Registered Nurse Case Manager Resume Sample
Consuelo Simonis
97748 Richmond Creek,
Dallas,
TX
+1 (555) 699 8665
Work Experience
Registered Nurse Case Manager
04/2018
-
PRESENT
Boston, MA
- Utilize community resources to support patient’s post hospital needs. Documents choice in available resources
- Utilize community resources to support patient’s post hospital needs. Documents choice in available resources has been offered
- Tracks resource statistics to identify improvement opportunities. Attends medical staff and other hospital committee meetings to report findings
- Active/current agency health requirements
- Current nursing icensure in state and CPR certification
- Initiates nursing procedures appropriate for the patient’s Hospice care and safety
- Observes signs and symptoms and reports to the physician and IDG members any unexpected changes in the patient’s physical or emotional condition
Registered Nurse / Case Manager
08/2015
-
10/2017
Houston, TX
- Performs specific nursing procedures as needed (e.g., treatments, management of symptoms) following doctor’s orders
- Always communicates to the supervisor if unable to meet a patient’s need or perform a procedure
- Completes an initial assessment of patient and family to determine home care needs. Provides a complete physical assessment and history of current and previous illness(es)
- Current licensure in State, CPR certification and valid driver’s license
- Demonstrates and promotes Plaza Medical Center of Fort Worth’s Mission and Values philosophies
- Contributes to the organization’s goals of success
- Provide education and training to employees in Health, Safety and Wellness topics, including: BBP, Universal precautions, in proper lifting techniques and body mechanics, as well as other OSHA surveillance, health and wellness related topics.
- Review clinical condition treatment against established criteria
Registered Nurse Case Manager Days
02/2011
-
07/2015
Dallas, TX
- Provide clinical information to payor when applicable (on site or telephonic) and verifies patient eligibility and benefits
- Obtains authorization for additional Inpatient days, if needed
- Collaborate with payor to foster positive relationships
- Communicate with Physician and other care givers to facilitate appropriate patient care and interface with Physician Advisor to resolve discrepancies between actual patient care and clinical criteria
- Manage concurrent in-house appeals and Concurrent Denial management
- Review for level of care (e.g., ICU, Tele, Med Surg) and review patient status (Inpatient, Outpatient, Observation) for consistency with clinical criteria
- Demonstrates knowledge of regulatory requirements of various agencies to include Center for Medicare and Medicaid Services (CMS), VHA, The Joint Commission (TJC) and insurance systems
- Utilization Review and Management: Demonstrates knowledge of UR process (InterQual) validated by inter-rater reliability reviews. Demonstrates knowledge of using Medical Center/Care Line resources to provide the highest quality of care in the most cost-efficient settings
Education
Nebraska Wesleyan University
2006 - 2010
School's Degree in Nursing
Professional Skills
- Three years of experience in nursing with prior experience in Utilization Review, Home Health, Quality Management and/or Discharge Planning
- Demonstrated ability to critical thinking, analytical and decision-making skills, and negotiation
- Exhibits strong organizational skills and ability to manage a caseload while also acting as a resource to department members and throughout the hospital
- That s/he can perform the essential functions of the job, with or without reasonable accommodation, using some other combination of skills and abilities
- Experience of Utilization Management-review and Discharge-planning experience
- Two (2) years of clinical experience or two years experience in discharge planning, case management, utilization review
- Two (2) years prior work experience in an acute care hospital as a Registered Nurse
How to write Registered Nurse Case Manager Resume
Registered Nurse Case Manager role is responsible for training, nursing, health, interpersonal, education, security, patient, case, physical, compliance.
