Care Coordination Resume Samples
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Care Coordination Resume Samples
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JM
J Mante
Jessika
Mante
71707 Janelle Points
San Francisco
CA
+1 (555) 622 3362
71707 Janelle Points
San Francisco
CA
Phone
p
+1 (555) 622 3362
Experience
Experience
Houston, TX
Rn-care Coordination
Houston, TX
Walker LLC
Houston, TX
Rn-care Coordination
- Has a working knowledge of financial and reimbursement processes Medicare DRG payment, Case Rates, Managed Care Risk Contracting, etc
- Other duties as assigned by CIN Director/Care Management/Social Services Manager
- Serves as a professional role model/mentor and change agent to develop and assist others
- Identifies opportunities for improvement (at individual, facility/CIN levels and actively works with healthcare and facility/CIN team to correct or improve results
- Applies established utilization care guidelines/criteria maintaining compliance and stewardship of resources to enhance outcomes
- Facilitates the Utilization Management plan to include pre-authorization, continued stay review, quality review, and denial/appeal processes throughout the organization
- Participates in the design, development and implementation of the Care Coordination data management process that demonstrates value and impact to the organization
Los Angeles, CA
Business Analyst Care Coordination
Los Angeles, CA
Gerhold Group
Los Angeles, CA
Business Analyst Care Coordination
- Work under the direction of the Manager to provide application solutions for assigned business areas
- Provide data to generate team performance metrics
- Assist in supporting activations and rollouts
- Document issues with resolutions and share with team members to improve team productivity
- Provide accurate and timely information and escalates when there are issues
- Knowledge transfer with other team members to improve overall team education level
- Design and execute functional, integration, and regression test plans for new application functionality, product releases and enhancement and regulatory modifications using business scenarios and use cases
present
Boston, MA
VP, Care Coordination Services
Boston, MA
Yost, Bradtke and Schmidt
present
Boston, MA
VP, Care Coordination Services
present
- Performs new market implementation project planning in partnership stakeholders and with PMPIO
- Oversees staff coverage, assignments, and schedules
- Monitors work flow of all operational processes to ensure care management is successful to ensure outcomes achieve targeted performance goals
- In collaboration with program administration partners, directs staff development programs related to training, competencies, retention, and continuing education
- Ensures departmental operations, policies and procedures are compliant with health plan standards, accreditation standards and state/federal regulatory agencies
- Reports on all functions (intake, transitions, complex care, DM and other care management services) performed by assigned staff and analyzes and evaluates to determine areas for improvement
- Oversees development and management of clinical guidelines
Education
Education
Bachelor’s Degree in Detail Orientation
Bachelor’s Degree in Detail Orientation
Cornell University
Bachelor’s Degree in Detail Orientation
Skills
Skills
- Good organization skills; ability to prioritize multiple activities and objectives in a rapidly changing environment, and deliver quality service
- In-depth of knowledge of application environments including production, test and interfaces
- Demonstrated increasingly responsible professional growth
- Strong problem and issue resolution experience
- Strong collaboration and consulting skills
- Broad knowledge of multiple and integrated systems
- Strong analytical and critical thinking skills
- Ability to be involved in multiple projects at the same time
- Work closely with health care application users, vendors, and technical professionals
- Experience in healthcare applications as typically acquired in 6 to 8 years
15 Care Coordination resume templates
Read our complete resume writing guides
1
Supervisor, Care Coordination Resume Examples & Samples
- Experience in utilization management and discharge planning required
- Progressive experience leading innovative case management programs
- Strong critical-thinking, problem resolution and time management abilities and customer relation skills
- Experience in planning, leading and organizing the resources of a team preferred
- Experience in patient care or health education in variety of settings preferred
- Leadership experience in acute case management preferred
- Experience with clinical assessment for clients with complex medical, emotional and social needs
- Experience in coordinating Clinical Review teams preferred
- Experience coaching, counseling and administering corrective action preferred
- Demonstrated ability to develop and manage complex projects
- Ability to interact effectively with key internal and external constituents using collaboration, negotiation and analytical problem resolution skills
- Demonstrated ability to implement continuous quality improvement processes and techniques, including benchmarking and outcomes measurements preferred
2
Regional Care Coordination Director Resume Examples & Samples
- Day to day site operations, daily management and oversight of multiple levels of internal and external staff
- Lead, mentor and develop clinical leadership staff
- Identifies and drives local Healthcare Affordability Initiatives along with medical director(s) and clinical team
- Ensures monitoring and oversight of CHOICES Long term services and support/staff to meet defined goals / targets, contractual requirements
- Develops, translates and executes strategies or functional/operational objectives for the CHOICES program including care coordination, financial accountability and customer (Members and State Partner) satisfaction
- Serves as the CHOICES Health Services SME and liaison with the State
- LTSS Special Programs / Projects management (for example Nursing Facility to HCBS Transitions, HCBS Consumer Directed (CD) services, Community Living Supports (CLS) Services, ERC Services program oversight, CEA request and reductions project oversight site etc.)
- LTSS CHOICES Policy and Procedure, SOP reviews updates and maintenance
- Health Plan benefits and LTSS benefits Coordination management (DSNP, Optum Care Plus, PCCM, BH, DME etc.)
