This Resume Has Not Been Formatted
0000 xxxxxx xxxx , xxxx , xxxxx 00000 xxx-xxx-xxxx ● email@example.com
Claim Analysis ~ Team Collaboration ~ Decision-Making ~ Report Writing
Excel at providing high-quality and cost-effective nurse case management services.
Proven success in guiding, closely monitoring, and ensuring timely clinical transition of patients through medically appropriate levels of care.
Adept at evaluating and updating treatment and return-to-work (RTW) plans throughout claim life cycle.
Draw upon outstanding clinical judgment to make prudent decisions which promote patient health while ensuring resources are available to those most in need.
Possess a strong blend of assessment, negotiating, communication, and documentation skills.
Effectively cooperate with patients, healthcare management companies, insurance companies, or other third-party payers to determine and coordinate quality, cost-effective care.
Optum/United HealthCare, 2005-2017
Nurse Case Manager
Managed Worker s Compensation/injury/auto/liability cases within states of New York and New Jersey.
Leveraged substantial knowledge of ancillary services, DME, diagnostics, and pharmaceutical programs to optimized cost-effective measures for the insured.
Sole designated bilingual Nurse Case Manager for North Jersey territory for last seven years.
Achieved RTW goals within ODG guidelines for over 90% of assigned cases to result in excellent overall cost savings to the insured and employer.
Monitored patient progress towards desired outcomes through ongoing assessment and evaluation.
Procura Management Inc., 2005-2015
Senior Bilingual Nurse Case Manager
Coordinated and attended medical evaluations with health providers for Worker s Compensation cases within New Jersey territory, and actively assisted with New York Worker s Compensation cases when requested.
Leveraged training in hospital audits to facilitate Worker s Compensation and auto no-fault claims.
Applied strong leadership talents toward training, mentoring, educating, and coaching new case managers.
Arranged specialty referrals, consultations, and services in alignment with clinical guidelines to expedite recovery and RTW.
ADP Claims Solution Group, 2004-2005
Case Management Specialist II
Promoted to senior position based on proven expertise in closely monitoring medical care received by claimants and seamlessly liaising between account, provider, and claimant.
Arranged and attended medical evaluations, physician s appointments, physical therapy and diagnostic imaging, coordinated home health care, and arranged for transportation when necessary.
Quality Review Systems, 1999-2004
Field Nurse Case Manager
Independently managed both Worker s Compensation and auto no-fault files for multiple insurance companies throughout NY, NJ, and PA territory.
Assembled preferred provider list of specialists knowledgeable in Worker s Compensation regulations to facilitate treatment plans which result in achieving specific RTW targets.
Page 2 of 2
Field Nurse Case Manager
Planned, delivered, and documented telephonic and field case management for New York tri-state area.
Methodically conducted client assessments and steered patient care process from initial hospitalization through rehabilitation and return to work.
Efficiently functioned as liaison between claims adjuster, physician, and claimant to expedite medical recovery at minimum expense to Corvel.
Maimonides Medical Center, 1997-1999
Staff Nurse, Med-Surg Unit
Cared for patients on 40-bed unit affected by cardiac, oncology, CVA, COPD, diabetes, ESRD, AIDS, TB/infectious disease, ortho & neuro problems, psychiatric, and other medical and post-op conditions.
Exhibited outstanding clinical proficiency with vents, trachs, IVs, central lines, cardiac/pulse oximetry monitoring, tube feeding, TPN, chest tubes and drains, peritoneal dialysis, PCA/pain management, ostomy care, and wound care.
Provided family teaching and compassionate emotional support for terminally ill patients.
Assessed and admitted patients, created care plans for patients across the age spectrum, and performed comprehensive charting to ensure stringent compliance with JCAHO policies and other regulations.
Proactively coordinated unified efforts among multidisciplinary teams (social workers, PT/OT, physicians, pharmacists, and dieticians) to streamline discharge process for patients.
Witco Corporation, 1992-1998
Compensation Specialist and Safety Coordinator / Emergency First Aid Responder
Efficiently provided full-scope case management services for Worker s Compensation and other industrial injury cases.
Meticulously documented incidents, monitored and followed up on cases to expedite RTW, and actively assisted in administering onsite semi-annual employee physicals.
Systematically conducted quality audits to ensure rigorous compliance with ISO9000 standards.
Facilitated monthly safety meetings and prepared safety/first aid tests to measure staff comprehension and compliance.
As Safety Coordinator, provided emergency first aid, medical triage, stabilization, and transport for up to 140 industrial employees.
BS, Nursing, Long Island University, 1995
BS, Psychology, Brooklyn College, 1992
RN license NY and NJ
Life Care Planning
CPR / First Aid
Remember: Hire Us To Write YOUR New Resume
And We GUARANTEE That If You’re Not Working In 60 Days Or Less,
We’ll Revise Your Resume, Refund Your Money,
AND Give You $50 EXTRA!