge of professional issues
  • The contractor shall have the skills to effectively consult with health care providers at all levels and negotiate with outside providers for services and products in order to obtain client services and support

Experience For Workers Compensation Telephonic Nurse Case Manager Resume

  • Knowledge of local, state, and federal laws and regulations, professional code of ethics, and practice standards in order to ensure adherence within legal and professional parameters
  • Three years acute care experience or managed care experience is required
  • Worker’s compensation or disability management experience is highly desired, but not required
  • Previous med-surg experience required
  • All Health Care Providers shall have and maintain current certification in Basic Cardiac Life Support (BCLS) as certified by the American Heart Association

Experience For Telephonic Nurse Case Manager Resume

  • Current RN Texas License
  • Contact patients at scheduled intervals to assess for therapy compliance, provide education and support on disease state and medication therapy
  • Update physician office with patient concerns and/or actions that impact compliance to prescribed therapy
  • Communicate with patient, physician, program staff and other health care providers to assure high quality and continuity of care
  • Recognize and escalate potential risk management issues
  • Act as a clinical resource for non-clinicians

Experience For Transitional Care Nurse / Case Manager Resume

  • Identify and report adverse events based on the REMS requirements for each medication
  • Ensure reports are generated as/when required by program
  • Excellent verbal communication skills with the ability to communicate with participants and communicate professionally with individuals who serve in a variety of functions, i.e. physicians, account managers, brokers, customer service staff, IMMS executive management, other IMMS Medical Management nurses, hospital utilization review nurses, etc
  • Assists health care teams in prioritizing patient follow-up, especially for emergency department frequent visitors and recently hospitalized patients
  • Assists team members with escalated patient matters to improve the patient experience relating to care management, disease management and case coordination

Experience For Nurse Case Manager Rn-medicaid Resume

  • Facilitating multi-disciplinary cross continuum patient care needs
  • Collaborating with physicians, office staff and hospital departments
  • Ability and willingness to function both independently and as part of a team
  • Applies a series of criteria and measures to stratify a patient population and assigns patients to certain risk strata for case management and other preventive health programs
  • Improves the patient connections to appropriate post discharge services focusing on transitions of care (i.e. medical home, nurse access clinic, faith- based clinics, etc.)

Experience For Nurse Case Manager Rn-field Based & Telephonic Resume

  • Documents case management processes and interventions as outlined by department guidelines
  • Collaborates with physicians and office staff in a Patient-Centered Medical Home (PCMH), focusing on identifying the needs of complex, high risk patients while assisting the practice to develop a process for managing the patient population using best practices for preventative care and disease management
  • Applies electronic tools to help identify high risk, high need, and potentially high cost patients
  • Uses registries and EMR to manage the population’s health in preventive health care, disease management, behavioral health screenings and interventions, care opportunities, etc
  • Applies process improvement strategies in conjunction with other departments in evaluating standardized processes for outcomes of care

Experience For Nurse Case Manager Rn-field & Telephonic Resume

  • Performs other job related as assigned
  • Provides consultive support and acts as a resource for team members requiring advanced skills in collaborating, developing, implementing, monitoring, and evaluating the case management process for extremely complex patients
  • Collaborates with physicians and office staff in a Patient-Centered Medical Home (PCMH), while focusing on identifying the needs of complex, high-risk patients
  • Provides intensive case management to a high-risk population as defined by protocol to include assessment, plan development and implementation
  • Utilizes the electronic medical records system to identify high-risk, high need, and potentially high cost patients; Uses registries and electronic medical records system to manage the population’s health in preventive health care, disease management, behavioral health screenings and interventions, care opportunities, etc
  • Identifying and referring complex patients to disease management programs and community resources as needed
  • Provides telephonic case management in a workers’ compensation environment

Experience For RN Nurse Case Manager Specialist Resume

  • Works collaboratively with Senior Return-to-Work Specialist to
  • Provide telephonic outreach for assessment, and follow up to close gaps in care
  • Implementation of the transition plan
  • Complete patient education to support health needs
  • Provide timely, complete and concise documentation
  • Concurrently enters all information into the healthplan’s computer documentation system ensuring complete and accurate information per established policies and guidelines

