Top 50 Registered Nurse Case Manager Skills

high Demand

• Paper and computer documentation with McKesson system per Medicare and agency protocols.
• Provided admissions, re-certifications, and discharges per Medicare Oasis-C guidelines.
• Performed assessments and completed thorough documentation required by Medicare.
• Follow Medicare Guide line criteria/charting.
• Documented all problems, goals, and interventions regulated by The Centers for Medicare and Medicaid Services (CMS).

• Managed Therapists, Nurses, and Caregivers for opening Medicare home health branch under compliance with State and Federal regulations.
• Worked with OASIS doing Starts of Care, Had patient case load doing daily dressing changes, following Medicare guidelines.
• Ensured quality control, HIPPA, compliance, and compliance with conditions of participation for Medicare and Medicaid.
• Coordinate care and services for Medicare, Medicaid, and private pay residents.
• Initiated plans of care for home health patients according to Medicare regulations.

• Worked with Medicare rules and regulations to implement care guidelines for members.
• Case manage medicare/private insurance skilled clients of various ranges.
• Well trained in Oasis data collection and medicare requirements.
• Coordinate average caseload of 60 adult Medicare patients simultaneously planning, coordinating and maintaining discharge follow-up care within company-wide standards.
• Processed home health referrals for the Cape Cod region; screened patients for insurance eligibility under Medicare and managed care programs.

• Direct and develop home care plans and outpatient services, ensure adult Medicare patients have access to physicians and necessary services.
• Provide telephonic outreach to Medicare members, education and support to plan members to Support healthy lifestyle.
• Perform management of Adult Medicare High-Risk Readmit Program, conduct regular reviews and evaluations; helping to avoid unnecessary re-hospitalization.
• Initiate certifications and maintain recertifications on all medicare residents.
• Review Medicare claims from CMS Accomplishments Assisted in Development of 2014 Budget and business plan.

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high Demand

• Volunteered initiative and trained for Case Management position during corporate restructuring due to unexpected loss of acting case manager.
• Facilitated patient assessments and devised effective treatment methods/care plans to reduce pain and discomfort.
• Provide comprehensive case management designed to improve individuals and/or family quality of life.
• Maintained patient privacy and confidential patient information.
• Developed a positive rapport with families and coworkers ensuring that patient's and families needs were met on a daily basis.

• Liaised among CM members, referral services and Q&HI departments, claims staff, and health plan representatives.
• Received after hour's clinical calls, reporting any abnormal labs, findings to the physician on call.
• Receive authorization request for OB services form providers, review them and approve if meets clinical requirements.
• Coordinated all appropriate disciplines to coordinate comprehensive care for the convalescing patient in the home environment.
• Identify members in critical condition and coordinate reliable delivery of the special care services they require.

• Received positive feedback from patient's families throughout hospice care and after patient had deceased.
• Included patients with extensive wound care, Infusion therapy and medical/surgical post hospital discharges.
• Coordinated military and community outreach activities (presentations, etc.)
• Conducted OASIS assessments and developed care plans based on individual needs.
• Followed large clientele of post operative surgical Cardiac and Orthopedic patients.

• Identify healthcare needs and gaps through collaborative communication and assessment.
• Draw labs and deliver to laboratory; follow-up on results and notify healthcare provider as needed.
• Strived daily to provide excellent care to our patients.
• Reason for termination was inactive lisence.
• Educate patients and their caregivers on their conditions and the steps needed to ensure proper recovery.

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high Demand

• Developed a system of staff communication that ensured proper implementation of treatment plans and comprehensive patient care.
• Identify gaps/barriers in recommended treatment plans.
• Initiate and modifies patient care plan with strict attention to accurate documentation regarding treatment plans, medications, and physicians orders.
• Document clients' medical and psychological histories, physical assessment results, diagnoses, treatment plans, prescriptions, or outcomes.
• Coordinated treatment plans per HEDIS and HIPPA with clients, families, Physicians, Pharmacists, and equipment companies.

• Acted as a liaison between patients, family, therapists and physicians to ensure patient comprehension of treatment plans.
• Educated patients on disease processes, medications, diet and nutrition, current treatment plans.
• Collaborated with members of the interdisciplinary team in coordinating patient care and treatment plans.
• Conducted initial assessments and preparation of treatment plans for each new patient.
• Create and initiate patient driven care treatment plans and timely clinical outcomes.

• Modify patient treatment plans as indicated by patients' responses and conditions.
• Identify gaps or barriers in treatment plans and coordinate care as needed.
• Suggest alternative treatment plans and service appropriate needs for patient's condition.
• Liaised between patients and physicians to ensure patient comprehension of treatment plans.
• Modify treatment plans to comply with changes in clients' status.

• Conduct nursing assessments and formulate nursing treatment plans.
• Conducted periodic reviews of existing treatment plans.
• Identified gaps and barriers in treatment plans.
• Established treatment plans for home bound patients.
• Collaborated with Medical Directors/ Physician Advisors on development of care management treatment plans.

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high Demand

• Provide LPN supervisory visits and CNA supervisory visits
• Provided skilled nursing services and supervision of LPN's and Home Health Aides.
• Home Health Aids, LPNs, and Physical/ Occupational/ Speech Therapy as physician-prescribed.
• Trained and supervised nursing staff to include STNA's and LPN's.
• Manage and educate Home Health aide and LPN performance.

• Provided education to client and LPN / PCA.
• Case management and supervision of LPN/CNA.
• Supervised home health aides and LPNs.
• Develop a schedule for when LPN's, CNA's and I would see the patient.
• Supervised 1 aide and 1 LPN on my team.

• Mentor for new RN and LPN staff.
• Worked as LPN until 4/13.
• Coordinate care with other providers / insurers and secure referrals as needed Direct LPN / CNA assignments and activities
• Care and treatment of the homebound patient, supervision of field staff of LPNs and aides.
• Case manager for home health, CNA and LPN supervision visits, admissions and doscharges

• Implemented and reviewed home health aide and LPN assignments.
• Supervised team of LPN & CNA's 1.
• Case management duties included supervising LPNs and HHAs, completing OASIS starts-of-care, resumptions-of-care, and recertifications.
• Supervised LPNs and HHAs in the home/facility setting and offered guidance when necessary.
• Oversee the cases at facilities Medicine management Care plan meetings with team Supervise LPN and aides

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high Demand

• Coordinated care with a multidisciplinary team which included nursing, physical therapy, occupational therapy, and speech therapy.
• Reviewed all physical therapy and chiropractic claims.
• Home visits, physical assessment, interdisciplinary treatment planning with physician, therapist, physical therapy and all other disciplines daily.
• Assess home situation and environments and determine need for the necessary disciplines, i.e., MSW, HHA, Physical Therapy.
• Consulted with the physician regarding physical therapy, nutrition, speech therapy, respiratory therapy and other ancillary services as needed.

• Assess client needs and implements a plan of care by coordinating with other disciplines such as physical therapy and occupational therapy.
• Coordinated discharge orders, such as: ordering medical equipment, setting up physical therapy up for Home Health and Outpatient.
• Attended physician appointments with client, scheduled all appointments; including physical therapy, follow up appointments and diagnostic tests.
• Utilized coordination of care with patients' families, physician, social services, pharmacy, occupational and physical therapy.
• Case coordination with physical therapy, occupational therapy and home health aides to provide exceptional care to a diverse population.

• Worked with physical therapy, occupational therapy, speech therapy and medical social workers on behalf of the patients.
• Case managed Home health patients, coordinating Between physician, physical therapy, Occupational therapy and home health aide.
• Assessed, designed and implemented programs to facilitate healing such as physical therapy, nutrition, and counseling.
• Recommend drugs, medical devices, or other forms of treatment, such as physical therapy, in.
• Developed plan of care utilizing physical therapy, occupational therapy and home health aide team through agency.

• Coordinate with physicians, physical therapy, and other disciplines in patient's plan of care.
• Coordinated care with IDT (physicians, physical therapy, social worker, etc).
• Coordinate care with Physicians, Physical Therapy, Pharmacy needs, Home Care etc.
• Conducted review of chiropractic, imaging and physical therapy cases.
• Case manage multiple patients by overseeing physical therapy, home health aides, speech therapy, and LPN visits.

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high Demand

• Combine clinical/quality considerations with regulatory/financial/utilization review demands to assure patients are receiving care in the appropriate setting and level of care.
• Assigned additional responsibilities as a performance improvement case manager, handling utilization review and discharge planning.
• Case Manager/utilization review of emergency room, medical unit, medical surgical unit.ICU, Observation unit
• Performed utilization review/management with authorizations of procedures and visits in relation to insurance companies.
• Edit position Inpatient on-site Case manager /concurrent utilization review/- managed Large IPA groups

• Perform utilization review in accordance with all state mandated regulations.
• Served as discharge planner to enhance cost-effectiveness, Utilization review
• Perform utilization review according to established guidelines.
• Remained involved in Utilization Review, processed client and provider phone calls and liaison for other Case Management providers.
• Work closely with Utilization Review team in coordinating treatment plan(C-9) until completion.

