Case Manager Resume Samples
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Case Manager Resume Samples
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JT
J Tremblay
Jane
Tremblay
2911 Chelsea Springs
San Francisco
CA
+1 (555) 525 1042
2911 Chelsea Springs
San Francisco
CA
Phone
p
+1 (555) 525 1042
Experience
Experience
San Francisco, CA
Case Manager
San Francisco, CA
Doyle and Sons
San Francisco, CA
Case Manager
- Completes Departmental Orientation Checklist within 90 days of employment and completes all identified competencies for job description on an annual basis. Completes all identified competencies for job description on an annual basis. Keeps current with professional literature and trends in mental health case management through network and external educational opportunities
- Leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team. Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)
- Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals. Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data
- Reviews content of legal documents and applies legal and tax rules to determine accuracy. Applies concepts, principles and business protocols in conjunction with relevant federal and state-specific laws and tax rules (Internal Revenue Code) in the process of validating the accuracy of settlement documents. Provides recommendations for edits as necessary to comply with federal and state regulations
- Coordinate campus and community resources to support students. Collaborate and consult with key stakeholders and members of student support networks, on and off campus to develop a coordinated, multidisciplinary approach for responding to, advocating for, and supporting students, including coordinating with hospitals for intake, discharge planning and follow up care
- Maintain a comprehensive overview of students identified as being in distress. Managing record keeping through electronic reporting database system making sure all correspondence and action items are accurately documented relevant to compliance with university, local, state, and federal guidelines on reporting. Analyze and maintain data, prepare reports, statistics and presentations documenting campus and national trends
- Developing tailored case management plans by formulating evidence based strategies for managing the case toward the optimal claim outcome
present
Detroit, MI
Case Manager
Detroit, MI
Stanton-Pacocha
present
Detroit, MI
Case Manager
present
- Responsible for review/approval of the New Relationship Review Form (Know Your Client Story) of all new clients for the above-mentioned businesses; making sure both the client’s story and the source of wealth supporting documentation are according to business’ and enterprise AML Compliance standards/policies/guidelines. The Case Manager will
- Strengthen and improve Case Management Services: Establish strong relationships with clinicians and other health care team members. Communicate data on population case managed, utilization and outcomes. Education of staff/clinicians. Development and distribution of education, tools and materials for member coordination. Contributing to ongoing process improvement including related procedures, policies, patient support and documentation tools
- Facilitates multidisciplinary communication to maintain ongoing, positive relationships with healthcare team, patients, families, payers/TPA and community providers; functions as a resource to all customers to optimize care coordination and resource utilization Initiates and leads team conferences to achieve consensus regarding continuing care plans
- Making sure Initial Case Management assessments are performed on all new admissions
- The case manager role is structured around 3 major functions: care coordination, utilization management and discharge planning. Each of these functions supports the CM department goals: improved patient satisfaction and patient outcomes, decreased length of stay and decrease unit cost. The case manager provides case management resources to the inpatient CM program on both medical-surgical and psychiatric units
- Monitor and assure implementation of complex medication regimens; provide support for patient/family. Collaborative partnership with clinicians and members of the care team. Responsibilities include assessment, analysis, planning and implementation of medication regimens and monitoring their effectiveness; maintaining and evaluating the plan of care; facilitating changes in the plan and brokerage of necessary services
- Participating in all Utilization Management performance improvement projects
Education
Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
University of Illinois at Chicago
Bachelor’s Degree in Nursing
Skills
Skills
- Proficient in basic computer skills including Microsoft Windows (or its equivalent) along with the ability to access the internet to do research
- Basic knowledge of Quality Improvement techniques
- Intermediate ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
- Ability to multi-task, capable of daily problem-solving complex issues
- Knowledgeable in the use of intranet and internet applications
- Working knowledge of Quality Control Medical Management system
- Ability to operate PC-based software programs including proficiency in Word, Excel, PowerPoint, Access and Project
- Strong attention to detail is critical
- Excellent communication skills and ability to work collaboratively with all members of the health care team
- Knowledge of and ability to adhere to the Nurse Practice Act
15 Case Manager resume templates
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1
Case Manager Resume Examples & Samples
- A credit process specialist dealing with a range of credit activities for a number of portfolios
- Provide high-quality credit processing support to Relationship Directors, acting as an interface with other areas of the bank
- Responsible for preparation of complex Facility Letter documentation and Instruction for completion of necessary security documentation
- Will be responsible for managing drawdown of significant lending deals ensuring that Regulatory and Internal procedures are adhered to
- Working in partnership with the sales team, servicing team and other specialists to ensure that we provide a joined up service to our customers at all times
- Highly analytical and strong numeracy skills
- Very decisive and ability to reason decisions through
- Able to work to tough deadlines in a pressure environment
- Strong initiative, strong intellect, adaptable and innovative - producing a practical and pragmatic approach
- Knowledge of Post Sanction Fulfillment Process would be an asset to any candidate
- Full fluency in both Spanish in English is mandatory for this role
2
Case Manager Resume Examples & Samples
- 2+ years of related experience
- Care / Case management skills
- Knowledge of NYS Medicaid and CMS Medicare guidelines related to provision of care and services to members
- Well-developed ability to communicate via phone and email
- Technological skills, including all programs of Microsoft Office (Outlook and Excel, namely)
- Experience working with multiple EMR systems simultaneously
- UAS experience
- MLTC experience
- Telephonic assessment experience
- Strong documentation and follow up skills
- Large case volume experience (over 100)
- Previous experience in a Managed Care setting
- Certified Case Manager
3
Case Manager Resume Examples & Samples
- 2+ years of Managed Care, Case Management, and/or Utilization Review experience
- Registered Nurse (RN) license
- Workers' Compensation, Pain Management or Orthopedic experience
4
Case Manager Resume Examples & Samples
- BSN is required
- 5+ years of case management experience
- Multiple licenses for multiple states
5
Case Manager Resume Examples & Samples
- 1+ year of Homecare experience
- Experience in Nursing with emphasis on community health education/experience
- Experience with OASIS and the Medicare/Medicaid population
- Experience with a Healthcare computer system
- Previous experience with Allscripts
6
Case Manager Resume Examples & Samples
- 5+ years of Nursing experience; 3+ years of Clinical Nursing experience; 2+ years of Case Management experience
- Familiar with InterQual and/or Milliman guidelines
- Previous Oncology experience
7
Case Manager Resume Examples & Samples
- 3-5 years of Managed care experience as a Supervisor/Team Leader doing concurrent case management
- 1-2 years of progressive supervisory experience in Utilization Management Managed Care
- Thorough knowledge of all utilization management processes, expectations, requirements, medical terminology; ICD-9 and CPT coding, medical management criteria, reporting and benefits plan designs
- Excellent communication skills and a high proficiency in Microsoft Word and Excel $
8
Case Manager Resume Examples & Samples
- LPN
- Managed care case management/UR experience or orthopedic clinical nurse experience
- Excellent communication skills $
9
Case Manager Resume Examples & Samples
- Nursing Degree
- NYS Registered Nurse (RN) License
- Previous MRDD experience
10
Case Manager Resume Examples & Samples
- 2+ years of Case Management experience in a hospital setting
- NYS Registered Nurse (RN)
- PRI Certification
11
Case Manager Resume Examples & Samples
- BSN $
- CM certification
- PRI certification
- Experience with Case Management software, especially Canopy and ECIN
12
Case Manager Resume Examples & Samples
- Registration and current RN license in the state of MA in good standing
- 2 years of experience in a Medical/Surgical setting and one year of experience in discharge planning/utilization management
- Familiarity with Medicare, Medicaid, managed care, and other third-party payor expectations and community resources
- Baccalaureate degree in nursing
13
Case Manager Resume Examples & Samples
- 1+ year of relevant experience
- Knowledge experience in the Coordinator of Care model of case management
- CHHA experience
- Organized and able to handle telephonic role
14
Case Manager Resume Examples & Samples
- RN with Case Management or Discharge Planning experience
- Graduate of an accredited school of nursing (Diploma, AD, BS, BSN)
- CT Licensed Registered Nurse or eligible to be licensed
15
Case Manager Resume Examples & Samples
- Interacting with patients, families, physicians, and other disciplines to facilitate high Quality cost effective patient outcomes
- Reviewing all new admissions within 24hrs (1 business day), except weekends/holidays, when they will be reviewed within 48hrs (2 business days), to assure admission appropriateness
- Making sure Initial Case Management assessments are performed on all new admissions
- Documenting initial assessment concurrently on the Admission Assessment form
- Initiating denial management by communicating any prospective or concurrent denial information to the Attending Physician
- Maintaining a working knowledge of insurance specific provider networks when arranging post-acute care services
- Performing all aspects of Utilization Review
- Accurate documentation of Utilization Management related activities per current process
- Acting as a member of the interdisciplinary team by attending patient care rounds, communicating patient needs for teaching to the nursing staff and assuring a safe level of patient understanding with regard to disease process and treatment regime. Also assures documentation in the medical record supports this
- Making appropriate referrals to Social Work Services to meet the patient’s identified psychosocial needs
- Making appropriate referrals to Director of Utilization Management for discussion with the Associate Medical Director or Utilization Management Consultant
- Reviewing all readmissions within 30days, for quality of care, adequacy of discharge planning from the prior admission and refers for quality review as appropriate
- Effective communication of discharge plan to physician, family, patient
- Completion of PRI’s as indicated on cases within assigned case load
- Maintaining a working knowledge and professional relationship with community wide post-acute care providers
- Participating in all Utilization Management performance improvement projects
- Tracking and monitoring variances to identify and improve processes
- Serving as a resource to the community and represents the Department, as requested, within the hospital and the community
- Maintaining current knowledge of community resources and post-acute providers
- Maintaining working knowledge of all Utilization Management related regulations and requirements
- Maintaining current knowledge of the standards of Case Management practice
- Handling coverage for peer group as needed
- Other duties / tasks as assigned by Department Director
- 3+ years of Med/Surg or Critical Care experience
- 3+ years Utilization Management, Discharge Planning, Case Management or Home Care experience
- Case Management Certification
16
Case Manager Resume Examples & Samples
- 5+ years of experience in Med-Surg nursing
- 2+ years of experience in UM
- Experience with Case Management
17
Case Manager Resume Examples & Samples
- Manage patient care with Medicare/Medicaid members, their families or significant others and coordinate with the PCP, SCP and all members of the health care team to facilitate the patient's care across continuums of care episodes
- Perform preadmission, concurrent and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter
- Assess member's physical, psychological and discharge planning needs through communication with appropriate hospital staff
- Act as a clinical resource/educator for the multi-disciplinary health care team on an ongoing basis in order to maximize quality of patient care
- At least 2 years of clinical and case management experience serving both Medicaid/Medicare populations
- RN/LPN
- Knowledge of the concepts and philosophy of case management and utilization review regulations
18
Case Manager Resume Examples & Samples
- Reviewing and evaluating the patient's medical record to determine the appropriateness and medical necessity for admission and continued hospitalization
- Evaluating appropriate resource utilization, and assesses patient for transitioning to the next appropriate level of care
- Collaborating with the health care team to ensure the achievement of quality outcomes for patients/families
- RN; BSN required
- 3-5 years medical-surgical experience
- 2 years of utilization management/ case management experience in a hospital setting
19
Case Manager Resume Examples & Samples
- 3+ years of case management, and/or discharge planning experience
- Med-Surg or inpatient experience
- Highly organized with a careful attention to detail
20
Case Manager Resume Examples & Samples
- Managing a system to coordinate the caseload of patient’s care throughout the entire episode of illness
- Exploring strategies to develop a patient focused discharge plan
- Pre-screening all elective admissions
- Reviewing treatment pathways
- Working with patients, families, physicians, and outside agencies to establish, coordinate, and complete a discharge plan
- 2+ years case management experience in a hospital setting
- RN, AN in Nursing
- Acute care background
- Leadership skills/experience
- P/C planning experience
21
Case Manager Resume Examples & Samples
- Facilitation of the collaborative management of patient care
- Pre-certification and payer authorization processes
- Application of process improvement methodologies in evaluating outcomes of care
- Coordination of communication with physicians, nursing and staff of ancillary departments
- Evaluation of care provided against the GMLOS
- Communication with patients and their families around medical plan of care and discharge plan
- Assessment and plan for discharge needs and arrangements
- BSN / RN
- 3+ years of hospital case management experience (managed care considered)
- Experience with utilization review and discharge planning
22
Case Manager Resume Examples & Samples
- 4+ years of Clinical experience
- Bachelor’s Degree in Nursing or an equivalent combination of education and experience
- Solid presentation and negotiation skills
- 1+ year of experience in a Managed Care setting
- Certification in Utilization or Case Management
- Proficiency with the use of Mobile technology (Smartphone, wireless laptop, etc.)
23
Case Manager Resume Examples & Samples
- Clinical Hospital experience
- Previous Home Care experience
- Geriatric experience
- Knowledge of Medicare and Medicaid
- Solid phone etiquette
24
Case Manager Resume Examples & Samples
- Perform benefit investigations with insurance companies as required
- Manage patient transition to HAE products. Work with nurses to provide injection/infusion training to patients
- Provide back-up coverage for other Case Managers
- Attend patient meetings and represent Shire HGT at industry conferences
- BA/BS in the life sciences or communications preferred
- 3 -5 years of prior case management experience preferred
- Individual must possess and portray strong emotional resilience
25
Case Manager Resume Examples & Samples
- Bachelor's degree in social work or related field, such as psychology, vocational rehabilitation, or occupational rehabilitation
- One (1) to of case management or related experience
- Knowledge of and ability to follow agency mission, philosophy and policies and procedures
- Knowledge and ability to understand department policies and procedures
- Ability to be patient and sensitive to individuals with disabilities
- Must be computer literate with a working knowledge of MS Word and MS Excel
- MSW or master's degree
- Bilingual (English-Spanish)
26
Case Manager Resume Examples & Samples
- Current NYS license as a Registered Professional Nurse
- 2+ years of medical-surgical clinical experience
- 1+ years of case management, utilization review, or disease management experience required
- Experience with discharge planning
- Working knowledge of standard utilization criteria, Medicare and Medicaid coverage guidelines, health claims processing, and medical coding
27
Case Manager Resume Examples & Samples
- Stakeholder Engagement
- Balancing Metrics & Quality
- Proactively communicating with the customer to evaluate their history, medical treatment, level of function and abilities, social network; uncover all biopsychosocial influencing factors potentially impacting the claim; understand the customer's needs and expectations of appropriate work accommodations to facilitate RTW
- Constantly engaging all stakeholders to ensure highest customer satisfaction and opportunity for the customer to return to their best life
28
Case Manager Resume Examples & Samples
- Carry out name screening of entity, directors, beneficial owners in NESS ( Name and Entity Screening System)
- Collate and review information internal and external sources for company news (Firm website, Regulatory websites, Company website, Dun & Bradstreet, Google etc.)
- Validate the information within the CADD and CIP document to ensure complete and accurate ( Company/Entity Formation, Ownership, Management, Market Reputation etc)
- Complete eCADD incorporating local regulatory requirements
- Highlight any discrepancies to BSU Senior Case Manager
- Follow up with Relationship Managers for outstanding information
- Report any negative news to AML Compliance department
- Assist relationship and coverage teams globally in completion of the CADD and CIP-P (Customer Identification Programme) documents
- Coordinate and carry out CADD renewal process with coverage, business, and compliance
- Manage flow of CADDs to adhere to internal SLAs
- Proficient use of ECADD application
29
Case Manager Resume Examples & Samples
- Create workitems in CitiKYC system sourcing information from internal and external sources by the agreed deadline
- Proactively interact with coverage teams and compliance to update system with information until final approval of workitems in CitiKYC
- Collate and review information from internal and external sources for company news (Firm website, Regulatory websites, Company website, Google etc.)
- Validate the information within the CitiKYC system and CIP document to ensure it is complete and accurate ( Company/Entity Formation, Ownership, Management, Market Reputation etc)
- Complete workitems in CitiKYC incorporating local regulatory requirements
- Carry out name screening of related parites in NESS ( Name and Entity Screening System)
- Take responsibility for workitems in CitiKYC and associated documentation completion from initiation to approval
- Meet agreed daily targets for workitems review and completion within agreed Service Level Agreement timeframes
- Escalate any negative news and high risk cases to Coverage/AML Compliance department
- Knowledge of local regulatory KYC/AML requirements Skills
30
Case Manager Resume Examples & Samples
- 2+ years of Clinical Patient Care experience in an Acute Care and/or Chronic Disease Management setting
- Microsoft Office/Suite proficient (Word, Excel, Access, etc.)
