Inpatient Case Manager Resume Samples

As an Inpatient Case Manager is a registered nurse who is tasked with the evaluation and implementation of health care plans for in-patients. The job description entails providing effective and efficient medical care while managing the costs of treatment. A well-drafted Inpatient Case Manager Resume mentions the following core duties – acting as a liaison between patients, their families, doctors, and health care providers; assessing new patients; updating and revising patient health care plans; educating patients and families and health care plans; making clinical decisions for routine patient care, providing emotional support to patients and families; and implementing physician orders and other nursing procedures.

Professionals in this role are expected to have to the least an associate’s degree from an accredited nursing school, with majors in anatomy, psychology, behavioral science, or nursing. A Successful Inpatient Case Manager must be able to multitask, handle numerous responsibilities, and communicate well with patients and families, and doctors. The capacity to understand and explain the features of Medicare, Medicaid, and other insurance options and knowledge of health care services and medical terminologies are also some requirements.

Inpatient Case Manager Resume example

Inpatient Case Manager Resume

Summary : A versatile and analytical Registered Nurse with over 15 years of experience. Details oriented, proactive team member in the multi-disciplinary transition planning process. I have a diverse ground in nursing. I have been working primarily in Medical/Surgical nursing, and Case Management/Utilization Management. Dedicated to case management, utilization review, and quality improvement.

Skills : Milliman, Interqual, Computer/Software Proficient, Computer/Software Proficient.

Description :

    1. Ability to quickly determine medical necessity and implement real time interventions.
    2. Supported hospital goals by achieving lowest Medicare Length of stay, tracking high risk and high utilizing patients, and decreasing re-admission rate.
    3. Participated in developing auditing tools for high utilizing patients.
    4. Monitored the delivery of services over the entire continuum of illness by utilizing InterQual guidelines.
    5. Performed daily CERMe.
    6. Documented and communicated with physicians, hospital staffs, workers compensation case managers and plan members in reference to acute inpatient reviews and discharge needs.
    7. Skilled nursing placement, coordinate home health services, order DMEs, and transfer non-Kaiser members to outside hospitals.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Bachelor Of Science In Nursing


Inpatient Case Manager Resume

Summary : Inpatient Case Manager with 22 years of experience in the following areas: Inpatient hospital setting, outpatient clinic, hospital sales- marketing, home care, and HMO management skills. Seeking opportunities in management and/or administrative positions for further growth and contributions within the healthcare system.

Skills : Inpatient and ambulatory care case management experience; Strong verbal and organizational.

Description :

    1. Daily concurrent reviewered on all HMO cases at a local hospital in Charlotte NC.
    2. Reviewed cases with hospital case managers/physicians and Cigna Medical Director.
    3. Provided authorization for home health, durable medical equipment and skill nursing facilities.
    4. Refered cases to the appropriate disease management team and case management.
    5. Outreached calls to orthopedic pre-admissions and post discharge cases.
    6. Participated in creating a developmental plan as a guide for inpatient case managers to strengthen there abilities in careeer advancement within CIGNA Healthcare.
    7. Kept abreast to DRG, Discount and Per Diem hospital contract changes.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
BS


Inpatient Case Manager Resume

Headline : Inpatient Case Manager with over eighteen years of experience in Management, Home Health, Care Coordination, Case Management, Utilization Review, and Acute Care. I am currently seeking to join a team that will allow me to apply my nursing knowledge and improve health outcomes.

Skills : Assessments, Critical Thinking, Defensive/accurate Documentation.

Description :

    1. Managed a high volume caseload of inpatient, residential and partial hospitalization Medicaid clients to facilitate appropriate benefit usage while ensuring quality care both in hospital and free standing program settings.
    2. Directed discussion with members and families regarding concerns about benefit usage.
    3. Directed discussion with members calling in clinical crisis.
    4. Facilitated discharge planning with facility staff and ensured appropriate follow-up within targeted HEDIS follow-up range.
    5. Developed strong working relationships with Attending Physicians and facility staff within the facilities I was responsible for managing.
    6. Able to meet utilization targets for my assigned markets and facilities.
    7. Tracked of inpatient census, maintaining current reviews on all Members inpatient in my assigned Facilities and provide accurate and ongoing information to the Medical Director and Management.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Masters Of Art In Counseling

Inpatient Case Manager Resume

Objective : Seeking an Inpatient Case Manager position as a case manager in the medical field where I can utilize my experience, skills, and knowledge in the best possible way.