• Case Manager/Utilization review nurse, for busy and high acuity medical/surgical floors, ICU.
• Conducted utilization reviews for all providers, collaborated with staff individually and via participation in interdisciplinary rounds.
• Performed utilization review using Interqual standards on all assigned patients.
• Discharged planning and utilization review utilizing Interqual.
• Completed utilization review for inpatient stays, diagnostic tests etc, using Milliman and Roberts Criteria.

• Perform utilization reviews, using Interqual program.
• Perform utilization review part time.
• case manager, utilization review,
• Perform Utilization review using Computerized Interqual guidelines and confer with insurance companies Participate in committee meetings with multidisciplinary team members
• Benefit Panel Services Los Angeles, CA Utilization Review Nurse * Initial and concurrent review, referrals to specialist by phone.

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high Demand

• Work independently after office hours to provide individualized nursing care to hospice patients in different settings.
• Coordinated care between Hospice Medical Director and Attending Physician.
• Worked closely with hospice patients to help them fulfill their wishes and have time to say good-bye to their loved.
• Handled the primary task of case management/direct patient care for hospice patients in the home and facility setting.
• Managed patient medications, communicated with other members of hospice team and other medical providers in the community.

• Ensured individualized and appropriate hospice plan of care through efficient use of the interdisciplinary team.
• Assess for hospice appropriateness and admit patients for home hospice or acute inpatient hospice care.
• Assessed, evaluated, and cared for perinatal, pediatric, and adult hospice patients
• Evaluated patients in acute care settings for hospice care.
• Educated patients and families about the hospice philosophy.

• Managed cares for hospice and home health patients.
• Worked with many geriatric hospice patients.
• Coordinate a collaborative hospice care team.
• Admitted new patients to hospice services.
• Case manager for hospice patients.

• Collaborated with healthcare facilities to coordinate admission of patients requiring hospice care.
• Triaged On Call after hours for Hospice patients and caregivers
• Assess and evaluate patients for hospice eligibility * Admit patients to hospice services * Manage hospice patient caseload
• Provided hospice care in various settings including homes, SNFs, ALFs and group homes.
• Registered Nurse Provided nursing care for a C-1 quadraplegic, and Hospice client.

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high Demand

• Manage all aspects of patient care with detailed patient teaching, assessment, documentation, follow-up, and CNA supervision.
• Assist CNA with bathing, dressing, grooming for bed bound patients, skin assessment with wound care as needed.
• Educated and supervised all CNA's on team, ensuring care is appropriate and within scope of practice.
• Supervised and coordinated clinical field staff LPN's and CNA's to assess and ensure superior patient care
• Completed PRN supervisory visits for LPN's and CNA's involved in the care of patients.

• Supervised and directed care of patients provided by the CNA and/or LPN.
• Direct responsibility for management of services provided by CNAI and CNAII.
• Prepared CNA schedules, responsible for CNA training and skills.
• Supervised CNA and instructed on proper ADL's.
• Team nurse supervising 1 LVN and 1 CNA for a total of 10 patients per team.

• Assist with orientation of all new hires, RN, LPN, CNA and HHA.
• Oversee LVN's and CNA's.
• Admit new clients following quidelines as per Medicare and Medicare, supervisory visits for LPN and CNA.
• Designed supportive patient care using a multidisciplinary approach including nurses, family, CNAs and volunteers.
• Supervised LPNs and CNAs and the care they provided to the patients.

• Managed the Morehead office including the CNA assignments and patient care.
• Supervised CNAs providing personal care in the client's home.
• managed 15-18 hospice patients including weekly assessments reported to MD, drug and supply management, supervise CNAs
• Managed a caseload of 25-35 patients, in coordination with LPNs and CNAs Same as previous position
• Maintained and Created schedules for 5 CNAs, 2 RNs, 1 PRN RN and 1 PRN social worker.

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high Demand

• Provided education and training to Patients and Family members regarding disease management; medication management; and infection control/disease prevention.
• Serviced adult psychiatric population who required assistance with medication management, diabetic/ wound/ respiratory care and placement of HHA services.
• Provided medication management and set-up for patients who could not take their medications properly without assistance.
• Conducted admissions, assessments, medication management, and participated in case conferences.
• Delivered pain and symptom palliation through medication management, education and compassionate care.

• Facilitated supportive counseling, medication management, and crisis intervention.
• Skilled nursing visits includes: blood draws, IV antibiotic administration, Wound Care, PICC lines, medication management.
• Ensured that doctors' orders were effectively carried out, including testing, medical procedures, and medication management.
• Help patients in their home settings with their disease processes including wound care, IV management, and/or Medication management
• Performed vital signs, medication management, range of motion exercises, and ADL assistance.

• Educated members on disease processes, preventative care, medication management, and healthy lifestyle.
• Serve as the lead nurse in a rapidly growing medication management clinic.
• Provide medication management and case management in the private sector.
• Serve as a clinical specialist for medication management issues.
• Care planning, family education, collaboration with other facilities, medical& medication management.

• Complete MDS/Monthly home visits/develop and implement Plan of Care/Education regarding diseases and medication management.
• Blood draw for laboratory purposes and medication management.
• G tube care, wound care, DM management, Medication management, PT/INR, Hemoglobin A1C, Accu check.
• Scheduled, coordinated, and delivered patient care for homebound patients in need of medication management and teaching.
• Coordinated Hospice Pharmacia and other medication management to provide timely delivery of ordered medications and education reguarding use.

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average Demand

• Obtained orders for durable medical equipment and facilitated patient attainment of needed equipment.
• Make referrals for durable medical equipment and transportation.
• Managed pharmaceutical and durable medical equipment costs.
• Coordinate ordering durable medical equipment and supplies.
• Assisted with activities of daily living, wound care, pain management and evaluated the need for durable medical equipment.

• Synchronized home health care services and durable medical equipment, and provided compassionate care and understanding for distressed members.
• Evaluated patient needs for services, durable medical equipment, extension of or concurrent treatment and appropriate discharge.
• Educated patients, families and facility staff on disease process, medications, durable medical equipment and safety.
• Assessed patient for durable medical equipment needs prior to discharge, secure order and delivery of items.
• Implemented care such as negotiating and coordinating the delivery of durable medical equipment and nursing services.

• Reviewed medications; provided thorough nursing assessment, including the need for durable medical equipment.
• Input of ICD 9 codes for patient diagnosis, procedures and durable medical equipment.
• Order medications, supplies and durable medical equipment that will aid in pt care.
• Manage labor, pharmacy, durable medical equipment, supplies, and mileage.
• Ensured continuing care services including transportation, durable medical equipment, etc.

• Home safety and durable medical equipment needs assessed with each visit.
• Ordered durable medical equipment as needed.
• Oversee and manage medications, durable medical equipment and varied treatment and modalities to provide comfort during the dying process.
• Facilitated hospital transfers, hospice, home health, and durable medical equipment..
• Coordinate set-up of homecare, enteral therapy,IVinfusions, transports, medication authorizations, and durable medical equipment.

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average Demand

• Administered intravenous medications and blood products via PICC line and peripherally inserted lines.
• Accessed PICC lines, SQ PORTS for med administration, lab and performed peripheral and central line dressing changes.
• Provide IV infusion care, access and maintenance of central lines (PICC lines, Ports)
• Established IV Therapy for fluids and antibiotics including PICC lines and implanted port-a-catheter maintenance.
• Provide care of central lines, including PICC lines, Hickman's, and Port-A-Cath's.

• Home care visit nurse: Rehab, IV/PICC management, Infusion, Med Surg, HHA supervision, Triage
• Case managed greater than 25 patients, competent with wound-vac application, PICC line care, and venipuncture.
• Performed and monitored infusion therapies of PICC lines, Hickman catheters, infusports and CADD pumps.
• Nurse Consultant * Placement and maintenance of PICC lines, mid-lines and peripheral IV lines.
• Inserted IV catheters, assessed, accessed and maintained PICC lines and Medi ports.

• Managed IV administration, changed IV/Picc line dressings, and administered wound care.
• Perform blood specimen collection via venipuncture and PICC line.
• Care included all types invasive lines including piccs.
• Blood draw through IV placement, central lines, PICC lines and ports.
• Experienced with PICC's, PAC's and venipuncture for lab work.

• Care includes, wound care, PICC and subq.
• Perform wound care, venipuncture, PICC line care, catheter care, and stoma care.
• Administered IV medications and cared for IV access devices such as mediports and PICCs.
• Completed various in home infusions using Picc, port-a-cath and peripheral lines.
• Direct care including procedures (wound care modalities, wound vac, IV (PICCs, ports, other devices).