To write great resume for registered nurse case manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Registered Nurse Case Manager Resume
The section contact information is important in your registered 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
- Telephone number
Work Experience in Your Registered Nurse Case Manager Resume
The section work experience is an essential part of your registered 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 registered 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 registered 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 Registered Nurse Case Manager resume experience can include:
- Responds to supervisor & CFO requests for information & assistance in a cooperative manner & within appropriate time frame and comes prepared to weekly self pay meeting
- Excellent interpersonal skills and written/oral communication skills required
- Work independently with little direction, follow established policies and procedures and be accountable for team work. Good time management skills
- Demonstrates appropriate judgment skills to be able to make independent clinical decisions
- Applies critical thinking and analytical skills to identify barriers for optimal patient care delivery
- Applies skills, such as health coaching to promote patient self-management toward patient-driven holistic care plan for life
Education on a Registered Nurse Case Manager Resume
Make sure to make education a priority on your registered 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 registered 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 Registered Nurse Case Manager Resume
When listing skills on your registered 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 registered nurse case manager skills:
- Strong skillset in Microsoft Office
- Effective communication and compassionate interpersonal skills
- Demonstrated ability to communicate effectively in oral, written and electronic form
- Proven ability to work well with others, at all levels within the organization and collaborates effectively
- Demonstrated ability to establish and maintain collaborative and effective working relationships
- Provides and promotes patient-driven care in a safe, efficient and cost-effective manner, using evidence-based principles
List of Typical Experience For a Registered Nurse Case Manager Resume
1
Experience For Registered Nurse / Case Manager Resume
- Competency in relationship building and social interactions; Excellent communication and collaboration
- Experience as a case manager in a healthcare setting
- Demonstrates a sound knowledge of specialty and related fields
- Monitoring/evaluation of quality and performance improvement activities
- Using Interqual criteria monitors and documents all admissions, observation stays and continued stays for specific medical necessity
- Prevent unwarranted hospitalizations by meeting patient and family needs in the home
- Collaborates with Physicians taking orders for Home health care and durable medical equipment
- Role model attributes such as a positive attitude, approachable and calm demeanor with the ability to defuse challenging situations in a professional manner
2
Experience For Registered Nurse Case Manager PRN Resume
- Model expertise through comprehensive assessment, planning, implementation and overall evaluation of individual patient needs
- Discusses alternate level of care with physician. Refers cases not meeting acute care criteria to Physician Advisor as needed
- Current licensure as an RN by Texas Board of Nursing
- Evaluates psychosocial and medical/nursing information to determine an appropriate discharge plan
- Ensure that the appropriate decision makers are informed and involved in treatment planning
- Obtains and documents authorization and reauthorization for Home Care services from Insurance Case Managers during a patient’s home care
- Earn 10 continuing education credits annually
- Demonstration of ongoing competence as a Registered Nurse in the provision of direct patient care
- Discharge Planning Responsibilities
3
Experience For Registered Nurse Case Manager Days Resume
- Obtains and documents authorization and reauthorization for Home Care services from Insurance Case Managers during a patient's home care
- Current RN Licensure from the State of Wyoming or Compact equivalent
- Documents patient’s admission status in Support Services
- Collaborate with the Inter-Disciplinary Team to coordinate home health care for the patient and family
- Explain home health services and Medicare benefits to patients and families
- Oversee the care given by Licensed Practical Nurses and Home Health Aides
4
Experience For Registered Nurse, Case Manager Resume
- Coordinates with and corresponds to appropriate agencies and third party payers regarding pre-admission screening, concurrent, outpatient and retrospective review process as it relates to federal and commercial insurance plans to maximize positive financial outcomes
- Collaborates with Medical Director and/or multidisciplinary treatment team in planning the care of patients and families within the acute setting and along the healthcare continuum
- Responsible for providing intensive nurse case management of referred youth (ages 17-25) and women living with HIV. Complete intake, assessments and develop service plans, care coordination, education and prevention
- Complete home and community-based visits working extensively to support medication adherence, health literacy, and client engagement in medical care, while maintaining client confidentiality
- Manage and maintain program data for enrolled clients. Acquire necessary patient information from off-site clinical venues and ensure accurate inclusion in the program database. Collaborate with the WI HIV Primary Care Support Network to ensure appropriate grant related data points are included in the Network data system
