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Case Manager Utilization Review

Location:
Canton, MI
Salary:
43.00 per hr
Posted:
April 02, 2023

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Resume:

LaKisha Mack

Registered Nurse

Contact

Canton, Michigan

313-***-****

adwan3@r.postjobfree.com

Dear Human Resource Manager,

Are you looking for a RN with drive, passion, experience, and business analytical skills?

●Over 8 years as a Registered Nurse

●5+ years working as a Case Manager reviewing and analyzing patients’ medical history and reason for admission.

●Over 4 Years of Utilization Management, ICD coding, for acute care admission to meet CMS guidelines of Medicare and Medicaid Services.

●Experienced in both oral and written communication

●Expected graduate of a MBA, early 2023

If so, then you need look no further. You will see from my enclosed resume that I meet all of these qualifications and more.

My commitment and dedication to the completion of my MBA, has brought me to this juncture in my career. As a RN CM, who enjoyed discharged coordination, interdisciplinary rounding, and educating patients and their families, I have chosen to step down from that role, and pursue my degree. I am looking to advance my career in clinical documentation, data analytics and related processes along with, patient care services preventative measures in the healthcare industry. I feel this position with allow me to pursue this aspect of my career endeavors and develop these skills more in-depth. I would love to very much so discuss my qualifications and skill sets in more detail. Whilst I do prefer email communication, I can also be reached at my cellular phone number listed within this cover letter.

Thank you for taking the time to review my resume. I look forward to talking with you.

Sincerely,

LaKisha Mack

LaKisha Mack

Canton, MI.

313-***-****

adwan3@r.postjobfree.com

Introduction

Experienced Registered Nurse with over 5 years of Acute Care Case Management and 2 years of Lead Nursing in an Ambulatory setting. Experienced in Epic, Cerner, Power Chart, Allscripts, Outlook, Teams Meeting, and more. Typing speed of over 65 WPM.

Employment

8/2022-Present, Davita

ICHD RN

Assess patients for hemodialysis treatment

Administer medications during hemodialysis

Discuss patient outcomes, needs and care plans with Nephrologist and other interdisciplinary team members.

11/2020-8/2022, Trinity Health

RN Case Manager

Acute Care Inpatient Case Management

Discharge coordination preparation to home settings, SAR/SNF, and or ALFs.

Conduct the Interdisciplinary rounds with the interdisciplinary teams including, nurses, APPs, Unit Manager, and Pharmacy

Educate the patients on the post discharge follow-up needs and clinical diagnosis

Utilization Review through Epic to validate that inpatient criterion is met

5/2017-11/2019, ST. John Providence Hospital

Coordinator Case Manager

Arranged the discharge plan for patients leaving the hospital

Ordered DME supplies through various suppliers

Conducted the utilization review for various health insurance coverages including BCBS/BCN/HAP/ and other Medicare and Medicaid managed plans with InterQual

Coordinated with physicians and other team members regarding patients’ discharge plan

9/2018-5/2019, Sinai Grace Hospital

Transition Coach

Provided education to patients related to the CMS readmission monitored diagnoses.

Provided telephonic coaching to patients post discharge related to the inpatient admission diagnosis.

Lead meetings for quality care initiatives with Sub-Acute Rehabs and Health Home Care agencies

10/2017-9/2018, Blue Cross and Blue Shield

Case Manager

Provided Case Management services to Medicare clients of BCBS and BCN with chronic comorbidities in health.

Completed medication reconciliation for members via telecommunication

Coordinated DME services for members and communicated with providers on BCBSM/BCN members behalf

1/2016-10/2018, Henry Ford Health System

Triage Nurse

Triaged acute injuries or other subjective medical concerns

Started IVs to provide intravenous therapy

Educated patients on current diagnosis and treatment

Completed monthly audit reporting for clinic

3/2016-11/2016, Centria Healthcare

Clinical Nurse Supervisor

Validated the nursing skills of hired licensed staff

Supervised in home care and documentation provided by licensed and unlicensed personnel

Created the Plan of Care for Pediatric and Geriatric clients with Trachs/Vents, Fractures, TBI and SCI diagnoses

5/2015-1/2016, Beaumont Health System Dearborn

Staff Nurse Cardiac Step Down

Assessed, diagnosed, planned, implemented, and evaluated patients in an acute care setting.

Administered antiarrhythmic drips and other high-alert medications

Intervened with critical care nursing procedures and communicated with the interdisciplinary team.

Educated patients about the various disease conditions such as heart disease, COPD, Stroke, DM, and other diseases

Education

08/2020 Southeastern Oklahoma University

MBA of General Business Studies- Expected Completion Date 3/2023

10/2014, University of Detroit Mercy, Detroit, MI.

Bachelor of Science in Nursing (BSN), GPA 3.49

8/2012, Wayne State University, Detroit, MI.

Bachelor of Science GPA 3.3

Certifications

Registered Nurse of the State of Michigan

Registered Nurse of North Carolina Compact License

BLS/ACLS-American Heart Association 10/2023



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