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average Demand

• Perform discharge planning evaluations to determine continuing care needs and make appropriate referrals to community resources.
• Provided community resources for economically challenged patients and their families.
• Connected families with needed and available community resources.
• Provided education to patients on community resources.
• Identify and establish relationships with community resources which can contribute to the network of care for patients.

• Assess the options for care including use of benefits and community resources to update the care plan.
• Evaluated the stress level of non-paid family caregivers, provided instruction, and recommended community resources.
• Researched, developed, and maintained community resources, initiated referrals for clients and family.
• Coordinated community resources, with emphasis on medical, behavioral, and social services.
• Provide patient education, monitoring of health needs, and coordination of community resources.

• Coordinate with physicians, community resources to provide comprehensive patient care.
• Assisted clients with locating community resources and education of disease processes.
• Organize and distribute community resources for specific patient needs.
• Research, develop, and maintain community resources.
• Coordinate community resources as needed by the patient.

• Utilized community resources for specific needs of patients.
• Assist patient and family with community resources.
• Identified community resources for members as needed.
• Utilize critical thinking skills to intervene with acute exacerbations, ability to use community resources to assist family with needs.
• Assess new admissions, liase with family members and community resources to develop personalized care plans.

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average Demand

• Anticipate disease progression and implications for symptom management.
• Provided continuing symptom management throughout patient journey.
• Recorded pain/symptom management changes/outcomes as appropriate.
• Assessed and implemented symptom management such as pain, sob, altered mental status, fluid overload and wound care.
• Provided hands on care to patients during end of life care ensuring symptom management to patient and family satisfaction.

• Educated patient, family, and/or caregivers on end stage disease processes, safety, and symptom management.
• Educate patients, families and facility staff in comfort care, symptom management and disease progression.
• Provide support, symptom management, dignity at end of life to patients and families.
• Work with an interdisciplinary team to provide pain and symptom management of terminally ill patients.
• Specialized in symptom management and education in comfort care of patients at end of life.

• Provision of bedside nursing, symptom management, and crisis/ family intervention.
• Provide assistance to other Case Managers for acute symptom management.
• Recorded pain and/or symptom management changes and outcomes as appropriate.
• Evaluate patient for symptom management, health problems and needs.
• Provide pain and symptom management.

• Transferred/Admitted patients into the Hospice House for pain/symptom management, special procedures such as paracentesis.
• Collaborate with physicians and make medication recommendations to ensure best treatment for symptom management.
• Team designed to see both hospice and homecare patients with poor prognosis or needing aggressive symptom management.
• Provide symptom management and services requiring substantial and specialized nursing skills related to end of life care.
• Provided expertise in pain and symptom management while addressing physical, psychosocial and spritual needs of the patient.

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average Demand

• Review medical records for authorization of inpatient hospital, skilled nursing facility or swing bed admissions.
• Contributed substantially to medical records and QA/QI department with weekly review of nursing documentation.
• Document and review medical records via computerized medical records system.
• Assess documentation of medical records for completeness on concurrent basis.
• Perform concurrent review of medical records for utilization review.

• Maintain accurate and updated medical records.
• Perform a thorough review of patient's medical records, current and prior medical and social histories.
• Assist with QA of medical records and some billing, assigning all disciplines as appropriate.
• Complied with all HIPPA regulations regarding proper storage and disposal of medical records.
• Recorded medical histories, vital statistics, and tested results in medical records.

• Maintain accurate and detailed medical records and charts.
• Performed current and concurrent review of medical records.
• Documented and managed medical records in C3 software.
• Reviewed CM medical records to assist QI/QA.
• Analyzed medical records data and identified nursing diagnoses to develop DDA clients individualized comprehensive plan of care.

• Provide documentation through electronic medical records for recertification periods.
• Recorded patients' medical history, nursing assessment, vital statistics, treatments, medications and test results in medical records.
• Gather medical records on new enrollees to input in to electronic medical record while evaluating for deficiencies.
• Accessed Care 4 electronic medical records for Memorial Hermann clinical.
• Care for terminally ill patients Draft medical records Comfort grieving families Respond to emergency situations Educate patients and their families Administer medications

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average Demand

• Performed medication administration, set up and teaching and monitoring of client self-administration of medication.
• Provide direct skilled nursing care to patients suffering from dementia; wounds stages I-IV; CHF exacerbation; IV medication administration.
• Conduct in-person nursing assessment, medication administration at urgent care setting, assists providers with health evaluation when it is necessary.
• Administer medications via PICC line, peripheral intravenous line, and intramuscular injection adhering to the five rights of medication administration.
• Provided triage, direct nursing care, and medication administration to patients during end of life and crisis situations.

• Organize, prioritize, and document assessments, interventions, medication administration, education, and care plans.
• Handled medication administration, dressing changes, IVs and all other aspects of nursing care.
• Pain management, IV medication administration, blood transfusions, wound care, discharge planning.
• Followed MD orders for medication administration, wound care and special procedures in patient homes.
• Provided nursing care to include medication administration, dressing changes, F/C, and labs.

• Administer insulin, perform wound care, catheter care, and medication administration.
• Port central line IV care access and IV medication administration through central line.
• Monitor patient TS for changes in needs and effectiveness of medication administration.
• Instruct patients and families on proper medication administration and side effects.
• Case Management, medication administration, treatment plans.

• Counseled members on how to organize their healthcare needs, medication administration, follow up care, and self-advocacy.
• Blood draws, Foley catherer insertion, IV feedings and medication administration, wound care.
• Performed blood draws, foley catheter insertion, and medication administration.
• Provided compassionate nursing procedures, medication administration, labratory collections and other treatments prescribed by physicans.
• Performed daily V/s and Head to toe assessment on clients Venipuncture for blood collection Medication administration UAS/SAAM report trained

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average Demand

• Collaborate effectively with interdisciplinary team to include physicians, social workers, and other support staff.
• Facilitated referrals to physicians, physical and occupational therapists, chaplains, social workers and home health aides based on need.
• Coordinate with physicians, social workers, chaplains, and home health aids to provide elite care during end of life.
• Maintained continuous communication of patient status to all disciplines including social workers, chaplaincy, physicians, and family members.
• Collaborate with members, family, social workers, physicians, therapists and various service providers based on need.

• Coordinated care with social workers, physical therapists, occupation therapists, speech therapists and personal care workers.
• Coordinated patient care with physical therapist, speech therapist, social workers and wound care specialist.
• Work collaboratively with other disciplines including social workers, volunteers, chaplains, and aides.
• Assisted chaplains and social workers in providing supportive care to patients and their families.
• Worked closely with Social Workers to coordinate care of the developmentally disabled members.

• Supervised staff of eight case managers consisting of RN's and Social Workers.
• Coordinate care with hospice aides, chaplain, social workers, and PCC.
• Coordinated with physicians, social workers and chaplains to provide holistic care.
• Trained and supervised, 1 LPN and 4 Licensed Medical Social Workers.
• Provide patient and provider education - working with social workers post discharge Review and audit patient charts through on-site hospital visits.

• Coordinated care with a multi-disciplinary team which included, nursing, physicians, physical therapists, social workers, and chaplains.
• Coordinate care with physicians, CNA's, Social Workers, Volunteers and Facility nurses to ensure team driven care.
• Managed a team of Chaplains, Social workers, and home health aides to provide best possible care to patients.
• Worked closely with pharmacists, dieticians, and social workers in delivering excellent care.
• Coordinate a collaborative hospice care team that includes healthcare providers, at-home care services, social workers and spiritual advisors.

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average Demand

• Managed all aspects of patient care, scheduled LPN/HHA visits, Collaborated with team members for optimal quality of care.
• Perform home assessment with HRA's for new/existing patient and justified hours for HHA.
• Required to perform supervision of other disciplines (HHA, LPN.)
• Supervised nurses and HHA, completed on call and routine schedules.
• Case Management, Admissions, HHA SV, Teaching and Discharges

• Supervised care given by HHA and LPN
• Developed/supervised HHA plans of care.
• Performed HHA and LPN supervision.
• Coordinated care with MD's, PT, OT, HHA & other personnel involved in patients care.
• Coordinate care with other disciplines-PT, PTA, HHA, SN, etc.

• Team Management: Managed LPN'S and HHA'S.
• Provide supervision of LPN's, HHA's.
• Oversee licensed practical nurses (LPNs) or home health aides (HHAs) working with patient as care team leader.
• Supervised and evaluated CHHAs, monitored staff assignments, and staffing patterns.
• Plan and write yearly schedule of HHA inservices.

• Supervised LPNs and HHAs and reported findings.
• Supervised and provided clinical support to 40 HHA's, 10 LPN's and RN's.
• Supervised CHHAs and LVNs, with progressive documentation every two weeks.
• Managed and supervised a team of RNs, LPNs, HHAs and PCAs to provide effective and quality home care services.
• Case manager for 25-30 pts ,supervising HHA, PT, OT ,SW,OT,LPN'S.