- Seek out and develop client education materials on a wide range of topics (HIV prevention, disease progression, medication adherence etc.), educate clients, their support systems, and members of the multidisciplinary team on treatment options for youth (ages 17-25) and women living with HIV
5
Experience For Registered Nurse Case Manager hrs / wk Resume
- Act as a resource, advocate, and serve as a care consultant within the community and healthcare system on behalf of the clients with, or at-risk for HIV
- Maintain appropriate and up-to-date knowledge of HIV treatment options through reading professional journals, affiliation with appropriate professional or community organizations, attendance at interdisciplinary care team meetings, collaborative case conference meetings, and other professional opportunities
- Demonstrates proficiency in the use of the electronic medical record (EMR)
- Participates in HIV Primary Care Support Network quality initiatives and activities
- The Case Manager assesses by interview and charts review discharge needs of all high-risk patients (and others referred). Identifies resources available to address the needs identified, coordinate referrals and document plan
- Performs admission and continued stay reviews
- Provides clinical information to payers upon request for certification and reimbursement of care
6
Experience For Hospice Registered Nurse Case Manager Resume
- Case Manager tracks resource statistics to identify improvement opportunities
- Attends medical staff and other hospital committee meetings to report findings
- Currently licensed and registered as a professional nurse in the State of New York
- Assesses by interview and charts review discharge needs of all high-risk patients (and others referred)
- Identifies resources available to address the needs identified, coordinate referrals and document plan
- Performs admission review and continued stay review to determine the clinical appropriateness and medical necessity of the level of care ordered by the physician by applying InterQual® criteria
7
Experience For Registered Nurse Case Manager Orthopedics Resume
- Enter working appropriate DRG -for ELOS determination
- Participates in the development and improvement of clinical initiatives focused on reducing LOS, Denials; Readmissions
- Acts on behalf of the department in the training of new case managers and social worker’s
- Knowledgeable of payor requirements including Federal/State guidelines, policies and and procedures
- Maintains current knowledge of Utilization Review standards and practices
8
Experience For Registered Nurse, Case Manager, Day Shift Resume
- Provides clear and accurate information to insurance representatives, hospital facilities, and case managers
- Maintains professional intradepartmental and community relationships
- The case manager is responsible for utilization review, discharge planning and care coordination with the patient, patient’s family, physician and health care team
- The Care Coordinator proactively assesses, identifies, and works to mitigate the risk posed by barriers to the patients’ transitions of care
- Oversees and facilitates the collaborative management of patient progress
- Identifies psycho social needs
- Interacts with patients and families to identify needed social support
- Assesses, develops, implements, coordinates and monitors a comprehensive plan of care in collaboration with the physician and interdisciplinary team
- Completes initial, comprehensive and ongoing assessments of patient and family to determine hospice needs. Provides a complete physical assessment and history of current and previous illness (es)
9
Experience For Registered Nurse Case Manager General Surgery Resume
- Assists the patient and/or caregiver/family with the activities of daily living, provision and education, and facilitates the patient’s efforts toward maintaining independence for as long as possible and optional comfort care
- This is a PRN (as needed) RN Case Manager position
- Reviews all admissions and continued stay for assigned group of inpatients to determine appropriateness utilizing standardized criteria (Milliman/Interqual) to achieve optimal outcomes and reimbursements. Identify variance, avoidable days and address readmission reasons timely
- Document external/internal barriers and outcomes
- Knowledgeable of payor requirements including Federal/State guidelines, policies and and procedures. Provide timely clinical informations to the managed care companies as part of contractual agreements
- Works collaboratively with MD's and managed care companies on concurrent denial issues and coordinates direct communication between MD's
- Actively involve in daily, weekly rounds and intervene in management of complex cases especially (d/c planning) areas. Knowledgeable in hospital and community resources. Preparedness in taking role of resource person among other disciplines
- Maintain effective relationship and positive outlook when interfacing with other departments, interdisciplinary team including managed care companies in effort of achieving optimal outcomes
- Based on clinical expertise,assist in the development of plan of care and ensure that plan is implemented timely
10
Experience For Registered Nurse Case Manager Plastic & Reconstructive Hand Surgery Resume
- Discuss with team where delays are identified; provide direction, assistance and support in developing strategies, intervention to move patient through the continuum of care. F/u any delays and help expedite diagnostic,treatment consults
- Make referral to Physician Advisor as needed