- Bachelor’s Degree or Masters in Social Work Studies
- Licensed RN or Social Worker
- 3+ years providing care coordination within LTC services
- 2+ years within managed care or long term care organization
- 3+ years of Leadership / management experience aligned with effective team building
- Experience or ability to work in a matrix organization
- Ability to manage projects to completion
- Ability to travel to state meetings or offices as needed
- Resides or ability to relocate to Johnson City / Nashville, TN area
3
Sutter Care Coordination Case Manager Resume Examples & Samples
- Initiates and participates in consultative and collaborative relationships to enhance patient care
- Communicates significant information relating to the patient, his family, plan or care, or other planned events to appropriate health care personnel, payers, and administrators
- Arranges family conferences/visits/appointments/medication refills and supplies as needed
- Responds to requests for consultation in a timely manner and documents interactions, assessments, and recommendations
- Seeks and provides peer consultation about cases that are problematic and/or present significant deviations from the plan of care
- Meets all applicable department standards for productivity, annual competency validation, safety education, licensure, and departmental performance/process improvement
- Sick or absent time off does not exceed the facility guidelines as outlined in the Personnel Policy manual
- Provides proper notification of absence or tardiness within established departmental time frames
- Strong clinical skills in biopsychosocial assessment, crisis intervention, counseling, interdisciplinary collaboration and linkage with resources
- Knowledge of child, elder and dependent adult abuse and domestic violence reporting requirements and other significant regulations affecting clinical social work practice (e.g. Tarasoff, patient-psychotherapist privilege)
- Knowledge of suicidal behavior, and the skills necessary to assess lethality, and to develop appropriate treatment plans
- Masters in Social Work required with concentration in geriatric population preferred
- Knowledge of managed care
- Knowledge of the process of long-term care and the private/public resources available to support the clients served
- Experience in a healthcare setting is preferred
- Previous experience in community based health care
- Experience developing care plans
- Experience working as a member of a multi-disciplinary team
- Experience in in-home and telephone patient case management, knowledge of health related information, education, resource and referral services
- Ability to administer assessment testing and to create individual assessment protocols
- Word processing and data base management skills
- Ability to type 45 cwpm
- Demonstrated ability to effectively communicate, both verbally and in writing
- Work is performed with many interruptions
- Must demonstrate strong interpersonal and organizational skills, to work effectively in a fast-paced environment with rapidly changing priorities and competing demands
- Must be able to occasionally flex time to handle emergencies
4
VP Ancillary Services / Care Coordination Resume Examples & Samples
- Demonstrates professional leadership practices that facilitate improvement and empowerment of the staff in critical thinking and decision-making
- Establishes a collegial and collaborative relationship with members of the medical and nursing staff. Promotes positive working relationships through open, direct, honest communication between staff and physicians
- Represents the Ancillary Services/Care Coordination division along with clinical areas of responsibility at medical staff and other interdisciplinary meetings. Collaborates with team to develop and implement standards to maintain professional practice that promotes excellence and is consistent with community standards, legislative changes and current trends
- Keeps abreast of current healthcare trends through membership in professional organizations, attendance at conferences in order to develop administrative and clinical operational improvements that are evidence-based
- Seeks to establish innovative methods that encourage the retention and recruitment of staff. Implements staff educational programs to ensure continuity of staffing with staff competent for related patient conditions
- 5-7 years of clinical experience or experience managing ancillaries
- Must be knowledgeable about health care laws, regulations, accreditations requirements and clinical standards of practice
- Core knowledge of service line concepts, program development, and establishing effective partnerships relationships
- Working knowledge of healthcare strategy, operations, service lines, and physician relations
- Demonstrated in-depth financial and analytical acumen
- Ability to develop a clear, realistic, and actionable vision, as well as provide results-orientated strategic and systems leadership
- Exhibit strong analytic skills to resolve complex issues, generate actionable recommendations and make informed decisions
- Ability to effectively and credibly interact with and influence external and internal constituencies with sensitivities for relationships and political dynamics that will create a climate of support and trust for creative thinking, marketing and planning at all levels
- Ability to develop a high performing service line, with teamwork as its hallmark
- Strong leadership skills to include organizational agility, political savvy, and effective communications
- Strong general administrative skills including strategy, finance, and performance management
- Demonstrated drive to meet patients’, physicians’, and employees’ needs
- Ability to learn a marketplace quickly, and determine critical success factors for optimal performance and profitable growth
- Ability to communicate with others verbally and in written format including negotiation, presentation and facilitation skills consistent with executive-level leadership
- Demonstrated ability to evaluate and implement managerial, personnel and procedural system changes as required to improve and accommodate the growth of services, and establish an environment which is customer friendly and meets the expectations of physicians, employees and the community
- Proven track record in developing division goals, objectives, and 90day work plans. Ability to establish and implement policies and procedures for service line operations
- Daily travel to locations within the bay area region
5
Rn-care Coordination Resume Examples & Samples
- Documents case management plan to include: assessment, client/family participation and understanding, consult referrals and discharge plan of care
- Ensures effective communication through the continuum to support ongoing progress toward identified outcomes
- Educates staff, clients/families, and medical community on care coordination and regulatory issues that impact care and outcomes
- Monitors level of care issues by aligning individual needs with appropriate or available resources maximizing benefit coverage
- Has a working knowledge of financial and reimbursement processes Medicare DRG payment, Case Rates, Managed Care Risk Contracting, etc
- Coordinates and conducts patient care rounds and family conferences
- Consults clinicians, other departments, and committees as needed to support the patient through the care continuum
- Implements strategies to reduce resource consumption and length of stay for assigned patient
- Collaborates with appropriate staff and management to facilitate the development of case management tools, i.e. pathways and protocols, clinical indicators that demonstrate best practice and disease state management processes
- Serves as a professional role model/mentor and change agent to develop and assist others
6
Supv, Care Coordination Resume Examples & Samples
- Supervises non-clinical support staff and department workflows to achieve successful quality outcomes and benefit maximization towards members' care
- Monitors and tracks production and quality driven work and outcomes of team
- Makes process improvement recommendations to management
- Required An Associate's Degree in a related field
- Required 4+ years of experience in a health care customer service or call center environment
- Required Intermediate Microsoft Outlook Ability to use proprietary health care management system
