Nurse Management Resume Sample

4.9
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Harry Ernser
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Work Experience


Case Management Nurse
06/2015 - PRESENT
Houston, TX
  • Applies critical thinking skills and problem-solving techniques to the disease management process. Accurately conducts a thorough and objective holistic evaluation of the patients’ current status, including psychosocial, physical, financial, and educational needs, prognosis, and past and present treatment course and services
  • Educate and assist members in understanding their disease process in an effort to increase self-management maximize optimal health
  • Identify members educational needs and mail appropriate educational material to each member
  • Responsible for timely resolution of case management referrals
  • Responsible for providing quality case management services in a manner compliant with department case management quality indicators
  • Obtains, records, and coordinates all case management inquiries and relays information to departments including Medical Director, Blue Cross and Blue Shield Customer Service representatives, claims staff, Marketing, Institutional and Professional Relations, Behavioral Health Vendor, and Legal Counsel when necessary
  • Responsible for analyzing atypical or complicated cases and case management claims until resolved to include preparing and presenting case scenarios to the Corporate Medical Director with appropriate medical, financial or cost/benefit information for review and input
  • Responsible for identifying potential quality of care issues and making appropriate referrals
Disability Management Nurse
01/2011 - 01/2015
Chicago, IL
  • Assists with the gathering of quality assurance/utilization management data, problem identification and analysis of data. This includes development of criteria and guidelines
  • Maintains appropriate caseload, follows case management process to include appropriate documentation and follow-up
  • Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Performs telephonic Case Management, which includes patient evaluation and education regarding disease and early symptom identification
  • Applies critical thinking skills and problem-solving techniques to the disease management process
  • Accurately conducts a thorough and objective holistic evaluation of the patients’ current status, including psychosocial, physical, financial, and educational needs, prognosis, and past and present treatment course and services
  • Consistently demonstrates excellent communication and interpersonal skills with supervisor, case manager, physicians, clinic staff, and corporate personnel
Case / Care Management Nurse
02/2008 - 08/2010
Dallas, TX
  • Identifies opportunities and readily participates in performance improvement activities
  • Performs Disease Management for members of FEP with specific chronic diseases and as assigned
  • Conducts clinical assessments to identify individual member knowledge, skills and behavioral needs
  • Works with the member to identify a specific disease management plan to address objectives and goals as identified during assessment
  • Implements care plan by educating members regarding clinical needs and referrals to health professionals as appropriate
  • Monitors and evaluates the effectiveness of the Disease Management plan and modifies as necessary
  • Interfaces with health professionals to coordinate care plan for the member as appropriate
  • Refers member to catastrophic Case Management as appropriate
  • Works with Disease Management team to manage day-to-day activities

Education


University of Phoenix - St. Paul Learning Center
2003 - 2008
Bachelor's Degree in Nursing

Professional Skills


  • Demonstrate proficiency with interpreting and utilizing Interqual guidelines in conjunction with critical thinking skills and good clinical
  • Strong oral, written and interpersonal communication and customer service skills
  • Strong organization and time management skills with the ability to manage workload independently
  • Based on position, prior experience in one or more of the following areas including
  • Clinical experience; 2+ years of Case / Utilization Management and Discharge Planning experience
  • Experience working with diabetics, hypertensives, and asthmatics members required
  • Previous experience working remote

How to write Nurse Management Resume

Nurse Management role is responsible for health, clinical, techniques, basic, physical, travel, insurance, oncology, compensation, security.
To write great resume for nurse management job, your resume must include:

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

Contact Information For Nurse Management Resume

The section contact information is important in your nurse management 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 Management Resume

The section work experience is an essential part of your nurse management 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 management 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 management position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Nurse Management resume experience can include:

  • Utilizes critical thinking skills to meet needs of individual patients
  • Acute care clinical experience
  • Working knowledge of Windows and Microsoft Office desired
  • Capable of ascending/descending stairs when necessary and moving to/from vehicles for outreach and health fair programs
  • Current licensure by Tennessee Governing Boards. (Tennessee Board of Nursing, if an RN)
  • Capable of remaining in stationary position (chair) for periods of time during member telephone calls

Education on a Nurse Management Resume

Make sure to make education a priority on your nurse management resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your nurse management 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 Management Resume

When listing skills on your nurse management 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 management skills:

  • Interpret policies and procedures, make decisions, and communicate complex topics effectively
  • Establish and maintain effective working relationships with Members and their families, Health Plans and local personnel
  • Establish and maintain effective working relationships with Members and their families, DaVita Medical Group, Health Plans and local personnel
  • Self-direct, make independent decisions, prioritize daily activity
  • Valid Florida State LPN or RN license
  • Self-direct, make independent decisions, and prioritize daily activity

List of Typical Experience For a Nurse Management Resume

1

Experience For Case Management Nurse Resume

  • Responsible for providing quality Disease Management services in a manner compliant with Disease Management process
  • Responsible for performing all job functions within the scope of the Kansas Nurse Practice Act
  • Responsible for timely contact of members enrolled in the Disease Management program
  • Maintains appropriate caseload, follows Disease Management process to include appropriate documentation and follow-up
  • Hold current, unrestricted RN license in the state of California
2

Experience For Disease Management Nurse Resume

  • Assess the member s current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
  • Utilize knowledge, experience and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member s needs and promote desired outcomes
  • Coordinate services between Primary Care Physician PCP , specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
  • Actively participate in integrated team care management rounds Identify related risk management quality concerns and report these scenarios to the appropriate resources
  • Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems Direct care to participating network providers
  • Triage customers with an HRA to decide if they need further follow up
3

Experience For Disability Management Nurse Resume

  • Assess, implement, monitor, and evaluate available resources in an effort to promote quality, cost effective outcomes while meeting the individual s health needs
  • The case manager identifies appropriate providers and facilities in an effort to improve or maintain the social, emotional, functional and physical health status of the client, as well as enhance the coping skills of the family or other caregiver
  • Hold current, unrestricted RN license in the state of Tennessee
  • Demonstrates knowledge of human growth and development, assessment, range of treatment and care of patients appropriate to the ages of patients served as per Scope of Service
  • Promotes internal and external customer service initiatives
  • Participate in Performance Improvement activities as assigned
  • Works with Business office to manage payment issues of third party payers
4

Experience For Supervisor, Field Nurse Case Management Resume

  • Communicates with third party payers to review patients' care
  • Acts as a liaison with patients, physicians, and Program Coordinator to keep them informed of care issues, such as discharge plans, insurance reviews, etc
  • Actively works with treatment team to assist patient and family with discharge plans
  • Execute a wide range of program evaluations in areas of pain management. Advise on the appropriateness of AFMS pain management resources to include the evaluation of metrics to be collected. Provide analytical and methodological support as needed. Conduct Monthly In Progress Reviews and monthly Evaluation Roll-Up Reports. Generate actionable recommendations

List of Typical Skills For a Nurse Management Resume

1

Skills For Case Management Nurse Resume

  • Clinical nursing experience in a clinical, acute care, or community setting and
  • Case management experience in a managed care setting
  • Experience in the healthcare field
  • Three years clinical RN experience
  • Provide disease care management to best meet the member’s specific healthcare needs and to promote quality and cost-effective outcomes
  • Typing brief notes into a computer bank during or after a customer call
  • Capable of complying with all Kansas laws and regulations regarding the operation and the use of a motor vehicle
  • Handle sensitive situations in a positive, professional manner. Awareness and understanding of current provider medical and utilization practices
2

Skills For Disease Management Nurse Resume

  • Capable of utilizing a calculator, telephone and personal computer
  • Able to travel including overnight
  • Capable of transporting supplies up to 30lbs each within the department and to/from vehicle for outreach and health fair programs
  • Case Managment with discharge planning
  • Capable of utilizing a calculator, telephone, and personal computer
  • Able to travel, including over night
  • Delaware Nursing licensure required
  • Responsible for maintaining compliance in turnaround time requirements as mandated by the TAT Standards. 20%
  • Participate in delivering 1:1’s to employees
3

Skills For Disability Management Nurse Resume

  • NJ Registered Nurse (RN) or Licensed Practical Nurse (LPN )
  • Schedule requires alternative work hours which does include 3 evenings until 9pm CST
  • Participates in Best Practices, Quality/Risk Initiatives, RCA’s and other teams to improve patient care
  • Identify and select instruments and equipment necessary for patient procedures
  • Current unrestricted Kansas RN license required
  • Current unrestricted RN license in KS or LA
4