- Provide timely clinical information to the managed care companies as part of contractual agreements
- Assess patient's clinical readiness and discuss with team available resources based on patient's clinical needs. Initiate PRI as needed. Collaborate and assist SW in the coordination of discharge plan
- Obtain authorization for post acute care needs timely. Maintain easy flow of communication regarding patient's development and progress to all involved in care of patient
- Collaborates with health-team members in planning and implementing plan-of-care
- Participates in the development and improvement of clinical initiatives focused on reducing LOS, Denials; Re-admissions
- Creates plan for care across the continuum, integrating patient/family preferences, and values
List of Typical Skills For a Registered Nurse Case Manager Resume
1
Skills For Registered Nurse / Case Manager Resume
- One (1) year prior experience in a Case Management, Discharge Planning, or Utilization Management role
- Five (5) years prior clinical experience in an acute care hospital as a Registered Nurse
- Five (5) years prior work experience in an acute care hospital as a Registered Nurse
- Exercises professional skills related to the plan-of-care
- Advanced communication skills (verbal and written)
- Basic computer skills to perform data entry
- Recent clinical experience or 3 years recent hospital case management experience
- Nursing Process: Demonstrates the use of nursing process as a problem solving model
- Skill in evaluating cases and determining appropriate care and status
2
Skills For Registered Nurse Case Manager PRN Resume
- Nursing experience in an acute care / hospital setting
- Case management/utilization management and/or discharge planning experience in an acute hospital setting
- Two years nursing experience in acute care setting is required
- Strong abilities in decision-making
- Experience with PC applications required. (Such as word processing, spreadsheet and graphics)
- Current / Good Standing :Registered Nurse (RN) license in the state of CA
- Manager/supervisory experience (i.e. payroll/time cards, annual evaluations, scheduling)
- Licensed registered nurse with a current state license in good standing
- Experience in clinical nursing
3
Skills For Registered Nurse Case Manager Days Resume
- Experience in providing patient care
- Three years experience in nursing
- Demonstrated ability to perform basic word processing and spreadsheet functions
- Participate in the development, implementation, evaluation, and ongoing revision of initiatives to improve quality, continuity, and cost-effectiveness
- Five years professional nursing or social work experience desirable
- Professional nursing or social work experience desirable
4
Skills For Registered Nurse, Case Manager Resume
- Previous Registered Nurse experience is required - preferably in the hospital/acute care setting
- Two- year’s recent experience as an RN Case Manager in an acute care facility with responsibility for discharge planning and payor systems
- Give skilled nursing care and prescribed treatment to geriatric patients in the community
- One year experience in Case Management in an acute care environment
- Greater than three years’ experience
- Experience with electronic patient information systems required
- RN with at least 2-5 years clinical experience in an acute care/case management environment
- , current experience in specified area of practice
- Previous Registered Nurse experience is required
5
Skills For Registered Nurse Case Manager hrs / wk Resume
- Case Management or utilization management experience desirable
- Actively participates in care delivery with priority attention to patient preference
- Administers medication. Demonstrates preparation of IV Drips
- The case manager promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals
- The Case Manager works closely with physicians and all clinical departments in assuring high quality, cost effective patient care
- RN with at least 2-5 years clinical experience in an acute care environment
6
Skills For Hospice Registered Nurse Case Manager Resume
- Demonstrated knowledge of end of life care
- Experience with computerized clinical information systems
- Valid Virginia Driver License
- Medical surgical experience
- Has demonstrated proficiency for the requirements for NC I
- Demonstrates an ability to perform specific competencies as identified on the Case Management Competency assessment
- Registered Nurse (5) years clinical experience
- Two years psychiatric experience required
- Valid BLS Card for Healthcare Providers
7
Skills For Registered Nurse Case Manager Orthopedics Resume
- LPN with current state licensure and experience (PerDiem Only)
- Identifying, procuring and coordinating services and resources needed by patient and family for discharge
- Communicating and educating the patient and family on their plan of care
- Ensuring and facilitating achievement of quality and clinical cost outcomes
- Understanding of the healthcare/HMO industry
- Completing a holistic assessment of the patient and family
- Rotating weekend coverage is required
- Working knowledge of criteria for Medicare, Medicaid, HMO and private insurance coverage
8
Skills For Registered Nurse, Case Manager, Day Shift Resume
- He position encompasses assessing, planning, implementing, coordinating and evaluating health-related service options throughout the continuum
- Acts as a role model in fulfilling work commitments, seeking out and assuming additional responsibilities and assisting others with career development
- Performs supportive counseling to assist patients/families in adjusting to diagnosis and illness in an effort to meet realistic planning goals