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average Demand

• Performed initial nursing assessments and ongoing weekly assessments to ensure effective delivery of palliative care within the hospice philosophy.
• Provided palliative care in outpatient/inpatient settings ranging from assessment to development and implementation of care plans.
• Trained extensively in Medicare and state regulations governing home care and hospice/palliative care.
• Pain management and comfort/palliative care given.
• Provided medical care to those in need including, but not limited to diabetes, cardiac, wound and palliative care.

• Attended Interdisciplinary group meetings and collaborated with the hospice team to provide continuity of care and ensure palliative care being administered.
• Perform palliative care, end of life treatment to terminally ill patients at their homes and private and government facilities.
• Served as a community liaison on issues related to referrals and admissions for hospice and palliative care services.
• Lead Nurse San Diego Hospice and Palliative Care, San Diego, CA Inpatient setting Charge nurse.
• Executed palliative care while, acting as the Lamaze coach for patients in their final stages.

• Position: Certified Case Manager in chronic disease, post-surgical and end of life palliative care populations
• Coordinated care for hospice and palliative care patients under Medicare, Medicaid and private insurance guidelines.
• Administered palliative care and comfort measures for patient and family members at end of life.
• Gained extensive experience in palliative care and aggressive pain management in cancer patients.
• Educate the patient and their family about the dying process and palliative care.

• Administer skilled nursing and palliative care to terminal patients and their families.
• Care of terminally ill patients that have opted for comfort/palliative care.
• Initiate VNA Home Hospice Program for palliative care patients.
• Provide palliative care to patients on hospice services.
• Provided Palliative Care for homebound Medicare/Medicaid clients and support for family and caregivers.

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average Demand

• Collaborated and coordinated patient medical services with Primary Care Physicians, Behavioral Health, specialist and vendors.
• Experience in instructing primary caregivers to provide care as indicated.
• Coordinated with primary care physician and patients insurance providers to assist patients with optimal health benefits that fit their needs.
• Ordered labs and obtain specimens for diagnostic testing, communicated all findings and current conditions to primary care physician.
• Managed panel of complex adult patients in an ambulatory medical home in partnership with primary care providers.

• Informed primary care physicians of any changes in patients' condition, exacerbation of the disease process.
• Conducted nursing visits, attended primary care visits, and contributed to development of treatment plans.
• Frequent contact with Doctor s offices to maintain open lines of communication with Primary Care Teams.
• Coordinate services between Primary Care Physician (PCP) specialists, and other ancillary/ non-medical providers.
• Monitor, record and report symptoms or changes in patient's conditions to primary care physician.

• Coordinate care of patients with primary care physician and insurance companies for optimum health of patients
• Assist the OEF/OIF Veterans with Labs, Mental health, and Primary care appointments.
• Provide care coordination with patients, primary care providers, and relevant Pastoral support.
• Identified teaching needs of primary caregivers and taught them a variety of subjects.
• Instruct families, primary caregivers and agency caregivers to provide quality care.

• Provided weekly status review with Primary Care Physician for all patients.
• Collaborate with Primary Care Physicians to support patient-specific plan of care.
• Provided primary care and assistance with daily living activities.
• Team leader, Primary Care and case management.
• Monitored, planned and advocate for the patients Delegates tasks of ADLs and IADLs to primary care givers.

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average Demand

• Documented all pertinent information in patient record, including medication dosage and pain management.
• Developed and implemented pain management care; provided emotional and spiritual support.
• Provide professional pain management and symptom management for hospice patients.
• Completed Certification in Advanced Pain Management therapy techniques.
• Educated patient and family about pain management, signs and symptoms of approaching death and how to handle these events.

• Instructed patients and their families on proper care, teaching provided on dietary, medications and pain management.
• Instruct clients and care takers on home infusion treatments, pain management, infection control, and medications.
• Conduct home-health visits, overseeing pain management, wound care, charting and patient observations.
• Consult with senior executives and provide experience and knowledge for tentative Pain Management Program.
• Coordinated pain management in concert with physicians, pharmacies, patients and families.

• Pain management is the daily goal, help pt.maintain his/her comfort level goal.
• Handled quality of life tasks, including providing comfort and pain management.
• Educated family to assess and provide pain management and support for patient.
• Case management of terminally ill patients including pain management and wound care.
• Provided education in disease processes, medications, and pain management.

• Facilitated symptom and pain management during end of life process.
• Pain Management and symptom control along is priority.
• Experienced in pain management and patient comfort.
• Pain management is my major concern and I use many different tools to ensure my patient's pain is under control.
• Collaborated with medical director, formatting comprehensive pain management program utilizing pharmaceutical and nonpharmaceutical modalities.

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average Demand

• Assess for medical necessity & appropriateness of admissions/ treatments by utilizing InterQual criteria using a multidisciplinary approach
• Utilize InterQual criteria to confirm medical necessity for admission and continued stay.
• Performed utilization management and discharge management according to InterQual criteria.
• Utilize InterQual Criteria for observation and in-patient admission status.
• Based on InterQual Criteria, medical history, and current illness, wrote an appeal or accepted current status.

• Determine the medical necessity and appropriate admissions through the ER using InterQual criteria.
• Use of InterQual criteria software and EHR for secondary reviews.
• Used INTERQUAL for guidelines for reviewing for approval.
• Reviewed inpatient charts for medical necessity using the interqual criteria;assisted in development of discharge plan
• Provided utilization management for medical necessity of hospital level of care using Interqual criteria software.

• Utilized approved medical resources including InterQual Criteria, and Millman Guidelines.
• Perform concurrent and retroactive utilization reviews on patient units using Interqual.
• Facilitated utilization review for 58-90 patients daily using Interqual.
• Visit multiple hospital in the area for the purpose of Care review and application of Interqual criteria.
• Promoted quality and cost effective outcomes using Interqual criteria for 138 bed acute care facility.

• Completed Interqual Assessments on all new potential Hospital Admissions from the ED.
• Perform Interqual reviews as per policy on accounts with government payer.
• Enter case management information into MIDAS and Interqual.
• Performed medical necessity reviews for admission and concurrent reviews based on InterQual criteria.
• Complete chart reviews utilizing Interqual and Milliman Guidelines to aid the physicians in documenting for payer reimbursement.

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average Demand

• Collaborate with facility, family and hospice team to assist with providing optimal level of comfort during end of life care.
• Served as a liaison between patients and multidisciplinary team, assisted patient and family with end of life care/decisions.
• Offered support to patient, family, friends, and staff when it came to end of life care.
• Home and Nursing Home care visits to adult, geriatric and pediatric patient for end of life care.
• Provided end of life care for patients and their families following diagnosis and treatment for a terminal disease/illnesses.

• Performed end of life care, as well as the pronouncement of patient death on a consistent basis.
• Assist the Case Manager when needed to provide end of life care for patients in their homes.
• Provided end of life care for people in their own homes as well as in care centers.
• Provide end of life care for terminal patients in their homes and long term care facilities.
• Registered Nurse Case Manager for high profile hospice and provider of end of life care.

• Consulted with and educated patients and family members regarding self-care and end of life care.
• Coordinate care for patients to provide comfort and dignity in end of life care.
• Managed patient medications, provided patient and family education on end of life care.
• Provide compassion and support for patients and families needed end of life care.
• Educated patients and families on hospice philosophy and end of life care.

• Prepare the family for what happens during end of life care.
• Participate in educational programs about hospice and end of life care.
• Learned the philosophy of hospice for end of life care comfort
• Developed and managed end of life care plan.
• Served as a member of interdisciplinary healthcare team in providing End of Life care and nursing interventions to promote patient comfort.

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average Demand

• Monitored Aides, collaborated with Doctors, Physical Therapy Occupational Therapy and Assisted Living staff.
• Collaborated with physicians, occupational therapy, and physical therapy for additional patient interventions.
• Coordinated care with physical therapy, occupational therapy and speech therapy.
• Collaborated care with physical therapy, occupational therapy and social work.
• Evaluated their need for physical therapy, occupational therapy, speech therapy, social worker, and home health aide.

• Reviewed and evaluated treatment plans to determine medical goals for physical therapy, occupational therapy, and speech therapy.
• Confer and manage patient care with physicians, physical therapy, occupational therapy, and other disciplines as needed.
• Coordinated other disciplines such as physical therapy, occupational therapy, speech therapy and social work as needed.
• Admit and assess patients for skilled nursing, physical therapy, occupational therapy or speech therapy needs.
• Work closely with physicians, physical and occupational therapy, social workers, aides, chaplains.

