Your name
Your Email
Last 4 Of SSN
Date
E-Signature
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.
Acute Care 0★★★★−
Skilled/LTAC 0★★★★−
MDS Coordinator 0★★★★−
Home Health 0★★★★−
Telephonic 0★★★★−
Workers Compensation 0★★★★−
Insurance 0★★★★−
Managed Care 0★★★★−
Acute Rehab 0★★★★−
InterQual 0★★★★−
Milliman 0★★★★−
MIDAS 0★★★★−
Allscripts UR 0★★★★−
Word Processing Software 0★★★★−
Other: 0★★★★−
Epic 0★★★★−
Cerner 0★★★★−
Eclipsys 0★★★★−
McKesson 0★★★★−
Meditech 0★★★★−
Allscripts 0★★★★−
EMR Conversion
BLS
Certified Case Manager (CCM)
Accredited Case Manager (ACM)
Certified Disability Management Specialist (CDMS)
Certified Clinical Documentation Specialist (CCDS)
ACLS
Other: Please note any ICD 10 training
Other Specify:
