Name:
Email:
LAST 4 OF SSN:
This checklist was electronically signed on (Today’s date)
This checklist is designed to guide our client facilities in assessing your proficiency in your nursing specialty. Please use the scale provided to indicate your level of experience and expertise in each of the areas listed below.
Skill Level Indicator:
★ = No Experience
★★ = Requires Training
★★★ = Capable with Supervision
★★★★ = Capable Independently
Written Communication Skills
Verbal Communication Skills
Basic Negotiation Skills
Job Related Computer Skills
Ability to Prioritize
Knowledge of Community Health Care and Vocational Services
Ability to Properly Maintain Records
Knowledge of Medical Billing Procedures
Ability to Work Effectively in All Situations
Ability to Assess, Plan, Implement and Evaluate Individual Patient Care Programs and Treatment Plans
Ability to Gather Data, Compile Information and Prepare Reports
Ensure Outcomes are Met within an Appropriate Length of Stay
Document All Client Encounters
Complete and Submit Billing Documentation as Appropriate
Identify and Provide Emergency Crisis Services as Necessary
Ability to Develop and Implement Action Plans for Health Centers to Improve Performance
Disability Review
Long Term/Short Term Disability Case Management
Workers Compensation Case Management
Pre Certification/Pre-Admission Certification
Catastrophic Case Management
Continued Stay Review
MCM-Medical Case Management
Discharge Planning
Criteria for Hospital Admissions
Intensity of Service- Diagnosis & Therapeutic Services
Discharge Screens- Specific Indicators of Patients Ability
Appropriateness of Care- Patients Ability
Diagnosis Related Grouping
ICD- 9-CM
CPT
SIMS- Interqual- Criteria for SSO Waiver
Milliman and Robertson Criteria
PPR- Prospective Procedure Review
PA- Physician Advisor
Prior Authorization
Utilization Review
Utilization Management
Acute Care/Hospital
Managed Care
SNF/ Long Term Care
Home Health
Outpatient
Newborn (birth – 30 days)
Infant (30 days – 1 year)
Toddler (1 – 3 years)
Preschooler (3 – 5 years)
School Age (5 – 12 years)
Adolescents (12 – 18 years)
Young Adults (18 – 39 years)
Middle Adults (39 – 64 years)
Older Adults (64+ years)
BLS
5
CNRN
ACLS
CCRN
Other:
I hereby certify that ALL information I have provided on this skills checklist and all other documentation is true and accurate. I understand and acknowledge that any misrepresentation or omission may result in disqualification from employment and/or immediate termination.