7
Rn-care Coordination Resume Examples & Samples
- Applies established utilization care guidelines/criteria maintaining compliance and stewardship of resources to enhance outcomes
- Facilitates the Utilization Management plan to include pre-authorization, continued stay review, quality review, and denial/appeal processes throughout the organization
- Has a working knowledge of financial and reimbursement processes related to Tax Equity and Fiscal Responsibility Act (TEFRA) and Medicare DRG payment, Case Rates, Managed Care Risk Contracting, etc
- Participates in the design, development and implementation of the Care Coordination data management process that demonstrates value and impact to the organization
- Documents program specific outcomes along with periodic revisions
8
Care Coordination Clerk Resume Examples & Samples
- Experience in a healthcare related field preferred
- Experience in a Billing / Coding or medical office environment is helpful
- Ability to use 10-key
- Ability to type 55 wpm
- Ability to operate a fax machine, scanner and copy machine
- Ability to work with frequent interruptions and minimal supervision
9
VP, Care Coordination Services Resume Examples & Samples
- Directs plans and supervises activities and priorities within all areas of the department
- Administers and supervises recruitment and hiring process for assigned area as well as provides oversight to managers and promotes personal growth and development of team members
- Monitors work flow of all operational processes to ensure care management is successful to ensure outcomes achieve targeted performance goals
- Evaluates processes for improvement opportunities and engages PMPIO as needed
- In collaboration with program administration partners, directs staff development programs related to training, competencies, retention, and continuing education
- Ensures departmental operations, policies and procedures are compliant with health plan standards, accreditation standards and state/federal regulatory agencies
- Reports on all functions (intake, transitions, complex care, DM and other care management services) performed by assigned staff and analyzes and evaluates to determine areas for improvement
- Oversees development and management of clinical guidelines
- Collaborates with process improvement team to create efficiencies and cost effective strategies
- Monitors staff productivity regularly and makes accommodations as necessary
- Oversees staff coverage, assignments, and schedules
- Conducts regular staff meetings and keeps staff informed of department and organization actions
- Oversees Medication Voucher Program (MVP) and support (yearly review and updates)
- Manages vendor relationships (i.e. Pharmacy vendors, Envisions, Byram, and Sole Support)
- Coordinates with partners and contracting to ensure value added services are available in all markets
- Performs new market implementation project planning in partnership stakeholders and with PMPIO
- Represents department at key meetings (PCC, PHC operations, WM/DNG operations, UMC, QI and quarterly financial/market meetings)
- Ensures provision of excellence in customer service, monitors quality service and customer service delivery by staff and resolves customer service complaints
- Interacts directly with all health plans, medical groups and senior leadership and acts as a resource to all internal and external customers
- Ensures the timely preparation of reports, budgets, and records for dissemination to stakeholders
- Bachelor of Science in Nursing degree, management, business administration or related field
- Registered Nurse with current license in Texas, or other participating states
- 10+ years experience in managed care and / or disease / utilization management with a minimum of 5 years at a management level
- Master’s degree in a related field
10
Supervisor, Care Coordination Resume Examples & Samples
- Provides counseling/corrective action procedures when required
- Maintains documentation of performance including attendance and disciplinary actions
- Provides significant input into associates' performance evaluations and hiring/terminations
- Prepares and completes projects, reports and assignments as needed to meet departmental goals and initiatives
- Investigates issues of an unusual nature and proposes solutions in a clear and concise manner
- Required an Associate's Degree in a related field or equivalent work experience
- Preferred 1+ year experience in leading/supervising others
- Intermediate ability to work independently
- Intermediate ability to work in a fast paced environment with changing priorities
- Intermediate demonstrated interpersonal/verbal communication skills
- Intermediate demonstrate effective critical thinking and decision making skills
- Required intermediate Microsoft Word, Outlook, Excel, Power Point
- Ability to use proprietary health care management system
11
Care Coordination Representative Resume Examples & Samples
- Ability to use and maintain filing systems both electronic and physical
- Ability to work in a confidential setting
- Must be able to work in a demanding, fast paced environment balancing multiple priorities and take appropriate actions in challenging
12
Care Coordination Representative Resume Examples & Samples
- Working knowledge of medical terminology, ICD-9, CPT Codes, HCPCS
- Knowledge of level of care including criteria required for payment and applications processes
- Knowledge of the healthcare industry and available healthcare programs and resources
- General knowledge of illnesses, current treatments and their physical and psychological sequelae
- Ability to accurately interpret contractual and financial payer risk information
- Experience within a health care setting is preferred as well as within an healthcare insurance experience
- Experience with reading, comprehending, and understanding complex medical guidelines is fundamental
- Experience and ability to maintain federal and state regulatory requirements including NCQA, CMS/HCFA, and DMHC
- Experience of data collection techniques and methods of analyzing and reporting data
- PC proficiency in word processing, spreadsheets, graphics, flow charts, organizational charts, and database software required
- Microsoft products preferred (i.e. Windows, Word, Excel, Power point, Access, Outlook)
- Excellent interpersonal skills and time management skills, ability to work efficiently in a fast pace environment, with rapidly shifting priorities and competing demands
- Ability to work independently with minimal supervision. Ability to exercise discretion and make independent judgments, seeking review when decisions represent significant departure from established guidelines
- Organizational and teamwork skills
- Must be able to work in a demanding, fast paced environment balancing multiple priorities and take appropriate actions in challenging situations
- Knowledge of the Sutter Health organization is desired
13
Manager of Care Coordination Resume Examples & Samples
- Lead a team of Utilization Review/CDI Specialists and Social Workers to achieve organizational goals on measures of appropriate utilization of medical services and resources
- Oversee the denial management process for inpatient and outpatient Medicare, Medicaid and commercial insurance denials
- Support medical staff decision-making and clinical documentation that conforms with reimbursement policies on inpatient and observation status
- Oversee programs to reduce hospital readmissions and promotes DSRIP initiatives
- Oversee an effective and efficient discharge planning process
- Participate in hospital compliance with federal core measure and value based purchasing programs
- Provide hands-on involvement in concurrent clinical reviews, core measure abstraction, denial management, readmission reviews, Patient Review Instrument completions, CDI, staff education and other case management duties of the department as needed
- MSW/RN/BSN preferred, Master’s degree in health related field a plus
- Experience in case management, CDI, utilization review and discharge planning in the acute care, home care or insurance setting
- Working knowledge of Microsoft Word and Exel
- Familiarity with commonly accepted medical necessity guideline resources and with managed care industry UR program requirements
- Prior experience with Meditech EHR information systems a plus
