Humana - Front Line Leader Post Acute Team Resume Example

Love this resume? Build your own now

Michael Moore
  • XXXX XXXXXX XXXX XXXX, Knoxville, TN 37923
  • H: XXXXXXXXXXXX
  • XXXXXXXXXXXXXXXXXX
Professional Summary
Accomplished and energetic registered nurse with four years management experience as Front Line Leader for   Post-Acute Team seeking role as Utilization Management Manager. Highly skilled and qualified professional with 29 years of nursing experience in a variety of roles. Motivated leader with strong organizational and prioritization abilities. Exceptionally organized, disciplined, accountable clinician and leader. Demonstrated ability to make difficult decisions. Excellent computer skills. Excellent written and verbal communication.
Professional Qualities
  • Strong work ethic
  • Easily adaptable to change
  • Positive attitude
  • Accountable
  • Loyal and ethical
  • Compassionate and caring
  • Commitment to excellence
  • Goal oriented
Professional Experience
Front Line Leader Post-Acute Team, 02/2011 to Present
Humana Knoxville, TN
  • Manage team of nurses conducting utilization management for post-acute services.
    • Manage daily department staffing.
    • Manage nursing staff workload and facility assignments.
    • Conduct staff meetings.
    • Conduct staff charting audits.
    • Conduct performance evaluations.
    • Create training materials for staff education.
    • Train and mentor staff.
    • Conduct interviews and hire staff.
  • Research and resolve issues/complaints from members/providers.
  • Implementation and oversight of skilled nursing facility on-site program.
  • Implementation and oversight of skilled nursing facility scorecard/evaluation program.
    • Collect and analyze data.
    • Collaborate with scorecard nurse.
    • Collaborate with contracting.
  • Collect and analyze data related to QIO appeals.
    • Track trends related to QIO overturns.
    • Monitor timliness of QIO notifications to Humana.
  • Oversight of on-call/appeal process.
    • Assist with document preparation.
    • Assist with staff orientation.
  • Collect and analyze data related to utilization management in skilled nursing facilities, acute inpatient rehabilitation hospitals, and long-term acute care hospitals.
  • Participate in quarterly meetings with skilled nursing facility corporate teams.
    • Discuss trends related to length of stay.
    • Discuss issues brought to Humana.
    • Provide education related to Humana processes.
Clinical Advisor, R.N., 06/2008 to 02/2011
Humana Knoxville, TN
  • Conduct medical necessity reviews for admissions and concurrent stays for skilled nursing facility, acute inpatient rehabilitation hospital and long term acute care hospitals, utilizing CMS and Milliman Care Guidelines.
  • Assist co-workers with admissions and concurrent reviews.
  • Collaborate with Regional Medical Directors for cases that did not meet criteria.
  • Consult with facilities for discharge planning needs.
  • Initiate Case Management referrals as needed.
  • Initiate denial letters.
  • Volunteer for on-call and process QIO appeal requests for IM and Grijalva notices which includes: gathering information from facilities, writing Detailed Explanation of Non-Coverage letters and Detailed Notice of Discharge letters, faxing required information to appropriate contact for appeal, entering all information into appropriate spreadsheets and authorizations.
  • Teaching and mentoring  nurses on the post-acute care team.
  • Knowledgeable in use of Excel and Word.
  • Assisted FLL in NOMNC audits.
  • Provided input into the design of the current functionality of the post-acute care team.
Outpatient Nurse Scheduler, 04/2004 to 06/2008
Knoxville Gastrointestinal Specialists Knoxville, TN
  • Process orders faxed by primary care physicians.
  • Data entry.
  • Scheduling outpatient procedures.
  • Pre-procedure traching for scheduled procedures.
  • Patient interview and history.
  • Confirm medical clearance for procedures.
  • Insurance pre-certification for scheduled procedures.
Staff Nurse, 10/2003 to 08/2004
Blount Memorial Hospital Maryville, TN
  • Perform pre-operative and post-operative nursing care for patients with a variety of orthopedic conditions.
  • Administer medications.
  • Administer blood products and monitor patient during administration.
