Yyyyyy x. yyyyyy

Committed to innovative processes and eager to apply strong clinical skills, work ethic, and passion for providing superior care

9955 Southwest 53^rd Street ￨ Xxxxxx, XXXXXX xxxxxx ￨ (xxx-xxx-xxxx ￨ abc@xyz.com

• Dynamic RN who facilitates the delivery of responsible direct patient care for all ages based on industry and facility standards of practices and who offers Inpatient Unit, Hospice, and Home Health Care experience, as well as proven talents in Case Management, Clinical Review, Provider / Community Referrals, and Medical Policy Interpretation while collaborating with healthcare services leadership teams to maximize patient outcomes per treatment goals.
• Ambitious Self-Starter who excels in promoting facility optimization, including making sound recommendations for continued beneficial industry relationships, as well as preferred network providers to enhance quality and minimize cost.
• Bilingual Communicator (English / Spanish / Italian) who builds solid relationships with healthcare teams, patients, and families, and who exhibits up-to-date knowledge of national care management trends and statistics to align objectives.

Bachelor of Science in Nursing (2010) Xxxxxx National University

Registered Nurse (Active License) State of Xxxxxx

Certifications IV Therapy ￨ Phlebotomy ￨ EKG ￨ PCT ￨ CPR

Milliman Criteria ￨ CMS Guidelines ￨ InterQual ￨ Jiva System ￨ Microsoft Office

RN Inpatient Unit

• Spearhead patient-focused care within a fast-paced RN Inpatient Unit, including working with diverse patients to observe and record patient behavior, establish treatment plans, and consult with physicians and other healthcare professionals.
• Apply strong leadership talents toward supervising Licensed Practical Nurses and Certified Nurse Assistants in daily workxxxxxxow, including planning and prioritizing assignments to maximize use of resource and achieve healthcare objectives.
• Conduct targeted research to support improved practice and patient outcomes, along with exhibiting proven skill in handling comprehensive treatments, judiciously managing pain, administering medications, and performing wound care.
• Build and sustain valuable relationships with patients and family members by providing advocacy and emotional support.

Case Manager ￨ Nurse Clinical Reviewer

• Utilized broad scope of industry knowledge toward serving as a Second-Level Reviewer for health plans in South and North Xxxxxx, including performing utilization and concurrent review of ongoing home health cases using Milliman criteria or CMS guidelines per MD direction, and coordinated requests for services / care with cost-effective outcomes.
• Processed FFS requests and compiled recommendation summary for submission to health plans, along with processing beneficiary or patient referrals to provider network, researching beneficiary history prior to determination, and educating and evaluating needs of patients for referrals to outpatient therapies and community resources.
• Expertly interpreted medical policy and benefit plan descriptions, reviewed clinical records and medical history sent by hospital, SNF, or MD office, and routed wound care and pharmacy supply requests to vendors as required.
• Participated in department-wide staff meetings and trainings while mentoring peers to boost productivity.

Hospice Nurse

• Played a vital role in assisting RNs in re-evaluating patients and revising plans of care as necessary with IDT approval.
• Contributed sharp analytical and multitasking abilities toward maintaining accurate records of vital signs and treatments, as well as managing key documentation compliant with hospice, Medicare, Medicaid, and HHS policies.
• Ensured seamless healthcare processes by maintaining open communications with physicians and healthcare teams to inform them of changes in patients conditions and needs, and followed procedures per hospice policy and regulations.

Home Health Nurse

• Delivered quality-oriented nursing care per treatment plans and RN assessment, including providing ongoing physical care, emotional support, and patient / family education while reporting any condition changes to the Case Manager.
• Supported physician and / or RN in performing specific procedures required by patient, including consistently adhering to strict aseptic techniques and accurately recording patient condition and treatment outcome in notes.
• Demonstrated skill in educating patients / families on proper self-care techniques to enhance treatment success.