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Online Resumes with "Care Management Utilization Review"



Case Management Manager - 20 Years of Experience - Near 72023

I am a Registered Nurse with more than 22 years’ in clinical review, assessment, and reporting. Specialized expertise in care management, utilization review, prior authorization, Medicaid, Medicare and private insurance.

Tags for this Online Resume: Utilization Review, Quality Assurance, Case Review, RN, Registered Nurse, Medicaid Contract Manager, Medicaid Appeals, Health Care

Featured Profile

Registered Nurse - 20 Years of Experience - Care Management/Utilization Review

Dynamic and versatile BSN with 20 years of Nursing managment, patient advocacy and leading multidisciplinary teams in Utilization Review/Case Management and controlling costs.

Tags for this Online Resume: utilization review, hospital, pt care navagator, psychiatric, insurance, community liason

Featured Profile

Physician executive strong CM/UM experience, demonstrated ability to avoid readmission and increase claims efficiance - near 60637/430

Experienced medical professional, expert in adult and geriatric medicine, care coordination that avoids unnecessary readmission,chronic disease management (including home visits,) Medicare, it's managed care partners and dual eligible,managed care administration, medical education, and clinical practice. Committed to empowering providers and utilization/care management nurses to fully partner with payors and health systems ...

Ideal Companies: BlueCross/BlueShield, Medicare, Anthem, Cigna, United Health Care, CMS, Presence, Valence

Tags for this Online Resume: Geriatrics, Chronic disease management, Utilization/Care Management, HIPAA/Clinical Medical Ethics, HealthCare Professional Education, clinical policy development, Physician, Director, Medical Director, Physician Executive, Adult Medicine, Geriatric Medicine, Care Coordination, Population Health, Dual Eligibility Systems, Risk Management, Medical Education, Multidisciplinary Education, Clinical Ethics Training, Medical Ethics, Oral Communication, Written Communication, Social Media, MS Office, MD, FACP, AGSF, Underwriting, Claims, Non Profit, Principle

Registered Nurse - 20 Years of Experience - Near 64507-1973

Summary Summary Summary Education Care Manager/Utilization Review (Most recent position) * Worked in Critical Care 16 years as a staff RN caring for critically ill patients and supporting the patient and their families during the acute/chronic illness Provided care planning, implementation of care plan and revisions of individual patient plans * Managed ventilators/IABP/continuous IV infusions/ conscience sedation/ * RN Car...

Tags for this Online Resume: ACLS, Automobile Claim Law Specialist, BLS, Critical Care, PALS, Ventilators, Documentation, Insurance

registered nurse- 27 years experience. Case manager 10 years

PROFESSIONAL SUMMARY: I am a dedicated Registered Nurse with 25 years of experience ranging from Case/Care Management, Utilization Review, Disease Management, Telephonic Nursing and Coronary ICU. I have a strong commitment to providing quality nursing care while maintaining strong organizational skills. I can work closely with multidisciplinary teams which ensure appropriateness of care and medical necessity. Last but not l...

Tags for this Online Resume: Management, Computer Aided Software Engineering, Referrals, ACLS, Automobile Claim Law Specialist, BLS, physical therapist, registered nurse