Candidate Information Name Available: Register for Free Title Case Management Manager Target Location US-NJ-Nutley Email Available with paid plan Phone Available with paid plan	20,000+ Fresh Resumes Monthly     View Phone Numbers     Receive Resume E-mail Alerts     Post Jobs Free     Link your Free Jobs Page     ... and much more Register on Jobvertise Free
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Candidate's Name , BSN, RN, CPC-ANutley, NJ EMAIL AVAILABLE LINKEDIN LINK AVAILABLE PROFESSIONAL SUMMARY Case Manager Utilization RNExperienced RN and CPC-A with 13+ years in acute care, hospice, and subacute settings. Skilled in patient assessment, accurate documentation, and care coordination. Proficient in evidence-based decision-making. Seeking a Case Management / Utilization Management role to optimize healthcare services for members. KEY SKILLS Care Coordination & Case Management: Extensive experience in developing, implementing, and evaluating care plans for patients with complex and chronic health conditions. Patient Advocacy: Skilled at identifying patient needs, removing barriers to care, and coordinating resources across the care continuum. Clinical Assessment & Planning: Proficient in conducting holistic assessments, including reviewing claims and clinical data, to address physical, mental, and social health determinants. Collaboration & Communication: Proven ability to collaborate with physicians, care managers, and community resources to ensure seamless care delivery. Motivational Interviewing: Skilled in engaging patients through motivational interviewing techniques to promote active participation in their own care management. Regulatory Compliance: Knowledgeable in Medicare/Medicaid guidelines, HEDIS, and HIPAA standards to ensure patient confidentiality and quality care delivery. LICENSES AND CERTIFICATIONSRegistered Nurse (RN): New Jersey State Board of Nursing (Expires 05/2025) Registered Nurse (RN): New York State (Expires 10/2026) Certified Professional Coder (CPC): American Academy of Professional Coders (AAPC) (08/2024) EDUCATIONBachelor of Science in Nursing (BSN), Manila Doctors College, Pasay City, Philippines June 2009 PROFESSIONAL EXPERIENCEClinical Outcomes & Insights Nurse Team Lead (Remote) Circadia Health Los Angeles, CA June 2024 - present Lead a team in reviewing clinical documentation for accuracy and compliance with healthcare policies and regulations. Supervise clinical report generation, ensuring that coding and documentation align with medical necessity and regulatory standards. Collaborate with multidisciplinary teams to address discrepancies in documentation and ensure the accuracy of patient care records for claim evaluations.Clinical Outcomes & Insights -AI Risk Report QA (Remote) Circadia Health Los Angeles, CA February 2024 - June 2024 Conducted comprehensive assessments of patient needs and implemented care coordination strategies to address medical and social determinants of health. Reviewed clinical data and claims records to assess the appropriateness of care and identify gaps in service delivery. Assisted in care plan development, ensuring alignment with best practices and regulatory standards for dual-eligible populations.Charge Nurse Saint Michaels Medical Center Newark, NJ September 2018 - February 2024 Managed care for patients with chronic and acute conditions, conducting comprehensive assessments and developing care plans in collaboration with case managers. Facilitated discharge planning and ensured continuity of care for patients transitioning to post-acute services, including home health and rehabilitation services. Monitored patient progress and adjusted care plans as needed to improve health outcomes. Charge Nurse Summit Oaks Psychiatric Hospital Summit, NJ September 2017 - September 2018 Led patient care coordination for individuals with complex mental health and medical needs, conducting thorough assessments and managing care plans. Collaborated with care providers to evaluate the effectiveness of treatment plans and made necessary adjustments to ensure optimal patient outcomes.Hospice Case Manager Barnabas Hospice/VNAHG West Orange, New Jersey April 2015 - Sept 2017 Managed the care of terminally ill patients by developing comprehensive care plans and coordinating with interdisciplinary teams to address medical, emotional, and social needs. Conducted home visits, assessed patient needs, and ensured that care plans aligned with the goals of patients and families. Worked with community organizations to provide resources and support for patients with complex social challengesShift Supervisor Alaris Health at Belgrove Kearny, New Jersey October 2014 - April 2015 Ensured smooth operations across all units during assigned shifts, addressing concerns as needed. Alerted administrator, associate administrator, head nurse or manager of urgent concerns Communicated non-urgent concerns to manager via phone message or email Received employee, resident and family grievances and referred to appropriate department Worked with staffing schedule and nurse managers to ensure vacancies are filled in advance Unit Manager Alaris Health at Belgrove Kearny, New Jersey April 2014 - October 2014 Participated in the Utilization Review committee, conducting concurrent reviews to assess the medical necessity of patient admissions and continued stays. Reviewed clinical records for completeness and accuracy, ensuring that documentation met regulatory and reimbursement standards. Collaborated with the Director of Nursing to provide orientation and ongoing education for unit staff members.Staff Nurse RN Alaris Health at Belgrove Kearny, NJ April 2013 - April 2014 Provided clinical care for a diverse patient population, including sub-acute, hospice, and long-term care. Additional duties include pain management, assessments, medication pass, treatments, admissions, discharges, IV therapy, trach care, colostomy care, wound care, wound vacs, dressing changes, oxygen therapy, nebulizers, BIPAP, CPAP and taking accurate documentation Educated patients and family members on disease processes and prevention. Conducted thorough assessments, medication administration, and treatment protocols. Staff RN Sub-Acute Unit and Long-Term Care Unit Care One at Wellington Hackensack,New Jersey April 2011 - April 2013 Provided comprehensive care for patients in subacute settings, managing admissions, transfers, and discharges. Educated patients on post-acute care options, including home health and rehabilitation services. Coordinated care with multidisciplinary teams to ensure smooth transitions between levels of care. RN Staff New York Center for Nursing and Rehab Astoria, Queens, New York November 2010 - April 2011 Consulted and coordinated with healthcare team members to assess, plan,implement or evaluate patient care plans Maintained accurate and detailed reports and records Monitored all aspects of patient care, including diet and physical activity Administered medications to patients and observed patients for reactions or side effects