• Qualified to provide referrals to physical therapy, occupational therapy, and speech therapy.
• Discussed cases with physician and physician's nurse, physical therapy and occupational therapy.
• Coordinate care with physical therapy, occupational therapy, social workers and doctors.
• Assessed and delegated needs for physical and occupational therapy and personal care needs.
• Coordinate physical therapy, occupational therapy, and home health aide needs.

• Coordinate Physical Therapy, Occupational Therapy and Speech Therapy disciplines.
• Coordinated patient care with physical therapy, occupational therapy, speech therapy, medical social workers, and home health aides.
• Coordinate care of patient between physical therapy, occupational therapy and speech therapy Coordinate care with primary physicians of each patient.
• Coordinate appropriate care, encompassing various healthcare personnel (such as Physical Therapy, Occupational Therapy, Home Health Aides).
• Collaborate care with multidisciplines such as certified nursing assistants, physical therapy, and occupational therapy, and speech therapy.

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average Demand

• General assessment and care/case management of Medicare patients including wound care, diabetes, cardiac complications, respiratory treatments.
• Provided patient and family education on home infusion of antibiotics, wound cares, diabetes management, and heart failure management.
• Provided skilled, intermittent home care services to adults including assessments, wound care, diabetes management and colostomy care.
• Performed the duties of a telephonic case manager for a high risk diabetes Medicaid population in the Florida Panhandle.
• Experience with various health problems including Parkinson's, Dementia, Alzheimer's, diabetes and cancer.

• Educated family on management of chronic conditions such as asthma, diabetes, hypertension, and CHF.
• Provided telephonic case management to members with Congestive heart failure, Diabetes, and complex medical conditions.
• Specialize in care of patients with conditions such as diabetes and heart failure, etc.
• Provided education for diabetes, heart disease, after surgery care, and medication teaching.
• Specialized in intensive wound care including wound vacs, diabetes education and post-surgery care.

• Manage Diabetes in Pregnancy, patient care, education and follow up.
• Provide nursing staff skills training (diabetes management and wound management).
• Implemented chronic disease management protocols for congestive heart failure, chronic obstructive pulmonary disease, diabetes, and coronary artery disease.
• Prepared and administered Diabetes education, Nutrition and Advance Directive classes.
• Experience with various medical conditions including Parkinson's, Dementia, Diabetes, Cancer, Alzheimer's and Cardiovascular Disease.

• Educate patient to become independent in self care needs related to Diabetes, ostomy care wound care, etc.
• Promote healthy lifestyle ie smoking cessation, diabetes lifestyle changes, and other autoimmune diseases.
• Educated newly dianosed diabetics on the disease process and chronic complications related to diabetes.
• Assessed affects of patient meds, monitored patients diabetes and blood sugar readings.
• Prepared and administered Diabetes education, Nutrition and Advance Directive classes Received Care Manager of the Year March 2004

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low Demand

• Performed on-site supervision of assigned staff and provided clinical directions to the LVN to ensure quality and continuity of service provided.
• Supervised and provided clinical directions to the HHA/LVN to ensure quality and continuity of service provided.
• Participate in interviews for RN's and LVN's and provide input for hiring.
• Provided initial assessment and concurrent review for patients; managed LVN staff.
• Evaluate and develop care plans of LVN's to ensure patient outcomes.

• Direct LVN's and health technicians throughout the work day.
• Completed OASIS visits, on call and supervising LVN co-workers.
• Team leadership & collaboration with field LVN's,
• Oversee LVN and HHA working as care team leader.
• Evaluated LVN's and CHHA's performances.

• Provided care cordinationfor patients such as home health aide, PT, and LVN intervention.
• Supervised home health aides and LVNs, with progressive documentation every two weeks.
• Skilled in the supervision of LVNs and Home Health Aides.
• Reviewed and co-signed orders taken by LVNs.
• Delegated and supervised LVNs and nursing aides.

• Obtained insurance authorization for visit for all disciplines(LVNs, RNs, and aides).
• Supervised LVNs and CHHAs providing care to patients within my caseload.
• Instructed and supervised LVNs and CHHAs.
• Implement complete homecare with all disciplines, including LVNs and CHHAs, and documented every two weeks.
• Manage multiple patients with all aspects of nursing Multi-disciplinary team meetings Monitor LVNs, HHA documentation EHR documentation: AHT

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low Demand

• Audit patient charts for completed documents necessary for billing and reimbursement of Medicare/Medicaid and other private insurance companies.
• Served on point to establish coordinated efforts with government regulators and insurance companies.
• Involved and responsible for fiscal management with Medicare and Insurance companies authorizations.
• Work closely with private insurance companies and monitor the needs for patients while in the hospital and after discharged from facility.
• Case managed over 200 patients through contract work for insurance companies to help keep their clients out of the hospital.

• Performed admission and concurrent chart reviews for insurance companies, worker's compensation and other third party providers.
• Planned and scheduled patient visits, obtained insurance authorizations from insurance companies and CCCI.
• Worked with the insurance companies to provide member's with referrals for needed services.
• Reviewed all therapy notes to collect important information and report to insurance companies.
• Manage the appeals process for 2 major insurance companies in the Philadelphia area.

• Refer to EHR or insurance companies as appropriate for reimbursement.
• Worked with third-party insurance companies and workman's compensation.
• Provide reviews and update to managed-care insurance companies.
• Provide clinical review for insurance companies.
• Worked closely with insurance companies for pre-authorizations and stays.

• Obtain authorization by many health care insurance companies by phone, fax, and web portals.
• Coordinate outpatient care with panelists, homecare, infectious disease, and various insurance companies.
• Work with insurance companies, third-party payors and Medicaid to get needed services approved.
• Work closely with insurance companies to reduce readmissions.
• Skilled nursing visits for med-surg and hospice Function as liaison between clients, insurance companies, and physicians Obtained R.N.

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low Demand

• Monitored vital signs, ensured safety and supported and coordinated medication administration with physicians.
• Take vital signs, give injections, fill pill boxes, syringes, and perform wound care.
• Performed initial intake, physical assessments, obtained vital signs, past medical histories, and consents.
• Monitor vital signs, dialysis adequacy, medication adherence, monitor for signs of fluid overload.
• Home visits to include checking vital signs, collecting labs, checking and caring for wounds.

• Carried out duties such as administer and setup medications, monitor and document vital signs.
• Interviewed patients to obtain medical information and measure their vital signs, weight and height.
• Obtain routine vital signs and cardiopulmonary assessments and report to physician.
• Perform evaluation tasks, including vital signs and medication review.
• Record patients' medical information and vital signs.

• Obtained and recorded patients' vital signs.
• Full set of vital signs.
• Collaborated closely with nurses and nursing staff with feeding patients, bathing, and obtaining vital signs.
• Monitor, record, and report vital signs, symptoms or changes in patients' conditions.
• Monitored patients vital signs, electrolytes, oxygen saturation, and glucose levels.

• Monitor vital signs, signs and symptoms of decline, medications.
• Obtain vital signs and complete careplan.
• Monitor patient status and vital signs Schedule case load Communicate with physicians and other ancillary departments when needed
• Used Kinnser systems for documentation Record patients' medical information and vital signs.
• Admit patient to service Full body patient assessment & vital signs Assess home for safety issues Check medications

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low Demand

• Integrate case management, care coordination and/or utilization management and discharge planning assessment.
• Care coordination for case load of terminally ill patients in cooperation with interdisciplinary team
• Participate in care coordination activities and discharge planning as appropriate.
• Care coordination and direction provided.
• Case manage High Risk Veterans for Suicide and assist with their case management and care coordination needs.

• Provided primary case management, care coordination services for military beneficiaries, retirees and their families.
• Care coordination for geographical areas of the state's top 2% high -acuity Medicaid population.
• Care Coordination Committee - meet with administrators to discuss all aspects of patient and resident care.
• Managed teams in association with AHRC, to develop care coordination based on person-centered care.
• Post inpatient and ER visit outreaches to members for follow up and care coordination.

• Conduct face-to-face home assessments of physical and functional factors as basis for care coordination.
• Care coordination, discharge planning, and concurrent review for Adult Medical Observation Unit.
• Care coordination among disciplines for optimal end of life experiences.
• Provided care coordination for HIV/AIDS clients.
• Provided care coordination and education to clients telephonically.

• Participate in IDG meetings with Hospice Team and Care Coordination meetings with faciities involving patient care.
• Assessed the members health status and care coordination needs.
• Care Coordination and Clinical nursing Case manager for Pediatric HIV program Case manager for Cleft Lip/Palate program
• Work with insurance to receive prior auths and care coordination performed with multiple therapies.
• home IV therapy, patient education, care coordination

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low Demand

• Provided wound care, central line care, lab draws, and medication/disease education for proper health maintenance.
• Care includes IV infusions, wound care including wound vac, lab draws, and skilled nursing assessments.
• Skilled nursing cares; wound care, lab draws, infusion therapy, general nursing assessments.
• Administered IV infusions, performed lab draws, wound care, catheter care as needed.
• Performed lab draws, prepare specimens, and set up patient rooms.