- 1+ year of Case / Utilization Management experience in an Acute Care or Insurance company setting
- Experience with Standard Office Technology in a Window based environment
- Experience with Standard Office Equipment (Phone, Fax, Copy Machine, Scanner, Email/Voice Mail)
31
Case Manager Resume Examples & Samples
- 1+ year of Case Management experience
- Medical-Surgical experience in a Hospital setting
- Previous Concurrent Review and Utilization Review experience
32
Case Manager Resume Examples & Samples
- Care Management experience
- Proficient computer skills, including Microsoft Office and EMR systems
- Prior experience in Managed Care
33
Case Manager Resume Examples & Samples
- Florida State Registered Nurse license
- Fluency in written and spoke English
- Familiarity with the operations of the healthcare industry and healthcare delivery systems
- Ability to use the medical record in order to obtain clinical information to perform Interqual reviews
- Possess a solid clinical background to accomplish extensive Medical Record review
- 3 or more years of acute care hospital experience
- Work experience in Medical-Surgical, Telemetry, Critical Care, and/or Pediatrics, and NICU
34
Case Manager Resume Examples & Samples
- New York State RN License
- 3 years of acute care clinical experience
- 3 years of discharge planning experience and/or utilization management experience
35
Case Manager Resume Examples & Samples
- Highlight any discrepancies to Senior Case Managers
- Escalate any negative news and high risk cases to RM/AML Compliance department
- Languages - fluent in English; other languages is an advantage
36
Case Manager Resume Examples & Samples
- Key point of contact for clients planning cross border travel, engagements and events
- Relationship building and networking with both formal network of specialists as well as the clients
- Advising the business on steps and actions to take in order to create the best margins
- Review and assess case information to determine the necessary actions and requirements. This will require considerable time spent on data collection and administration
- Coordinate, schedule and document all activity with support from the Contact Center
- Centralized resource for keeping client and stakeholders regularly informed
- Reach out to colleagues across organization (e.g., global network of tax and immigration specialists) for input and advice as required
- Compile and issue case briefing to client, addressing their tax and immigration requirements and required actions
- Project work to enhance different areas of CBTS
- Develop extensive cross border knowledge and project management skills,
- People manager for other members of the CBTS EMEIA function (at manager and advisor level)
- Review client’s long term travel situation or engagement to identify multiple trip implications
- Use immigration and tax knowledge to identify cross border travel requirements
- Maintain and leverage a knowledge repository to continuously improve client support and services
- Strong knowledge of immigration and tax issues (Payroll, Income Tax, Social Security etc) derived from having worked in a Mobility, Expatriate Tax or Immigration role
- Proven ability to convey complex information in way that can be easily comprehended by senior- level, internal clients (e.g., risks, costs, engagement economics)
- Demonstrated ability to develop strong relationships with internal clients across all levels of organization, all areas of business and supporting functions
- Ability to work in challenging and pressurized environment
- Excellent administration and time management skills
- Effective verbal and written communication skills with an emphasis on professionalism, confidentiality, tact and diplomacy
- Ability to work against tight deadlines
- Proficient with firm standard technology including Windows, Excel, Word, Lotus Notes, Intranet and Case Management tools
- Performs duties and responsibilities with limited supervision in accordance with policies and procedures
- Mobility experience
- A strong working knowledge of tax and immigration implications
- Experience of working in a large/complex/global organisation
37
Case Manager Resume Examples & Samples
- AS/BS in nursing
- 2 years of acute care clinical experience, or any combination of education and experience
- Current unrestricted RN license in applicable state(s)
38
Case Manager Resume Examples & Samples
- AS and or BS in Nursing
- 2 years of acute clinical care experience
- Registered Nurse licensure
- Prior experience in utilization review and well-rounded experience in hospital, skilled nursing, or home care
39
Case Manager Resume Examples & Samples
- Request and review all underwriting requirements, Attending Physician Statements, Inspection Reports, Motor Vehicle Reports, and other medical and/or financial underwriting requirements
- Maintains and updates the Resonant new business system with the current status of each case and any outstanding requirements
- Respond quickly and accurately to all interested parties (agents, wholesalers, management, etc.) by phone, email or mail regarding inquiries on pending case statuses
- Answer incoming calls on ACD line for life insurance status calls
- Taking initiative to proactively push cases through the underwriting process and reducing cycle time from application to issue and delivery
- Strong knowledge of state and regulatory guidelines including Suitability, Knowledge of Replacements including Regulation 60 in NY, and 1035 Exchange processing
- 1-3 years case management experience within the financial services industry
- Attaining LOMA 1 & 2 within 12 months of hire
- Good understanding of state & regulatory guidelines including replacements & suitability
- BA/BS Degree in business / or related field preferred
- Knowledge of life insurance including variable products
- Outgoing, positive attributes with the ability to build and maintain great working relationships
- Extremely detail oriented
- Strong written and verbal communication skills; must poses a keen ability to communicate via e-mail in a clear, concise and professional manner
- Self-directed: able to multi-task, prioritize and manage multiple requests
40
Case Manager Resume Examples & Samples
- Connecticut State Registered Nurse (RN) license
- 2-3 years of nursing experience
- Ability to assess patient status and identify requirements relative to age-specific needs
41
Case Manager Resume Examples & Samples
- Prior experience with InterQual
- Massachusetts State registered Nurse license
- Case Management certification
42
Case Manager Resume Examples & Samples
- 2+ years of prior Case Management / Discharge Planning experience
- Active NYS Registered Nurse (RN) license
- Knowledgeable with Assessment protocols
- Exceptional clinical skills
- Interqual / Milliman experience
43
Case Manager Resume Examples & Samples
- Case management and coordination of care of members enrolled in Humana's Medicaid HMO products by utilization of nursing skills to triage, assess, monitor, evaluate, instruct, intervene and document goals and outcomes
- Coordination of medical management efforts with other Humana departments including, but not limited to Medicaid Administration, Health Services Onsite Staff, Case/Disease Management, Quality Improvement, and Provider Relations
- Collaborate with Team Leader and Health Services Manager for data collection, reporting and Quality Improvement initiatives on clinical programs, including evaluating ongoing effectiveness and improvement opportunities
- Strong computer skills including Microsoft Office (including Word, Excel, Outlook)
44
Case Manager Resume Examples & Samples
- Massachusetts State Registered Nurse (RN) license
- 3-5 years of acute medical/surgical experience
- 3-5 years of Case Management experience
- Certification in Case Management (CCM)
- Strong knowledge in Microsoft Office applications - Word, Excel, Access, PowerPoint
- Understanding of the health care delivery setting
45
Case Manager Resume Examples & Samples
- Conduct telephonic outreach to assigned members to assess health, environment, nutrition, and psycho-social areas of concerns using a variety of assessments
- In response to assessments, coach and problem solve with member to identify and address specific goal(s) to support health and behavior change
- In addition, provide appropriate interventions to optimize health and well-being. Interventions may include education, the coordination of community based support services, national resource; Integrated Voice Response (IVR) programs; or the intervention of a Field Care Manager (FCM)
- Collaborate with other members of the Humana Cares interdisciplinary team to include; Humana At Home Care Manager-RN, Humana At Home Care Manager-Social Services, Field Care Manager and Community Health Educator
- To better serve members and implement the model of care, will understand the clinical program design, program monitoring and reporting
- Minimum of two years combined experience as a medical assistant or certified nurse assistant, health related field,or care management and/or degrees in psychology, health education, or social work
- Ability to interact effectively with multi-disciplinary team members
- Intermediate to advanced computer skills and experience with Microsoft Word and Excel
- Excellent keyboard and web navigation skills
- Ability to use a variety of electronic information applications/software programs
- Work and train onsite plus additional travel as needed for ongoing training
- Ability to work a full-time (40 hours minimum) flexible work schedule
- Must have accessibility to high speed DSL or cable modem for a home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance from Humana systems is 10M x 1M
- Associate’s degree in Behavioral Health or health related field
- Experience with behavior change, health promotion, coaching and wellness
- Previous managed care experience
- Previous work with vulnerable adults or the geriatric population
- Knowledge of scope and activities of public and private health agencies
- Previous telephonic case management experience working in the medical/insurance field
- Basic knowledge of complex care management and care management principles
- Experience with motivational interviewing
- Ability to communicate clearly and professionally in both written and oral communication
- Demonstrated ability to proficiently use multiple programs to manage one process
46
Case Manager Resume Examples & Samples
- New York State Registered Nurse License
- 5 years of clinical experience
- Knowledge of PRIs
- Prior experience performing Utilization Reviews
47
Case Manager Resume Examples & Samples
- 4+ years of Clinical experience in Home Health Care
- Graduate of an accredited 2 or 4 year Nursing Program
- Current NYS Registered Nurse (RN) license
- Managed Long Term Care experience
- Prior Case Management and/or Managed Care experience
- Experience with personal computer using Windows operating system
48
Case Manager Resume Examples & Samples
- 2+ years relevant Hospital=based experience in an Acute Medical Rehabilitation setting or related area
- NJ Registered Nurse (RN) license or Licensed Social Worker (LSW)
- Hospital Case Management experience or Acute Care with Managed Care / Case Management experience
- Certified Medical Coder
49
Case Manager Resume Examples & Samples
- 2+ years of Clinical experience
- Associate's and/or Bachelor's Degree in Nursing and/or a Health related field
- Previous experience in a Neonatal Intensive Care Unit (NICU)
- Previous OB/GYN experience
- Proficiency in the use of personal computers and supporting software in a Windows based environment, including MS Office products (Word, Excel, PowerPoint) and Lotus Notes
- Knowledge in the use of intranet and internet applications
- Working knowledge of Case / Care Management principles
- Knowledge of principles of Utilization Management
- Basic knowledge of Healthcare contracts and Benefit Eligibility requirements
- Knowledge of Hospital structures and Payment systems
50
Case Manager Resume Examples & Samples
- Connecticut State Registered Nurse license
- 1 year of Case Management, utilization review, or discharge planning experience
- 3-5 years of current acute care experience
- Demonstrated skills as a leader and strong clinical skill in the practice setting
- Compassionate and Empathetic
51
Case Manager Resume Examples & Samples
- Licensed Master Social Worker (LMSW)
- Prior work experience in the healthcare field
- Experience working with a frail adult or elderly population
- Accurate typing skills
- Experience managing large case loads
- Adept at working in an environment with fast-past changing priorities while achieving departmental goals and objectives
- Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems
- Ability to troubleshoot or explain basic hardware and software errors
- Fluency in speaking Spanish or Mandarin/Cantonese
- Knowledge of InterQual criteria
52
Case Manager Resume Examples & Samples
- 1+ years of related experience
- Previous Discharge Planning experience
- Previous Case Management experience within a Managed Care Organization or Skilled Nursing Facility
53
Case Manager Resume Examples & Samples
- 3 years of US based work experience as a licensed Registered Nurse
- Knowledge of current community health practices for the frail adult population and cognitive impaired seniors
- Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors
- Care management knowledge, including the concepts and philosophy and relevant standards of patient care
- Experience managing member information in a shared network environment using paperless database modules and archival systems
- Experience with multiple Medicaid managed care plan
- Knowledgeable of the values offered with integrated care
- Knowledge of InterQual
54
Case Manager Resume Examples & Samples
- Answer the 1-800 ITVERP Resource Line, responding to and assisting victims of international terrorism
- Process victim applications for reimbursement, including but not limited to, drafting and mailing claimant, collateral source and provider correspondence
- Enter and track all claims activity into Excel based tracking systems
- Interact regularly with victims of international terrorism
- Draft expense summary sheets in Excel for claim recommendations
- Draft meeting minutes, after action minutes, and weekly reports
- Participate in and contribute to weekly case management meetings
- Maintain daily operations of the claims management process
- Respond to data requests in a timely matter
- Interact professionally with diverse government officials, including but not limited to, the Department of State, the Federal Bureau of Investigation, and the National Security Division within the Department of Justice
- 2+ years of government based, client, or customer facing experience in the social sciences field
- Proficiency with Microsoft Office (Word, Excel, and PowerPoint)
- Experience processing claims
- Experience working in the field of international terrorism
- Demonstrate commitment to client satisfaction
- Ability to work independently and in collaboration with a team
- Solid customer service skills
- Strong outreach abilities and interpersonal skills
55
Case Manager Resume Examples & Samples
- 1+ year of experience working within an Acute Care Hospital
- Graduate of from an accredited School of Nursing
- Solid clinical skills
- BSN or Master's Degree from an accredited School of Social Work
56
Case Manager Resume Examples & Samples
- Judgment and integrity
- Ability to priorities simultaneous tasks
- Detail oriented approach
- Ability to navigate complex organizational structures
- Project Management/Coordination
- IT skills, especially in relation to data collection and analysis
- Ability to understand a wide range of technology platforms
- Understanding of legislation pertaining to eDiscovery and IT Security
- Business oriented educational background
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Case Manager Resume Examples & Samples
- Trouble shoot and resolve ongoing reimbursement issues (lifetime caps, insurance changes, PA’s, etc)
- Act as a mentor to Case Manager I
- Be an on the floor leader
- Become the subject matter expert for the group in a particular area (ex – Medicare, healthcare reform, etc) and present this section to new hires during training process
- Present quarterly case review sessions for others to learn from
- Attend regional CMSA conference or national meeting
- 3 -5 years of prior case management experience
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Case Manager Resume Examples & Samples
- Recommend services for Humana Plan members using care alternatives available within the community and nationally
- Examine clinical programs information to: manage our members on an outpatient basis and develop strategies to prevent readmission; mine health risk assessment data reports to identify potentially high-risk membership; identify and refer members to Disease Management Programs; conduct discharge planning; coordinate Behavioral Health management
- Coordinate: in versus out-of-network movement; care in out-of-network facilities; care with specialty networks; care with DME providers; transfers to SNF and back
- Conduct post-discharge calls and discharge planning
- Current RN license
- 2-5 clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Valid drivers license and/or dependable transportation necessary (variable)
- Special Certifications: Case Management Certification
- Health Plan experience Previous Case Management experience
- Medicaid/Medicare experience
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Case Manager Resume Examples & Samples
- Associate's or Bachelor's Degree (or higher) in nursing and/or a health related field or accredited nursing school diploma
- Active New Jersey State Registered Nurse license
- Proficiency in the use of personal computers and supporting software in a Windows based environment
- Working knowledge of case/care management principles
- Working knowledge of principles of utilization management
- Basic knowledge of health care contracts and benefit eligibility requirements
- Knowledge of hospital structures and payment systems
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Case Manager Resume Examples & Samples
- Active New Jersey State registered Nurse license
- Associate's or Bachelor's Degree (or higher) in nursing and/or a health related field, accredited nursing school diploma
- 2 years of clinical experience
- 3 years of experience in the healthcare delivery system/industry
- 2 years of experience with healthcare payer experience
- Excellent clinical skills
- CDE
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Case Manager Resume Examples & Samples
- 2+ years of Clinical experience; 3+ years of experience in the Healthcare delivery system/industry; 2+ years of experience with Healthcare Payer experience
- Associate's or Bachelor's Degree (or higher) in Nursing and/or a Health related field OR accredited diploma Nursing school
- Experience in Case Management and Utilization processes
- Knowledge of Medical Management systems
- Pending or obtained certification in Case Management, Certified Diabetes Educator (CDE), or other applicable Clinical specialties
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Case Manager Resume Examples & Samples
- Associate's Degree in Nursing from an accredited program
- Experience as a licensed RN in one or more of the following areas: Geriatrics; Discharge Planning; Case Management; Assessment; Acute, Sub-Acute, Long-Term Care (LTC); Health insurance; Home care environment; Homeless; Addiction; and, Foster care
- Able to pass UAS training
- Experience using a Corporate e-mail system
- Adept at operating within a diverse and multi-cultural work environment and community of Members such as Spanish, Chinese, Russian, Creole and Korean
- Knowledge of care management including the concepts and philosophy and relevant standards of patient care
63
Case Manager Resume Examples & Samples
- Responsible for admissions, concurrent and/or retrospective reviews of all patients in accordance with the criteria and the policies and procedures approved by the Performance Improvement Committee, and consistent with Federal and State guidelines, PRO regulations, JCAHO standards and contractual agreements with insurers or outside review agencies
- Serves as a liaison to
- Responsible for processing Medi-Cal TARS (Treatment Authorization Request) and obtaining physician signature in a timely manner
- Collaborates with discharge coordinator regarding patient cases not meeting intensity of services/severity of illness criteria
- Initiates the appeal process upon notification of denial by business office
- Demonstrates knowledge of pediatric, adolescent, adult and geriatric variations in treatment/procedure as evidenced by annual age specific competency assessment/evaluation
64
Case Manager Resume Examples & Samples
- Prior experience with Interqual
- Proficiency with computer platforms and applications, particularly Microsoft Excel
- Strong data analytic skills
65
Case Manager Resume Examples & Samples
- Clinical hospital experience
- Home care experience
- Strong phone assessment skills
- Exceptional computer skills
- Prior experience in case management
66
Case Manager Resume Examples & Samples
- Graduate of NLN Accredited School of Nursing
- 1+ year of experience in an Acute Care hospital
- Strong clinical, organizational, and interpersonal skills
- BSN or Master's Degree from an accredited school of Social Work
67
Case Manager Resume Examples & Samples
- Master's Degree in Social Work
- Prior experience working with the geriatric population
- Experience with DFTA STARS database
68
Case Manager Resume Examples & Samples
- Strong oral and written communications skills coupled with excellent customer service skills are essential
- Dedicated to a team environment and culture with proven ability to work well with others
- Ability to communicate effectively with end user clients during service calls and provide resolutions to problems
- Ability to work cooperatively within a team, communicating ideas and providing coverage as required
- Ability to prioritize workflow
- Accuracy and attention to detail are critical to this role
- Strong knowledge of TDWISI business requirements and how it relates to third parties is a plus
- Personal insurance experience is a plus
69
Case Manager Resume Examples & Samples
- Active Florida State Registered Nurse license
- Strong experience with Utilization Review
- Discharge Planning experience
- Compassionate and empathetic $
70