14
Senior Care Coordination Specialist Resume Examples & Samples
- Client monitoring to assess the efficacy of the plan
- Periodic re-evaluation and adaptation of the plan as necessary over the life of the client
- Responsible for patient specific health education, monitoring, assessment and deployment of techniques to assure the engagement and retention in care of the identified patients
15
Director of Care Coordination Resume Examples & Samples
- 4+ years of related work experience in an Ambulatory setting
- NYS Licensed Clinical Social Worker (LCSW), Licensed Social Worker (LSW), Nurse Practitioner (NP) license and/or Registered Nurse (RN) license
- Proven experience of managing hospital-wide Care Coordination / Care Management program, including: Care Coordination; Utilization Management; Care Transitions; and, Social Work
- Master’s Degree in Nursing, Health Care Administration, Social Work or other Health-related degree
- Possession of a Case Management certification–ACM
16
Administrative Assistant, Care Coordination Resume Examples & Samples
- Support Director, Managers, and/or Supervisor for assigned campus(es)
- Responsible for completing Complex Case Review Action plan & communications
- Assist Directors with posting and distributing department reports
- Assist Director with invoice coding and approval processes
- High School diploma or equivalent. Associate or Bachelor degree preferred
- Demonstrates proficiency in MS Office Suite; Outlook, Word, Excel spreadsheets, PowerPoint presentations, developing graphs, forms, copying, scanning, faxing required
- Prior experience in administrative support required
- Ability to type 45 WPM required
- Prior experience in health care preferred
- Demonstrates proficiency in advanced administrative skills in taking minutes, scheduling, and phone skills
- Demonstrates proficiency in using and troubleshooting issues with office equipment; LCD projectors, changing print toners, copy machines, ordering supplies and expense reporting
- Visio preferred
- Ability to manage multiple projects in an efficient manner for highly productive, fast-paced department
- Able to successfully navigate computer systems including Taleo, OnBase, Kronos, Midas and Allscripts for generating reports
17
Acn Care Coordination Navigator Resume Examples & Samples
- Clearly communicates the purposes and services available in the ACN Care Coordination program to patients, family members and caregivers
- Receive patient requests for assistance and refers patient to appropriate member of ACN Care Coordination Team (PCP, Care Coordinator, Social Worker, Pharmacist) for resolution, unless Navigator can resolve on his/her own and within the scope of the position
- Coaches patients in self-management of their chronic health conditions
- Develops relationships with community resources and service providers
- Assists patient with barriers to care including but not limited to scheduling appointments, transportation needs, and access to community resources unknown or otherwise unavailable to patients without appropriate referrals
- Works collaboratively with the rest of the ACN Care Coordination Team, including regularly communicating feedback from patients and providers
- If applicable; work in collaborative and cooperative matter with team in physician office embedded in, as well as with assigned QPR, RN, SW as appropriate, and their supervisors
- Basic understanding of ALOS, re-admission rates, Gaps in Care
- Other duties as assigned by Navigator Manager
18
Scicn Care Coordination Navigator Resume Examples & Samples
- Effectively works with patients, staff, health service providers, agencies, etc. from diverse backgrounds to reduce cultural and social-economic barriers between patients and institutions
- Clearly communicates the purposes and services available in the SCICN Care Coordination program to patients, family members and caregivers
- As part of the Care Coordination Team, assists patients in understanding care plans and instructions and helps patients actualize health management plans and goals
- Receive patient requests for assistance and refers patient to appropriate member of SCICN Care Coordination Team (PCP, Care Coordinator, Social Worker and other relevant clinical care participants as necessary for resolution, unless Navigator can resolve on his/her own and within the scope of the position
- Documents activities, plans, and results in an effective manner to maintain case files and provide reports
- Works collaboratively with the rest of the SCICN Care Coordination Team, including regularly communicating feedback from patients and providers
- Fully discloses relevant training, experience and credentials, in order to help patients understand the scope of services the community resource aide is qualified to provide and refrains from any activity which could be construed as clinical in nature
- If applicable; work in collaborative matter with team in physician office embedded in, as well as collaborate with assigned PPL, RN, SW as appropriate
- Abstract clinical data as necessary to support clinical integration quality programs
- Other duties as assigned by Executive Director
19
Care Coordination Analyst Resume Examples & Samples
- Experience in acute inpatient Utilization Review, Medi-Cal, Medicare and Managed Care principles is desirable. Experience in Quality Improvement is desirable but not essential
- Basic medical terminology required
- Able to navigate multiple computer programs and design analysis reports also required. Excellent attitude is of primary importance
- Proficient in MS Word, Excel, Power Point, Midas. Excellent communication skills, telephone etiquette and public relations a must
- Minimum 2 years healthcare experience, high level administrative clerical and computer skills essential
- Proficiency in Spanish a plus but not required. HSD/GED OR 2 years equivalent work experience
- Data entry, monitor performance trends, create graphs, tables, Power Point presentations, liaison with all facets of Care Management Department as well as external customers of the department, e.g. Medical Staff Committees, physicians, case managers, social workers
- Ability to sit for long periods of time, focus in spite of frequent interruptions, multi-tasking a must
- Must be outgoing and personable, able to interact with all customers
- Excellent public relations skills and interpersonal skills
- Must be able to share and teach knowledge to others, strong ability to work independently is required
- Must be able to read, write and speak English fluently
20
Care Coordination Assistant Resume Examples & Samples
- High School Graduate or equivalent education
- Two years of vocational training, medical office experience or relevant work experience. If operational conditions permit, training a candidate without the experience may be considered
- Demonstrated experience in Microsoft Office, typing and computer data entry. 4.Excellent customer service and presentation skills are a must
- Strong interpersonal and written communication skills are essential. 6.Demonstrated ability to apply analytical and problem solving skills. 7.Demonstrated ability to manage multiple tasks or projects effectively
- Ability to work independently as needed with a high degree of detail orientation. 9.Ability to work efficiently in a fast-paced environment with changing priorities
21
Business Analyst Care Coordination Resume Examples & Samples
- Work under the direction of the Manager to provide application solutions for assigned business areas
- Possess functional knowledge of assigned application technology
- Serve liaison role between application technology vendors, internal IS groups, and business users
- Demonstrate new functionality to business users seeking inputs on future direction
- Ensure the quality of the deliverables as per the defined defects standards
- Take complete ownership for the assigned task and timely inform the progress of the project / task to all stakeholders
- Take initiative and drives to bring to logical conclusion; proactive approach
- Provide accurate and timely information and escalates when there are issues
- Bachelor's degree preferred and/or other relevant combination of training and experience
22
Care Coordination Specialist Resume Examples & Samples
- Acquire and maintain a working knowledge of “delegated” agreements and related insurance products