List of Typical Skills For a Nurse Case Manager Resume


Skills For RN Nurse Case Manager Resume

  • Resolve moderate to complex issues applying judgment, critical thinking and problem solving skills to determine a proper course of action
  • Demonstrates evidence of continuing education, minimally 1 per quarter to maintain clinical expertise
  • Utilize clinical/nursing skills to collect, review and analyze health data from medical records and/or other sources as provided
  • Prior experience in an NICU
  • Clinical / case management experience; or any combination of education and experience, which would provide an equivalent background

Skills For Field Nurse Case Manager Resume

  • Keeps case notes and tracks cases effectively using proprietary computer system
  • Determine appropriateness of care, quality of care, and testing utilizing evidenced based guidelines
  • Experience dealing with multiple tasks, and problem solving under pressure
  • Actively participates as a contributing team member as demonstrated by attitude, cooperation, shared problem solving and participation in projects
  • Experience as a Registered Nurse within a Home Care or Medical-Surgical setting
  • Responsible for collaborating with healthcare providers and members to optimize member benefits and to promote effective use of resources
  • Build solid working relationships with internal staff, matrix partners, key functional areas, customers, and providers
  • Active RN licensure in good standing is required

Skills For Behavioral Health Nurse Case Manager Resume

  • Strong working knowledge of clinical research concepts, ethics, processes and protocol implementation and management
  • Experience using pc's with multiple screens
  • Three (3) years of RN experience in a hospital setting, required
  • Two years' experience in any case management setting or Acute Care is required
  • Ambulatory care or Acute care nursing experience
  • Nursing experience required
  • 3+years clinical experience in acute setting
  • Perform telephonic care management consultations with members, promoting high quality, evidence-based practice recommendations

Skills For Workers Compensation Telephonic Nurse Case Manager Resume

  • Facilitate effective transitions of care through timely communication of necessary information for patient care and discharge planning
  • Previous home care or medical-surgical experience
  • Three or more years’ experience in clinical case management of members with multiple and complex chronic conditions
  • Establishes and maintains effective working relationships with Hospital ER Staff
  • Exhibits a proven knowledge of multiple product lines and services
  • Using Transitional Care Nursing guidelines, assesses/identifies the needs of the individual/family/caregiver
  • Commuting / Daily travel within Washington, DC required
  • Working knowledge of the financial aspects of third-party payors and reimbursement

Skills For Telephonic Nurse Case Manager Resume

  • Ongoing promotion and maintenance of quality assurance standards from a Case Review/Case Management standpoint, as well as in the provision of customer service
  • Reviewing utilization patterns
  • Working knowledge and application of client Decision Point Review Plan and AICRA
  • Performing admission and continued stay review per policy and procedure
  • Assisting with physician documentation
  • Identifying and referring complex patients to disease management programs and community resources as needed,
  • Communicating with patients and families about the plan of care, collaborating with physicians, office staff and hospital departments,
  • Obtaining and maintaining applicable designations are encouraged; these designations are required where dictated by state regulations
  • Sitting 5 to 8 hours a day during office time requirements

Skills For Transitional Care Nurse / Case Manager Resume

  • Working knowledge of the Cost of Medical Care
  • Develops reporting, tracking and trending for presentations to DFSM Management
  • Exercise independent judgement in decision making, utilizing all relevant information
  • Site Coordination. Assists in coordinating the opening of additional practice sites
  • Collaborates with Core Care Coordinators to determine how to manage acute issues as they relate to any existing care plan, any barriers, and any ongoing needs
  • Participate in ongoing training meetings and in-services
  • The Case Manager- Registered Nurse is responsible for providing pre-admission, discharge planning, and utilization management functions for the Hospital
  • Responsible for capturing and monitoring P4Q quality metrics

Skills For Nurse Case Manager Rn-medicaid Resume

  • Assists in improving operation workflows and streamlining work processes
  • Develop, implement and evaluate individual care planning for all members
  • Responsible for carrying out case management activities for members referred to the case management program across all levels of care
  • Manages all aspects of discharge planning/transition process
  • Manage/coordinate an active volume of cases by providing information and coordination to customers worldwide in a multicultural population
  • Manages/coordinates an active caseload of case management cases by providing Information, Navigation and Coordination for our global members
  • Conduct ID15 online interviews with employer, injured worker and medical provider, following RTW standards for appropriate classification of high risk claims
  • Build a working relationship with all ID15 high risk injured workers, customers and medical providers