• Performed wound care, IV infusion, patient/family education, lab draws.
• Access ports for lab draws and infusion therapies using sterile technique.
• Obtained lab draws on patients that were difficult sticks.
• Perform any lab draws or SNV as needed.
• Performed weekly lab draws and central line care.

• Performed lab draws and IV therapy.
• Perform lab draws, PT INR's, and any orders per positions.
• Performed weekly lab draws and central line care to patients with Picc lines, ports and peripheral lines.
• Perform head to toe physical assessment, wound care, home infusion therapy, home lab draws.
• Performed at home IV therapy, PICC line and implanted medi-port management and lab draws.

• Performed lab draws, scheduled MD appointments, provided wound care, and foley changes.
• Perform wound care, lab draws, urinary catheter and tracheostomy care.
• Experience with PICCs, lab draws, and medication administration.
• Case managed home health care patients, IV home infusion, IVIG and picc care, lab draws.
• Monitor patient conditions, psychopharmacology drugs, Foley catheters,injections, lab draws, and wound care.

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low Demand

• Provide education to clients and family members about disease processes and provide emotional support and recommendations.
• Provided emotional support and caregiver validation during difficult time in life of patient and families.
• Provide emotional support to family members during expiration process and after patient expiration.
• Provided behavioral/emotional support and supervision for those with dementia and Alzheimer's.
• Provided emotional support to distressed families.

• Provided emotional support and resources.
• Provide clinical aspect of the end of life, emotional support, spiritual, and social aspect as well.
• Assist with care, provide companionship and emotional support for patients, assist with office data processing as needed.
• Provided emotional support and education to the patient and their families, including terminal diagnosis and death.
• Provide direct nursing care, education and emotional support to terminally ill patients and their families.

• Educate patients, caregivers, and their family members on disease progression while providing emotional support.
• Provide emotional support for the patient and their families keeping them educated and informed.
• Provided emotional support and education to patients and families during end of life.
• Provide symptom control and emotional support to patients and families in five-county region.
• Provide comfort, reassurance and emotional support to the family and the patient.

• Provided respite care and emotional support for families and caretakers of the dying.
• Educate and provide emotional support to patient and family during the dying process.
• Provide emotional support for patients and families during active dying and death.
• Provide emotional support to patients and families.
• Home Care Patient-Centered Focus Emotional Support Geriatric Treatment Knowledge Chronic Care Experience

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low Demand

• Provide direct care to patients as prescribed by the Interdisciplinary Team (IDT), assuming primary responsibility for case management.
• Work closely with members of IDT, including physicians and provide direct patient care in the home and in nursing facilities.
• Develop, coordinate and direct hospice nursing care according to the Interdisciplinary Team (IDT) plan of care.
• Attend weekly IDT meetings with (medical director and hospice team) to ensure patient needs are being met.
• Coordinated care with IDT members, PCP, medical directors, facility staff and patients and their families.

• Coordinated nursing care, IDT support, assessment, admission, utilization management, and patient education.
• Work in cooperation with the family/caregiver and IDT to meet the emotional needs of the patient/family/caregiver.
• Conducted timely intervention, education, IDT collaboration, cost savings, and effective caseload management.
• Participated in IDT meetings, keeping all team members up to date on clients' conditions.
• Attend IDT with medical director to discuss recent admissions and symptom management for current patients.

• Team member in collaboration with the IDT to ensure quality of care.
• Participated in IDT meetings to evaluate client's response to care.
• Initiate and update care plans within an IDT setting.
• Attended IDT meetings on a 2 week basis.
• Attend bi-weekly IDT meetings for patient's review.

• Worked with IDT to manage patient care.
• Attend IDT meeting via webex conferencing or in person with physicians to discuss patient care, HEDIS measures, care plan.
• Case Manager, IDT Team Member, Caring for patients with life expectancy of 6 months or less.
• Collaborated with Families Physicians and IDT Admission Nurse for Rosenthal Residence End of Life.
• Identify barriers and participate in weekly IDT meetings with staff of hospice..

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low Demand

• Secured top-quality care via advocacy, assessment, planning, facilitation, and improving care coordination through communication and collaboration.
• Focused primarily on patient assessment, delivery of quality care, supervision of auxiliary staff.
• Provide quality care through developing, implementing and evaluating individual patient care plans.
• Assisted and intervened as appropriate to ensure quality care was consistently provided.
• Provide a complete continuum of quality care through close communication with members (patients) via in-person or on phone interaction.

• Maintain department philosophy, goals and objectives, standards, policies and procedures and interpret these to ensure high-quality care.
• Performed direct supervision of clinical care group to ensure following of plan of care and provided quality care to patients/clients.
• Developed and maintained quality care systems and standards, including but not limited to, creating and improving medical protocols/guidelines.
• Work closely with physician's to adjust medication and other pertinent treatments to provide the highest level of quality care.
• Track patients' progress through the continuum of care with a focus on quality care and improved patient outcomes.

• Developed individual client care plan's in order to provide quality care through a client's plan provider.
• Delivered compassionate and high quality care to home health and hospice care patients of varying backgrounds and cultures.
• Work in a team concept to provide quality care to patients and their families.
• Interacted with family, caregivers and primary physicians to ensure quality care.
• Focus on outcome based quality improvement for patients and effective quality care.

• Developed plans of care and provide quality care.
• Ensured residents were treated with respect and dignity and received quality care as resident's healthcare needs change.
• Key Accomplishments: Provided patient needs in order to ensure quality care while marinating their home environment.
• Coordinated with all members of the healthcare team to provide quality care to patients with terminal illnesses.
• Coordinated care between members of healthcare team to provide quality care for patients.

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low Demand

• Provided nursing care for patients with diagnosis including: Dementia/Alzheimer, Cancer (various), COPD, and many others.
• Experience in teaching patients about their disease process including COPD, CHF, diabetes, stroke, and VAD patients.
• Cared for a variety of patients with skilled needs including wound care, CHF/COPD/Diabetic management, post-surgical and psychiatric conditions.
• Managed clients with chronic illnesses such as Diabetes, CHF, COPD, Heart Disease, Kidney Disease and Arthritis.
• Work with providers to institute educational programs for patients with chronic diseases such as diabetes, hypertension and COPD.

• Educated patients and caregiver information related to their condition (diabetes, COPD, cardiac).
• Educated patients and families with multiple chronic diagnoses including COPD, Diabetes, and CHF.
• Assisted patient's with multiple chronic diagnoses, including COPD, CHF, etc.
• Coordinate and administer out-patient care to lower income asthma and COPD population.
• Monitored cardiac, COPD, diabetic, wound care and post-operative patients.

• Focus on diabetes, cardiovascular disease, CHF, and COPD.
• Experience in teaching on COPD, CHF, diabetes, stroke and VAD patients.
• Provided behavioral/emotional support and supervision for those with dementia and Alzheimer's.Assisted patients with multiple chronic diagnoses including COPD and asthma.
• Diagnosed and treated patients with chronic and acute health problems such as MI, arrhythmias, asthma, COPD and pneumonia.
• Assisted patients with multiple chronic diagnosis, including COPD, asthma, MI, arrhythmias and pneumonia.

• Care for patients with terminal CA, end-stage heart disease, end-stage COPD and end-stage dementia.
• Assisted patients with multiple chronic diagnoses including COPD and asthma.
• Cared for Cardiac, CHF, COPD and Wound Care patients, Wound Vacs and Drains.
• Educated pt and family on disease process such as htn, copd, diabetes, and heart disease.
• Use of biometric monitoring to assist members with HF and COPD to manage their condition and prevent readmissions.

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low Demand

• Provided education to patients on disease process, and return demonstration of skills r/t blood pressure monitoring and blood glucose testing.
• Complete verification of the healthiness of the patient by examination of body temperature, blood pressure, patient record and signs.
• Developed multiples educational programs relating to first aid, CPR, Heart disease, Diabetes, and High blood pressure.
• Evaluate patient monthly in clinic i.e., blood pressure, weight, adequacy, and ongoing patient education.
• Participated with Health Fair as the RN, taking blood pressures, answering health questions and distributing pamphlets.

• Provided education on disease state management, medication changes, blood pressures, and did community flu clinics.
• Established and lead Transplant Blood Pressure clinic for patient/family and multidisciplinary care clinics for client members.
• Created new ARC Baltimore policies for Hospital Admissions, Shingles Vaccination and Routine Blood Pressure Monitoring.
• Complete check of the health of the patient through observation blood pressure and body temperature.
• Assess blood pressure and blood sugar, notifying MD if results are out of parameters.