- Provide administrative and enrollment support for team to meet Care Coordination & Care Management program goals
- Maintain strong understanding and educate TEC physicians, clinical staff, patients and families regarding
- Minimum: 5 years experience in health care, including an understanding of health plan related operations. Experience in Managed Care preferred
- Proficient in Microsoft Office (Excel, Access, Word and Outlook)
- Able to type 25 wpm
- Excellent organization skills
23
Care Coordinator Rn-care Coordination Resume Examples & Samples
- Must possess and maintain a current Registered Nurse license with the state of California
- A Master's Degree in nursing with a concentration in Case Management can serve as a substitute for the experience requirement
- BSN degree or experience equivalent preferred
- CM certification preferred RN
24
Director, Integrated Care Coordination Resume Examples & Samples
- Maximize the opportunities in the Integrated Care Coordination division by identifying and implementing innovative ways to adapt with the changing healthcare landscape
- Adept at keeping up with new technology so as to innovate effectively
- Provide sales support for new prospective clients
- Successfully on-board new value based care clients and provide ongoing executive client relationship management
- Demonstrate ability to grow a client facing team
- Strong creative problem solving ability
- Exhibit productivity in anticipating problems and challenges in the changing landscape
- Effectively collaborate and communicate with stakeholders (clients, internal leaders including physicians)
- Monitors key performance indicators and escalates issues to senior management as appropriate
- Manages and develops a high functioning team that includes manager and supervisor levels
- Develops staff that can analyze and recommend ongoing improvements to processes, procedures, systems and reports
- Ensures compliance with MPAS policies and procedures, health plan requirements, and federal and state laws and regulations
- Develops, monitors and evaluates performance metrics; manages the collection, analysis and presentation data relevant to the utilization of healthcare resources including but not limited to avoidable/variance days, readmissions, one-day stays, DRGs, LOS
- Works closely with leadership and Physician Advisors on strategic initiatives, audits and secondary reviews; may include but not limited to data gathering, chart audits and participating in internal and external meetings
- Supports leadership with completion of financial analyses including cost of care to reimbursement, denials management, and non-reimbursed services, promoting effective resource utilization, clinical documentation/queries quality care and patient safety
- Regularly communicates with payors and/or their contracted vendors
- Assumes accountability for improving utilization metrics associated with department/unit and meeting organizational/departmental targets
- Thorough understanding of Utilization Review, Case Management, Care Coordination, Disease Management, Referral management practices and procedures, including knowledge of state, local and federal laws
- Strong knowledge of industry standard performance metrics
- Working knowledge of criteria for medical necessity
- Minimum of 10 years progressively responsible management experience in healthcare
- Experience with multiple clinical management systems; Epic experience preferred
25
Dir, Care Coordination Resume Examples & Samples
- Development and execution of provider and patient focused care coordination services and care delivery plans to facilitate cost effective and quality patient care to meet overall business goals
- Continuity and transition of care between various healthcare organizations and facilities
- Clear communication amongst the Physicians and supporting care team
- Documentation of care identifying progress toward the desired care outcomes and, when appropriate, the intervention as it relates to plan deviations
- Collection of data, reporting of health outcomes, and clinical audits
- Support network development and onboarding teams in continuous growth of organization and physician participation
- 10+ years’ experience in a clinical setting building and leading a care coordination or care management program function
26
Care Coordination Hub Manager Resume Examples & Samples
- Performs care coordination review activities consistent with Magellan policies, procedures, and standards
- Supervises care coordination staff through approved audit processes including performing annual reviews and provides counseling and disciplinary action as necessary
- Assists management in the development of strategic and operational goals and plans
27
Manager of Care Coordination Resume Examples & Samples
- Interviewing, hiring, disciplining, evaluating and mentoring a diverse care coordination work force
- Care Coordinator Manager will facilitate the smooth onboarding process of new employees by supporting the local BSL team following all relevant processes related to onboarding
- Responsible for communication and mentoring members of the care coordination team to ensure long-term and home and community based care guidelines, policies and procedures are followed
- Monitor performance of staff including service performance and adherence to establish utilization and care coordination benchmarks
- Care Coordinator Manager will perform ride along visits with each assigned care coordinator to observe and evaluate Care Coordinator field visits
- May be required periodically to staff a case load of members, when dictated by census fluctuation or staffing overage; will satisfactorily complete member initial visits and assessment and develop member individualized care plan
- Consult with the United Healthcare Community Plan Medical Director on complex cases and participate in interdisciplinary case conferences
- Runs, reviews and analyzes management reports to ensure contract compliance for member outreach, initiation of services, visit compliance; initial monthly, quarterly and /or annually
- Registered Nurse or Licensed Clinical Social Worker (LCSW) with active and unrestricted license in the state of VA or qualifying reciprocal license
- Experience communicating with members who have complex medical needs, the elderly, individuals with physical disabilities, and / or those who may have communication barriers
- 5+ years of relevant health care experience, preferably in managed and / or long-term care supervising the management of complex cases
- 3+ years supervisory / management experience
- Experience working in vertically - matrix organizations
- Intermediate to advanced user of software applications such as Microsoft Word, Excel and Outlook
- Experience providing care coordination to persons receiving long-term care and/or home and community based services
- Working knowledge of Medicaid / Medicare regulations
- Experience in chronic disease management
- Experience working in/or managing a field based staff
- Experience in case management to include assessment, planning, and service coordination
28
Healthplan Care Coordination Liaison Resume Examples & Samples
- Oversees the day to day processes in place for care coordination requirements with MCOs as defined by customer
- Monitors and evaluates data with MCOs on a regular and ongoing basis to drive the highest level of performance around referral, triage and coordination practices
- Collaborates with MCOs in order to establish processes and procedures in an effort to achieve a seamless system among all providers and/or vendors providing services to members identified as having acute care needs
- Facilitates meetings in which care coordination issues are presented. Recommends practice adjustments, policy and procedure revisions, training and support in an effort to provide continuous improvement to care coordination and access to care. Represents Magellan medical/clinical management policy at such meetings
- Maintains a barrier resolution process within and between the MCO partners to translate system successes and barriers into positive systematic changes
- Works collaboratively with site QI, Clinical Management, Medical Management and ICM programs in order to identify enrollees that will require care coordination and intensive services
- Works with the State and the MCOs to identify encounter data that will be shared monthly to ensure care coordination is facilitated between acute, primary and behavioral health services
29
Director Care Coordination Resume Examples & Samples
- Graduate of an accredited college or university nursing program. Master’s Degree preferred
- Knowledge of governmental reporting programs
- Mentor, influence, and manage through matrix reporting relationships
- Ability to gather, analyze, and interpret complex data
- Ability to prepare comprehensive management reports
- Project Management: Skilled in project planning, task prioritization, effectively manages resources, outcomes measurement, and tracking. Takes initiative and exercises good judgment
- Effective change leadership knowledge and skills
- Ability to work under minimal direct supervision but maintain a high degree of communication of current work activity with supervisors
- Minimum 3 years of related clinical and management experience involving care coordination, ambulatory care, quality improvement, leadership, and healthcare quality practices, as well as associated regulatory rules and laws. At least one year must have been in capacity as direct supervisor of other professional level employees
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Rn Care Coordination Nb Resume Examples & Samples
- The RN Care Coordinator evaluates the medical necessity of a patients utilization of healthcare services with designated screening criteria upon point of admission and throughout the provision of care in accordance with and in compliance of the Dignity Health Utilization Review Policy
- The RN Care Coordinator establishes and documents a working DRG on each assigned patient at the time of initial review to estimate a targeted length of stay and anticipate the date of discharge for planning and care coordination purposes
- O The RN Care Coordinator completes and documents a discharge planning assessment on those patients identified as high or moderate risk by the designated screening process, or upon the request of a physician, NP, PA or patient representative
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LVN, Care Coordination Asst PD Resume Examples & Samples
- Highly Preferred; 2-3 years of experience in acute care hospital
- 1-2 years in the utilization of criteria based guidelines for clinical reviews and authorization requests
- Familiarity with community resources and experience in discharge planning
- Utilization Review required, using Milliman Care Guidelines or InterQual Guidelines required
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Quality Metric & Care Coordination Manager Resume Examples & Samples
- Additional languages preferred, not required
- Clinical background required
- Clinical License required (LPN, RCP, RT, MLT, etc.)
- 1-3 years in a managed care. May accept clinic experience as a case manager or clinic leadership
- 3-5 years experience interfacing with patients on care needs required. May accept patient engagement experience
- Knowledge and experience with Microsoft Office products required
- Strong interpersonal communication skills required
- High school, GED equivalent required
- Certified Case Manager, Certified Disease Manager, Certified Professional of Health Quality (or equivalent) preferred
- Ability to independently develop effective action plans based on current condition(s), data stream analysis or other sources of information
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Rn-care Coordination Resume Examples & Samples
- Documents clearly and timely in the Electronic Health Record and other required systems to insure effective communications along the continuum
- Understands and self manages to support facility/CIN level success goals; including improvements in quality, cost of care and member experience for the facility/CIN’s population
- Identifies opportunities for improvement (at individual, facility/CIN levels and actively works with healthcare and facility/CIN team to correct or improve results
- Other duties as assigned by CIN Director/Care Management/Social Services Manager
- Licensed by the State of Iowa as an RN, required
- Three years RN or Care Coordination experience, required
- Bachelor’s degree in nursing or actively pursuing (at least six credits per year). A Bachelor’s degree in a related field is also acceptable
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Care Coordination Specialist Resume Examples & Samples
- Three to five years clinical nursing experience
- License to practice as a Registered Nurse in the State of Michigan
- Case management certification strongly preferred. [BRASSRING IMPORT 9/1/16]
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Director Care Coordination Resume Examples & Samples
- Bachelor’s Degree required, Master's Degree preferred. Clinical licensure as an RN is preferred
- Minimum of 10 years of healthcare experience including clinical and/or administrative experience in the acute or post-acute environments
- Strong knowledge of
- 1) regulatory requirements related to healthcare reimbursement
- 2) payment models related to coordination of care
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Care Coordination Resume Examples & Samples
- Experience in healthcare applications as typically acquired in 6 to 8 years
- Demonstrated technical and/or business experience
- Demonstrated increasingly responsible professional growth
- Proficient at specifying user requirements
- Knowledge of health care operations and structure, general requirements in an integrated delivery system, and use of information system applications in the practicing health care environment is desired
- In-depth of knowledge of application environments including production, test and interfaces
- Broad knowledge of multiple and integrated systems
- Ability to be involved in multiple projects at the same time
- Committed to providing exceptional customer service and responding to user needs in a prompt, courteous manner
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Care Coordination Supervisor Resume Examples & Samples
- Provide oversight for Health Plan Help Desk
- Ensure team members follow procedures for care coordination to provide first-level case management during incoming requests and outbound calls
- Evaluate trip requests to ensure medical necessity and monitor program functions to protect against fraudulent activities
- Assist the Manager/Director with internal and external reporting
- Respond to, document and ensure follow up to all service inquiries received from internal and external customers in a timely and thorough manner
- Act as a resource for Care Coordinators and handle escalated requests
- Research, review, compile, maintain reports/spreadsheets
- Interact with team members, other A2C department personnel, health plan personnel, health plan members medical providers/health care facilities and transportation providers
- Complaint management/monitoring/investigation as requested by Manager/Director
- Manage recurring, short notice and future trip scheduling
- Review/audit completed team projects/work
- Mentor employees, conduct performance evaluations if applicable, counsel and provide disciplinary actions to assigned personnel with a goal of developing a team oriented approach with positive results. Assist in driving performance management
- Comply with all employment laws and support equal opportunity and diversity goals
- Demonstrate a professional approach
- Minimum two years of supervisory/leadership experience
- Minimum two years of previous inbound call center experience preferred
- Prior dispatch/routing experience preferred
- Must have excellent leadership and management skills
- Ability to manage and provide follow-up on projects/tasks, set priorities
- Ability to learn and understand various computer programs
- Collaborative/Teamwork orientation
- Excellent interpersonal skills with ability to maintain effective working relationships with all levels of management and ability to excel in a team environment with internal and external contacts
- Knowledge of medical terminology and services preferred
- Must type 30 wpm
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Supervisor, Care Coordination Resume Examples & Samples
- Required an Associate's Degree in a related field
- Required intermediate Microsoft Word and Outlook
- Required intermediate Microsoft PowerPoint
