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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in patient advocacy, care coordination, and discharge planning, with a strong focus on achieving positive patient outcomes and managing quality of care across the healthcare continuum. Proficient in utilizing clinical knowledge and interpersonal skills to navigate complex healthcare systems and collaborate effectively with multidisciplinary teams.
Highest-signal resume keywords
Registered Nurse (RN) LicenseUtilization Review ExperienceCase Management ExperienceBasic Life Support (BLS) CertificationCertified Case Manager (CCM) Certification
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Patient Care CoordinationDischarge PlanningClinical AssessmentUtilization ReviewCare Management TheoryDocumentation ProceduresPatient Care Chart KnowledgeSocial Determinants of Health ScreeningMedication ManagementPatient Progress Monitoring
Soft Skills
Interpersonal SkillsCommunication SkillsCritical ThinkingOrganizational SkillsCoordinating Skills
Tools & Technologies
Electronic Medical Record SystemsMicrosoft Office Suite
Certifications & Qualifications
Registered Nurse (RN) LicenseBasic Life Support (BLS) CertificationCertified Case Manager (CCM) Certification
Industry Keywords
Acute CareLong-Term CareSkilled Nursing Facility (SNF)Community HealthHealthcare SystemsPatient AdvocacyClinical StrategyHome HealthSocial ServicesHealthcare Quality Management
About the role
Key responsibilities & impact- Achieve positive patient outcomes and manage quality of care across the care continuum
- Advocate for patients and families navigating external providers and healthcare systems
- Coordinate longitudinal care with healthcare team members
- Establish relationships with families, caregivers, physicians, hospitalists, specialists, social workers, facilities, home health companies, and health plans
- Conduct onsite hospital visits and coordinate care with hospitalists and hospital staff
- Review inpatient versus observation status and support timely discharge to the lowest appropriate level of care
- Record daily inpatient updates in internal and hospital electronic medical record systems
- Anticipate post-acute and long-term care needs from the first day of hospitalization
- Follow patients discharged to SNF or LTC with weekly updates and reconnect them with primary care
- Provide warm handoffs to Community Care Nurses for patients returning home
- Maintain daily presence at assigned hospitals during core hours and balanced caseloads
- Conduct safety, social, functional-status, medication, self-management, and knowledge-deficit assessments
- Collaborate with Complex Care and Clinical Strategy Teams on acute-care procedures
- Explain care and disease-management programs and introduce Community Care Managers
- Implement the ACM Coaching program
- Identify discharge barriers and facilitate discharge to appropriate levels of care and preferred providers
- Communicate discharge information to patients, families, PCPs, leadership, and Community Care Nurses
- Perform Social Determinants of Health screenings and communicate identified needs
- Identify new diagnoses and provide documentation to PCPs
- Arrange four-day post-discharge PCP follow-up appointments
- Discuss CCM and DM program benefits and identify patient interest
- Coordinate acute utilization-review physician meetings
- Perform other duties as assigned
Requirements
What you’ll need- A valid, active Registered Nurse (RN) license in State of employment required
- A minimum of two (2) years’ clinical work experience required
- A minimum of one (1) year of utilization review and/or case management, home health, hospital discharge planning experience required
- Basic Life Support (BLS) certification from the American Heart Association (AMA) or American Red Cross required within first 90 days of employment
- Current, valid driver’s license required
- Bachelor’s Degree in nursing (BSN) or RN with bachelor’s degree in a related clinical field preferred
- Compact License preferred for states where compact license is available
- A minimum of one (1) year of case management experience in acute case management or community case management experience highly desired
- Certified Case Manager certification preferred; CCMC or CMCN certification desired
- Strong interpersonal and communication skills
- Critical thinking, organization and coordinating skills
- Ability to monitor, assess and record patients’ progress and adjust plans accordingly
- Understanding of utilization review and inpatient medical-cost reduction strategies
- Ability to plan, implement and evaluate individual patient care plans
- Knowledge of nursing and case management theory and practice
- Knowledge of patient care charts and histories
- Knowledge of clinical and social services documentation procedures and standards
- Knowledge of community health and social services agencies and networks
- Proficiency in Microsoft Office Suite, including Excel, Word, PowerPoint, and Outlook
- Ability and willingness to travel locally, regionally, and nationwide up to 10% of the time
- Spoken and written fluency in English; bilingual preferred
Benefits
Comp & perks- Great compensation
- Comprehensive benefits
- Career development and advancement opportunities
- Work-life balance
- Opportunities to grow
- Potential eligibility for bonuses or commissions