Case Manager Resume Examples & Samples
- 5+ years of current Acute Hospital or equivalent experience
- Expertise in Case Management / Utilization Review
- Knowledge of Medicare/Medicaid regulations
71
Case Manager Resume Examples & Samples
- 3+ years of nursing experience
- 1 year at the Charge / Supervisory level
- 1 year of Utilization Review, Quality, Risk, Discharge Planning or Case Management experience
- Exceptional case management skills
72
Case Manager Resume Examples & Samples
- 2+ years of Medical and Surgical Clinical experience; 1+ year of Case Management, Utilization Review, or Disease Management experience
- Strong experience with discharge planning
- Strong knowledge with standard utilization criteria (Milliman, Interqual), Medicare and Medicaid coverage guidelines, health claims processing, medical coding and interpreting provider contracts
- Solid problem-solving, clinical assessment, and care planning skills
- ASN / BSN
73
Case Manager Resume Examples & Samples
- Active Massachusetts State Registered Nurse license
- 5+ years of current acute hospital or equivalent experience
- Expertise in Case Management/Utilization Review with knowledge of Medicare/Medicaid regulations
74
Case Manager Resume Examples & Samples
- Bachelor's Degree with grade level which indicates competence in absorbing and integrating information and concepts
- Ability to act responsibly in stressful situations in order to undertake emotionally difficult aspects of working with young adult populations
- Knowledge of group dynamics and interaction, especially with the mentally ill and adolescent populations
- Ability to independently and professionally assess the physical and emotional well-being of the patient
75
Case Manager Resume Examples & Samples
- 1+ year of Case and/or Utilization Management experience
- Experience and be proficient with InterQual and MCG (formally Milliman)
- Solid documentation skills
76
Case Manager Resume Examples & Samples
- Previous Case Management, Managed Care, and/or Utilization Review experience
- Previous experience in the Orthopedic, Neurology, or Intensive Care Unit (ICU) areas
- Pain Management experience
77
Case Manager Resume Examples & Samples
- 2+ years of experience working in an Acute Hospital setting, including Utilization Management / Case Management
- Solid documentation and clinical skills
- Behavioral Health InterQual experience
78
Case Manager Resume Examples & Samples
- 5 years of current acute hospital or equivalent experience
- Expertise in Case Management/Utilization Review
- Outstanding communication and customer service skills
79
Case Manager Resume Examples & Samples
- Previous working experience in a Hospital and/or a Rehab setting
- Supervisory background
- Solid documentation and assessment skills
80
Case Manager Resume Examples & Samples
- Associate's / Bachelor's Degree in nursing and/or a health related field, or accredited diploma nursing school
- 3 years of experience in the health care delivery system/industry
- 2 years of experience with health care payer experience
- Pending or obtained certification in case management, Certified Diabetes Educator (CDE), or other applicable clinical specialties
81
Case Manager Resume Examples & Samples
- Proficient in medical processes and terms
- 3+ years of experience in a clinical practice
- 2+ years of experience working in programs serving individuals with special needs
- 1+ year of experience with the geriatric population
- Experience in managed care and/or care management
- Bachelor's or Master's Degree in health, human or education services
- Care Manager Certification
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Case Manager Resume Examples & Samples
- Active Registered Nurse or Practice Nurse license
- Knowledge of CMS and Interqual
- 5 years of hospital, skilled nursing facility (SNF), home care agency or managed care organization
- Strong case management skills
83
Case Manager Resume Examples & Samples
- Assist in departmental projects as required Person Specification
- Years of experience in banking, finance or law
- Languages : Fluent
84
Case Manager Resume Examples & Samples
- Active MA Registered Nurse license
- Prior experience with Utilization Review and Discharge Planning
- Exceptional documentation and assessment skills
85
Case Manager Resume Examples & Samples
- 3-5 years of relevant clinical medical surgical, ICU or ER experience
- 3-5 years of experience in managed care performing utilization review and discharge planning or experience in acute care performing utilization review and discharge planning
- Demonstrated case management skills
- CCM experience
86
Case Manager Resume Examples & Samples
- 2+ years of experience in a Human Services role
- Bachelor's Degree (social services field preferred)
- Working knowledge of issues related to homelessness, HIV, substance abuse, mental illness, and entitlements
- Crisis intervention skills
- Degree in Social Services
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Case Manager Resume Examples & Samples
- Provide rotational support for all departments within the Transactional Support organization, including Case Management, Sourcing, Payments, ECD, Parser, Integration Support and Top Customer. Daily assignments will be determined by the business needs and will vary in length
- Effectively and professionally works with customers, solving their problems and addressing concerns and suggestions; ultimately looks to make it right for all fans
- Produce quick and accurate customer issue resolutions that balance the needs of the customer with solid financial judgment
- Identify and push for new and better ways to do things to improve the fan experience, drive down occurrence rates of customer issues and decrease time to resolve
- Based on service levels, provide departmental support in other CS roles, including inbound phones, chat and email support
- Meets or Exceed performance metrics on a daily, weekly, monthly basis
- Drive relentlessly towards helping each department within Transactional Support meet and exceed performance goals
- Help build and maintain a team environment characterized by “can do” attitudes and high levels of cooperation and energy
- Potential to lead or participate in cross-functional project teams
- Establishes and maintains effective relationships with customers and gains their trust and respect
- Ask appropriate questions to properly identify problems and solutions
- Uses his/her time effectively and efficiently
- Is able to communicate clearly and succinctly in a variety of settings and styles
- Works collaboratively with others to achieve group goals and objectives
- Proficient computer skills; ability to learn and adapt to new technology
- Must be comfortable working in a fast paced environment
- Strong attention to detail is critical
- Strong decision making abilities
88
Case Manager Resume Examples & Samples
- 1+ year of experience working with the economically disadvantaged, homeless, welfare recipients and other disadvantaged populations or a combination of work and education
- Ability to navigate web-based systems, spreadsheets, and other Microsoft Office programs
- Ability to obtain and evaluate information from customers through personal interviews
- Ability to obtain the respect customer confidentiality
- Ability to communicate effectively with others
- Ability to meet deadlines, juggle multiple priorities, and excel in a team environment
- Ability to prepare materials and facilitate group workshops
- Ability to develop community resources and maintain updated resource file
- Bachelor’s Degree in Counseling or other Social Service field
- Knowledge of case management theories of practice
89
Case Manager Resume Examples & Samples
- ASN or BSN
- Knowledge of CM, UR, Discharge Planning and Coordination of Care
- Certification in case management
90
Case Manager Resume Examples & Samples
- Direct engagement with clients for on-boarding related client education & documents/forms collection
- Validating client information & documentation is in accordance to ANZ Compliance requirements including identification of any red flags
- Liaise with the customer for onboarding documentation, coordinating and tracking the onboarding cases whilst delivering service excellence and client satisfaction
- Maintain collaborative relationships with key local stakeholders, including Relationship Management, Operations, Implementation, Product, Compliance, Legal and other business partners
- Tertiary qualification
- Experienced in KYC documentation and processing
- Ideally from a compliance background
- A strong conceptual and practical understanding of Client Onboarding
- Product knowledge in Cash, Trade, Markets and Lending preferred
- High level oral and written communication and negotiation skills
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Case Manager Resume Examples & Samples
- 2+ years of experience
- CHHA
- Allscripts experience
92
Case Manager Resume Examples & Samples
- Bachelor's Degree in Social Work
- Experience working with the Homeless and Substance Abuse population
- Working knowledge of AWARDS system
93
Case Manager Resume Examples & Samples
- 2+ years of Case Management / Home Care experience
- Knowledge of Medical Terminology
- Solid assessment and time management skills
- Working knowledge of Lotus Notes
94
Case Manager Resume Examples & Samples
- Associate’s or Bachelor’s Degree (or higher) in nursing and/or a health related field, or accredited nursing school diploma
- Proficiency in the use of personal computers and supporting software in a Windows-based environment
- Prior authorization experience
95
Case Manager Resume Examples & Samples
- Proven administrative and/or customer service experience in a Financial Services environment
- A basic understanding of Life Insurance, key terms and how it worksExcellent written and verbal communication skills
- A great customer service ethic and ability to relate effectively with people at different levels
- Strong organisational skills, time management and attention to detail
- HSC or relevant diploma qualification is a plus
96
Case Manager Resume Examples & Samples
- Prior home care experience
- 3+ years of case management experience
- Managed long-term care experience
97
Case Manager Resume Examples & Samples
- Achieve KPI's which will include both restructuring and management of restructured portfolio of customers
- 4 years'+ experience of working in a lending and / or restructuring area of a financial services company is highly desirable
- QFA Qualified
- An ability to prioritise and plan to effectively achieve goals and to be dependable in consistently delivering reliable results
- Housing Loans, Home Reversion Agreements and Associated Insurances
- Consumer Credit and Associated Insurances
- Proficiency in Microsoft Word, Excel and Outlook
98
Case Manager Resume Examples & Samples
- 2+ years of business experience, preferably in a medical support related position or health insurance environment
- Proficient in the use of personal computers and supporting software in a Windows-based environment, including MS Office products
- Knowledgeable in the use of intranet and internet applications
- Strong typing, data entry and numeric keypad skills
- Comfortable using a calculator for simple math calculations
- Knowledge and understanding of case management, philosophy and process
99
Case Manager Resume Examples & Samples
- Works to monitor and obtain ongoing authorizations as regulated by
- Maintains effective channels of communication with facility personnel
- Attends facility meetings and participates in facility quality improvement
- May act as liaison between the facility and the outside community
100
Case Manager Resume Examples & Samples
- Basic PC and data entry skills
- Knowledge of medical terminology and telephone etiquette
- Demonstrated ability to organize and prioritize work, provide oral and written instructions, interact tactfully with customers and establish and maintain effective relationships with others
- Must be able to apply specific departmental policies rules and regulations relating to verifying patient information, collecting payments and maintaining records and forms
101
Case Manager Resume Examples & Samples
- Three years of experience in providing case management, crisis intervention, and counseling services to college students
- Experience working in a university counseling center
- Training and experience in brief therapy and group therapy
- Demonstrated ability to work effectively with campus personnel, such as professionals in academic affairs and/or student life
- Experience helping clients navigate insurance systems
102
Case Manager Resume Examples & Samples
- The accurate setup in Client Administration Billing (CAB) System
- Identification of documents in OnBase needed for certificates
- Review and mail premium notices after Underwriting decision is made and all outstanding documents (i.e., signed amendments, health certificates, riders) are received
- Advanced knowledge of Contracts and Titles (i.e., beneficiaries, trusts, authorizations, ownerships, collateral assignments), which ensures accuracy at the initial setup of the policy
- Works closely with multiple vendors (i.e., MRS, ExamOne) managing the relationship between vendors and member
- Ensures applications received are managed and billed from initial submission
- Promote and maintain high customer focus by communicating effectively, promptly and offering reasonable detailed solutions that meet customer needs while protecting the business objectives
- Must be knowledgeable and continue education on SOX controls
- Bachelor’s Degree in related field, or equivalent experience
- At least 4 years of experience and understanding of insurance, benefits and contractual workings of life and disability products
103
Case Manager Resume Examples & Samples
- Confidently formulating and rationalizing decisions on STD, LTD and Life Waiver claims using contractual, medical, functional and vocational analysis
- Ongoing analysis of contractual, medical, functional and vocational information to develop and implement goal-oriented claim management plans
- Respond in a timely fashion to a high volumes of written and verbal communication with a wide range of internal and external stakeholders
- Maintain productive relationships with internal team members to maintain service level targets
- Constant prioritizing of conflicting demands
- Strong written and verbal communication skills in English with the ability to effectively deliver difficult messages to clients
- Analytical problem-solving and strategic decision-making
- Knowledge of provincial legislation and regulations
- Ability to effectively prioritize conflicting demands
- Previous Group Disability Claims Experience is highly preferred
104
Case Manager Resume Examples & Samples
- Managing relationships with back offices and producers at firms distributing John Hancock LTC insurance (day-to-day interaction; conference calls; reports; trend management)
- Managing relationships with internal Long Term Care departments: underwriting, marketing, distribution and compliance
- Understand and use appropriate methods of communication when dealing with clients (e.g. phone vs. e-mail)
- Managing the overall new business cycle time through
- Post secondary school graduation or equivalent work experience
- Previous experience in the insurance or financial services industry is preferred
- Current knowledge of the area’s business/ procedures is highly desirable
- Solid negotiation and problem-solving skills
- Excellent customer service skills and communication skills
- Ability to multitask and prioritize under changing circumstances
- Strong technical competence
105
Case Manager Resume Examples & Samples
- Bachelor’s Degree or equivalent, relevant experience
- CCM Certification required within two years of hire date
- Three years clinical experience in a hospital/outpatient clinic
- Active licensed RN in state of employment
- Computer skills in charting, Word, Excel, Access, PowerPoint
- Two years case management experience
- Managed Care Experience
106
Case Manager Resume Examples & Samples
- 3+ years of Clinical Practice experience; 2+ years of Case Management experience
- Experience with Short or Long-term disability
- Knowledge of Workers Compensation regulations
107
Case Manager Resume Examples & Samples
- Reviews and verifies the accuracy and completeness of applications to include premium handling; is thorough when performing reviews and conscientious about attention to detail to ensure a high quality product to customers. Ensures the effective use of procedures in accordance with business practices and compliance with state and federal regulations
- Handles and prioritizes multiple concurrent tasks. Takes ownership of the case management process and facilitates the work flow of complex cases in a way that is seamless to the customer
- Develops a strong, positive reputation to earn the trust of the producers. Delivers an exceptional customer service experience by providing appropriate product/process education and demonstrating a high level of responsiveness and follow-up on commitments
- Relationship manager for internal and external customers; provides information and researches, analyzes and resolves problems to satisfy customer expectations; provides high quality customer service by remaining knowledgeable of current guidelines and practices. Builds strong relationship with all business partners to provide superior service
- Meets or exceeds time service, quality and customer service expectations as defined by management; ensures timely responses to internal and external customers submitted via phone, email and workflow systems
- Communicates effectively with internal and external customers; verbal and written communication is clear, concise and professional; uses appropriate grammar and spelling in written correspondence
- Uses various databases to document reporting requirements and system generated reports. Accesses various other systems to provide information required by underwriting and maintains underwriting files
- Proactively recognizes problems and works collaboratively to recommend process improvements to enhance customer service, increase efficiency or reduce unnecessary steps/hand-offs
- Mentors associates; creates process documentation and training presentations; proven ability to make sound business decisions to include exception handling
- This position requires extensive or prolonged typing/keyboarding
- Experience working in customer service, ability to collaborate with internal and external clients to find the best solution possible
- Experience in key job functions, systems and product knowledge; takes full end to end ownership of assigned work load
- Proven ability to build and maintain relationships with customers through effective written and verbal communication
- Experience handling escalated situations and using sound judgment for exceptional handling
- Experience in creating process documentation and training presentations
- Ability to multitask effectively, work under pressure, meet deadline requirements and be flexible to meet changing customer needs
- Demonstrates learning agility with industry education
- Solid understanding of insurance operations including: Distribution, marketing, and Underwriting
- Industry education such as LOMA
- Insurance experience
- Disability Income and Critical Illness experience
- Experience mentoring new associates
108
Case Manager Resume Examples & Samples
- In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes case management objectives
- Manages 60 to 80 active cases based on case intensity and acuity. Specialty Case Manager case loads may vary
- Acts as liaison and member advocate between the member/family, physician and facilities/agencies
- Schedules or facilitates scheduling appointments and follow-up services
- Requests consultation and diagnostic reports from network specialists
- Contacts members to remind them about upcoming appointments and/or missed appointments
- Participates in monthly chart audits
- Case load may differ by state and/or location based on contract requirements, membership, plan and/or operational best practice
- Required 2+ years of experience in a clinical acute care position(s), preferably in home health, physicians office or public health
- Required 1+ year of experience in current case management experience
- Intermediate Ability to drive multiple projects a plus
- Intermediate Ability to work in a fast paced environment with changing priorities
- Required Licensed Registered Nurse (RN)
- Required Beginner Microsoft Word
- Required Beginner Healthcare Management Systems (Generic)
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Case Manager Resume Examples & Samples
- Evaluates members for case management services and determines appropriate level of care coordination/ management services for member
- Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services
- Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description
- Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities
- Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan
- Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers)
- Act as liaison and member advocate between the member/family, physician and facilities/agencies
- Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines
- Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues
- Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities
- Meets with clients in their homes, work-sites, physician’s or hospital to provide management of services
- Adapts to changes in policies, procedures, new techniques and additional responsibilities
- Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds
- Travel to inpatient bedside, member’s home, provider’s office, hospitals, etc required with dependable car. May spend up to 70% of time traveling with exposure to inclement weather and normal road hazards. May require climbing multiple flights of stairs to a member's home, provider's office, etc
- Required A Bachelor's Degree in Health Services or Nursing
- Required 2+ years of experience in clinical acute care
- Preferred 1+ year of experience in current case management
- Preferred Other Managed care experience
- Preferred Other Prior utilization management experience preferred in some geographic regions
- Preferred Other Experience in care of the elderly is required in some geographic regions
- Preferred Other Experience in home health, physicians office or public health
- Intermediate Ability to multi-task Bilingual skills a plus