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Rn-care Coordination Resume Examples & Samples
- Licensed RN in the State of Indiana
- Associates or Bachelor’s degree in Nursing (BSN preferred)
- CCM preferred (Certified Case Manager)
- Knowledge of DRG management and third party payor requirements preferred
- Experience with InterQual and/or Milliman Care Guidelines preferred
- Minimum of two years direct clinical experience required and a minimum of two years’ experience in utilization review, quality, discharge planning or case management REQUIRED
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Director Care Coordination, Days Resume Examples & Samples
- Comprehensive knowledge of care management and discharge planning, Medicare and Medicaid admission and review requirements, and general commercial admission and review requirements
- Minimum of 3 years progressive supervisory or management experience in an acute hospital setting
- Working knowledge of Interqual criteria
- Effective communication skills, especially medical staff
- Working knowledge of finance and budgetary process, and government billing regulations
- Knowledge of conditions of participation and joint commission standards
- Ability to work independently as needed with a high degree of detail orientation
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Arnp-care Coordination Resume Examples & Samples
- Professional School; Master’s Degree in Nursing required
- Current Florida Nursing/ARNP License required
- Required ARNP Certification required
- Current ACLS/BLS Certification required
- Clinical experience for at least 2 years in any combination of medical surgical nursing/emergency-critical care/ambulatory care or other comparable field is required
- Case management, care planning experience preferred
- Knowledge of current trends in quality improvement in managed health care
- Knowledge of clinical documentation improvement (CDI), coding and quality care gaps
- Ability to demonstrate the skill and judgment necessary to implement physician orders, nursing procedures and nursing interventions
- Ability to perform appropriate documentation to maintain the standards set by the hospital and regulatory agencies
- Willingness to work some weekends and evening hours to meet changing client goals
- Proficient in Microsoft Office products, such as Word, Excel, Access & Power Point
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Telephone Care Coordination Resume Examples & Samples
- Performs all components of call processing for inbound and outbound contacts; Ensures complete, timely and accurate documentation of call handling in applicable system
- Able to identify emergent clinical concerns and promote safe outcomes under the direction of a Registered Nurse
- Demonstrates effective time management skills in all aspects in their role as LPN – Patient Care Advocate within NCCM
- Additional state licensures identified at time of hire, applications to be submitted within 120 days of employment
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Supervisor of Care Coordination Resume Examples & Samples
- Knowledge of the methods and processes needed to determine and provide resources needed to achieve business results and ability to identify plan and mobilize resources required to fulfill operational objectives and plans
- Knowledge of federal, state and local healthcare related laws and regulations; ability to comply with these in healthcare practices and activities
- Knowledge of the factors contributing to quality patient care, and the ability to influence these factors in a positive way
- Knowledge of the medical, social, economic, and other services provided by other departments or facilities, and the ability to integrate these multidisciplinary treatments for optimal patient care
- Knowledge of various managed care service principles and techniques; ability to deliver and ensure cost effective and efficient operations in a managed care system
- Minimum of three (3) years experience in Care Coordination or Case Management
- Bachelor's degree in nursing or experience equivalent required
- Current Registered Nurse (RN) license required
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Care Coordination Consulting Director Resume Examples & Samples
- 7-10 years of consulting experience with at least 3 of those years spent in a care coordination or managed care subject matter expert role
- Advanced degree in an applicable field (MBA, MPH, MHA)
- Program design and implementation experience
- Expertise in relevant areas that include health care financing, strategic planning, clinical integration, population health, policy, change management, performance excellence/process improvement (to include, but not limited to Lean/Six Sigma)
- High level of proficiency in Microsoft Office suite (Outlook, Word, Excel, PowerPoint and Project Management)
- Experience in project management or training in project/program management methodology (PMBOK)
- Experience working with care coordination models, data analytics and health information technology, and financial reimbursement
- Detail-oriented and able to work well independently
- Superior creative problem-solving, analytical and quantitative skills
- Experience developing successful health care curricula
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Rn-care Coordination Resume Examples & Samples
- Acts as an education consultant to Dignity Health Care Coordination, Dignity Health Corporate Divisions and Dignity Health facilities regarding Care Coordination performance, tools, and data interpretation
- Develops, implements, and maintains tools to assess and measure Care Coordination staff against position specific competencies
- Assists with Planning, implementation, and evaluation of a comprehensive care coordination training program, including an orientation and onboarding program, skill
- Development, and regulatory and/or system process updates, and software documentation compliance
- Assists with development of education tools for Care Coordination processes and workflows
- Uses resources and tools in the identification of best practices and performance improvement strategies,
- Uses information to develop facility strategies to improve Care Coordination performance
- Collaborates with outside vendors to implement and maintain Care Coordination applications and products
- Supports onboarding and continued education of Facility Care Coordination Directors and Managers
- Supports change and participates in the development, implementation and evaluation of the goals/objectives and process improvement activities across the organization. Works with facility care coordination departments to make necessary changes to process
- Performs all functions according to established policies, procedures, regulatory and accreditation requirements, as well as applicable professional standards. Provides all customers of Dignity Health with an excellent service experience by consistently demonstrating our core values and leadership behaviors on a daily basis
- Prepared short and long-term planning and programs to address identified needs
- Support and assist in planning and coordination of annual conferences, projects, and team meetings as requested
- Participate in administrative team meetings and seminars as requested to keep current with policy, procedure, and regulatory changes
- Leads committees, work groups and/or projects related to the implementation of education activities
- Assist VP of Care Coordination with various ad-hoc projects as requested
- Requires a proficiency level typically attained with 5+ years in case management
- Must have a working knowledge of hospital operations, medical/nursing staff procedures, hospital and community resources
- Previous management experience is preferred
- Requires excellent leadership skills and an ability to interact well across departments, facilities and organizations
- Demonstrates an executive presence
- Excellent organizational, human relations and communication skills are required to maintain good rapport and effective working relationships with internal and external customers
- Excellence and experience in developing instructional material in all types of media and format
- Experience in holding a variety of educational sessions including one-on-one, classroom settings, and web-based programs
