Post Job Free

Resume

Sign in

Review Nurse Case Manager

Location:
Springfield, IL
Posted:
May 15, 2023

Contact this candidate

Resume:

Sarah Shaffer

Springfield, IL

adw4n6@r.postjobfree.com

630-***-****

Professional interest in promoting optimal health care through education, application and regulation of standards within the institution's policies, state and federal laws.I will be relocating to Springfield with husband.

Authorized to work in the US for any employer

Work Experience

Patient Safety Coordinator

MHS - Springfield, IL

February 2019 to July 2020

Review hospital events and refer to designated supervisor for follow-up, perform investigations for patient briefings and DC as and member of several hospital committees. Assist with regulatory dept. with preparations for regulatory visits.

Manager of Clinical Excellence & Performance Improvement Provident Hospital of Cook County Health Systems - Chicago, IL May 2017 to February 2019

Participate in conducting QPI and Patient Safety meetings, assist departments with quality data, and corrective action plans. Summarize incidents, schedule and oversee RCAs. Initiate patient complaints/ grievances investigations. Assist with Director of Regulatory with tracers in preparation for regulatory visits (TJC, CMS & IDPH). Participate in several departmental meetings monthly. Teach classes for staff on patience safety.

Clinical Performance Improvement Analyst

COOK COUNTY HEALTH & HOSPITALS SYSTEM - Chicago, IL April 2016 to February 2019

Collect, develop and report QA Data related to nursing processes performed in a correctional facility, and participate in multidisciplinary committees to report, review and revise processes to improve the delivery of healthcare. Participate in the Department of Justice facility surveys. Collaborate with the educational department and supervises two Nurse Clinicians. Case Management Nurse

John Stroger Cook County Hospital - Chicago, IL

April 2012 to April 2016

Responsibilities:

Review admissions inpatients & observation for medical necessity, initiate and perform ongoing insurance reviews for Medicare, Medicaid, MCOs, and private insurance carriers. Assess need for case management and assist with social workers safe discharge plan. Participate in QA/QI departmental initiatives. Liaison between medical team and external case managers to aid in services and possible transfers.

Accomplishments

Certified Case Manager -April 2014

Certified ABAURP -healthcare quality -October 2015 Utilization Review Nurse

Rising Medical Solutions - Chicago, IL

February 2008 to April 2012

Review medical records related to Workmen's Compensation injuries. Determine medical necessity within evidenced based National Guidelines, compile medical summaries including past treatments and diagnostic results to refer to a medical peer reviewer to determine medical necessity, review and compile medical records for appeals and reconsiderations, correspond with insurance carrier adjusters, attorneys, and medical providers,and supervise other nursing staff within the UR department. In-House Registry

Little Company of Mary Hospital - Evergreen Park, IL February 2005 to March 2008

* Provide direct patient care (ante-partum, postpartum, gynecology, newborn)

* Performed newborn screening & hearing tests.

* Provided patient education on maternal/child care. Clinic Nurse

West Surburban Women's Health - Willowbrook, IL

November 2005 to June 2006

Directed flow of out patient OB/GYN clients

* Assisted Physicians with medical procedures (Colposcopy/LEEP)

* Obtained medical history and provided general nursing assessments

* Provided clients with education on pregnancy, routine pap smears, Breast exams, birth control and high-risk pregnancies Education

Master of Jurisprudence in Health Law

Loyola University - Chicago, IL

1998 to 2000

B.S. in Nursing

Saint Xavier University - Chicago, IL

1981 to 1986

Skills

• Micosoft Office, Word, & Cerner electronic healthcare documentation

• Utilization Review

• Family Planning

• Case Management

Certifications and Licenses

Nurse's License

May 2024

Class: RN, State: IL

Certified Case Manager

July 2020 to August 2022

Certified in case management through the ACMA

Certified in Healthcare Quality & Risk Management

BLS Provider

March 2020 to March 2022

Groups

ACMA

February 2014 to 2022

ABQAURP

July 2015 to Present

Additional Information

Skills

CPR

Professional



Contact this candidate