- Intermediate Other Ability to understands the business and financial aspect of case mgmt in a managed care setting
- Intermediate Demonstrated written communication skills
- Intermediate Demonstrated customer service skills
- Required Other Maintain required contact hours to fulfill regulatory requirements
- Required Intermediate Microsoft Word Proficient in Microsoft Office including Excel, Word, PowerPoint, Access and Outlook Express
- Required Intermediate Microsoft Excel Knowledge of or the ability to learn company approved software such as CRMS, Peradigm, InterQual, Sidewinder and other software in order to perform job duties
110
Case Manager Resume Examples & Samples
- Utilization management of hospitalized health plan members, care coordination, improved transitions of care and discharge planning
- Ensure patients receive quality medical care in the most appropriate setting
- Performs the following case management skills on a daily basis
- AA Degree
- Active Nevada RN license
- CCM within 2 years of employment
- Access to reliable transportation
- 1+ years of varied clinical experience in a hospital setting with an emphasis on case management or utilization management
- Experience in a managed care organization
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Case Manager Resume Examples & Samples
- Review referrals and authorization requests in accordance with partner health plans (PHP) referral/authorization processing standards
- Act as liaison between member, physician(s), Medical Director(s), facility(ies), ancillary provider(s) and health plan(s)
- Identify and evaluate members for case management (CM) through the following mechanisms
- Physician referral
- High-risk screen tool
- Ambulatory utilization
- Inpatient concurrent review (acute/sub-acute) as assigned
- Diagnosis screen criteria
- Member/ family/significant other referral
- Provide alternative health care services utilizing contracted and community resources
- Collect and analyze health services data for tracking and trending of utilization
- Current, valid and non-restricted California license
- Minimum of two years experience in the clinical environment, preferably hospital and/or physician office setting
- Minimum of two - five (2-5) years case management or utilization management experience in the managed care environment (HMO or IPA)
- Knowledge of medical standards and practices
- Knowledge of community health resources
- Knowledge of medical coding, including, but not limited to, ICD9, CPT, ASA, HCPCS
- Knowledge of health plan benefits, HFCA regulations, NCQA criteria and any/all other healthcare and managed care regulatory agencies
- Ability to prioritize, problem solve, and manage multiple assignments simultaneously
- Maintain a professional manner and work ethic
- Computer literate using Microsoft Office Suite programs
112
Case Manager Resume Examples & Samples
- Serves as the primary coordinator of clinical care within the DVBIC TBI program
- Ensures interventions and testing ordered by treating clinicians are scheduled, and results are shared with the multi-disciplinary team
- Participates in scheduled meetings and be available for other ad hoc meetings as needed
- Provides direct care to service beneficiaries with TBI and their families
- Other duties consistent with the above responsibilities
- Performs a variety of complex administrative and analytical tasks in support of a contract program
- Establishes and defines program plan requirements and performs in-depth studies to determine optimum program plans
- Monitors and reports performance against plans to ensure contractual, cost, and schedule objectives are met
- May perform business development activities
- May provide guidance and work leadership to less-experienced employees
- 3-5 years’ experience in case management required. Minimum of 3 years of TBI experience preferred. Experience in the care of patients with TBI – in-patient, out-patient, or rehabilitation settings or obtain Certified Brain Injury Specialists (CBIS) certification within 6 months from the date of employment is required. Prior experience within the DoD/VA systems of care strongly preferred
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Case Manager Resume Examples & Samples
- Develop working relationships with customers and monitor engagement and progress
- Work with customers on a regular basis to meet and achieve program goals and/or maintain program services and eligibility
- Conduct workshops and other training related services for customers
- Exhibit considerable programmatic knowledge and assist customers in multiple phases of the application process, ranging from enrollment through the awarding of benefits and services
- Assist customers to acquire services that facilitate program goals (e.g., educational and/or vocational training, medical, child care, transportation, substance abuse/mental health, child support establishment, legal, and other related needs)
- Follow up with customers to ensure that their needs are met and questions and concerns are resolved
- Interact with other team members to provide expertise and assistance in resolving participant issues
- Maintain accurate and timely case notes on all customer contacts and document activities
- Share information about outreach and engagement efforts with project staff
- Inform project staff of any barriers that they identify and that are preventing the customer from engaging with the Provider
- Perform other duties as may be assigned by leadership
- Bachelor's degree from an accredited college or university required, preferred field of study in human services or equivalent years of experience in employment services or human services
- Ability to develop, evaluate, and implement a case management plan meeting all milestones
- Ability to work with customers in a caring and respectful manner and with due understanding of and consideration for their unique circumstances
- Ability to perform comfortably in a fast-paced, deadline-oriented work environment
- Ability to work as a team member, as well as independently
- Occasionally lifts, carries, or otherwise moves items weighing up to 25 pounds
114
Case Manager Resume Examples & Samples
- Experience: 3 years clinical experience
- Experience in Case Management, Quality Management and/or Appeals Management preferred
- Skills & Abilities: Keen analytical, critical thinking and problem-solving skills. Excellent written and verbal communication skills. Ability to meet deadlines and work under pressure. Word processing skills: Word, Excel, Access and OHS systems. Strong organizational skills
115
Case Manager Resume Examples & Samples
- Manage a portfolio of group insurance claims for death, terminal illness, total & permanent disablement and salary continuance
- Liaise with Insurance Helpline colleagues, and as required - the claimants, members and insurers
- Manage underwriting tasks such as following up with the member and insurer, requesting and obtaining forms and medical evidence, as required and maintaining file records
- Working with members and claimants over the phone in a sensitive manner
- Build and maintain effective relationships with the claimant, members, authorized representatives at a company, the insurer and the fund trustees
- Previous experience within insurance and/or superannuation (claims and benefit payments experience highly regarded)
- RG146 compliant (or working towards)
- Computer literate-MS Word and Excel
- Numerate with good written and verbal communication skills
- Extremely customer focused and empathetic
- Self-motivated and able to work towards deadlines
- Mercer is a truly a global organisation with long term opportunities for growth, career progression and national/international job opportunities with over 20,000 employee’s based in more than 40 countries
- A supportive team environment with solid training and development, yet autonomy on a day-to-day basis for you to manage your own workload
116
Case Manager Resume Examples & Samples
- Must have a minimum of 2-5 years handling patients programs
- Industry experience desirable
- Experience on managing chronic therapies
- Safety medical monitoring and report experience
- Excellent knowledge of local and/or regional regulations and requirements of Pharmacovigilance
- Strong project management, interpersonal, communication and presentation skills
- Additional requirements as applicable based on local regulations
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Case Manager Resume Examples & Samples
- Build/maintain patient relationship in order to educate, provide ongoing treatment support and assist with gaining access to therapy
- Facilitate the coordination of health care provider and payor resources to ensure access to chronic complement inhibition therapy for patients with PNH and aHUS
- Obtain patient consent and comply with privacy rules
- Develop and implement case plans for patients
- Anticipate and prevent or identify and resolve (through coordination of efforts and resources) interruptions or barriers to care
- Maintain records, complete reports and communicate case status and direction
- Organize resources for patient assistance
- Establish and maintain partnerships with field staff
- Attend patient meetings, conferences and trade shows to educate patients, providers or payors regarding disease/product information and case management services
- Maintain a current knowledge base regarding insurance options and requirements (state, federal and commercial payors)
- Contribute to the development of departmental policies, procedures and special projects
- Participate in and complete required pharmacovigilance training
- Identify those areas of work and standard operating procedures related to pharmcoviligance
- 3-5 years recent Clinical Nursing experience, case management, or insurance experience with a strong, successful track record
- Experience working in a multi-disciplinary team environment for continuation of care
- Ability to handle sensitive issues with opposing opinions
- Work independently and handle special projects
- Ability to multi-task and use up to date technology
- Some travel requirements (15%)
118
Case Manager Resume Examples & Samples
- Process aligned cases in an accurate and timely manner to reduce case re-work keeping in line with policy/procedural and legislative requirements
- Ensure that the Project methodology on case management is applied accurately and consistently whilst maintaining accuracy in workload against policy and procedures to ensure delivery of the Project’s goals and objectives
- Provide assistance in fielding questions from internal stakeholders as well as from clients
- Monitor personal workflow to ensure productivity commitments and milestones are met
- Work output is delivered in line with internal policy, procedural, legislative and regulatory requirements & displays a commitment to ANZ vision, values and strategic direction
- Background in financial planning related field (key requirement)
- Attention to detail to ensure accuracy is a must as is the ability to multitask
- Excellent interpersonal skills to ensure effective relationships with stakeholders
- Ability to use Microsoft Office suite of products and financial planning related systems
119
Case Manager Resume Examples & Samples
- One year utilization management/discharge planning experience preferred
- Three years clinical nursing experience
- Working knowledge of the community's resources preferred
- Knowledge of hospital routine as it relates to admissions and patient placement
- Knowledge of current utilization management principles, PRO criteria and standards, third party payer requirements and discharge planning process
- Ability to establish a smooth working relationship with Medical Staff, Nursing Service, Social Services, Home Health/Hospice and other departments
- Self-direction and ability to function independently
- Licenses/Certifications
120
Case Manager Resume Examples & Samples
- Work with physicians and payers to advocate for product specific coverage. Ability to communicate product benefits and efficacy to positively influence payer policy
- Capability to monitor drug coverage policies for multiple payers. Review case outcomes to analyze and identify payment and denial trends as well as key findings for client reporting
- Must be able to analyze reimbursement specific data and prepare written reports for management and client communications
- ICD-10, HCPCS, CPT experience
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Case Manager Resume Examples & Samples
- Work with the patients, families, and other members of the health care team to formulate appropriate post-acute discharge plans
- Gathers and assesses information regarding the patient's biopsychosocial needs, including but not limited to mental status, family support system, financial resources, and available community and governmental resources
- Works with the inter-disciplinary team to create a comprehensive care management plan that addresses the needs identified
- Discharge plans will be action- oriented, time-specific, and include collaboration with utilization management to manage length of stay, ensure cost-effectiveness, and ensure in-network providers are being utilized
- Identifies gaps between identified service needs and resource availability
- Ensures patient is given choice in regard to agencies and services
- Collaborate with healthcare professionals within multi-disciplinary team meetings and during patient rounds. SW will provide information pertinent to patients discharges needs (i.e. barriers, family dynamics, and resource limitations) and works to identify high-risk patients through this process
- Provides education to patient/families on how to navigate throughout the healthcare delivery system
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Case Manager Resume Examples & Samples
- Participate in managing the organization's complaint and grievance process. Accountable for investigation of all issues, including collection and documentation of appropriate data. Identify and address specialty / flagged cases and follow appropriate processes for different types of cases. Communicate with a diverse set of internal and external clientele to achieve excellent results in the areas of complaint and grievance handling, compliance, documentation and enhancement of the member experience
- Partner with and outreach to internal staff, other MS Departments, managers and physicians to resolve issues as quickly as quickly as possible. Research, resolve and communicate complaints and grievances filed by members and communicate Health Plan's decisions appropriately back to member or their authorized representatives
- Ensure that complaints and grievances are processed in accordance with regulations, compliance standards and policies and procedures. Meet timeframes for performance while balancing the need to produce high quality work related to complex and sensitive member issues
- Ensure integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory protocols and effectively manage case resolution inbox everyday
- Answer questions and manage members on existing / open cases. Escalate issues to management as appropriate to maintain compliance
- Minimum four (4) years of customer service experience OR minimum four (4) years working in a complex health care environment
123
Case Manager Resume Examples & Samples
- Independently and proactively complete chart reviews, screening calls and full assessments related to the anticipated level of care and document findings using standardized approved documentation tools
- Triage findings from member assessments, identifying needs and issues, engage patients to define a plan of care and appropriate level of self management and interventions. Determine Level of Care. Communicate findings and actions to involved care providers through succinct summaries that include findings, actions and further recommendations
- With the member/family and appropriate KP staff and providers, develop and document a patient-centered care plan that addresses short term goals that are specific, attainable and measurable
- Act as a liaison between the patient and appropriate care delivery team
- Minimum two (2) years of experience in case management, care coordination, or population care preferred
- Microsoft Word, Excel, and Health Connect experience preferred
- Quality management methodology and utilization management experience preferred
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Case Manager Resume Examples & Samples
- Utilization Management: Performs daily pre-admission, admission, and concurrent utilization reviews using guidelines, institutional
- Minimum two (2) years of experience in patient care delivery or completion of Master's degree in Case Management Program in lieu of minimum years of experience
- Master's degree in case management preferred
125
Case Manager Resume Examples & Samples
- 1-15 years of CHHA experience
- Some in-house experience
- Excellent case management skills
- Bilingual skills
126
Case Manager Resume Examples & Samples
- Participate in the admission process including pre-admission assessment, rate negotiations, benefit verification care need s and reporting
- Assist interdisciplinary team in planning for admission and ensure staff are adequately prepared to meet needs for the manage care/Madicare resident on admission
- Greet newly admitted care and Medicare residents upon admission
- Escort them to their rooms as necessary
- Participate in marketing function as deemed appropriate to assist with increasing managed care and Medicare census
- Report known or suspected incidents of fraud to the Administrator
- Ensure that appropriate supplies and equipment, etc., are available to meet the needs of assigned residents
- Participate in the orientation of new resident/family members to the facility
- Make rounds with physicians as necessary
- Admit, transfer, and discharge Medicare and managed care residents as required
- Must have , as a minimum, three (3) year’s experience in a hospital, nursing care facility, or other related health care facility
- Must have training in a rehabilitative and restorative nursing practices
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Case Manager Resume Examples & Samples
- Acquires appropriate clinical records, clinical guidelines, policies, EOC, Benefit Policy and coding guidelines
- Assesses the member's current health status, resource utilization, past and present treatment plan and services; prognosis, short and long term goals, treatment and provider options
- Develops plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs
- Performs prospective, concurrent and retrospective reviews and first level determination approvals for assigned members, as appropriate, or refers reviews to appropriate associate
- Works closely with delegated or contracted providers, groups or entities (as assigned) to assure effective and efficient care coordination
- Maintains confidentiality of all PHI in compliance with state and federal law and Health Net Policy
- Must have and maintain active, valid and unrestricted license that meets licensure requirement for the state in which you practice, i.e., Registered Nurse, Clinical Psychologist, or Licensed Clinical Social Worker
- Case Management certification preferred
- Demonstrated ability for assessment, evaluation and interpretation of medical information, and care planning
- Possess a high level of understanding of community resources, treatment options, home health, funding options and special programs
- Ability to effectively analyze, interpret, apply and communicate policies, procedures and regulations
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Case Manager Resume Examples & Samples
- 2+ years of relevant professional experience (Spring 2016 MSW graduates may be considered for the position)
- Bachelor's Degree in Social Worker
- NYS Licensed Master Social Worker (LMSW) licensure within 90 days of hire
- Master's Degree in Social Worker
- Previous work with At-risk and/or Court-involved populations
- Experience in a Court or Criminal Justice setting
129
Case Manager Resume Examples & Samples
- Coordinates the care of the patient
- Manages the utilization review process
- Oversees discharge planning process
- Adheres to payor requirements
- Supports hospital quality of care initiatives
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Case Manager Resume Examples & Samples
- Maintains knowledge of current contractual arrangement with the Health Plans and vendors
- Functions as clinical resource for benefit interpretation. Researches complicated cases
- Screens for CCS diagnosis and refers appropriately
- Screens all tertiary referrals through Compliance Director
- Oversees UM Coordinators to ensure accurate and timely processing of the authorizations
- Assists in preparing annual evaluations for UM Coordinators
- Attends monthly UM Committee meeting for related groups and assists in the preparation of the agenda, minutes, and packet
- Identify any patterns of over/under utilization and refer to appropriate source
- Refer appropriate cases to the Outreach Department
- Perform related duties or fill in for others in the department as requested by the Director of Compliance and UM
- Foster positive interaction and relationships with all internal departments as well as cultivating positive working relationships with external contacts
- Perform other assigned duties / special projects on an as-needed basis as directed by the Director of Compliance and UM
- Prevent and avoid harassment and discrimination. Respond promptly to any complaints in accordance with policies in the Employee Handbook
- California License , RN or LVN
- Minimum 3 years case management, utilization or discharge planning experience in an IPA, Medical Group, Hospital or Health Plan environment
- Knowledge of Apollo, Milliman, or Interqual Guidelines
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Case Manager Resume Examples & Samples
- Must possess a Bachelor's or Associate level degree from an accredited school of nursing
- Current Illinois Registered Nurse License required
- CPR Certification
- Ability to establish and maintain effective working relationships with the public
- Must be able to follow directions and to perform work according to department standards when no directions are given
- Must be emotionally mature and able to function effectively under stress
- Must possess crucial thinking skills, effective written and oral communication skills, strong self-initiative and interpersonal skills
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Case Manager Resume Examples & Samples
