Nurse Case Manager
Resume:
Nikki Barrow
P O Box *****
Chattanooga, TN *7416
Phone: 423-***-****
Email: ********@*******.***
CAREER OBJECTIVE: Looking for a career opportunity as a Nurse Case Manager. Currently
possess a compact state license.
EDUCATION:
BSN degree at University of TN at Chattanooga (December 2001)
MBA at Bryan University in Dayton, TN (August 2012)
PROFESSIONAL EXPERIENCE:
Health Wellness Nurse (Work from home)
HCA-January 2013 to December 2014
Assist participants by making outbound calls and performing one on one phone
•
coaching and engage members in creating a wellness vision and goals for the Health &
Wellness program
Assist participants by coaching them with such goals as diabetes, weight
•
management, physical activity, nutrition, disease management, smoking cessation,
pregnancy, etc utilizing motivational interviewing techniques
Participate in monthly in-service trainings
•
Conduct telephonic health coaching that promotes and motivates behavior change
•
during outbound calls
Appropriately create and update plan of care with participants
•
Assign learning assignments to participants and ensure completion before
•
program year
Telephonic Nurse Case Manager (Work from Home)
Humana-October 2010 to Present
• Decreased ER visits, hospital admissions and high claims by executing plans of care for
patients with specific disease management conditions and providing telephonic wellness
coaching to these patients such as smoking cessation, weight and disease management,
diabetes, CHF,COPD,Transplant, etc. (Medicare,Medicaid members-complying with
CMS)
• Improved the member’s overall health by coordinating with physicians, nurses, and social
workers and reviewing medical records and working closely with medical claims area for
continuity of care for 100% of patient load and reduce hospital admissions
• Improved the member’s overall health status by completing telephonic assessments and
updating current health status and assisting members in meeting their short term and long
term goals within the member’s care plan by using motivational interviewing techniques
• Provide members assistance with community resources such as transportation, DME, cost
of medications, food, etc and sent referrals to various departments when appropriate
• Worked and Collaborated with members that were waiting on organ transplants and
assisted member with benefit information.
• Collaborate with member’s PCP and Specialists regarding gaps in care that included
questions about medications, appointments, and current health status
• Complete telephonic post discharge and general assessments with members and
telephonic assessments with members and provided health coaching to them
• Collaborate with Medical Director in virtual rounds on complex member cases and work
closely with onsite nurses regarding discharge planning and appropriateness of treatment
• Reviewed medical records to complete hedis abstraction information
• Worked with onsite nurses to complete concurrent and retrospective reviews
Manager/Disability Case Manager/ Pacesetter Project Manager
Unum- February 1998 to October 2009
• Developed an understanding and working knowledge of Unum's disability products and
claims, policies and contracts such as short term disability, long term disability, individual
disability and worker’s compensation products
• Developed an understanding of the applicable contract/policy definitions of disability and
relevant provisions, clauses, exclusion, riders and waivers as well as statutory
requirements. Worked very closely with underwriting on policies issues, riders,
exclusions, etc
• Reviewed medical records, claims, claims history and underwriting questions posed to
underwriter and investigated claims for payments and/or fraud
• Managed team of 10 professionals in managing claims benefits and operations
• Developed and implemented performance plans, developmental plans and worked closely
with HR with employees that had performance issues
Completed yearly performance reviews, merit increase reviews and monthly one to one’s
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Held employees accountable for performance metrics
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Organized team outings
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Involved in success planning meetings with other Directors and VP
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Completed audits on employees work and gave feedback
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CLINICAL EXPERIENCE:
Erlanger Medical Center-2001-2002 (Staff Nurse)
Provided direct patient care by conducting physical assessments, monitoring vital signs,
•
completing lab draws, dispensing medications/IV therapy
• Completed admissions assessments and discharge assessments with patients
• Completed nurses notes and updated notes timely
• Prepared patients for transfers to units and/or various diagnostic testing
• Ordered dietary meals for patients and assisted in setting up various consults at direction
of MD’s
Erlanger Medical Center Continuum Care-2002-2003 (Home Health Nurse)
Provided direct patient care by conducting physical assessments, monitoring vital signs,
•
completing lab draws and changing foley catheters in patient’s homes
• Completed admissions assessments and discharge assessments with patients
• Completed nurses notes using laptop
• Administered IV antibiotics and IM injections to patients in their homes
• Provided teaching and education on health conditions and medications
• Completed wound care including dressing changes on patients
Home Care Solutions-2003-2006 (Home Health Nurse)
Provided direct patient care by conducting physical assessments, monitoring vital signs,
•
completing lab draws and changing foley catheters in patient’s homes
• Completed admissions assessments and discharge assessments with patients
• Completed nurses notes using laptop
• Administered IV antibiotics and IM injections to patients in their homes
• Provided teaching and education on health conditions and medications
• Completed wound care including dressing changes on patients
CERTIFICATIONS:
Well Coaches Certificate (June 2013)
CCM-Certified Case Manager Certification (November 2009)
Lean Six Sigma Black-belt Certification (November 2007)
REFERENCES: Available Upon Request
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