Skills For Nurse Case Manager Rn-field Based & Telephonic Resume

  • Conducts an evaluation of members needs & benefit plan eligibility; facilitates integrative functions using clinical tools/information/data
  • Analyze information and evaluate results to determine the proper course of action while following established standards
  • RN and current unrestricted nursing license required
  • Graduate of an accredited nursing program, BSN required
  • Coordinate the individual’s treatment program while maximizing cost containment
  • High level knowledge of the worker’s compensation industry and claims processes, reporting and regulatory requirements
  • BSN from an accredited nursing program

Skills For Nurse Case Manager Rn-field & Telephonic Resume

  • Participates in clinical rounds, presenting complex cases
  • Computer/typing proficiency to enter and retrieve data in electronic clinical records
  • Current, unrestricted RN license in applicable state(s) required. Multi-state licensure is required if this individual is providing services in multiple states
  • Can show proof of success in the following areas
  • Travel to and work at participating practices, to facilities and within the community
  • Documentation. Maintains records documenting activity and performance of delivery services
  • Utilizes Medical Staff approved monitors for ongoing measurement/evaluation of utilization management
  • Performs the “denial” process for all patients according to particular payor
  • Maintains current clinical records according to department policy and professional standards and prepares monthly statistical reports

Skills For RN Nurse Case Manager Specialist Resume

  • Is available to be on a rotating basis on weekends, evenings and holidays with other staff to provide onsite Utilization review services
  • Serves as patient advocate in assuring a collaborative approach to patient care management
  • Participates in improving processes related to the Continuum of Care, Performance Improvement, and the Joint Commission Important Functions as appropriate
  • Current Maryland State Nursing License
  • Exposure to and familiarity with GA state regulations governing work related injury claims
  • Maintenance of continuing education appropriate to case management, Workers' Compensation issues
  • Coordinates services and authorizations for members transitioning from AHCCCS health plans to the American Indian Health Program
  • Communicates with all parties in order to gather information regarding the work injury, medical treatment needs, functional status and work ability
  • Assures that screening tests, immunizations and urgent referrals are up to date; perform outreach when additional action is needed

List of Typical Responsibilities For a Nurse Case Manager Resume


Responsibilities For RN Nurse Case Manager Resume

  • Confident presentation skills/excellent verbal communication skills
  • Demonstrates excellent customer service skills in a high demand telephonic business environment
  • Experience in a hospital setting, acute care, direct care experience as an RN and/or experience as a telephonic Case Manager for an insurance company
  • Strong problem solving skills and ability to perform critical analysis
  • Strong oral, written, and presentation skills required in order to represent the organization to internal and external customers
  • Experience: Previous workers’ compensation and/or disability case management experience or Occupational health experience
  • Excellent written, verbal, telephonic skills
  • Clinical experience and/or case management, utilization review, and/or discharge planning experience in an acute care setting

Responsibilities For Field Nurse Case Manager Resume

  • Fast and accurate typing, data entry and word processing skills is required
  • Prior experience working in case management
  • Two years Lactation Consultant current experience or RN with 4 years Breast Feeding Counselor experience or Certified Nurse Midwife
  • Effectively utilizes desktop tools to conform to State jurisdictional guidelines and account specific criteria
  • Clinical nurse experience with a preference for previous orthopedic, emergency room, critical care, home care or rehab care experience
  • Hospice experience or other experience in Palliative care

Responsibilities For Behavioral Health Nurse Case Manager Resume

  • BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
  • Basic knowledge of analytic tools and data management skills
  • Proficient computer skills: MS Office (Word, Excel, Outlook)
  • Engage with all members during their hospitalization, giving priority to those with higher-risk and past history of high utilization
  • Experience in case management (ideally in a home health setting, acute or post-acute setting)
  • Organizes and prioritizes daily work by assessing new, current, and discharging patient needs in area(s) of responsibility. Completes documentation as required
  • Travel to hospitals, skilled nursing facilities, patient’s homes, and other sites where patients receive care as needed