- Provides ongoing support and expertise through comprehensive assessment, care planning, plan implementation and overall evaluation of individual patient needs
- Associate of Arts in Nursing or Diploma in Nursing
- Case Management in an acute care setting, or Case Management in a Home Health Care setting; or Case Management for an insurance company
- A.D. Nursing, B.S. Nursing, or Master's Social Work
- Initiates and provide Hospice nursing services, treatments and preventive procedures in the home setting
9
Skills For Registered Nurse Case Manager General Surgery Resume
- Applies scientific principles and clinical protocols when performing nursing procedures
- Provides early discharge planning and appropriate referrals by giving home instructions to patients and caretakers
- Knowledgeable of the principles of process improvement including data collection, analysis and reporting
- Documents all Case Management activities including Discharge Planning
- Counsels with patients and family members in decision making and in meeting psycho-social needs of the patient
- Assists in creating an environment that promotes educational growth and opportunities for nursing peers and colleagues
- Coaches, counsels and evaluates clinical staff in the delivery of nursing care. Intermittently serves as off-tour nursing supervisor
- Rotates administrative call as nursing supervisor to ensure continuity of nursing care
- Interview the patient to ascertain baseline and ongoing level of physical, emotional, psychological, and spiritual functioning
10
Skills For Registered Nurse Case Manager Plastic & Reconstructive Hand Surgery Resume
- Discharge planning (including DME and Home Health)
- Be an active member of clinical team, contributing to overall team function, team building, and enhancement
- Utilize patient tracking and reporting systems or clinical databases to assure follow up of patients in collaboration with other team members
- Patient satisfaction scores meet organizational goals, HCAHPS Discharge Planning question percentile target score
- Committed to working as a team to improve Employee satisfaction and engagement scores
- Follow prescribed doctors' orders (as documented in EHR or as directed) concerning treatment and medication
- Exhibits openness to change and willingness to try new approaches to problem solving
List of Typical Responsibilities For a Registered Nurse Case Manager Resume
1
Responsibilities For Registered Nurse / Case Manager Resume
- Partner in identifying and achieving timely patient care needs with implementation of the plan of care that is appropriate, resourceful, and valuable
- Assists with the hiring and onboarding of new employees
- Assists patient/family in utilizing and accessing relevant and appropriate community resources
- Perform triage of presenting patients to determine appropriate course of action when required
- Contributes to the evaluation of patient care through participating in unit quality assurance (QA) activities
2
Responsibilities For Registered Nurse Case Manager PRN Resume
- Assists Physician during treatments and/or diagnostic procedures
- Makes observations of patient's condition during treatments/ procedures. Reports and records same
- Recognizes and utilizes health teaching opportunities and resources/materials available
- Evaluates teaching by the feedback from patient/family and documents same
- Maintains contacts with supporting agencies, such as Social Security office, Home Care, and AIDS support groups
- Documents the patient's medical record with observations and action taken during patient's hospital stay
- Maintains documentation of patient's treatment, activity and condition, as well as patient's responses to medical and nursing interventions
3
Responsibilities For Registered Nurse Case Manager Days Resume
- Reports on current topics, meetings and conferences to attending members
- Performs in whichever capacity staffing level necessitates
- Attends nursing, hospital committees as assigned
- Responsible for facilitating the progression of the patient through the continuum of care
- Care for Cardiac patients
- Develop and implement care plans, which are goal oriented and patient centered and consistent with available resources
- Develop plan for discharge of patients
4
Responsibilities For Registered Nurse, Case Manager Resume
- Coordinate with an interdisciplinary team to provide high quality care within the Senior Care Center model of a Patient Centered Medical Home (PCMH)
- Advocate and support the case management process, matching an individual’s ongoing needs with the appropriate level and type of medical, psychological, health, or social care/services
- The Case Management Manager works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient patient care during the hospital stay
- Assesses and evaluates the nursing care of AIDS patients
- Communicates changes in patient's condition and/or treatments to designated Nursing management
- Assesses patients daily and revises plan of care
- Collaborates with other health team members when follow-up is necessary
- Administers patient care and considers patient's privacy and dignity
5
Responsibilities For Registered Nurse Case Manager hrs / wk Resume
- Acts/participates in emergency situations
- Interprets and implements physician's prescribed treatment regimen
- Performs Venipuncture, IV Therapy and IV Insertion
- Provides and maintains a safe, clean, noise-controlled environment for patients to reduce stress and anxiety
- Maintains constant vigilance over patients and ensures safety precautions/needs are followed
- Communicates non-clinical procedures to patient's family or caretakers
- Maintains principles of universal precautions and infection control
6