- Three years nursing experience in ICU, CCU, or ED acute care setting. Case Management experience preferred
- Certification in Case Management preferred
- Demonstrates an ability to perform specific competencies as identified on the Case Management Competency Grid
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Case Manager Resume Examples & Samples
- Assesses and responds to patient/family needs by coordinating efforts of other team members
- Coordinates the discharge planning process ensuring involvement of all members of the healthcare team. Counsels with patients and family members in decision making and in meeting psycho social needs of the patient
- Collaborates with personnel at other facilities to coordinate smooth and effective patient transfers and transitions
- Texas State RN license or compact license accepted
- Graduate of an accredited school of professional nursing. Bachelor's of Science in Nursing preferred
- Knowledge of CMS guidelines and experience working with payor specific guidelines and contractual rules preferred
- Customer service abilities including effective listening skills
- Critical thinking skills, decisive judgment and the ability to work with minimal supervision meeting firm deadlines
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Case Manager Resume Examples & Samples
- Minimum 3 years acute care experience (Medical-Surgical, ICU or ED preferred)
- Prefer experience as a case manager, UR nurse or a discharge planner
- Ability to be tactfully assertive / proactive in accomplishing job functions
- Ability to work independently and responsibly without direct supervision
- Ability to interact effectively with medical staff, hospital personnel, patients / families (interpersonal skills that reflect a positive attitude and a sense of commitment
- Ability to develop positive relationships with outside post acute care agencies such as SNFs or ECFs as well as with private insurance companies, HSAG and CMS
- Ability to identify problems, analyze feasible solutions and implement problem Resolution
- Ability to deal with stressful situations and multiple tasks
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Case Manager Resume Examples & Samples
- Dedicated to a team environment and culture with proven ability to lead and work well with others
- Personal insurance experience is a bonus
- Ability to speak French is a bonus
136
Case Manager Resume Examples & Samples
- Advises management and employees regarding HR compliance requirements and disability laws, policies and processes
- Builds effective plans to mitigate risk by analyzing HR Compliance and Disability data trends
- Leverages data and provides reports to promote value of programs and engages Sr. Leadership to design, implement, and communicate strategic action plans
- Ensures local facility practices are in legal and regional compliance
- Develops and delivers training and education programs for local facilities regarding HR disability and HR compliance related regulations, laws, policies, and processes
- Responsible for management of the interactive process as required by ADA/FEHA, resulting in the offer of reasonable accommodations to include of the transitional work program
- Consults with department managers, claims administrators, legal, union representatives/leaders
- Human Resource peers, employees and leadership through the course of disability case management
- Consults with department managers and employees regarding medical leaves, industrial leaves, general leaves planning (where applicable), maternity leaves and related labor contract/bargaining agreement provisions
- Provides a centralized, strategic focus to reduce employee lost time due to medical or industrial leave
- Coordinates with supervisors and department managers to ensure prompt and accurate reporting of workers compensation claims to support timely reporting and appropriate benefit payments
- Leads efforts to assist and consult with managers to ensure facility readiness and compliance with HR standards for hospital survey accreditation or other external agency reviews
- Manages and assists any corrective action plans to resolve findings from survey and audits to ensure compliance standards are met
- Coordinates with external vendors to ensure compliance with regulatory requirements
- Minimum of two (2) years' experience in Human Resources, Disability Management, HR Compliance or related compliance work experience
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Case Manager Resume Examples & Samples
- Utilizes chart review, electronic medical record, patient/family interviews, and interdisciplinary team as information sources
- Organizes, plans and prioritizes caseload to optimize care coordination; provides intense case management for patients with high risk factors
- Evaluates discharge planning needs on admission review. Collaborates with patient/family, physicians, nurses, ancillary personnel and external agencies to develop safe, individualized, and appropriate continuing care plans
- Obtains consent from patients for continuing care providers; initiates timely referrals, discharges, and transportation arrangements
- Ensures appropriate information is provided to anyone responsible for continuing care support
- Identifies appropriate hospice candidates and communicates with physician regarding options
- Reviews observation patients each day to determine appropriate level of care and patient status; confers with Admitting and Business Office departments regarding authorization issues as needed
- Participates in development of interdisciplinary care plans and documentation of patient education
- Identifies educational needs of patients, families and staff and takes appropriate actions; assesses readiness for understanding and assuming responsibility for ongoing care as needed
- Identifies avoidable hospital days and confers with director regarding findings
- Establishes positive rapport with patients and families; supports decision-making and advocates for patient to ensure advantageous use of benefits
- Utilizes knowledge of legal issues, COBRA regulations and regulatory agency requirements; issues notices of non-coverage, important message per CMS guidelines when necessary. Initiates and completes level 1 PASRR screen for all patients going to sniff level of care upon discharge
- Working knowledge of InterQual Acute Care guidelines
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Case Manager Resume Examples & Samples
- Manage all types of extended leave of absences for our US and Canadian workforce, provide exceptional customer service to associates navigating through their time off requests, coordinate relevant information with applicable vendors partnering with other departments in the firm
- Manage workers compensation claims in collaboration with outside vendors and within regulations of the various states
- Recommend and implement policies related to absence management
- Provide solutions for ergonomic workspace requests from associates and coordinate efforts for ADA accommodations
- Prioritize and meet deadlines in a fast-paced environment
139
Case Manager Resume Examples & Samples
- Conducts weekly client visits at home, school, work, or related sites as assigned
- Coordinates with various service providers to ensure fulfillment of the client's needs
- Completes Individual Treatment Plans and ensured all goals and objectives are met
- Familiarity with pre-delinquent and delinquent court procedures
- Bilingual applicant preferred at a minimum, the ability to understand and to make one's self understood to all individuals
140
Case Manager Resume Examples & Samples
- Nevada State Registered Nurse Licensure required
- 1 or more years case management experience, preferred
- 3 or more years' acute hospital, home health, hospice, inpatient mental facility experience required
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Case Manager Resume Examples & Samples
- Interviews patients and family members to identify preliminary issues for treatment as needed
- Completes Intake Assessments/Screenings on all referrals to the satellite program
- Facilitates clinically appropriate admissions to hospital services, congruent with needs and resources of individual
- Provides psycho-education groups and family education in a timely manner
- Initiates contact with treatment team members and recommends treatment alternative as necessary
- Works professionally and effectively with Business Office staff to collect co-payments, submit charges, and communicate Utilization Review information
- Practices by code of ethics set forth by your licensing board (as applicable)
- Assists with developing individual discharge plan for each assigned patient under the direction of the treatment team
- Facilitates discharge preparation with follow-up appointments prior to discharge in coordination with the treatment team
- Attends and participates in treatment team meetings for assigned cases
- Assists with discharge documentation with pertinent information for follow-up providers (such as contact information, address, appointments times, etc.)
- Establishes and maintains cooperative relationships with community agencies and other resources
- Reports incidents or suspected incidents of sexual/physical abuse and/or neglect to Protective Services in a timely manner
- Conduct follow-up calls with Protective Agencies assists agency in obtaining necessary information with report documented in patient chart
- Follows proper NCI de-escalation techniques when handling crisis situations
- Provides appropriate crisis intervention as necessary by anticipating and responding quickly to escalating behaviors, utilizing de-escalation techniques to diffuse the situation, correctly prioritizing safety concerns
142
Case Manager Resume Examples & Samples
- Coordinates care management process from patient’s entry into the Intensive Outpatient Clinic. Coordinates care and resources with physicians, social workers, and other team members to achieve optimal patient outcomes
- Participates with IOC care team and analytic team in identifying patients who are suitable for case management intervention based on health and demographic criteria established by the IOC
- Monitors and documents quality of care to ensure patient care plan goals are appropriate and that they are understood and implemented. Routinely assesses client and family response to services, while also measuring care plan effectiveness and necessity. Also identifies patient needs, including those of an ethical and cultural nature, and ensures they are addressed
- Facilitates cost effective outcomes by determining appropriate level of care based on diagnosis, severity, intensity of services required, and other relevant criteria, using national and regional length of stay standards and community norms
- Assesses and discusses funding and insurance issues with client, family, and healthcare providers to enhance cost effective utilization of services and quality outcomes
- Identifies actual and potential delays in service requests or treatment and communicates them to health care team so steps can be taken to eliminate or minimize delays
- Works with inpatient case management team to plan appropriate and effective transition to outpatient care
- Supervises technical support staff assigned to Intensive Outpatient Clinic
- May set up patients’ follow up appointments and per care team design
- May be required to complete home or site visits as required by the department
143
Case Manager Resume Examples & Samples
- 3 years of recent Clinical and Case Management experience
- Active Registered Nurse or Clinical Social Worker license
- Case Management certification (ANCC or CCM)
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Case Manager Resume Examples & Samples
- Previous case management experience in managed care,
- Some homecare experience (CHHA or MLTC)
- 3+ years of case management experience, minimum
- 3 years of direct care in an acute care facility or skilled nursing facility
145
Case Manager Resume Examples & Samples
- Provides case management services to a caseload of assigned participants, assisting them to remove both real and self-perceived barriers that interfere with obtaining employment
- Travel to business sites, community resource agencies and itinerant sites to meet customers
- Develops personalized and individual work plans facilitating and coordinating the development of the customer, on-the-job training, education opportunities and providing ongoing support and supportive services
- Monitors and assesses compliance and effectiveness of the work plan and customer progress
- Bachelors degree from an accredited college or university preferred
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Case Manager Resume Examples & Samples
- Master's Degree in Social Work/Psychology/Counseling
- Current professional licensure (LPC, LCSW etc) strongly preferred
- A minimum of one year post master's degree, preferred
- Strong clinical skills to address crisis situations, family, group, and individual therapy
- Performs Psychosocial Assessments
- Leads Group Therapy/Family Therapy as needed
- Develops and implements treatment plan
- Coordinates Transition and Discharge Planning
- Acts as liason between patients, their families, and various organizations in mental health matters
- Clinical Responsibilities
- Completes required social history within 48 hours of admission or makes appropriate provisions for completion
- Provides regular family therapy in accordance with presenting needs and medical orders
- Documents all family contacts and therapeutic activities in the record in a timely manner
- Provides parent training and family education as needed
- Intervenes in crisis situations as needed
- Counsels individual families and patients as needed
- Actively participates in treatment team meetings and communicates all pertinent information to appropriate staff
- Plans and documents all discharge activities in a timely manner
- Leads Groups as assigned
147
Case Manager Resume Examples & Samples
- Prior MLTC/Home Care experience
- Past case management experience
- UAS knowledge and experience
148
Case Manager Resume Examples & Samples
- Partner with Field Sales Reps and field-based Patient Access Managers to manage all patient cases within their assigned territories
- Travel to patient meetings, sites of care, department meetings and medical offices, as necessary
- BA/BS in the life sciences preferred
149
Case Manager Resume Examples & Samples
- Critically observe and identify inefficiencies and process gaps and articulate these opportunities to the client in a constructive, convincing manner
- Demonstrate ability to effectively use the computer to develop powerful, valid and user-friendly information and tools
- Demonstrate ability to effectively produce clear, concise and professional presentations
- Demonstrate motivation and effort in developing creative options for achieving desired outcomes
- Comprehend both technical and human constraints and convert these into relevant, viable supervisory, planning and management system options
- Adapt well to changing situations and varied work environments
- Demonstrate ability to analyze business metrics for clients
- Perform the day to day activities of projects including interaction with client personnel and Philips team members
- Apply qualitative and quantitative skills to various client situations
- Develop strategic working relationships with client counterparts
- Partner with other Philips Associates and Managers to implement process changes and oversee creation of deliverables
- Maintain detailed work-paper records of assumptions, methodologies, and information sources employed during the performance of all analytical tasks
- Influence key stakeholders to implement processes and/or drive organizational change
- Development of staff by serving as a performance coach and providing on-going feedback and coaching to project team members
- Active role in educating and coaching internal resources in area(s) of subject matter expertise
- Actively support methodology development in area of expertise
- Possesses an active RN license
- Three or more years of experience as a case manager in an acute care hospital
- Coordinates the care and services for assigned patients in collaboration with the patient, family, physician, patient care team, and payers to advance patient progression from admission through disposition
- Utilizes advanced clinical skills to facilitate the provision of care which includes the assessment, planning, intervention and evaluation principles of the nursing process
- Promotes and evaluates the effective utilization of resources using current clinical knowledge, awareness of community services, and assuming a leadership role with the patient care team to achieve optimal clinical and resource outcomes
- Graduate degree in Nursing, Health Care Administration or Business OR Bachelor’s degree required and 8-10+ years of experience in healthcare provider operations
- Possesses ACMTM certification as an accredited health care delivery system case manager preferred
- Ability to actively manage and deliver on client expectations around project activities, timelines, deliverables, outcomes, etc
- Ability to provide targeted communication, both verbal and written, to internal and external constituents
- Lead projects and work streams, scoping projects, defining project scope, structure and deliverable content
- Interact with clients on a day-to-day basis; understanding context of project with clients’ larger strategy and operations
- Proven analytical and process redesign skills, including problem solving, quantitative reasoning, workflow process, etc
- Ability to work with a diverse group of professionals and personalities in a team environment
- Advanced knowledge of MS Office applications, including Word, PowerPoint, Excel, and Outlook
- Five or more years of acute care experience as an RN prior to becoming a case manager – required
- Has held a case management leadership position
- Experience supervising or mentoring co-workers, and ability to coach and mentor staff
- Experience as a case manager in an emergency department - preferred
- Must be willing to travel weekly, typically out of town a minimum of four days/week (i.e., at least 80%)
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Case Manager Resume Examples & Samples
- Managing an average caseload of 40 members and meeting with supervisor regarding case status
- Providing support coordination that consist of identifying needs and available services and resources, planning, obtaining, and monitoring the effectiveness of contracted medical and non-medical services in meeting our members’ identified needs
- Working with members, family members, and care professionals as a team to review the needs and develop an Individual Service Plan (ISP)
- Meeting regularly to assess needs and supports, monitor progress, or make changes to the ISP, which includes travelling at different times throughout the day within and outside business hours to conduct onsite-visits to member’s home, placement, schools or program sites. This activity represents 30% of work time and may require driving your own personal car. Mileage will be reimbursed
- Experience conducting interviews and writing Individual Service Plans (ISPs)
- Knowledge of the Health Insurance Portability and Accountability Act (HIPAA)
- Excellent customer service and interpersonal skills
- Proficient using Microsoft Office and other office computer software
- Experience working in the Developmental Disabilities field
- Case management experience in the social services field
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Case Manager Resume Examples & Samples
- Assist in pre-meeting preparation of forms and reports, create prep folders
- Prepare paperwork for new clients and account transfers
- Process beneficiary and account ownership changes
- Communicate with the Broker/Dealer regarding client issues
- Develop and maintain written systems to track projects and activities
- Prepare Insurance product illustrations
- Participate in client meetings and record notes
- Execute and track post meeting follow-up
- Assist in client related investment and financial planning research
- Create investment reports using Morningstar software and other firm provided software
- Participate in investment committee review meetings and maintain model portfolios used in investment management process
- Create post meeting summary letters and financial planning deliverables
- Prepare financial analysis using the firm’s Financial Planning Software (Naviplan)
- Screen incoming calls and correspondence as needed
- Prepare outgoing mail and correspondence as directed, including email and faxes
- Help organize and maintain client files
- Positive attitude and an extraordinary client service orientation
- Experience in working with retired and pre-retired populations a plus
- Strong proof reading and report writing skills a must
- Ability to prioritize work flow and tasks
- Prior experience with financial planning software desired (Naviplan preferred)
- A Bachelor’s Degree in a related field, and a minimum of 2 years work experience in a financial planning firm
- FINRA Series 7, 66 and VA Life and Health Insurance licenses or willingness to obtain
- Comfortable working in a fasted paced, team oriented environment
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Case Manager Resume Examples & Samples
- Conduct eligibility interviews; review eligibility referral/redetermination; track redetermination; compile information regarding eligibility determination/redetermination form a variety of sources in order to make recommendations on DDD eligibility determinations
- Receive and screen referrals and refer to community resources
- Write comprehensive progress notes, set-up new member files
- Review documentation/make eligibility determinations/research disability diagnoses
- Correspondence with families on initial applications, denial of service notices, etc
- Federal and State statutes and agency policies and procedures relating to the eligibility criteria for individuals with developmental disabilities
- Community resources and medical and behavioral health issues and terminology
- Crisis intervention techniques, social work practices
- Reviewing documents, researching records and maintaining eligibility records
- Interviewing and interacting with members and family members
- Coordinate and facilitate eligibility interviews
- Using various computer software (Microsoft Word, Excel, etc.)