- Demonstrated ability to apply analytical and problem solving skills
- Capable of planning and organizing projects with short notice
- Intermediate proficiency with Microsoft Office Suite
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Care Coordination Case Manager Resume Examples & Samples
- RN or LSW with license in good standing
- 4-5 years of experience in case management, home care, acute care, and/or a rehabilitation setting
- Excellent computer and technical skills
- Positive and professional manner to represent CareScout internally and externally
- Efficient, organized, detail oriented, and able to complete tasks in time sensitive manner
- Ability to meet daily standards in both productivity and accuracy
- Self-directed with the ability to work both independently and as part of a team
- Excellent communication skills, both oral and written, with a customer service focused attitude
- Willingness and commitment to develop and maintain professional growth
- Long Term Care / Insurance industry knowledge
- Telephonic case management / Home Health Care experience
- Corporate office experience
- Assessing needs of families’ aging loved ones and developing services plan
- Extensive knowledge of senior care service provider and resource landscape
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Manager, Msho Care Coordination Resume Examples & Samples
- Licensed RN in Minnesota
- 7 years of nursing experience
- 3 years of Home Care or Case Management experience with extensive knowledge of Home and Community Based Services
- 1-2 years of geriatric case management
- Home internet for laptop
- Transportation for home visits
- Demonstrated skills in verbal communication, written communications and teaching skills, change management, stress management, problem solving, conflict resolution, and managing multiple competing priorities
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Care Coordination & Recovery Section Manager Resume Examples & Samples
- Bachelor's Degree in Human Services or related field. Qualifying experience may substitute year for year of education
- At least five years of recent experience working as a manager or supervisor in behavioral health and/or equivalent education on supervision and management skills and practice
- Knowledge of principles of equity and social justice and demonstrated ability to work with individuals from diverse backgrounds
- Strong interpersonal skills including collaboration, team player, and good listening skills
- Advanced knowledge of and recent experience in care coordination such as organizing care activities among different services and providers, and across various facilities
- Demonstrated leadership and experience in utilization management to facilitate the provision of quality, efficient behavioral health services to clients and providers, including, monitoring, evaluating and influencing the delivery of care
- Leadership in developing and implementing a recovery oriented system of care that is built on the strengths and resilience of individuals, families and communities who are actively engaged in their health, wellness and recovery
- Knowledge and experience in Centers for Medicare and Medicaid Services (CMS) rules and regulations related to behavioral health and the Mental Health and Addiction Equity Act application to Medicaid programs
- Demonstrated ability to manage projects using current project management principles, methodologies, and processes
- Skill in organizing, planning, and executing large-scale, complex multi-phase projects requiring multiple organization integration from vision through implementation
- Advanced skill in effectively communicating orally and in writing, including making formal presentations to groups and committees, influencing decision makers in a political environment, and working with the media
- Skill in gathering, analyzing and synthesizing data; writing papers and reports including the ability to present statistical and narrative information to non-technical stakeholders
- Skill in problem-solving, conflict resolution, and decision making; handling multiple competing priorities
- Desired Qualifications
- Master's Degree in Human Services or related field and/or equivalent education and work experience
- Knowledge of King County Recovery Plan, Mental Illness and Drug Dependency Sales Tax, Veteran and Human Service Levy and Best Starts for Kids program and other King County initiatives
- Knowledge of Washington State Medicaid and non-Medicaid services and contracts, including state contract and block grant requirements
- Knowledge of the King County behavioral health service system, social service network, and evidence based and promising practices
- Possess registration as a mental health professional and / or chemical dependency professional
- In recovery or have lived experiences in behavioral health
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Care Coordination Cis-clinical Management Resume Examples & Samples
- The Clinical Integration Specialist may be assigned to a variety of areas such as the Emergency Room or as a member of a Care Coordination team
- The CIS evaluates cases to determine the utilization and quality aspects of admission as it occurs in the acute care setting
- Current Ohio RN Licensed required
- 3 years Utilization Management, Discharge Planning, Documentation Specialists, Case Management experience preferred
- BSN/BS from an accredited school required, Master’s degree preferred
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Care Coordination Assistant Resume Examples & Samples
- High School diploma or GED required; Associates degree preferred
- Two (2) years medical office experience required. Case Management and/or care coordination experience preferred
- Advanced knowledge of medical terminology and medical procedures required
- Solid verbal, written and interpersonal communication skills required. Demonstrated customer service skills required
- Demonstrated proficiency in data entry
- Solid MS Office skills required (Word, Excel)
- Excellent organization skills, with attention to detail and follow through
- Capable of following complex processes, procedures, regulations and requirements per CMS, DOH, NCQA and/or regulatory guidelines
- Communicate and triage inbound calls effectively from members/providers/vendors/agencies/facilities and IH partner organizations; able to document complex messages and escalate to the management team
- Ability to evaluate and prioritize departmental tasks and work queues (under direction of the Manager or Supervisor) and provide timely follow up as required
- Ability to identify, communicate and document actual and potential regulatory (HIPAA, fraud, waste or abuse) or patient safety concerns
- Participates actively in the development and delivery of training and mentoring to CCA Associates
- Consistently offers proactive suggestions/solutions that result in departmental improvements
- Capable of taking on departmental projects and complex tasks with minimal direction and following the project/task through completion
- Ability to meet and/or exceed all established performance standards on a consistent basis (i.e., regulatory timeframes, accuracy and quality)
- Demonstrated proficiency with PC navigational skills; MEDecision, Health Rules and Siebel experience preferred
- Knowledge of medical billing procedures, CPT and ICD-9 coding preferred
- Ability to work flexible hours and/or overtime as needed
- Proven examples of displaying the IH values: Passionate, Caring, Respectful, Collaborative, Trustworthy and Accountable
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ED / Care Coordination CIS Resume Examples & Samples
- Specific job functions will vary based on assigned area but would include items such as: admission status assignment, core measures identification and management, procedure indications and scheduling verification, present on admission conditions and comprehensive discharge planning
- The CIS facilitates modifications to clinical documentation through extensive concurrent interaction with physicians, nursing and ancillary staff to support utilization, evidenced based practice guidelines and appropriate documentation of medical necessity to supports timely and accurate hospital initiatives and reporting physician and hospital outcomes
- Weekend and holiday shift rotation required