• Planned and implemented a blood pressure clinic in conjunction with the Internal Medicine Department.
• Take vital signs including temperature, pulse, respiration, and blood pressure.
• Performed and created blood pressure clinics and foot care clinics for the community.
• Provided IV therapy, assessed blood pressures, and diabetic status.
• Monitored vital signs, such as blood pressure and pulse.

• Coordinate and provide monthly blood pressure clinics.
• Blood Pressure, Exercise and Flu Clinics
• Take and record TPR's, blood pressures, etc.
• Assisted physician in part-time clinic obtaining blood pressures, weights, blood sugars, and 10-lead EKGs.
• Screened patients for vitals, weight, blood pressure, blood sugar and bone mineralization.

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low Demand

• Coordinated placement of discharged patients by interacting with top HMO and service provider officials to ensure continuation of quality medical care.
• Coordinate services, medical care and community resources involved in patient/family care.
• Devised cost-effective and medically necessary strategies for medical care.
• Managed a personal patient load that encompassed their medical needs, supplies, and direct medical care.
• Evaluated proposed treatment for medical necessity prior to and during the delivery of medical care.

• Work with high ER users to decrease hospital use and improve quality of medical care.
• Managed a caseload and educated our patient's on disease process and current medical care.
• Recognize symptoms of ill health and provide appropriate medical care such as wound care.
• Perform Clinical Case Manager task to provide an integrated solution to Home Medical Care.
• Conducted post injury assessment to ensure the delivery of timely and proper medical care.

• Provide in home skilled nursing visits in all aspects of medical care.
• Managed the medical care for 30+ individuals who are developmentally delayed.
• Coordinate medical care for 32 adolescent girls residing at facility.
• Coordinate management of patient services and medical care.
• Provide medical care to patients in their homes.

• Provide necessary medical care 24/7 to clients.
• Function autonomously as a consultant and collaborator with multiple disciplines to identify issues and circumstances that affect medical care.
• Case managed complex behavioral and medical care issues Developed marketing strategies to recruit and maintain business relationships with providers
• admitted patients into home health services, assisted in managing their medical care and needs using a multidisciplinary approach.
• Admitted, recertified, discharged, and re-started medical care for patients as necessary.

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low Demand

• Sound, ethical and independent decision making ability consistent with physician orders and medical protocols.
• Complete prior authorizations, obtaining signed physician orders and accompanying paperwork necessary for PA approval.
• Manage and process physician orders and medication administration records.
• Document electronically all physician orders and OASIS documentation.
• Received referrals and obtained physician orders as needed.

• Developed, implemented, coordinated and evaluated patient care plans according to physician orders as allowed by their scope of practice.
• Admit patients and confer with the physician in developing the plan of care based on physician orders and initial nursing assessment.
• Follow up with members on a regular basis to insure appropriate follow up with appointments, testing, physician orders.
• Identified patient's home care needs, obtained and directed physician orders toward home care, and obtained Insurance authorizations.
• Complete nursing assessments, creates plans of care, and carries out care to patients per physician orders.

• Plan, provide, supervise and document competent hospice nursing care for patients in accordance with physician orders.
• Educated patients and families on disease processes, treatment plans, medications, and physician orders.
• Implemented Plan of Care obtaining physician orders and provided skilled nursing care as appropriate.
• Communicate to physicians on patient's health status, receive and follow physician orders.
• Obtain physician orders and facilitate physician intervention when deemed appropriate and require Train staff on nursing care and general health assessments.

• Performed Starts of Care, nurse visits, supervised LPN's and Home Health Aides .maintained physician orders and patient relations.
• Provide direct patient care according to Physician orders and Caris policies and procedures.
• Registered Nurse carries out physician orders in a timely manner.
• Assure client authorizations and physician orders are obtained and current.
• Obtain and verify physician orders and coordinate care !

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low Demand

• Educated members on there medical diagnosis and ways to improve there health, better control there Asthma, CHF or Diabetes.
• Position required competency in verbalizing and demonstrated understanding of diabetes, asthma, COPD, CAD, and CHF disease processes.
• Skilled Nursing Services: Wounds including wound VAC, Vital Signs, Management of CHF, DM, Liver disease.
• Direct care for patients suffering from CHF, COPD, Diabetes, and Orthopedic Medical conditions in their homes.
• Served on the CHF committee at UVM@CVPH to provide outside community information to the hospital.

• Provided wound care, CHF and cardiac monitoring, urinary catheter care, various drains.
• Performed Core Measures for PNA, AMI and CHF to assist with performance improvement.
• Managed care for patients enrolled in Optimum Care COPD/CHF program within my assigned team.
• Provided services to patients with the following: Wound care, CHF education.
• Participated in Ethics Committee and CHF core Measure Committee for outcomes.

• Worked extensively with members with COPD, CHF, and Asthma.
• Case Manager for CHF and Renal floors.
• Provide disease management to patients with COPD, Asthma, DM, CHF, and CAD.
• Experience with CAD, CHF, COPD, Diabetes.
• Provide medication management, diabetic teaching, chf management and disease process management.

• Manage post op, ortho, oncology, cardiac rehab, CHF, COPD, Diabetic and cardiopulmonary patients.
• Assisted patients with multiple chronic diagnoses including terminal COPD, cancers, CVA, Renal problems and CHF.
• Installed and monitored Telehealth System in conjunction with CHF program.
• Assisted in developing chf teleheAlth program.
• Assisted in Chf protocol for chf teleheAlth program.

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low Demand

• Supervised licensed and paraprofessional staff members and coordinated all care delivery.
• Participated in Interdisciplinary Team Meetings with other hospice staff members.
• Transitioned staff members from written to electronic medical documentation.
• Based upon the plans they develop coordinators then work with all staff members to ensure the plan is implemented correctly.
• Initiated communication with attending physicians, other hospice staff members and referring agencies as needed to coordinate optimal care.

• Investigate and direct patient inquiries or complaints to appropriate medical staff members and follow up to ensure satisfactory resolution.
• Communicate accurately and completely to physicians, ARNP, staff members, patients, families and supervisors.
• Provide Plan of Care for the Patient and review them with staff members on the team.
• Assigned and supervised field nurses and other staff members o the patients team.
• Managed case loads of over 250 patients and oversaw over 20 staff members.

• Communicate effectively with physicians, staff members, patients and families.
• Manage staff members to ensure proper and efficient care is provided.
• Hired and provided quality orientation and in services to staff members.
• Coordinated discharge planning with the help of other staff members.
• Conducted interviewing, training and supervision of staff members.

• Promoted team work among other staff members.
• Assisted training new staff members.
• Train new hires Report to Medical Director and number prison facilities and work with numerous hospitals/staff members.
• Field mentor for new staff members.
• Orient and mentor new staff members - Administer immunizations as ordered - Other tasks as assigned by physicians

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low Demand

• Provide ongoing assessments and oversee PT, OT, HHA, Speech and MSW to assure individuals needs are being met.
• Work in team setting to include LPN's, Physical/Occupation Health, MSW, Pastor and Home Health Aids.
• Coordinated care with other members of the care team including Physical Therapy, Occupational Therapy, MD and MSW.
• Case Management, including referral to PT, OT, ST, MSW and HHA as indicated.
• Collaborate with the primary care team of MD, MSW, chaplain, and clinic manager.

• Open communication with physician, Chaplain, and MSW to provide excellent patient holistic care.
• Assessed patient needs bases for multidisciplinary services with PT, OTMSW and HHA.
• Determine care plan with referrals to CAN, MSW, and chaplain.
• Collaborated with the MSW in all aspects of discharge planning.
• Coordinate care of the client among several disciplines, including PT, OT, ST, MSW, LPN and MD.

• Coordinate plan of care with physicians, PT, OT, ST, MSW, dialysis centers, DME companies.
• Coordinate care between the therapists (PT/ OT/ ST), MSW, Doctors, families, and caregivers.
• Coordinated that care of patients that involved PT, OT, ST, MSW, CHHA and LPNs.
• Evaluate their need for HHA, PT, OT, ST, MSW care in home.
• Coordinate care among PT, OT, ST, MSW, LPN and MD.

• Coordinate care with PT, OT, SLP, MSW, and community resources
• Coordinate HHA, MSW & Chaplain visits.
• Coordinated patients and family on end of life care; coordinated with Dietician, Chaplin, MSW, CHHA and others.
• Coordinated complete home care with physicians, LVNs, certified home health aides, MSW, and therapists as needed.
• Coordinate care of patient with families, medical director, MSW, Chaplain and CNAs.

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low Demand

• Communicated with Program Medical director regarding high risk cases for potential complications and evaluations of appropriate care.
• Provided emergency services when required Evaluate patients and develop appropriate care plans.
• Provided clinical services per reimbursement requirements assuring cost-effective and appropriate care.
• Initiated and maintained contact with physicians; coordinated with all members of an interdisciplinary team to assure consistent and appropriate care.
• Direct all nurses in the appropriate action to take concerning emergencies or questions concerning appropriate care and safety of the patient.