- Work independently and within diverse work teams
- Organize and manage eligibility case load and follow timelines
- Document files and information within the required/mandated timelines and maintain confidentiality
153
Case Manager Resume Examples & Samples
- Experience working in the community ( family, homes, schools, etc.)
- Experience collaborating with other providers to strengthen client support systems
- Experience working with the homeless youth population
154
Case Manager Resume Examples & Samples
- Plans, develops, assesses and evaluates care provided to members
- In conjunction with primary care and specialist physicians, evaluates and develops baseline medical and psychosocial evaluations and individualized patient care/treatment plans
- Recommends alternative levels of care and ensures compliance with federal, state, and local requirements
- Develops individualized patient/family education plan focused on self-management
- Delivers patient/family education specific to a disease state
- Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy)
- Coordinates care/services with utilization and/or quality reviewers and monitors level and quality of care
- Coordinates the interdisciplinary approach to providing continuity of care, including utilization management, transfer coordination, discharge planning, and obtaining all authorizations/approvals/transfers as needed for outside services for patients/families
- Makes referrals to appropriate community services and outside providers
- Consults with internal and external physicians, health care providers, discharge planning and outside agencies regarding continued care/treatment, hospitalization or referral to support services or placement
- Coordinates repatriation of patients and monitors their quality of care
- Develops and collects data; trends utilization of health care resources
- Produces population based reports on outcomes specific to defined patient populations
- Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes
- Acts as liaison for outside agencies, non-plan facilities, and outside providers
- Minimum one (1) year of clinical experience as an RN in an acute care setting, plus two (2) years of clinical experience as an RN in a licensed home health or hospice agency required
- For positions in Special Needs & Care Programs (Care Plus/Guidance): Two (2) years of clinical experience as an RN in an acute care setting required
- Bachelor's degree in nursing or healthcare related field preferred
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Case Manager Resume Examples & Samples
- Communicate resident status, change in function and care plan either by phone or written report to payers
- Include payer representative in interdisciplinary meeting if requested or deemed necessary to promote payer/provider relationship
- Document all payer interaction regarding resident progress, expected outcomes and reporting capabilities including special instructions
- Ensure through and timely communication with managed care/insurance case manager to coordinate certification and concurrent stay programs
- Maximize benefits by coordination of cost effective care, avoid fragmented care duplication of services and ensure the appropriate level of care is provided in the most suitable setting
- Meet with facility interdisciplinary team to coordinates services to ensure that the resident’s total regimen of care is maintained
- Work with team members to ensure discharge-planning goals and objectives are developed and discussed at the interdisciplinary team meetings
- Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care Medicare resident
- Perform random charting to ensure accurate and through documentation to support reimbursement of services rendered
- Meet with resident, and/or family members, as necessary. Report problem areas to department directors
- Assist with contract negotiations as necessary
- Agree not to disclose assigned user ID code and password or accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Administrator
- Agree not to disclose resident’s protected health information and promptly report suspected or known violation of such disclosure to the Administrator
- Report any known or suspected unauthorized attempt to access facility’s information system
- Perform on-site clinical assessments of potential patients
- Assist with pre admission evaluation of potential manage care patients, including cost-cut insurance authorization and patient/insurance education as necessary
- Embrace Consulate Health Care’s Five core values of compassion, honesty, integrity, respect and passion, and incorporate them into one’s daily job function
- Demonstrate respect and compassion in every interaction
- Demonstrate a passion for caring as evidenced by interaction with co-workers, residents, families and visitors
- May be trained and assigned to perform the customer Care Liaison duties as needed
- Perform all other duties, as assigned
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Case Manager Resume Examples & Samples
- Collaborates with the patient/family, physicians, staff, and other health care professionals across the continuum to provide care coordination
- Identifies, assesses and manages disease population during care transitions per established criteria
- Performs risk, psychosocial and transitions assessments as indicated, collaborating with interdisciplinary team according to craft treatment plans consistent with evidence-based care guidelines
- Identifies problems or gaps in community resources that impact outcomes and takes leadership in efforts to effect changes; Coaching patients on red flags, triggers, medication management, and followup appointments
- Monitors efficiencies in scheduling physician visits, diagnostic procedures and coordination of treatments to facilitate achievement of effective clinical, fiscal, quality and patient satisfaction goals
- Monitors home visits and contacts after discharge, coaching the patient on how to manage their disease process at home working closely with their PCP
- Reports information generated from available sources to support operational, clinical, financial and outcome goals
- Collaborates with the physician advisor to facilitate achievement of clinical, quality, financial and patient satisfaction goals
- Measures effectiveness of interventions through direct communication with patients and caregivers and data collection of defined indicators (e.g. overall length of stay, readmission rates, feedback from referral sources, etc.)
- Collaborates with clinical pharmacist and providers when medication compliance issues are noted or adjustments needed to meet clinical guideline parameters
- Serves as a resource to nursing and ancillary staff, providing education on care management as needed
- Trends potential barriers to patient advancement through the system, intervenes assertively and appropriately when necessary
- Identifies need for patient evaluation by other members of the health care team or specialists and in conjunction with physician advisor, takes appropriate action to facilitate evaluation
- Registered Nurse with BSN or minimum of 1-year Utilization Management/Case Management or disease/population management
- Related work experience in Utilization Management, Case Management, Health Coaching, Health Plans and or Home Care preferred
- Maintains continuing education related to role enhancement and changes of clinical practice within assigned area. Attends additional educational offerings related to disease/population management, public health and care transitions
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Case Manager Resume Examples & Samples
- Identifies cases for individual case management by collecting information obtained from the patient, providers and caregivers
- Completes a thorough assessment, develops and implements a case/disease management plan including goals based on the assessment
- Coordinates and certifies services based upon information received from attending physician and/or other providers using established medical criteria. (Refers all cases which do not meet criteria to the Medical Director.)
- Monitors the case to its conclusion (making modifications as needed) while maintaining contact with all involved parties during all episodes of care no matter what the setting in order to meet the goals identified in the case/disease management plan
- Establishes an effective working relationship with the patient/family, provider and payer
- Acts as primary liaison with designated customers (employers), clients (patients), and providers for ongoing care management program operations
- Assess and recognizes benefit value to cost and acts upon cases to affect savings while maintaining quality care. Negotiates fees for appropriate care and ancillary services (involving the employer when appropriate). Implements cost management strategies within coverage parameters
- Takes part in quality improvement strategies by assessing individual and employer satisfaction of programs, identifying real or potential quality issues and working toward overall quality performance
- Adheres to the Case Managers’ ethical principles and standards as described in the CMSA’s Standards of Practice
- Participates in continued education in order to maintain active case management certification, clinical and case/disease management expertise through education courses, seminars, nursing literature and in-services provided by the company
- Registered nurse with active and unrestricted license to practice in the State of Wisconsin
- Bachelor of Science in Nursing or equivalent experience
- Minimum three years nursing experience in an acute care or relevant setting with evidence of the ability to make sound nursing judgment
- Case Management Certification; desirable
- Minimum one year experience in a managed care setting; desirable
- Excellent verbal, written and interpersonal communication skills are essential
- Evidence of ability to work cooperatively, tactfully and assertively with medical providers and others
- Proficient in basic computer skills including Microsoft Windows (or its equivalent) along with the ability to access the internet to do research
- Performs all activities within the scope of licensure and certification
- Acts within the scope of Federal and State Laws and programs
158
Case Manager Resume Examples & Samples
- Demonstrates responsibility and accountability in ensuring all admissions and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs and coordinates the delivery of care to meet these needs
- Develops, initiates, and coordinates individual patient case management plans to ensure appropriate level of care across the continuum. Ensures plan meets patient's clinical, psychological and discharge needs in collaboration with the attending physician and interdisciplinary team
- Acts as an educational resource and provides consultation to hospital medical personnel regarding discharge planning process and applicable federal, state and local regulations; identify benefits, implications and limitations of home care as appropriate
159
Case Manager Resume Examples & Samples
- Comprehensively assesses patient goals: biophysical, psychosocial, environmental, discharge planning needs and financial status
- Closely monitors patient’s progress for changes in medical needs that could effect present and future medical treatment
- Procures services and serves as advocate on behalf of the patient and family with scarce resources. *Works closely with third party payers to resolve problems and issues effecting continuity of patient care
- Coordinates and directs the discharge planning of patients with family members, health care team and the community
- Reviews admission data within the designated timeframe to determine the suitability of the level of care in accordance with ISD-A criteria and/or established criteria
- Education:Graduate of an approved school of nursing; and
- Experience:(3) years clinical nursing experience in an acute care facility
- Licensure: Current license with the Oklahoma State Board of Nursing as a Registered Nurse
160
Case Manager Resume Examples & Samples
- Visit Medicaid members in their homes and/or other settings, including community centers, hospitals or providers' offices
- Provide a complete continuum of quality care through close communication with members via in-person or on-phone interaction
- Support members with condition education, medication reviews and connections to resources such as Home Health Aides or Meals on Wheels
- Computer/typing proficiency to enter/retrieve data in electronic clinical records; experience with email, internet research, use of online calendars and other software applications
- Problem solving skills; the ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action
- Ability to communicate complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Case Management experience including Certification in Case Management
- Home care/field based case management
- Experience in Home & Community based or Long Term Care services delivery
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Case Manager Resume Examples & Samples
- Acts as medical liaison between patient, community resources and Neuroscience medical staff. Provides continuity of care to patient by coordinating care and services needed in all settings in continuum of care. Monitors plan of care and provides ongoing communication with Neuroscience health care providers
- Monitors and evaluates outcomes of patient treatment. Devises individualized plans of care to insure completion of treatment as recommended by physician and/or other health care providers. Tracks and manages patients' care and treatment
- Participates in problem solving and quality improvement monitoring to help develop, implement and evaluate department specific processes/policies. Assists and advises in development of standards, policies and procedures and educational tools for various patient treatments
- Partners with physician chief and assists in leading service meetings and following up on issues requiring resolution. Updates physician chief and/or clinic supervisor regarding any issues/concerns
- Serves as resource to staff. Ensures training for ongoing formal and informal staff development needs
- Assists with departmental RN functions to include phone advice according to operational needs
- Develops and implements plans/projects to improve operational efficiency and effectiveness. Monitors status and progress and reports to supervisor
- May perform patient care to the extent necessary to maintain clinical expertise, competency, and licensing necessary to fulfill job responsibilities and to direct the provision of care on the unit
- Incorporates the KP Nursing Vision, Model and Values throughout their Nursing Practice
- Minimum two (2) years of direct patient care experience
- Minimum two (2) years of case management or care coordination experience
- Master's degree in public health, clinical nursing, or related field
- Certified Case Manager (CCM) by the Commission for Case Manager Certification (CCMC)
- Experience in workers comp cases preferred
162
Case Manager Resume Examples & Samples
- New York State Registered Nurse (RN) license
- 2+ years of medical and surgical clinical experience
- 1 year of case management, utilization review, or disease management
- Computer and organizational skills
- College Degree
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Case Manager Resume Examples & Samples
- Provide day to day oversight and coordination of case load to ensure all case elements and tasks are completed timely and ensure cases move through the process as required
- Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- Communicate patient benefits and responsibility timely and accurately. Assess and refer patients appropriately for special programs/services when appropriate
- Performs quality checks on cases and reports trends to leadership
- 2+ yrs experience with insurance investigations and verifications preferred
164
Case Manager Resume Examples & Samples
- Provide day to day oversight and coordination
- Act as single point of contact responsible
- Recognize a product quality complaint and
- BS degree or six years of relevant working
- 0 - 2 years relevant experience in pharmacy
165
Case Manager Resume Examples & Samples
- Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
- Represents the Company in a professional manner, following all Company policies and procedures
- Responsible for quick and accurate triage response according to Company protocol
- Under direction and supervision of physician, administers prescribed medications and immunizations, provides emergency treatment and other patient services within the ambulatory setting
- Maintains clinical documentation within the medical records assuring compliance within all guidelines
- Conducts patient education and participates in health promotion activities
- Maintains equipment, adequate stock levels of consumables in all treatment and exam rooms
- Provides nursing care in the ambulatory setting to patients and families. Provides emergency treatment as required
- Participates in clinic’s Quality Management Program, High Risk Program, Group Visits, and other programs as requested
- Monitors inpatient, outpatient, and SNF patients and initiates patient care arrangements
- Assists with the education of the patient and/or family as directed by the physician
- Reports findings to Medical Management; Medical Director and Center Administrator
- Responsible for patient care management to assure appropriate care is provided; reinforces patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinates home health and DME requests and provides recommendations to the Center Medical Director
- Provides oversight in patient care evaluation, coordinates the collaboration of the Primary Care Provider and Consultants, and makes suggestions to improve plans to meet patient needs
- Assists with the monitoring of utilization management and makes recommendations regarding effectiveness of health care resources, trending and intervention
- Assists in the assessment of clinic operations and make recommendations as necessary
- Assures compliance with HCFA guidelines and covered service guidelines
- Assists with the contestation of Part A and Part B claims as needed
- Consistently applies guidelines to the medical record review process
- Evaluates and recommends health delivery network changes with the site Medical Director and Center Manager
- Attends Case Management meetings. Assists the Center Medical Director with the management of high-risk patient populations and appropriate Case Management plans
- Performs case management, but spends the majority of time performing triage functions
- Must have consistent, punctual and reliable attendance
- Ability to obtain CPR certification within 60 days of employment
- LPNs must have the ability to obtain IV Certification within 90 days of employment
- Five years of acute care clinical experience preferred
- Must be computer literate
- Ability to interact and communicate effectively with patients and all levels of personnel in a professional, courteous and effective manner using excellent customer service skills
- Strong working knowledge of triage nursing principles, theories and practices/
- Ability to take vital signs, perform approved clinical tasks including but not limited to: evaluate patient needs, emergency triage, administer prescribed medications, assist physician with examinations and treatments, prepare and apply dressings and perform wound care; instruct patient in health measures and self-care; change Foley catheters, and flush ports (or be willing to learn)
- Ability to record findings and observations
- Knowledge of medical equipment and maintenance
- Ability to provide on-site emergency treatment
- Ability to multi- task in a high paced environment with good organizational skills
- Knowledge of HIPAA regulations
- Ability to read, speak, write, and understand the English language fluently
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Case Manager Resume Examples & Samples
- Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements. Report findings to Medical Management, Medical Director and Center Administrator
- Responsible for patient care management to assure appropriate care is provided; reinforce patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinate home health and DME requests and provide recommendations to the Center Medical Director
- Provide oversight in patient care evaluation, coordinate the collaboration of the Primary Care Provider and Consultants, and make suggestions to improve plans to meet patient needs
- Assist with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention
- Assist in the assessment of clinic operations and make recommendations as necessary
- Assure compliance with HCFA guidelines and covered service guidelines
- Assist with the contestation of Part A and Part B /claims as needed
- Consistently apply guidelines to the medical record review process
- Evaluate and recommend health delivery network changes with the site Medical Director and Center Administrator
- Participate in QI projects. Attend Care Management Meetings
- Participate in patient satisfaction program as required and follow up on all inpatient/outpatient discharges
- Assist the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans
- 3 to 5 years of recent clinical nursing experience
- Preferred: Previous care management, utilization review or discharge planning experience
- Preferred: Managed care experience
- Ability to perform Care management
- Knowledge and skill in the applications of the techniques and practices of the nursing profession
- Ability to explain medical instructions to patients and their families
- Ability to learn and understand appropriate Federal, State, and local regulations
- Ability to interact and deal tactfully with the public
- Ability to read, write, speak and understand the English language fluently
- Ability to communicate effectively, establish and maintain an effective working relationship with patients and staff and deal effectively and professionally under pressure
- Ability to travel locally
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Case Manager Resume Examples & Samples
- Registered Nurse with a current California license
- Self-directed and able to work under pressure and constant change
- Demonstrates positive, professional relationships with department staff, physicians, hospital personnel and others, thereby promoting teamwork
168
Case Manager Resume Examples & Samples
