Case Manager Utilization Review

Jennifer Tatum

Bennington, Nebraska *****

641-***-**** - ***********@*****.***

Professional Summary

Effective and compassionate RN Case Manager with near 30 years of experience and exemplary team coordination. Offering reputation for working with patients to design care plan goals with available resources. Detail-oriented and skilled in case research.

Skills

Accurate Documentation

Clear Patient Communication

EMR Systems

Disease Processes

Patient Care Assessment

Acute Rehabilitation

Case Conferences

Treatment Recommendations

Work History

11/2020 to Current

Dual Special Needs RN Case Manager-Medicare

Aetna/CVS – Plantation, Florida

Effectively communicates with physicians regarding patient needs, performance, medications, and changes.

Completes initial assessments of patients and family to determine and address individual home care needs. ·

Coordinates with interdisciplinary professionals to develop plans of care, administer tests and monitor patient status.

Advocates for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.

06/2015 to 11/2020

Workers' Compensation Case Manager

Mercy One North Iowa – Mason City, Iowa

Developed strong, trusting relationships with Workers' Compensation Adjusters, Field Case Managers, Employees, and Legal staff.

Maintained clean, accurate and accessible records and kept close eye DART Rate for large hospital network.

Established and enforced internal controls, workflows, and policies for tracking, reconciling and reporting on employee injuries for 3500+ employee Hospital network.

Complied with established internal controls and policies.

Kept up-to-date and accurate funding account. Headed internal departments, key programs, and special projects.

01/2010 to 05/2015

Acute Care Case Manager

Mercy One North Iowa – Mason City, Iowa

Liaised with Doctors and hospital staff to mitigate patient discharge delays by coordinating tests, therapy, and other treatments.

Conducted utilization review to verify medically necessary care is received in correct setting.

Assessed patient health insurance plan and worked with insurer and providers to deliver best care with least financial burden.

Furnished insurer with information to approve payment for hospitalization and worked to prevent insurance claim denials.

05/1993 to 01/2010

RN

Mercy One North Iowa – Mason City, Iowa

Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.

Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.

Trained new nurses on all Units on proper techniques, care standards, operational procedures, and safety protocols.

Provided direct patient care, stabilized patients, and determined next course of action.

Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.

Education

Associate of Applied Science: Nursing

North Iowa Area Community College - Mason City, IA

Bachelor of Science: Marketing/Merchandising

Iowa State University - Ames, IA

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