  • Document patient care in medical record.
  • Lead team of RNs, LPNs, and CNAs.
  • Perform duties of charge nurse as needed.
Clinical Supervisor, 12/1994 to 12/1999
Blount Orthopedic associates Knoxville, TN
  • Responsible for supervision and scheduling of staff for 2 office locations.
  • Schedule surgeries and tests ordered by 5 physicians.
  • Complete all pre and post-op orders for all surgical patients.
  • Complete all pre-certification for all surgery, tests and other procedures ordered.
  • Coordinate care with other physicians and services.
  • Telephone triage of all nurse/medical calls.
  • Assist physicians with office surgeries and procedures.
  • Administer I.M. medications.
  • Conduct patient education for all surgeries, procedures and tests.
  • Conduct patient interviews and assessments.
Staff Nurse Physical Rehabilitation Unit, 04/1993 to 12/1994
Baptist Hospital of East Tennessee Knoxville, TN
  • Primary care of 6-10 patients daily care which includes: personal care, teaching and medication administration.
  • Team leader for a team of RN's, LPN's and rehab assistants.
  • Make rounds with medical director to communicate pertinent information on progress to determine plan of care and discharge.
  • Charge nurse for 7-3 shift responsible for unit staffing, staff assignments, staff supervision and problem solving.
  • Performed duties of Referral Coordinator on 2 separate occasions which included: pre-admission assessment of referred clients, consultation with medical director to determine appropriateness of admission, pre-certification of insurance and arrange for admissions.
Principal Nurse/Program Manager , 03/1992 to 04/1993
Baptist Hospital of East Tennessee Knoxville, TN
  • Responsible for coordinating and overseeing care for 13 clients with a variety of orthopaedic and neurological conditions which required knowledge of clients medical condition, medical history, home situation, family dynamics, treatment plan and discharge needs.
  • Participate in weekly team meetings to determine plan of care, therapy needs and discharge needs.
Staff Nurse Physical Rehabilitation Unit, 07/1989 to 03/1992
Baptist Hospital of East Tennessee Knoxville, TN
  • Primary care of 6-10 patients daily care which includes: personal care, teaching and medication administration.
  • Team leader for a team of RN's, LPN's and rehab assistants.
  • Make rounds with medical director to communicate pertinent information on progress to determine plan of care and discharge.
  • Charge nurse for 7-3 shift responsible for unit staffing, staff assignments, staff supervision and problem solving.
  • Precept new staff.
Staff Nurse Orthopedic Unit, 07/1986 to 07/1989
Baptist Hospital of East Tennessee Knoxville, TN
  • General nursing care of 8-10 orthopaedic patients.
  • Medication administration.
  • Enter care into patient's charts.
  • Precep new staff.
  • Performed charge nurse duties on my unit as well as a cardiac and neurological unit.
Education
Bachelor of Science: Nursing, Dec 2013 Jacksonville University - Jacksonville, TN
Diploma in Nursing: Jun 1986 Baptist Hospital School of Nursing - Knoxville, TN

People also search for

Front Line Leader Post Acute Team

Knoxville ,Tennessee

Michael Moore

Companies Worked For:

Humana , Humana

JobTitles Held:

Front Line Leader Post Acute Team , Clinical Advisor

crew member

Brooklyn ,New York

Savannah Hughes

Companies Worked For:

Ultimate Aircraft , Sears Holdings Corporation

JobTitles Held:

crew member , leader

Continuous Improvement Manager

New Braunfels ,Texas

Joshua Hill

Companies Worked For:

FACC , Hexcel Corporation

JobTitles Held:

Continuous Improvement Manager , Capex

Social Media

San Francisco ,California

Sebastian Green

Companies Worked For:

RetroSewingnet , RetroSewing

JobTitles Held:

Social Media , Sewing

resume flower ad

About this resume

Front Line Leader Post Acute Team FROM Knoxville , Tennessee RESUME

This is a resume for a Front Line Leader Post Acute Team in Knoxville, Tennessee with experience working for such companies as Humana and Humana. The grade for this resume is 0 and is one of hundreds of Front Line Leader Post Acute Team resumes available on our site for free. Use these resumes as templates to get help creating the best Front Line Leader Post Acute Team resume.

Dude
School Attended
Jacksonville University