- Communicate/consult with claimants, internal/external providers and government agencies
- Provide technical direction by reviewing and identifying file development needs
- Disability management and/or Group Benefit knowledge
- Previous case management experience within an insurance/financial organization
- Proficiency in MS Word, Excel and MS Office 365, MS Outlook, and Skype for Business
- Excellent communication skills (both oral and written), Bilingual in English/French an asset
- Previous customer service experience in a demanding environment
- Flexibility to balance conflicting priorities
- Analytical skills with a close attention to detail
- Organized and deadline driven
169
Case Manager Resume Examples & Samples
- Graduate of an accredited school of nursing. Bachelors of Science in Nursing or other clinical advanced degree preferred
- Training Clinical training in an acute care or clinic environment
- Chronic disease management training with focus on conditions of HF, Diabetes, COPD preferred
- Clinical training in a managed care capitated healthcare environment preferred
- Knowledge of evidence based clinical practice guidelines particularly for chronic conditions preferred
- Training in patient motivational interviewing preferred
- Demonstrated ability to independently assess, evaluate and interpret clinical information and care planning
- Ability to perform job functions independently and with minimal supervision
- Effective oral, written and listening communication skills necessary for constant interaction with patients, families, physicians and other members of the health team
- Able to stay organized and flexible in a work environment with multiple assignments and changing priorities
- Word processing, keyboarding and non scripted documentation skills
- Able to operate PC-based software program
- Strong clinical assessment and critical thinking skills preferred
- Ability to demonstrate leadership skills to delegate and provide direction/guidance to multidisciplinary team preferred
- Knowledge of regulatory and accreditation standards (URAC, NCQA) and complex case management (CMSA) preferred
- Knowledge of capitation/HMO, insurance payors and government healthcare plans preferred
- Experience with health plan audits preferred
- Knowledge of community resources preferred
- Experienced with word, excel, data collection, data entry, report generation and other computer systems and applications preferred
- Familiarity with an electronic practice management system/EMR preferred
- California RN license
- CPR
- Valid State of California driver's license with no restrictions and proof of insurance
- Certified Case Manager preferred
170
Case Manager Resume Examples & Samples
- Verbal and written communication with injured workers, employers and providers on a daily basis
- Management of a portfolio of claims, majority of which are entitled to medical expenses only
- Reviewing treatment and services that injured workers are entitled to, at various points in the life of the claim
- Attending meetings and claim reviews with clients
- Developing relationships with key stakeholders
- Providing a high level of customer service, including assisting dissatisfied customers and those with general queries
- Filing
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Case Manager Resume Examples & Samples
- Collaborate with physicians, patients and their families, nurses, therapists, social workers and other members of the patient care team to develop a patient specific care and treatment plan
- Cooperatively utilize varied solutions to educate and promote the health and independence of the patient
- Assess, monitor, document and report progress of patient's health and condition using required documents, reports and established timelines
- Provide supervision and evaluation of aides and licensed practical nurses/licensed vocational nurses
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Case Manager Resume Examples & Samples
- Exceptional phone skills
- Proven ability to talk with mental health patients
- Strong technical abilities
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Case Manager Resume Examples & Samples
- Bachelor Degree in Social Work or Human Service Field
- Minimum three years’ experience in acute care setting, Case Management experience preferred
- Performs a comprehensive assessment of psychosocial and medical needs of assigned patients
- Develops a case management plan of care to include identified clinical, psychosocial and discharge needs; coordinates plan of care; plan is documented in the medical record; plan is communicated to appropriate clinical disciplines
- Conducts interdisciplinary team meetings to provide a mechanism for all clinical disciplines to collaborate, plan, implement, and assess the plan of care; patient selection should be criteria based and interventions will be documented
- Evaluates and assess observation patients for appropriateness in observation status
- Applies Medicare Two Midnight Rule as applicable
- Acts as a liaison through effective and professional communications between and with physicians, patient / family, hospital staff, and outside agencies
- Demonstrates knowledge of regulatory requirements, HCA Ethics and Compliance policies, and quality initiatives; monitors self-compliance and implements process changes to ensure compliance to such regulations and quality initiatives as it relates to the provision of Case Management Services
- Makes appropriate referrals to third party payer disease and case management programs for recurring patients and patients with chronic disease states
- Documents professional recommendations, care coordination interventions, and case management activities to effectively communicate to all members of the health care team
- Tracks and trends barriers to care; makes recommendations and develops action plans to improve processes and systems. Documents Avoidable Delays in Midas
- Involves patient, family/responsible/significant others in identifying and clarifying needs and expectations to develop mutual and realistic goals
- Assesses patients’ post discharge needs and facilitates the provision of services necessary to meet identified needs
- Identifies patients with the potential for high risk complications and makes appropriate referrals acting as an advocate for the individual’s healthcare needs
- Directs activities to identify and provide for the needs of the under resourced patient population to include patient education activities, patient assistance programs, and community based resources
- Develops individual plans of care for recurring patients to include education on appropriately accessing healthcare resources, preventative education, and community based resources
- Coordinates with the RN Navigator to prevent high risk readmissions
- Tracks and trends variances to care and barriers to care; makes recommendations and develops action plans to improve processes and systems
- Adheres to established policy and procedure and standards of care; escalates issues through the established Chain of Command timely
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Case Manager Resume Examples & Samples
- Master's degree in Social Work or Counseling required
- Knowledgeable in child, adolescent, adult and geriatric psychopathology as well as psychiatric interventions
- Must be knowledgeable with psychiatric psychosocial and legal issues and chemical dependency assessment and treatment, understanding of current insurance benefits and restrictions in the area of mental health
- Knowledgeable of available community resources and of discharge planning policies
- Must obtain and maintain current certification in Management of Assualtive Behavior and CPR within 30 days of hire
- Current California RN license
- BLS-HCP
- National certification in Case Management
- Prior work experience in clinical social work position is required; preference for mental health experience
- Demonstrates ability to plan, organize, set and accomplish objectives
- Demonstrate sound clinical judgment, problem solving and decision making skills
- Must exhibit excellent communication skills
- Must be able to express ideas verbally in an articulate manner
- Must be able to perceive the nature of objects by sight and sound. Incumbent must have manual dexterity of fingers on either or both hands
175
Case Manager Resume Examples & Samples
- Excellent active listening and written/verbal communication skills required to
- Quickly and accurately understand the need of callers seeking information
- Provide responses that address the specific needs of each caller, while complying to Alkermes program and compliance guidelines
- Document call details with attention to data integrity for analysis supporting business objectives
- Effectively plan, prioritize, execute, follow up and anticipate problems
- Manage multiple projects in fast-paced, deadline driven environment
- Work collaboratively across multiple stakeholder groups
- Prior reimbursement experience with ability to communicate complex reimbursement scenarios and solutions to patients and medical professionals
- Demonstrated ability to work collaboratively in a team environment and as an independent contributor
- Ability to think critically and problem solve to address customer needs and barriers to product fulfillment
- Ability to support programs needs as necessary
- Accommodate approximately 5% overnight travel for
- Minimum of 3 years case management experience, or experience working in a reimbursement hub program preferred
- Experience working in a high volume patient services program preferred
- Extensive knowledge of health plan reimbursement requirements for specialty injectable products covered by both medical (AOB) and pharmacy benefits
- Working knowledge of the compliance and regulatory environment for manufacturers in the pharmaceutical space
- Experience and understanding importance of reimbursement hub metrics and operations in the pharmaceutical industry
- Proficiency in Microsoft Outlook, Word, Excel, and Power Point
- Program /product launch experience a plus
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Case Manager Resume Examples & Samples
- Move a small, complex patient population to an optimal state of health & wellness
- Focus on integrating patient care, enhancing clinical coordination, and implementing quality initiatives to address patient needs
- Collaborate effectively with physician groups, community organizations, & local nurses to enhance clinical efficiencies & quality outcomes for Aetna members
- Engage providers and patients both at a physicians office and in the members home
- Proficiently utilize care coordination & plan benefit platforms to maximize patient engagement and seamless integration within the ACO
- Work with the provider interdisciplinary care team to proactively manage care including care management planning, referral management, and post-discharge planning
- Help coordinate transitional and community based care & provide chronic care management, coaching, consultation & intervention for patients with diabetes or hypertension
- Identify, screen & assess patient needs, both in person & telephonically - Conduct patient health assessments; develop personalized condition-specific action plans; reinforce education and monitoring
- Educate the patient about their medical condition, and self- management of the chronic disease(s)
- Identify opportunities for health services, modifiable risk factors & educational needs; provide appropriate partner referrals
- Intervene to positively affect patient healthcare outcomes
- Apply behavior modification techniques to drive patient empowerment to understand & holistically manage all aspects of their healthcare needs
- Equip patients so that they are informed & actively engaged with their provider in making the best health care decisions
- Evaluate the patient's progress in setting/meeting goals; revise care plan accordingly
- Work in a team environment to include case transfer to telephonic case management
- Promote quality, cost effective outcomes; improve program/operational efficiency. Identifies & escalates quality of care issues through established channels
- Sets expectation of Member Activation as a goal for each member
- Evaluates member progress in setting/meeting established goals; revises care plan accordingly
- Create meaningful, comprehensive & clear documentations, including online records
- Direct patient clinical care experience in the past 5 years
- Local travel
- Disease & Case Management or Managed Care
- Interact with members on phone & in person
- Flexibility to changing processes and schedule
- Clinical critical thinking skills
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Case Manager Resume Examples & Samples
- Current, unrestricted RN license
- Minimum of 4 years diverse clinical background
- Case Management and/or Managed Care experience a plus
- Strong technical and computer skills are a must
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Case Manager Resume Examples & Samples
- Active and unrestricted Nursing/Registered Nurse (RN) License
- Minimum of 3-5 years of current clinical experience in a patient case management position such as CM, DM case worker, and other relevant roles
- Strong professional level knowledge of comprehensive clinical assessment skills in the adult population and experience with chronic diseases
179
Case Manager Resume Examples & Samples
- Registered Nurse with an active license and minimum 3-5 years clinical experience
- Knowledge of New York Metropolitan Area/5 Boroughs of New York City/Staten Island area participating provider community and hospitals to assist in facilitating referrals
- Public speaking, computer skills including Microsoft PowerPoint, Outlook and Word, strong interpersonal skills
180
Case Manager Resume Examples & Samples
- Develop a comprehensive service plan for the Advantage member. The service plan is developed to utilize the member’s strengths, supports and available resources and is outcome focused
- Involve the member in implementation of the service plan by reviewing the services and receiving signed authorization
- Coordinate with the Case Manager Supervisor and with DHS to complete the service plan authorization process
- Coordinate all aspects of service delivery, ensuring that all services are delivered according to the service plan
- Complete on-going monitoring with the member. The member is monitored for appropriateness of services, for health and safety issues, for re-evaluation of the service plan
- Complete the Universal Comprehensive Assessment Tool (UCAT) as needed according to the Advantage Program Policies and Procedures
- Communicate with the Director of Member Care, Branch Manager, Director of Nursing, the Case Manager Supervisor and Coordinators as necessary, regarding member issues or information
- Documents all member contacts and maintains accurate and complete member files
- Participate in all appropriate agency staff meetings and inservices
- Maintain confidentiality of member, attendant and staff information
- Adhere to and participates in Company’s mandatory HIPAA privacy program / practices, Business Ethics and Compliance programs / practices, and all Company policies and procedures
- Participate in special projects and performs other duties as assigned
- Bachelor's Degree or RN or LPN in lieu of Bachelor's Degree
- One year paid professional experience with the aging or disabled population obtained before or after receipt of degree. (Paid professional experience may include, but is not limited to: CNA, CMA, CHHA and PCA experience )
- It is required that you are able to speak Spanish fluently
- A minimum of one week of orientation to the agencies policies and procedures to include shadowing a certified Case Manager in the field
181
Case Manager Resume Examples & Samples
- Pre-Certification & Authorizations: This Position requires multi tasking to insure authorizations received at the highest level of reimbursement and as quickly as possible for admission
- Case Manager will be responsible for processing skilled nursing referrals to include insurance verifications, cost analysis when applicable
- Communicate with the insurance case managers to obtain authorization for correct level of care according to the patients needs under the reimbursement guidelines provided by patient's benefits and current managed care contract
- Ensure highest level of customer service to the managed care plan
- Provides facility case management/utilization review and discharge planning to assure that the patient progresses through the continuum of care and is discharged to the least restrictive environment
- Coordinate the integration of the social service function into patient care
- Coordinate the facility activities concerned with case management and discharge planning
- Adhere to departmental goals, objectives, standards of performance, and policies and procedures
- Ensure compliance with quality patient care and regulatory compliance
- Provide effective timely communication to insurance plans to facilitate best possible functional outcome with resources available within the patients benefit structure
- Coordinate the integration of social services/case management functions into the patient care, discharge, and home planning processes with other facility departments, external service organizations, agencies and health care facilities
- Conduct concurrent medical record review using specific indicators and criteria as approved by medical staff, CMS, and other state agencies
- Acts as patient advocate: investigates add reports adverse occurrences, and performs staff education related to resource utilization, discharge planning' and psychosocial aspects of health care delivery
- Promote effective and efficient utilization of clinical resources
- Mobilizes resources and interviews, as needed, to achieve expected goal to assist in achieving desired clinical outcomes within the desired time-frame
- Ensure that patient tests are appropriate and necessary and are carried out within the established time-frame and that results are promptly available
- Conducts review for appropriate utilization of services from admission through discharge
- Evaluate patient satisfaction and quality of care provided
- Initiates and presents "denial letters", as appropriate
- Assesses patient care required throughout continuum of care for diagnosis, procedures and reimbursement guidelines
- Communicates with Interdisciplinary team at regular intervals throughout Skilled Nursing and Rehabilitation stay and develops an effective working relationship
- Assist Interdisciplinary team to maintain appropriate cost, case, and desired patient outcomes
- Complete expanded assessment of patients and family needs at time of admission
- Assess patient's progress through expected hospital course
- Refers cases where patients and/or family would benefit from counseling required to complete complex discharge plan to social worker or facility Director of Nursing
- Serve as a patient advocate. Enhances a collaborative relationship to maximize the patient's and family's ability to make informed decisions
- Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identified post-admissions needs
- Collaborate with clinical staff in the development and execution of the plan of care, and achievement of goals
- Directs and participates in the development and implementation of patient care policies and protocols in order to provide advice and guidance in handling special cases or patient needs
- Coordinates the provision of social services to patients, families, and significant others to enable them to deal with the impact of illness
- 1) Associate degree in healthcare related field or Bachelor's degree is preferred
- 2) Minimum of two (2) years of utilization review/case management experience or social work experience
- 3) Minimum of one (1) year experience in discharge planning from a hospital is preferred
- 4) Maintain current professional licensure in nursing or professional field of certification. 5) Medicare Skilled Nursing and Rehabilitation assessment criteria and reimbursement process strongly preferred
- 6) Appropriate certification in case management preferred (e.g., Commission for Case Management Certification (CCMC); Association of Rehabilitation Nurses (ARN))
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Case Manager Resume Examples & Samples
- Previous experience with the Geriatrics, the Homeless, Addiction, and/or, the Foster Care population
- Discharge Planning, Assessments, and Health Insurance background
- Experience working within an Acute, Sub-Acute, Long-Term Care (LTC), and/or Home Care environment
- Solid clinical and documentation skills
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Case Manager Resume Examples & Samples
- Evaluate patient to determine care, when the patient should be discharged, home planning, and other needs and action plans
- Complete initial bio-psycho-social assessment of patient to determine treatment plan
- Coordinate the integration of social services/case management functions
- Communicate with physician and develop working relationship
- Assess patients progress throughout hospital stay
- Refer cases where patients and/or family would benefit from counseling
- Review treatment goals and resources
- Provide education and literature about diagnosis
- Perform telephonic concurrent review of acute and sub-acute services following the plans authorization guidelines
- Utilizes criteria and guidelines to validate medical necessity of continued stay and appropriateness of treatment and discharge planning
- Coordinates appropriate discharge planning with interdisciplinary health care team to coordinate timely discharge
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Case Manager Resume Examples & Samples
- Ensures all admission and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge planning needs and coordinates the delivery of services to meet these needs
- Evaluates the health status of assigned patients by collecting and analyzing patient and family information. Expedites and coordinates the delivery of services to facilitate patients' progression through the healthcare system
- Evaluates patients educational needs concerning continuum of care and available services and provides information and materials regarding community resources, discharge options, and pre and post treatment options and costs to patient and patient families. provides assistance in resolving clinical, psychosocial and financial barriers
- Maintains documentation on discharge planning notes and charts on patient's record as performed