Skills For Supervisor, Field Nurse Case Management Resume

  • Current unrestricted RN license in IN or DC
  • Pediatric Advanced Life Support (PALS) department dependent required
  • Current unrestricted RN license in Compact State
  • Current state’s RN license
  • URAC Recognized Care Management Certification required
  • Condition specific clinical or home health/discharge planning experience; or any combination of education and experience, which would provide an equivalent background
  • Current unrestricted RN license in WA, KY, or Compact State
5

Skills For Case / Care Management Nurse Resume

  • Currently licensed as a Registered Nurse in the state of Nebraska or current compact state
  • Work with multiple windows open on PC, move and toggle back and forth
  • Current unrestricted RN license in state of VA
  • Current unrestricted RN license from the state of Georgia required
  • PALS as required by facility
  • Think critically and make decision within individual role and responsibility
6

Skills For Nurse Disease Management Resume

  • Communicate effectively, verbally, in writing and via telephone regarding sensitive and confidential issues and maintain a positive professional image
  • The ability to assess, analyze, plan, and evaluate situations
  • Handle sensitive situations in a positive, professional manner
  • Active RN license as required by state of employment or appropriate compact licensure
  • Compact States ( VA, NC, SC, KY, TN DE, MD, RI, NH, ME, AR, MO, IA, AR, MS, WI, ND, SD, NE, CO, NM, TX, AZ, UT, ID, or MT)
7

Skills For Case / Disease Management Nurse Resume

  • Case managers are one part of a clinical interdisciplinary care team that involves plan physicians and partners, Medical Directors, Community Case Managers, SNF/Rehab/LTAC Case Managers, Partnership for Quality nurses and Specialists
  • Initiate and follow through in the discharge planning/transition of care process
  • Appropriate letter language and coding (denials, deferrals, modifications)
  • Ensure the patient is in the appropriate level of care
  • Appropriate coordination of member benefits through interventions such as: Transportation benefit assistance Facilitating prior authorization of high cost medication
  • Office Position, located at 5800 Northampton Blvd, Norfolk VA 23502
8

Skills For Nurse, Care Management Resume

  • Current unrestricted RN license in state of FL
  • CCM (Certified Case Manager certification)
  • Current unrestricted RN license in state of TX
  • Current unrestricted RN license in FL or GA
  • Usage of the Milliman Care Guidelines
  • Proper identification of eligibility and health plan benefits
  • Meets or exceeds production and quality metrics. 5%
  • Identifies Clinical Program opportunities and refers members to the appropriate healthcare program (e.g. case management, engagement team, and disease management). 5%
  • Attend all mandatory meetings and training. 5%
9

Skills For Supervisor Nurse, Care Management Resume

  • Maintains and keeps in total confidence, all files, documents and records that pertain to the business operations. 5%
  • Understand methods for assessing an individual’s level of physical/mental impairment; understand the physical and psychological characteristics of illness; be able to assist individuals with the development of short- and long-term health goals
  • Knowledgeable on how to access and evaluate the available resources to meet a client’s needs; able to develop new resources
  • Oversee a collaborative process with the member and those involved in the member’s care to assess, plan, implement, coordinate, monitor and evaluate care as needed
  • Orientation of new employees (support and professional)
  • Knowledge of California work comp rules and regulations, as well as other states
  • Conduct a comprehensive assessment of the patient’s health and psychosocial needs, including health literacy status and deficits, and develop a case management plan in collaboration with the family
  • Facilitate communication and coordination between members of the health care team, involving the family in the decision-making process in order to minimize fragmentation
  • Ensure correct level of utilization of services and resources for a select group of patients
10

Skills For Case Management Care Transitions Nurse Resume

  • Work with Special Needs Members completing the model of care requirements around Health Risk Assessments, High Risk Care Planning and Interdisciplinary Care Team meetings
  • Performs prospective, concurrent, and retrospective reviews for inpatient acute care, rehabilitation, referrals, and select outpatient
  • Ensures that case management program objectives are met by evaluating the effectiveness of alternative care services and that cost effective, quality care is maintained
  • Identifies appropriate providers and facilities in an effort to improve or maintain the social, emotional, functional and physical health status of the client, as well as enhance the coping skills of the family or other caregiver
  • Determine specific objectives, goals, and actions as identified through the assessment process
  • Ensures medically appropriate, high quality, cost effective care through assessing the medical necessity of inpatient admissions, outpatient services, focused surgical and diagnostic procedures, out of network services, and appropriateness of treatment setting
  • Works with medical directors in interpreting appropriateness of care and accurate claims payment

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