• Participate with interdisciplinary team to provide appropriate care and treatment to patient, and provide support and education to family members.
• Identified and categorized claims expeditiously to ensure each patient followed the most appropriate care path improving return to work outcomes.
• Communicate with doctors, nurses and other utilization review and care management professionals to coordinate appropriate care for each member.
• Communicate with patients and team of health care providers to determine appropriate care plan.
• Instructed multiple family members on disease appropriate care relative to patient's appropriate needs.

• Coordinate the efforts of medical and nursing team members to provide appropriate care.
• Utilize Medicare and Medicaid guidelines to ensure cost effective appropriate care.
• Ensured appropriate care and treatment given for safe return to work.
• Obtained patient history and needs assessment for appropriate care.
• Make sure patient receives quality and appropriate care.

• Evaluated patients and developed appropriate care plans.
• Coordinated appropriate care if required, encompassing various healthcare personnel.
• Redirected members when necessary to more appropriate care settings (i.e.
• Educated pts and families on appropriate care techniques.
• Perform patient assessments face to face and telephonically in order to provide appropriate care.

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low Demand

• Head to toe comprehensive physical assessments were conducted at initial visit and completely and accurately documented along with all information obtained.
• Perform physical assessments, perform respiratory management, nutrition and hydration management for pediatric patients.
• Provided in-person and telephone triage, performed physical assessments for pediatric and adult population.
• Conducted physical assessments, re-certifications, hospice admissions, discharges and revocations.
• Provided in-home services such as physical assessments and providing nursing diagnosis.

• Perform home health physical assessments and evaluate patient learning capabilities.
• Performed mental status examinations and physical assessments.
• Performed physical assessments of postpartum mothers.
• Conducted physical assessments, monitored for changes, and charted as to the appropriateness for hospice care.
• Offered hands-on support with physical assessments, treatment planning, evaluation, and emergency care for patients.

• Completed nursing admission and discharge assessments as well as detailed physical assessments at each visit.
• Performed basic physical assessments of all patients on a routine and as needed basis.
• Performed in home physical assessments of geriatric clients with chronic medical conditions.
• Complete physical assessments and provide direct patient care.
• Performed comprehensive head to toe physical assessments.

• Start of Care/Resumption of Care (post hospitalization) Recertification/Routine Visits * Physical Assessments/Wound Care/Catheter Care/Patient Education
• Provide complete physical assessments, creates plans of care, and advocates for patient's physical health and psychosocial needs.
• Complete physical assessments and medical history, evaluate health assessment data to determine appropriate level of care.
• Conducted physical assessments, wound care, phlebotomies, and diabetes testing/management.
• Performed physical assessments, developed care plans, evaluations and nursing diagnosis * Instructed patient/family in pharmacological and non-pharmacoloical pain control

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low Demand

• Develop a POC that corresponds with the physicians orders through assessment of patient's needs, condition, and environment.
• Assess patient condition to identify additional services needed and prepare a plan of care (POC) form listing treatments.
• Work closely with interdisciplinary team to develop, implement, and review the plan of care (POC).
• Coordinated POC with facility, staff and MD's involved with each patient case.
• Formulate and Implement the Plan of Care, reassess and change POC as indicated.

• Developed POC for Home Health patients according to their needs and PCP's orders.
• Complete monthly supervisory visits, bimonthly OASIS and create/update 485 home care POC.
• Worked directly with physicians to obtain orders and update effectiveness of POC.
• Developed a POC and disciplines necessary to carry out the POC.
• Use of laptop POC for patient charting and case updates.

• Coordinate with facility POC, Facility nurses and administration.
• Developed a POC according to individual's needs.
• Provide Hospice POC for patient in ALF setting.
• Reconcile on every visit medication and coordinate POC.
• Perform initial assessment and formulates POC.

• Complete assessment and implementation of patient POC, Med recs, PCG teaching and instruction.
• Created POCs (485), prepared 60-Day Clinical Summary and reconciled medications.
• Lead trainer in Caretinuum POC roll-out in our office and Northern locations.
• Assure coordinated POC between facility staff and Vitas, RN.
• address their comorbidities following POC signed by MD.

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low Demand

• Provide clinical oversight for hospitalized patients to determine appropriate level of care and medical necessity of admissions and continued stays.
• Determine appropriate level of care and utilization of services while ensuring quality cost effectiveness of services.
• Apply specific criteria for admission and re-certification to hospice care to establish appropriate levels of care and the patient's eligibility.
• Reviewed member's severity of illness vs intensity of services using InterQual criteria to determine the appropriate level of care.
• Assist with the discharge planning process with hospital and/or other appropriate level of care staff by ensuring adequate and appropriate.

• Discharge planning, coordinating with MD directors to ensure criteria is met, member at appropriate level of care.
• Participate in the active expedition of the movement of patient through appropriate levels of care to another facility.
• Establish appropriate levels of care and assist the physician in determining patient's eligibility for hospice.
• Review admissions through on-site and telephonic review to ensure medical necessity and appropriate level of care.
• Perform in home clinical assessments to determine appropriate Level of Care for admission and/or referral.

• Coordinated the transition of care to the appropriate level of care or setting.
• Evaluate Members for Case Management services and determine appropriate level of care.
• Review the charts of ER patients for appropriate level of care.
• Evaluated all admissions for medical necessity and appropriate level of care.
• Validate all in-patient admissions for appropriate level of care.

• Determine the appropriate level of care for the patient.
• Reviewed all Medicare admissions for appropriate level of care.
• Conducted initial and concurrent reviews of patients admitted to assess appropriate level of care, evaluate medical necessity.
• Facilitate Physician peer to peer discussion to discern appropriate level of care.
• Admit to appropriate level of service/ care.

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low Demand

• Provide assistance to severely injured military members and veterans transitioning from Department of Defense to Department of Veterans Affairs medical facilities.
• Worked independently and exhibited strong leadership qualities by producing excellent results efficiently without outside direction or management.
• Coordinated admissions and referrals for patients requiring long- term care and additional assistance.
• Completed 24 hour post hospital discharge telephonic calls with medication reconciliation.
• Review case records and reports, collects and analyzes data, evaluates injured workers medical status and defines needs and problems.

• Case Manager of Home Care patients in the field (northwest MI agency) based out of Traverse City office.
• Provided case management services with routine client follow-up for non-hospitalized and post discharge patients after an inpatient stay.
• Worked as part of team with PCP/Specialists to create/follow patient oriented plan of care for optimal patient outcomes.
• Provided critical needs overtime hours and acted as the resource for staff, patients and families of patients.
• Involve family/significant others, military, and workplace, together in a holistic program as appropriate.

• Assisted with any and all needs, to include transportation, assistance with food.
• Supervised certified nursing assistants and modified their plan of care as condition changed.
• Educated them on their pregnancy, and what to expect at each trimester.
• Provided reports of members status to the insurance company monthly.
• Worked closely with Low Vision/VIST, Rehabilitation and other departments.

• Communicated with members to assess their current health status.
• Maintain contact with insurance adjusters.
• Submitted monthly Stop Loss Reports.
• Assited High risk mothers to have testing done.
• Home visits, blood draws, wound and ostomy ccharting.

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low Demand

• Advocated for members to help navigate social services and collaborated with interdisciplinary team.
• Coordinate the integration of social services/case management function.
• Perform case management duties including care coordination, patient and family education, and reference to social services as needed.
• Evaluate a patient's physical condition and develop a care plan that addresses any medical needs and social services.
• Serve as liaison between patient, physician, physician referred therapies, social services, and insurance benefits verification

• Coordinated care for the patient in areas such as therapy, social services, and personal care.
• Coordinated nursing care, referrals, and state-mandated social services in three rural counties.
• Referred patients and family members to clergy and social services as needed.
• Coordinate with Social Services and Finance Departments regarding denial of benefits issues.
• Facilitate referrals to social services, skilled nursing facilities and support agencies.

• Coordinate with social services for care plan meetings and discharge planning.
• Coordinate with social services when appropriate.
• Directed multidisciplinary clinicians to include nurses, physical and occupational therapists, homecare aids and social services directors.
• Attended Ohana (social services) meetings for families who had children removed from homes.
• Specialized in coordinating end of life healthcare and social services for patients' and families.

• Case Manager: duties included managing Case Management personnel, Social Services.
• Coordinate end-of-life healthcare and social services for patients and their families.
• Arrange abeyances with social services, health and governmental agencies.
• Conduct medication reconciliation post discharge and report discrepancies to network pharmacist Collaborates with relevant community-base social services and healthcare organizations i.e.
• Attended weekly Clinical Standup to report client status Coordinated client need for support services - therapies, social services, MD follow-up

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