Responsibilities For Hospice Registered Nurse Case Manager Resume
- Provides the patient with explanation of his/her condition as indicated
- Communicates assessment data in an orderly fashion by recording, updating and verbalizing pertinent information to health care team members and to appropriate agencies
- Educates patients on Advance Directives
- Assures records of discharge are recorded in compliance to New York State AIDS Institute
- Communicates literature and current trends in related field
- Shares knowledge base with fellow staff members and colleagues
- Maintains standards of professional ethics and clinical competency
- Assumes charge responsibilities when assigned
- Assists in extended orientation of new staff
7
Responsibilities For Registered Nurse Case Manager Orthopedics Resume
- Demonstrates ability to be customer focused and able to effectively interact with physicians, team members, community agencies, families with diverse values, religious and cultural ideas
- Actively participates in the collaborative program which requires review of patient activities related to medical necessity of hospitalization, appropriateness of length of stay, timely and appropriate utilization of services rendered, and identification of patient needs related to patient care following discharge
- The position encompasses assessing, planning, implementing, coordinating and evaluating health-related service options throughout the continuum
- Facilitates discharge planning efforts to promote timely and safe discharge from the hospital
- Current or pending licensure in Texas as an RN
- Certification in Case Management desirable
- This facilitation includes evaluation of the history and physical, treatment plan, admission orders, and patient demographics against Inter-Qual and unit specific Admission/Discharge for the identification of the appropriate status and location for patient care
- Actively participates in the collaborative program which requires review of patient activities related to medical necessity of hospitalization, appropriateness of length of stay, timely and appropriate utilization of services rendered, and identification of patient needs related to patient care following discharge from the hospital
- The position encompasses reviewing, planning, implementing, coordinating and evaluating health-related service options throughout the continuum
8
Responsibilities For Registered Nurse, Case Manager, Day Shift Resume
- Coordinate the care and service delivery of the patient population across the continuum of illness with a focus on the following
- Exercise initiative and judgment and make decisions within the scope of assigned authority
- Registration with the Board of Nurse Examiners for the State of Texas
- Facilitates discharge planning efforts to promote timely and safe discharge from the hospital. The case manager promotes quality care and cost-effective outcomes to enhance the physical, psychosocial and vocational health of individuals. T
- Works cooperatively with Admissions Office and Business Services to facilitate and ensure proper pre-certification and assignment of accommodation status for hospitalized patients
- Monitors all admissions on assignment unit to communicate crucial patient information regarding policy coverage, limits, required documentation and other relevant financial characteristics of coverage to appropriate facility staff and medical providers
- Ensures required documentation and justification is provided to third party payors to obtain re-certification for continued hospitalization and treatment as needed
9
Responsibilities For Registered Nurse Case Manager General Surgery Resume
- Serves as liaison between interdisciplinary care team and funding sources, maintaining contact as required to report patient’s status, progress, required treatments, and estimated necessary length of stay
- Works with the patient and family to identify financial resources available to them in provision of necessary services, either inpatient or post-discharge
- Provides routine reports on effective utilization of case management services related to cost containment and interventions resulting in a more positive outcome with patient, family, funding source or other involved party
- Administers various human resource processes and procedures for the Case Managers to include PMP’s, coaching, disciplinary action according to policy with assistance from the department director
- Ensures compliance with all regulatory standards including Federal, State, Local and Joint Commission with review requirements for Managed Contracts, Medicare, Medicaid and Campus related to admission and continued stay approval
- Adheres to Utilization Management Plan
10
Responsibilities For Registered Nurse Case Manager Plastic & Reconstructive Hand Surgery Resume
- Monitors and evaluates data, fiscal outcomes and other relevant information to develop and implement strategies for improvement
- Forwards identified quality and/or risk issues appropriately
- Maintains positive relationships with outside/onsite reviewers and other payer representatives
- Involves patient’s family in the development of the treatment plan as appropriate while explaining procedures, therapies, systems treatment plans, and discharge plans in age/developmental/educational specific terms to patient/family
- Reviews patient’s discharge plan at multidisciplinary meetings and/or staffing to facilitate communication with other healthcare team members
- Assignment of initial DRG to determine GMLOS, while concurrently monitoring and managing LOS and transition planning as appropriate through assessment and reassessment and the application of Interqual guidelines
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