Case Manager Nurse

Amutalha Adbul Rahman, RN

Memphis TN ***** 901-***-**** *********@*****.***

OCCUPATIONAL REGISTERED NURSE CASE MANAGER

Multi-state registered nurse and an accomplished, service-oriented professional with 10+ years of experience in healthcare, including hands-on leadership and expertise in patient diagnosis, intervention, treatment, consultation, and follow-up. Highly proficient in directing the administrative and clinical activities of multidisciplinary teams of healthcare practitioners in a fast-paced environment. Self-directed professional with a firm understanding of protocols while delivering organizational leadership in clinical activities.

CORE COMPETENCIES

Multi-state Licensed RN Certified in BCLS Patient and Family Support Disease Prevention EMR Systems Primary Care Experience Pain Management Phlebotomy Intravenous Fluid Management Pre-operative Screening Audiometry Vision Testing ECG Spirometry TB Skin Testing Patient Education Medical Protocols & Policies Total Quality Management Case Management Critical Nursing Occupational Nursing Home Health Nursing Hospice Nursing Telecommute Nursing For Nurse Case Management Hospice Care Coordinator Triage Nursing HEDIS Over-reading Training & Mentoring

RELEVANT SKILLS

CASE MANAGEMENT

Integrate evidence-based insights into the continuous improvement of data-driven analytics and proper case management.

Identify risks and problems to promptly address and provide optimal resolutions, preventing further delays and errors.

QUALITY NURSING PRACTICE

Serve as an integral part of the country's healthcare system, upholding high-quality patient care in various clinical settings.

Exhibit a prolific understanding of age-specific and culturally diverse concepts in care coordination and patient management.

TEAMWORK AND COLLABORATION

Collaborate with interdisciplinary professionals to plan and deliver appropriate care plans and treatment procedures.

Facilitate cross-functional activities to effectively provide quality patient treatment and ensure the continuity of care.

PROFESSIONAL EXPERIENCE

WORK HEALTH SOLUTIONS MEMPHIS, TN MAY 2022 – PRESENT

Occupational Registered Nurse

Efficiently conduct triage and promptly perform health management protocols for injured employees while collaborating with the designated safety team to significantly reduce injuries and with the OSHA officers for cases involving reportable workplace injuries.

Conduct physical exams, including checking the vital signs, height, and weight, ECG, and TB skin testing.

Immunize according to FOH policies, SOPs and standing orders; provide non-emergency care to FOH clients according to FOH RN protocols; give emergency response and care according to BLS/AED protocol and FOH policies and SOPs.

Administer medications according to orders from outside prescribing MD (including allergy immunotherapy) only if orders have current approval from FOH medical director’s office; review destination specific travel information to FOH clients.

Oversee outreach activities according to FOH policies and Scope of Practices as requested by the company.

Facilitate a 5-man team of professionals and conduct weekly performance management, training, and mentoring tasks.

Perform thorough assessment and provide a diagnosis of patient’s condition to develop appropriate treatment plans.

Collaborate with several interdisciplinary teams to assess and coordinate appropriate services via a continuum of care.

Direct nursing care procedures to assist patients in alleviating symptoms including IV insertions, Foley catheterization, nasogastric (NG) tubes insertion, surgical and non-surgical wound care, and maintenance of gastrostomy (GI) tube.

Methodically streamline processes by taking the helm on the identification of the clinic’s procedural gaps and bottlenecks.

Assemble accurate and comprehensive documentation and reporting to support the successful continuity of patient care.

BLUE CROSS BLUE SHIELD MEMPHIS, TN JAN 2019 – APR 2022

Medical Case Manager

Advocated for high-quality patient care, strived for professional expertise, compassionate service, and excellence in nursing practice.

Acted as a clinical resource for field claim partners, communicating with clients, medical professionals, field claims staff, and attorneys to obtain information and negotiate proper medical treatment or return to work plans, if applicable.

PROFESSIONAL EXPERIENCE continued

Determined the barriers of care for prompt recognition and action response while sorting and providing needed resources.

Coalesced with the healthcare team to strategize combinations of various treatment approaches and interventions.

Meticulously gathered information and accurately identified the requirements for high-cost medical care before strategically developing an appropriate case management plan to address the patient’s particular, identified needs optimally.

Coordination to peer to peer physician reviews to establish medical necessity to authorize treatment.

Communication with insurance managed care providers, presenting patients’ cases to establish medical necessity and rationale to support a patients’ need for and authorization of specific levels of care.

Computer documentation of cases re: discussion with managed care providers authorizations, denials, appeals options, insurances issues etc.

Participating member of the Treatment Team, involved in the coordination of care with clinical, medical, and nursing staff.

SHELBY COUNTY HEALTH DEPARTMENT MEMPHIS, TN JAN 2016 – JAN 2019

Registered Nurse Case Manager

Perceptively inquired and gathered pertinent information from the electronic medical records, physician, and referral sources while actively ensuring face-to-face documentation requirements were consistently met in accordance with payer requirements.

Adhered to professional practice within the scope of licensure and accurately documented the requirements for clearance.

Discussed individualized care plans and responded to patients and their families' concerns to provide immediate straightforward resolutions, which can assist in alleviating patient recovery and ultimately improve patient holistic well-being.

Astutely performed the utilization review of 15+ caseloads to determine medical necessity and level of care under Milliman and Interqual criteria schedules while maintaining the database for the documentation for HIPAA and JCAHO reviews.

EARLIER WORK EXPERIENCE

Home Health Case Manager, Carter Home Care Management, Irving, TX

Rapid Assessment Nurse, Parkland Hospital, Dallas, TX

LTACH Registered Nurse, Select Specialty Hospital, Memphis, TN

EDUCATION

Bachelor of Science in Nursing, Tuskegee University, Tuskegee Al.

LICENSURE & CERTIFICATION

Tennessee RN # 183620 Tennessee Board of Nursing – Expires 03/2023

Basic Life Support (BLS) Certification American Heart Association

TECHNICAL SKILLS

Office Administration: EMR Systems, WorkDay, and Microsoft Office Suite (Word, Excel)

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