Skills : Proficient In Microsoft Office Suite Electronic Medical Records, Cerner.

Description :

    1. Responsible for day-to-day patient case management and supported appropriate utilization/resource management during the continuum of patients' care in acute care and skilled nursing facilities.
    2. Conducted initial and concurrent reviews of patient cases to ensure appropriate documentation of medical necessity, and timely, cost-effective provision of care and quality outcomes.
    3. Conducted case presentations on cases that did not meet criteria for approval.
    4. Initiated, developed, planned, and implemented discharge plans designed to promote the delivery of quality care and service.
    5. Interfaced with primary care physicians, specialty care physicians, mental health professionals, home health professionals, and other health care professions regarding patient care.
    6. Notified/issued Notices of Non-Medicare Coverage (NOMNC's) to skilled nursing facilities and home health care facilities.
    7. Planned and authorized services and equipment for patient discharges as needed.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BS In General Education

Inpatient Case Manager Resume

Summary : As an Inpatient Case Manager, responsible for Ensuring the appropriate utilization of capitated and contracted specialists, providers, facilities, and vendors according to region and risk.

Skills : Registered Nurse, Public Health Nurse, California BRN;.

Description :

    1. Worked on numerous areas of Pateint care settings as an Inpatient Case Manager.
    2. Participated in daily care rounds.
    3. Arranged and facilitated paient centered-family conferences if needed.
    4. Looked for barriers to discharge to decrease LOS.
    5. Developed excellent relationships with ancillary departments and community agencies.
    6. Greated organizatonal skills for changing demands of daily work environment.
    7. Able to asses and plan and implement and coordinate, monitor and evaluate and sometimes find out that you have to start back at step one, several times before discharge ever happens! Assist patient in navigating the healthcare system to achieve successful care during transitions.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Associate's

Inpatient Case Manager Resume

Summary : To use my vast knowledge in patient care to lead, challenge and enhance today's healthcare. Having spent 19 years in the trenches, it has become my life's work to successfully bridge the gap between patients and the healthcare industry. My background in patient care spans a broad spectrum from hospice, home health, behavioral health, and lastly targeting the past 13 years exclusively in managed care.

Skills : Microsoft Office, Case Management.

Description :

    1. Responsible for Inpatient and SNF Case Management of senior and commercial members.
    2. Concurrent review, coordinate Home Health, DME, PCP and specialist follow up appointments.
    3. Pered Milliman guidelines authorize services if medically indicated.
    4. Discussed advance care planning.
    5. Polsted completion, hospice or palliative care.
    6. Refered patients to high risk programs for disease management, complex case management or social worker for community resources.
    7. Attended daily rounds and participate in IDT meetings with patient, family and interdisciplinary team.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
AA In Liberal Arts

Inpatient Case Manager Resume

Summary : Inpatient Case Manager with over 15+ years experience in medical/surgical, medical intensive care, case management, home health care, and public health nursing. Recent graduate of Capella University with a Master's Degree in Nonprofit Management/Leadership. Prepared to return to the workforce after pursuing a master's degree and homeschooling my children full-time for the past two years.

Skills : Microsoft Word, PowerPoint, and Excel, Nursing.

