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RN Case manager

Location:
Westland, Michigan, United States
Salary:
70,000
Posted:
October 24, 2018

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Resume:

David W. Cooley

**** ****** **. ***.***

Westland,Michigan 48185

734-***-****

David.cooley60yahoo.com

Objective

Utilization review registered nurse. Management.

Nursing.

Employment History

Utilization review coordinator RN, 08/2011 – 02/2018

Henry Ford Hospital, Detroit, Michigan

Provide utilization reviews on inpatient admissions utilizing Interqual criteria.

Reporting these admissions to appropriate insurance companies seeking inpatient authorizations.

Preformed 20-30 inpatient reviews daily. Department standard, 12.5.

Preformed continued stay reviews weekly or sooner as dictated by the insurance company.

Provided further clinical information on more difficult cases that were going to be denied.

Preformed 15-30 day readmissions for medical appropriateness for the readmission.

RN Case Manager, 09/2005 – 07/2011

Blue Cross Blue Shield of Michigan, Detroit, Michigan

Provided catastrophic medical case management for State of Michigan employees and there .

Received two letters of accommodation from President and CEO Daniel Loepp and one form

Co-chair of the board of directors Spencer Johnson.

Reviewed inpatient, outpatient, and ancillary services either onsite or telephonically.

Preformed reviews on admissions to ensure medical necessity, appropriate length of

Stay, appropriate intensity of service and level of care, and appropriate utilization of

Ancillary services.

Establish care plans and coordinate care through the healthcare continuum.

Demonstrated consistent reviews utilizing national standardized criteria and sound nursing judgement.

Collaborated with providers and members to assess, plan, implement, coordinate, monitor, evaluate options and services to meet individuals health needs while promoting quality cost effective outcomes.

Manager Care Management Services, 06/2003 – 09/2005

Oakwood Hospital and Medical Center, Dearborn, Michigan

Responsible for guiding and teaching 30 case managers as to medical necessity for admission to hospital, appropriate length of stay, appropriate intensity of service and level of care, appropriate utilization of services, and discharge planning options.

Responsible for scheduling and assessing staffing needs based on hospital census and patient acuity.

Monitored staff attendance and performance and provided each staff member with annual performance evaluation with process improvement suggestions.

Responsible for developing and maintaining care management services budget and spending reports and reporting to upper management.

Set up continuing education seminars for all staff members.

Updated policy and procedures for case management and utilization management based on JCAHO standards.

RN Case Manager, 07/1993 – 06/2003

Oakwood Hospital and Medical Center, Dearborn, Michigan

Provided medical case management and discharge planning for 40-50 patients on cardiac unit. Was elevated to manager of care management department secondary to case management knowledge and experience.

Assess patients for appropriate level of care based on interquel level of care criteria.

Monitoring appropriate utilization of resources.

Making required phone calls to insurance companies seeking authorizations for inpatient admissions.

Assessing 40-50 patients post hospital needs and setting up post hospital care plans.

Educating patients and there caregivers as to there diagnosis and treatment plan.

EDUCATION

Associates Degree – Nursing

Wayne county community college, Detroit, Michigan

Licenses

Registered Nurse State of Michigan



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