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Candidate's Name , RNEMAIL AVAILABLE PHONE NUMBER AVAILABLESeasoned Registered Nurse Case Manager, Utilization Review CoordinatorAccomplished, results-driven, and performance-focused healthcare professional with successful 30+ year career in patient care, management, and clinical coordination. Recognized as a multi-disciplined, team-oriented, forward-looking leader with proven expertise in patient education and understanding, with a strong ability to develop and maintain successful relationships with healthcare professionals. Demonstrated ability to independently supervise hospitals of 270+ beds and maintain optimal efficiency; supports short and long-term business goals. Ensures compliance with procedures and documentation requirements; recognized for optimizing service and patient satisfaction rates. Excels during all complex challenges or conflicts. High bias for action, organized, and process-oriented approach that has provided proven business results and solid team performance. Experienced in InterQual and Milliman criteria to determine appropriate level of care.CORE COMPETENCIESCase ManagementUtilization ManagementExperienced in denials and appealsExperienced in root cause analysis and risk managementOncology experienceExperience with Milliman and InterQual criteriaOrthopedic Case Management experienceEvaluations and AssessmentsUses critical thinking skills and is a multitaskerProvides empathetic and compassionate careExperience in patient educationManagement skillsExcellent motivational interview skillsExperience working with families during illnessEstablish relationships with healthcare professionalsPROFESSIONAL EXPERIENCESupportive Care RN- WellMed, Port Saint Lucie, FL September 2023-presentRN Manager of Case Management Department HCA Lawnwood Medical Center, Fort Pierce, FL August 2021-October 2022RN Emergency Room Case Manager, Montefiore Nyack Hospital, Nyack, NY2017 2017- August 2021Manages time and workload to ensure both business and patient needs are met. Effectively communicate with diverse healthcare professionals and patients. Collaborate with ED doctors regarding criteria for admissions vs observations; conducts discharge planning and assessment for frequent admits. Builds relationships and educates patients and provides resources. Also, a member of the Ethics Committee.Registered Nurse, UM Coordinator, Blue Cross Blue Shield of Arizona, Phoenix, AZ 2015-2017Oversaw and perform precertification for surgical procedures, testing, hospital admissions, SNF admits and concurrent review; actively collaborated with Medical Directors, case managers, patients, and families, to ensure excellent care and services, utilizing InterQual criteria. Managed workload to consistently meet critical deadlines, ensured compliance and accurate documentation.Banner Health, Sun City West, AZ 2012-2015Effectively oversees Case Management and transitional care services for a large population of Medicare and private insurance clients; regularly provides in-home visits; performs accurate home safety evaluations, medication reconciliations, and DME assessments. Assess patient for medication side effects and determines interventions. Pro-actively communicates with Primary Care Physicians regarding assessment findings; ensures cases are followed through completion.Registered Nurse Case Manager, Hackensack University Medical Center, Hackensack, NJ 2004-2012Registered Nurse Case Manager, Good Samaritan Hospital, Suffern, NY 2003-2004Registered Nurse per- diem Supervisor, Good Samaritan Hospital, Suffern, NY 2003-2004Registered Nurse on -site Case Manager, Cigna Healthcare, Jersey City, NJ 2000-2003Registered Nurse Manager Concurrent Review Department, New York Medical Group 1997-2000Registered Nurse Manager, Westchester County Medical Center 1991-1997Staff Registered Nurse, Westchester County Medical Center 1985-1991EDUCATIONDominican Collage: RN-BSN -Anticipated graduation in August 2022-GPA 3.8Nominated to become a member of Zeta Omega Westchester-Rockland-at-Large Chapter of Sigma Theta Tau International (STTI)Orange County Community College, AAS in NursingADDITIONAL SKILLSAnalytical self-starter with experience in clinical care and coordination with emphasis in professional communication, and cross-functional team work across diverse disciplines.Displays ethical leadership, conflict resolution, critical thinking, team objectives, compliance, and communication. Ability to analyze and provide strategic solutions to ensure successful outcomes.Anticipates and understands patient needs and goals; manages and communicates with patients and patient families effectively.Manages and inspires team members with diverse cultural backgrounds to achieve project and company-wide initiatives.