Description :

    1. Responsible for day-to-day patient case management and supported appropriate utilization/resource management during the continuum of patients' care in acute care and skilled nursing facilities.
    2. Conducted initial and concurrent reviews of patient cases to ensure appropriate documentation of medical necessity, and timely, cost-effective provision of care and quality outcomes.
    3. Conducted case presentations on cases that did not meet criteria for approval.
    4. Initiated, developed, planned, and implemented discharge plans designed to promote the delivery of quality care and service.
    5. Interfaced with primary care physicians, specialty care physicians, mental health professionals, home health professionals, and other health care professions regarding patient care.
    6. Notified/issued Notices of Non-Medicare Coverage (NOMNC's) to skilled nursing facilities and home health care facilities.
    7. Planned and authorized services and equipment for patient discharges as needed.
Years of Experience
Experience
10+ Years
Experience Level
Level
Senior
Education
Education
Advanced Nursing

Inpatient Case Manager Resume

Objective : Inpatient Case Manager with track record of business development, client relationship management, and collaborative team participation.

Skills : Case Management, Computer, Wound Care, Meditech EMR, AHLTA DOD EMR, AllScripts EMR, Point Click Care EMR, Medication Administration.

Description :

    1. Acted as the liaison between the patient and personnel to ensure that all necessary care was provided.
    2. Established action plans based on case facts, best practices, protocols, and available resources.
    3. Worked with hospitalist to assess need for clients to continue an inpatient status in the hospital.
    4. Coordinated transition and completed follow-ups of clients from one level of care and service to another.
    5. Processed complicated benefit-related authorization referrals for procedures.
    6. Worked with Medical Director to provide DME or other special needs for clients.
    7. Worked effectively to complete work with rolling deadlines with minimal supervision.
Years of Experience
Experience
2-5 Years
Experience Level
Level
Executive
Education
Education
BSN In Nursing

Inpatient Case Manager Resume

Summary : Inpatient Case Manager Professional with impressive RN-based work history as Inpatient Care Manager, Agency RN, High Risk OB RN, Perinatal Clinician, Triage RN and Case Manager combined with solid track record in Information Technology as a Senior Quality Assurance Analyst, Web Administration, Technical Support and Customer Service.

Skills : Microsoft Office, QA Analyst.

Description :

    1. Responsible for utilization review, care coordination, case management and discharge planning for one acute care unit and one critical care unit.
    2. Conducted initial medical necessity clinical screening.
    3. Determined if clinical information presented meets medical necessity criteria per InterQual guidelines.
    4. Contributed Interact with unit RNs and unit secretaries because not all patient notes have been charted; seek for Highlights: real deal with each patient's situation in order to meet guidelines for payment/reimbursement.
    5. Broad experienced in nursing generates emphasis for more detail but also allows for more empathy for staff, patients and families.
    6. Dealed directly with MDs, specialists and their staffs to obtain additional information as needed to establish that patients and their treatments qualify.
    7. Readily challenged insurance carriers if payment is denied or patient described as not meeting qualifications; identify pertinent issues and address them to gain payment.
Years of Experience
Experience
7-10 Years
Experience Level
Level
Management
Education
Education
GED

Inpatient Case Manager Resume

Headline : Inpatient Case Manager with solid clinical, utilization review, and case management experience within a managed care environment acute and rehab (SNF). Experienced in both ambulatory and inpatient case management.

Skills : Collaborative Skills, MS Office.

Description :

    1. Identified patients and initiates case management services providing coordination of care related to discharge into the community.
    2. Assessed patient needs for durable medical equipment, home health nursing, home infusion therapies, and psycho-social support.
    3. Communicated with health care teams for the purpose of coordinating care, understanding the needs of payers, and identifying health care needs.
    4. Collaborated with on-site vendor liaisons in the transition of the child/family to home care services Establishes treatment plans by setting schedules, coordinating services, and arranging resources.
    5. Identified and coordinated necessary and available resources to accomplish timely discharge.
    6. Communicated with payers and/or their representatives regarding the reason for admission, the expected and ongoing plan of care, continues justifications for inpatient stay, discharge criteria and plans for post-discharge care.
    7. Collaborated with the staff RN and community providers to coordinate continued home care and discharge teaching needs.
Years of Experience
Experience
5-7 Years
Experience Level
Level
Executive
Education
Education
Master's In Nursing