Responsibilities For Workers Compensation Telephonic Nurse Case Manager Resume

  • Clinical experience in acute setting for 3 or more years
  • Experience in Case management, Utilization review, and/or discharge planning
  • Experience in managed care, acute care, post-acute (hospital) or Home Health setting
  • Varied clinical nursing experience
  • 0 – 2 years’ of Nephrology Nursing and/or case management experience
  • Experience in Nursing Case Management
  • Experience with case management or discharge planning
  • Manage competing priorities, multi-task with results oriented outcomes and work in a fast paced environment

Responsibilities For Telephonic Nurse Case Manager Resume

  • Possesses nursing license in good standing at all times of employment and to notify the immediate manager of any restrictions or disciplinary action imposed
  • Demonstrates fiscal responsibility with resources; including staff and supplies
  • RN state licensure in good standing with the State Board of Nursing
  • Utilizes evidenced based medicine when performing claim reviews
  • Demonstrates a commitment to professionalism and self-improvement”
  • Demonstrate knowledge of case management concepts, principles, and strategies
  • Strong ability to collaborate with others for a mutually beneficial outcome

Responsibilities For Transitional Care Nurse / Case Manager Resume

  • Experienced evaluating for GIP level of care
  • Experience with symptom management recommendations
  • Utilizes approved evidence based guidelines and general health and wellness strategies to achieve goals in the overall health of members
  • 1+years’ experience in a Managed Care environment
  • Maternal child care experience required
  • Good command of data management and development of data-driven processes that improve care, and/or decrease cost
  • Experience in public or private third party reimbursement arena or pharmaceutical industry in sales, managed care, or clinical support is an asset
  • One to three years’ experience in clinical and case management

Responsibilities For Nurse Case Manager Rn-medicaid Resume

  • Experience in a managed care environment
  • Registered nurse with current NY state RN license with at least 2 years of experience
  • Obstetrics experience required
  • Worker’s compensation case management experience
  • Experience as a Registered Nurse
  • Michigan Medicine work experience
  • Related experience in a healthcare environment. Knowledge of HEDIS/CAHPS/HOS/Stars, case management/ care coordination
  • 12 months nursing experience
  • Five (5) years of UM/CM experience

Responsibilities For Nurse Case Manager Rn-field Based & Telephonic Resume

  • Three to five (3-5) years of diverse clinical experience required
  • Recent supervised or managed care management experience
  • Handle multiple projects at the same time with ability to prioritize projects
  • Experience in case management or utilization management
  • Experience in medical-surgical, critical care or home health settings
  • Valid New York State Registered Nurse (RN) license

Responsibilities For Nurse Case Manager Rn-field & Telephonic Resume

  • Reviewing, understanding and practicing within the scope of licensure
  • Communicating and collaborating with physicians, their office staff and staff of ancillary departments (e.g., lab, pharmacy)
  • Understanding of renal and diabetes disease process and current management practices
  • Providing pertinent health and wellness information to meet the needs of the caller
  • Rotating weekend/holiday coverage also required, rotation approx. once weekend every 10 weeks
  • Ongoing need for employee to see and read information, labels, monitors, identify equipment and supplies, and be able to assess patient needs

Responsibilities For RN Nurse Case Manager Specialist Resume

  • With the managers, participate in the training process of new caseworkers, including but not limited to shadowing & call monitoring; and
  • Assists in identifying and evaluating providers and managed care vendors
  • Graduate of Accredited Registered Nursing Program with current active license (RN) to practice nursing in the state where the business resides
  • Social workers provide counseling and emotional support and assist in finding respite care when needed
  • Bereavement counselors offer counseling and bereavement support, including a specialized program for children, for up to one year after the patient's death
  • Proficient in Microsoft applications including Word, Excel, PowerPoint, and Outlook. Typing is proficient and accurate and at least average speed
  • Current, active, unrestricted Registered Nursing (RN) license with active state nursing license for area of assigned jurisdiction
  • Maintain case records with clear, concise, pertinent documentation, conforming to product standard operating procedures and medical/legal guidelines
  • Screens and coordinates with Transition Planning team in the discharge planning process from patient admission to departure

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