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Blue Cross Blue Shield Of Kansas - Certified Nurse Case Manager Resume Example

Ariana Alexander
XXXX XXXXXXXXX XXXXX, Lawrence, KS 66047
Ph: XXXXXXXXXXXX
XXXXXXXXXXXXXXXXXX
Professional Summary

Highly trained Nurse Case Manager with strong clinical abilities and successful career in both health care facilities and the payor industry. Proactive, organized with passionate commitment to quality patient care. Licensed in the State of Kansas by the Board of Nursing. Certification in Case Management by the Commission for Case Management  with expertise in medical case management. 

Significant Continuing Education

1998-1999 Home Health National Association Annual Conference 1992-1998 Continental Medical System Annual Meeting for Director's of Case Management

2001- present  Case Management Society of America Kansas City Chapter 2001- present U.R.A.C. Webinars  Core and Case Management Standards

2010-present Federal Blue Cross Blue Shield Federal Annual Conference 

Experience
Certified Nurse Case Manager May 2001Present Blue Cross Blue Shield of Kansas Topeka, KS Facilitate telephonic and on-site case management conferences for utilization review and discharge planning.
Completion of utilization review through independent review of medical information, consultation with attending physician, and referrals to physician consultants.
Coordination of discharge planning while serving as a resource to consult with physicians, staff and providers regarding available contractual benefits, community resources, available private funding, charitable organizations and support systems.
Responsible for negotiating with providers to obtain medically necessary services in a manner that promotes quality, cost effective care.
Analysis of quality assurance/utilization management data.
Research reports identify individuals to screen that may benefit from Case Management services.
Blue Cross Blue Shield Federal Blue Cross Case Management Team.
Member of the Letter Committee, URAC Accreditation Committee, BlueWeb Committee, Home Health and Hospice Guideline Committee and Federal Blue Cross National Task Force for Mental Health.
Employee Health Nurse Mar 1999May 2001 Stormont Vail Health Care Topeka, KS Responsible for the occupational and safety health for 2000+ employees in both the hospital and clinics.
Conducted new employee health physicals, worker's compensation injury and recovery program.
Participation on hospital safety committees and ongoing review and revisions of policy and procedures. 
Maintain records on each employee upon hiring and noting any injuries and or exposures.
Manage the blood borne pathogen exposure protocol.
Organizational Improvement Coordinator May 1998Mar 1999 Intensiva Hospital of Topeka Topeka, KS Responsible for the Quality Improvement Program.
Monitor for certification and regulatory compliance. 
Coordination of corporate policies and procedures.
Orientation of all new employees regarding policy and procedures.
Director of Case Management Apr 1992May 1998 Kansas Rehabilitation Hospital Topeka, KS Responsible for the inpatient and outpatient case management departments.
Responsible for collaboration between employer and worker's compensation patients in the Work Hardening Program.
Liaison between local hospital and corporate Case Management.
Prepare activity reports to inform management of the status and implementation plans of programs, services, and quality initiatives.


Home Health Agency Assisant Director Oct 1987Apr 1992 Topeka Shawnee County Health Agency Topeka, KS Responsible for day to day operation of the Home Health and Hospice nursing staff.
Liaison between the City of Topeka and the Home Health and Hospice Program during the annual budget process.
Ongoing review and revisions of  policy and procedures.
Monitors and maintain compliance with accreditation organizations and local health care policies and laws.
Home Health Nurse Oct 1986Oct 1987 Topeka Shawnee County Health Agency Topeka, KS Home health care nursing to patients in their own homes.
Independent assessment of patients ongoing health status and collaboration with physician as indicated.
Maintain accurate, detailed reports and records.
Direct or supervise home health aides.
Consult and coordinate with healthcare team members to assess, plan, implement, or evaluate patient care plans.
Instruct individuals and caregivers on topics such as health education, disease prevention and disease state.

Staff Nurse Feb 1986Oct 1986 Stormont Vail Health Care Topeka, KS
Consult and coordinate with healthcare team members to assess, plan, implement, and evaluate patient care plans.
Prepare patients for and assist with examinations or treatments.
Prepare rooms, sterile instruments, equipment and maintenance of stock supplies.
Modify patient treatment plans as indicated by patients' responses and conditions.
Maintain accurate, detailed reports and records. 


Group Home Parent Apr 1985Feb 1986 Lena Pope Children's Home Ft.Worth, TX Resided in a group home setting with at risk youth that were placed by Children and Family Services.
Meet with families, probation officers, police, psychologist or other interested parties to exchange necessary information during the treatment process.
Plan, organize, and lead structured programs of counseling, work, study and recreation, 
Educate families on youth's progress and on-going treatment needs. 
Collaborate with the treatment team regarding each youth progress towards and barriers to returning to their place of residence.


Head Nurse Apr 1983Apr 1985 Dr. James B. Neiburger Leawood , KS Responsible for all clinical office staff performance.
Liaison between physician and clinical staff.
Oversight of the allergy serum program.
Coordination for pharmacological representatives.
Ongoing review and revisions for office policy and procedures.
Critical Care Nurse May 1982Apr 1983 St. Luke's Hospital Kansas City, MO Monitor patients for changes in conditions such as sepsis or shock and institute appropriate interventions.
Evaluate patients' vital signs and laboratory data to determine emergency intervention needs.
Prioritize nursing care for assigned critically ill patients based on assessment data and identified needs.
Advocate for patients' and families' needs and  provide emotional support. 
Education
Bachelor of Science : Nursing Creighton University Omaha, NE
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Resume Details

This is a real resume for a Certified Nurse Case Manager in Lawrence, Kansas with experience working for such companies as Blue Cross Blue Shield Of Kansas, Stormont Vail Health Care, Intensiva Hospital Of Topeka. This is one of the hundreds of Certified Nurse Case Manager resumes available on our site for free. Use these resumes as templates to get help creating the best Certified Nurse Case Manager resume.

Previous Companies:

  • Blue Cross Blue Shield of Kansas
  • Stormont Vail Health Care
  • Intensiva Hospital of Topeka

Previous Job Positions:

  • Certified Nurse Case Manager
  • Employee Health Nurse
  • Organizational Improvement Coordinator
  • Director of Case Management
  • Home Health Agency Assisant Director

Schools:

  • Creighton University

Level of Education:

  • Bachelor of Science

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