Corvel Corporation Rn Telephonic Case Manager Resume Sample

Joshua Hill

XXXX XXXXXXXX XXX XX XXX XXX , Jacksonville , FL 32246 | (H) XXXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXXXX

Summary

I am a highly trained Registered Nurse with strong clinical abilities and a successful career working in diverse leadership roles. I am a proactive and organized leader with a passionate commitment to first-rate patient care. I work to develop positive relationships with patients, customers and staff to ensure there is a climate of motivation to meet everyone's needs. I am looking for a position where I can lead a team as an integral piece of the health care system to ensure patients receive quality outcomes and satisfaction through coordination of care and benefits.

Skills

Maintain optimum outcomes through chart review and QA
Critical Thinking

Customer and Personal Service
Strong Proven Leadership Skills

Judgment and Decision Making
Administration and Management

Experience

RN Telephonic Case Manager 01/2015 to Present
CorVel Corporation – Jacksonville, FL

Provide Medical Case Management through communications with the patient, physician, other health care providers, the claims adjuster and employer.
Provide assessment, planning, implementation and evaluation of the patient's progress.
Evaluate patient's treatment plan for appropriateness, medical necessity, return to work status and cost effectiveness.
Provide clear and extensive communication and documentation with the patient, physician, adjuster, other health care providers and employer.
Ensure all laws are followed per the Department of Workers Compensation in the state of jurisdiction.
Documentation in EMR at least weekly on case load of 60-70 injured workers.

RN Health and Wellness Director 09/2013 to 12/2014
Camellia at Deerwood – Jacksonville, FL

Educated the physicians, residents, and families on the level of care provided within scope of license the Standard License and to move forward with admissions process.
Coordinated with physician's, resident's and families to complete initial assessment and admissions working in collaboration with the sales and marketing team.
Completed all follow up assessments per state and company protocols.
Directed clinical staff in providing excellent customer service and resident care within the community.
I was to be proactive in identifying patients with complex needs within the community in collaboration with all relevant services.
Follow all residents through continuum of care, collaborating with physicians, home health companies, hospitals, and Skilled Nursing Facilities when care is needed.
Assuring compliance with all resident care related regulations (e.g., medication management). Maintaining guidelines, policies and procedures for the community to ensure we provide care within the scope of the practice of our license.
Documenting and providing accurate record-keeping, per federal, state and company regulations.
Working directly with the Sales and Marketing team for outreach events.
Demonstrating personal/resident safety methods and procedures.
Hire, train and manage all Health and Wellness employees.
Acting Administrator when General Manager is away.

Hospital Admissions RN 10/2012 to 08/2013
Haven Hospice – Jacksonville, FL

Collaborate with patients and their families, physicians and hospital, long term care and inpatient hospice care teams to determine best domicile for patient through assessment, data collection and chart review.
Facilitate admission to appropriate level of care working with insurance carriers while providing patient and family support and education.
Utilize Medicare guidelines (CMS) as a model to determine eligibility of services offered.
Completes the initial written Plan of Care for each admitted patient in conjunction with the interdisciplinary team, patient and family.
Reports to attending physician the discharge admission date, findings, obtains verbal orders as needed for continued care upon discharge as it relates to the diagnosis and plan of care.
Electronic medical record documentation utilized.

Office Manager 01/2012 to 09/2012
St. Vincent's Cardiology – Jacksonville, FL

Manage day to day duties of a cardiology practice including back office, front office, coding/billing, and assisting the physicians in scheduling and in patient education.
Responsible for reviewing billing daily to ensure proper coding and appropriate level of care designated for appointments and cardiovascular procedures.
Utilized ICD-9 and CPT codes along with Medicare guidelines to ensure proper coding and payment; rectify improperly coded visits or tests to ensure payment within set guidelines for Medicare and Managed care.
Supervised 15 employees.

Floor Nurse 11/2005 to 11/2011
Vicar's Landing – Ponte Vedra, FL

Performed patient assessments and administered medication and treatment per physician's orders.
Completed electronic medical record documentation and charting per facility protocol.
Notified physicians of changes in patient's status.

Documented and implemented new orders as ordered.
Supervised 2-5 team member.
Worked FT, PT and PRN depending on school schedule when I returned to get my RN.

Education

Associates Degree: Nursing Aug 2011 St. Johns River State College - Orange Park, FL Nursing

Vocational Degree: Practical Nursing Aug 2003 Florida State College - Jacksonville, FL Practical Nurse

Interests

Registered Nurse, State of Florida 2011* Licensed Practical Nurse Florida- 2004 (Inactive)

Additional Information

LICENSES: * Registered Nurse, State of Florida 2011* Licensed Practical Nurse Florida- 2004 (Inactive)

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Corvel Corporation - Rn Telephonic Case Manager Resume Example

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