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Case Manager Resume Examples & Samples
- Coordinate and oversee Outpatient referrals for integrated medical/behavioral health services to network practitioners based on practitioner specialty and member’s geographic, cultural and language preferences
- Collaborate with Inpatient and Outpatient Case Managers in identifying and removing barriers to member compliance with Outpatient care
- Oversee Inpatient member discharge plans
- Act as liaison between hospital staff and the member’s family/support system/providers
- Coordinate Outpatient care for members without a discharge plan, link members and their families to appropriate community supports and Outpatient treatment
- Coordinate urgent Outpatient referrals
- Bilingual in English and Spanish candidates encouraged to apply
- Ability to be self-directed
- Computer literate on Word and Excel
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Case Manager Resume Examples & Samples
- Coordinate and oversee referrals for integrated medical/behavioral health services to network practitioners based on practitioner specialty and member’s geographic, cultural and language preferences
- Track communication and correspondence for all members on caseload and maintain monthly reports on case disposition
- Responsible for monitoring and reporting compliance with Aftercare appointments for all members identified as having been admitted for Mental Health / Substance Abuse treatment
- Maintains detailed records of members who have been admitted to Inpatient treatment from the point of discharge for up to 30 days post-discharge to monitor compliance with 7 and/or 30 day ambulatory follow up
- Responsible for generating authorizations for facility-based, post-discharge follow up visits and maintaining accurate files for ambulatory follow-up notes submitted as evidence of a post-discharge visit
187
Case Manager Resume Examples & Samples
- At least 2 years health plan (or similar) experience doing utilization management and/or Case Management
- Degree from an accredited school of nursing –BSN preferred
- Current unrestricted RN license for the State of Washington and other states if indicated
- Minimum three years of clinical experience
- Demonstrated competency with Microsoft Office Suite
- Experience working with Medicare Advantage/Centers for Medicare and Medicaid Services
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Case Manager Resume Examples & Samples
- Do utilization management for Medicare advantage members for skilled nursing, long term acute care and acute inpatient rehab facilities
- Work with the facilities to identify high risk patients and help facilitate referrals to other resources in our network
- Work with our high risk population to insure they are at the right level of care at all times with follow up, insuring MD appointments are made and resources are set up for them to reduce the readmissions back to community facilities
- Help with many pilot programs and projects to enhance the overall care for our members
- 3+ years clinical experience in one of the following areas: skilled nursing, case management, utilization management, community nursing, public nursing, geriatric population
- Skilled nursing or field based case management
- Medicare, Managed Care experience
- Experience working with the needs of vulnerable populations who have chronic or complex bio - psychosocial needs
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Case Manager Resume Examples & Samples
- Identify all assigned ICM Members
- Manage, coordinate care, track and report on all assigned Members in the four various levels of case management: consultation, coordination, ICM, and CCM
- Collaboration with Community Support Programs (CSP)
- Provide phone coverage as needed on the Crisis Calendar Rotation with the health plan
- Assist in collection of outcomes information, annual analysis and other reporting and initiatives
- Case Managers are required to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management and must be a licensed behavioral health clinician
- Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes
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Case Manager Resume Examples & Samples
- Participate in the admission process including pre-admission assessment, rate negotiations, benefit verification, care needs and reporting
- Document all payer interactions regarding resident progress, expected outcomes and reporting capabilities including special instructions
- Ensures thorough and timely communication with managed care/insurance case managers to coordinate certification and concurrent stay programs
- Assist with the completion of the MDS for managed care patients
- Negotiate all one-time payer agreements and LOA’s with the assistance of the Executive Director, District Director of Case Management, and Vice President of Managed Care & Professional Services
- Coordinate all services for each managed care patient, including in home and outside of the care center
- Approves all payer changes affiliated with managed care patients
- Reviews all ancillary invoices with Executive Director and Business Office Manager
- Key communicator of discharge plans related to managed care patients
- Review and challenge documentation before sending to MCO
- Maximize benefits by coordination of cost effective care, avoid fragmented care, duplication of services and ensure the appropriate level of care is provided in the most suitable setting
- Meet with facility interdisciplinary team to coordinate services to ensure that the resident’s total regimen of care is maintained
- Perform clinical assessments
- Maintain communication with facility business office and medical records to ensure accurate census and payment of managed care and Medicare residents
- Perform random chart reviews to ensure accurate and thorough documentation to support reimbursement of services rendered
- Meet with residents, and/or family members, as necessary. Report problem areas to department directors
- Agree not to disclose assigned user ID code and password or accessing resident/facility information and promptly report suspected or known violations of such disclosure to the Executive Director
- Agree not to disclose resident’s protected health information and promptly report suspected or known violations of such disclosure to the Administrator
- Assist with pre admissions evaluation of potential manage care patients, including cost-cut, insurance authorization and patient/insurance education as necessary
- Embrace Consulate Health Care’s five core values of compassion, honesty, integrity, respect and passion, and incorporate them into one’s daily job function
- Demonstrate a passion for caring as evidenced by interaction with co- workers, residents, families and visitors
- Report known or suspected incidents of fraud to the Executive Director
- Report suspected or known incidence of fraud relative to false billings, cost reports, kickbacks, etc
- Must have, as a minimum, three (3) year’s experience in a hospital, nursing care facility, or other related health care facility
- Must have training in rehabilitative and restorative nursing practices
- Must have knowledge of managed care and PPS systems
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Case Manager Resume Examples & Samples
- Flexibility working in a rapidly changing environment as the program evolves and develops to meet our customers and members expectations
- Manage multiple priorities and adapt in a fast paced environment. Being responsible for production and quality metric
- Interacting with the interdisciplinary care team to formulate a care plan for the member
- Assisting and coordinating discharge planning
- Interpret applicable criteria and guidelines while assessing benefits to ensure appropriate administration of those benefits to help support in the development of the members care
- Adhere to all NCQA accreditation guidelines with timely documentation of the assessment and the care plan
- Demonstrate communication skills to engage and connect with member
- 3-5 years clinical practice experience, BH background essential Managed care industry experience preferred
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Case Manager Resume Examples & Samples
- Managing a portfolio of work-related injury claims, providing information and assistance to injured employees and their employers
- Developing and maintaining professional relationships with injured employees, employers and providers
- Making clinical assessments of injuries and determining the appropriate level of entitlements within the provisions of the Act
- Arranging case conferences, claims reviews and onsite visits
- Ensuring compliance with the legislation and audit requirements
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Case Manager Resume Examples & Samples
- Required a High School or GED
- Preferred a Bachelor's Degree in nursing or related field
- Intermediate ability to drive multiple projects a plus
- Intermediate ability to work independently, handle multiple assignments and prioritize workload
- Intermediate demonstrated time management and priority setting skills
- Intermediate ability to create, review and interpret treatment plans
- Intermediate demonstrated negotiation skills
- Intermediate ability to effectively present information and respond to questions from families, members, and providers
- Intermediate ability to implement process improvements
- Required beginner Microsoft Excel
- Required beginner Microsoft Word
- Required beginner Healthcare Management Systems (Generic)
- Required beginner Microsoft Outlook
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Case Manager Resume Examples & Samples
- Opportunity creation: Re-Orders, Add-On Orders
- Queue Management: Ensuring cases are addressed and resolved in adherence to response and resolution SLA
- Case Management: Resolving core transactional cases- to include obtaining approvals, ensuring compliance and adherence to Salesforce.com (SFDC) and corporate policy
- Error Review: Identifying root cause and solution to SFDC errors on behalf of sales in coordination with system administrators
- Case Creation: responsible for ensuring all activities are documented via case in order to ensure KPI data integrity
- Experience working with: Sales, Sales Operations, Order Entry/Processing or Customer Support
- Advanced experience with CRM-Salesforce.com highly preferred
- Experience with project coordination/management
- Advanced knowledge of sales processes
- Familiarity with contract review
- Familiarity with SaaS models and revenue recognition
- Candidate must be focused, detail oriented and able to work in a fast-paced and constantly changing environment
- Customer service experience is mandatory
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Case Manager Resume Examples & Samples
- Prepares written personalized program for each resident to establish measurable criteria of behavior, accomplishments and goals
- Monitors facility sanitation and safety
- Assists Job Developer with employment programs and verifications
- Prepares reports summarizing program performance
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Case Manager Resume Examples & Samples
- Manages a participant caseload using principles of the “What Works” system. Conducts risk/need assessments and creates individual treatment plans for each assigned participant. Meets regularly with participants and documents participants’ progress or regress in Company database
- Sets participant schedules and specifies all approved activities based on sentencing information. Approves temporary schedule changes for approved activities
- Collects participant fees on an on-going basis when required. Notifies the Program Manager of delinquent fees
- May review daily summaries each morning and forward reports to the appropriate agency as required
- May facilitate psycho-educational/behavior modification groups each week. Documents participants’ attendance, participation and progress in Company database
- Good organizational skills and attention to detail
- Bi-lingual (English/Spanish) skills may be required
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Case Manager Resume Examples & Samples
- Conducts facility orientation for newly assigned inmates or detainees explaining rules and regulations of the facility, available services and programs, and the disciplinary and classification process
- Provides individual counseling to inmates or detainees on an informal basis regarding work and housing assignments, adjustment problems, and family problems
- Resolves day-to-day problems with counseling. Refers inmates or detainees with serious problems to professional counseling staff
- Provides assistance to the inmates or detainees in obtaining needed services. Serves as a representative for the inmate/detainee at classification committee meetings
- Reviews inmate/detainee medical status to determine eligibility to work in volunteer job assignments
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Case Manager Resume Examples & Samples
- Interviews newly admitted inmates/detainees. Develops detailed knowledge of those assigned to specific caseload
- Resolves daily detainee/resident problems, complaints and concerns with general counseling techniques
- Conducts individual meetings with detainee/resident to provide assistance with rehabilitation program, housing-related challenges
- Makes daily assigned unit visits to ensure informal contact with detainees/residents and interaction with Housing Escort Officers and Resident Advisors
- Inspects units for cleanliness and adherence to security practices
- Assist in logging and distributing legal and certified mail and coordinate detainee telephone sign-up list
- Serves as an active participant on the classification teaming committee meetings to determine assigned housing, in addition to appropriate work and rehabilitation programs. May serve on the discipline committee
- Resolves day-to-day problems with counseling. Refers inmates/detainees with serious problems to professional staff
- Provides assistance to the detainees/residents in obtaining needed services. Serves as a representative for the detainee/resident at classification committee meetings, as requested
- Maintains appropriate documentation of detainee/resident daily contacts as detailed in the agency program procedures
- Assists the Housing Escort Officer with the security inspection of the living unit to ensure sanitary and security policies of the facility are adhered to
- Assists with intake functions as needed
- May assist the Transportation Officer on an as needed basis in gender specific transportation
- Assists Unit Manager as needed
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Case Manager Resume Examples & Samples
- Maintains a client caseload with appropriate service plans
- Enforces program norms, rules, and behavioral standards
- Coordinates and develops appropriate service plans through the utilization of various
- Facilitates groups for clients and families and assist in facilitating life skills workshops and
- Supports the Abraxas philosophy and mission and promotes the Seven Key Principles of
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Case Manager Resume Examples & Samples
- Meeting with participants face-to-face regularly as required by government contractual obligations
- Conducting intake interviews and orientation sessions with each ISAP Program Participant within contractual timeframes
- Installing electronic monitoring equipment on ISAP Program Participants as necessary and monitoring compliance with electronic monitoring program
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Case Manager Resume Examples & Samples
- Conducts group and individual meetings utilizing motivational interviewing techniques
- Monitors facility sanitation and safety. Assigns daily housekeeping chores to residents to comply with facility standards
- Verifies residents' jobs to ensure residents' employment is suitable under established program plan. Counsels unemployed residents by providing guidance in obtaining employment
- Verifies residents' pass plan through pass sponsorship according to contract so that the resident is accountable for his/her whereabouts in the community
- Prepares terminal reports within established time parameters upon resident release to summarize program performance and to satisfy contract requirements
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Case Manager Resume Examples & Samples
- RN Case Manager (New Britain, CT)
- Registered Nurse (Green Bay, WI)
- Registered Nurse / RN / Home Care - PRN (Jacksonville, FL)
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Case Manager Resume Examples & Samples
- Must be a licensed Registered Nurse (RN) in the state of Kentucky
- A minimum of one year experience as a Registered Nurse is required
- Previous experience in the home care setting is desired
- Possess the ability to transfer, maneuver, and lift incapacitated clients in the home setting
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Case Manager Resume Examples & Samples
- 3-4 years of working with individuals with chronic illnesses, co-morbidities, and/or disabilities in a Service Coordinator, Case Management, or similar role
- Prior experience treating geriatric patients
- Strong case management skills and knowledge
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Case Manager Resume Examples & Samples
- Bachelor's Degree or higher in a health-related field
- Active Registered Nurse license or certification as a Case Manager
- 3 years of clinical experience or any combination of education and experience
- Knowledge of care management assessment technique, provider community, and community resources
- Proficiency with computer platforms and applications including word processing, spreadsheet, and database applications
- Proven problem-solving skills
- 1 year of experience in home health/discharge planning
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Case Manager Resume Examples & Samples
- Participate in continuing education/professional development activities
- Communicate and demonstrate a professional image/attitude for patients, families, clients, coworkers and others
- Adhere to policies and practices of applicable professional organizations, client hospital and RehabCare Group
- Assist with the development of student programs as requested
- Contribute to client relations and marketing activities
- Maintain competency, licenses/ certifications, and memberships in applicable professional organizations
- Demonstrate use of effective case management skills to plan, coordinate and evaluate patient care and movement in the care continuum
- Supports the team in the development of individualized care plans
- Establishes and maintains a therapeutic relationship with patients and families
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Case Manager Resume Examples & Samples
- Graduate of accredited Professional School of Nursing, BSN preferred
- Current RN license in the state of Kansas
- Must have excellent interpersonal and organizational skills. Ability to work effectively with health care team required. Knowledge of computers, statistics and managed care concepts preferred
- Minimum of three years medical/surgical/critical care experience required. Case Management/ UR experience preferred
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Case Manager Resume Examples & Samples
- Requires a current, unrestricted LVN, LPN or RN license for the state of Nevada
- Must have 1-2 years of experience as a Case Manager or Discharge Planner in a Health Plan or Hospital setting
- Experience and excellent understanding of Coordination of Care of frail patients with multiple, complex, chronic diseases is a must!
- Ability to work in an extremely fast paced process driven environment is required
- Must be comfortable with working in an almost 100% telephonic role. With occasional in person off-site interaction with patient and/or patient families in hospital, skilled nursing or similar setting
- Bilingual in Spanish is Huge Plus
- Geriatric experience is a Huge Plus
- Medicare and/or managed care experience preferred
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Case Manager Resume Examples & Samples
- Facilitates communication regarding resident treatment process and needs with referral sources and payor
- Schedules and facilitates treatment team reviews and documentation
- Ensues coordinated, effective resident care including admission, continued stay, and discharge requirements
- Ensures positive relationships with external and internal customers
- Travels to resident's community representing the facility at FAPT meeting and court hearings
- Ensures continued availability (recertification) of financial resources throughout the residents stay
- Other duties as assigned based on the needs of the facility
- Must have a minimum of two years professional experience working with children
- Preference given to those with recent experience in a behavioral healthcare setting
- Needs basic understanding of and comfort level with medical terminology, residential treatment, clinical science/pathology and psychiatric disorders
- Must be articulate, assertive and able to communicate effectively with all stakeholders while at the same time demonstrate initiative, tact and good judgment
- Position is subject to a criminal background investigation and pre-employment drug screen
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Case Manager Resume Examples & Samples
- For Nursing, must possess minimum of an Associate Degree in Nursing, RN licensure with BSN preferred
- For all other eligible licensed or certified health care professionals, must possess a minimum of a baccalaureate degree (graduate degree is preferred)
- 2 years of direct hospital case management experience preferred
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Case Manager Resume Examples & Samples
- Works with member to close clinical and pharmacy gaps and to mitigate non-clinical barriers to care
- Acts as a liaison and facilitates the coordination of benefits, resources, healthcare providers, and institutions
- Completes and files all assessments and implements the care plans within the timelines outlined by the state
- Maintains a maximum weekly face to face visit schedule of seven members for field-based nurse coordinators, average caseload of 125
- Must be a Registered Nurse with a current, unrestricted Texas License
- Must have strong computer skills using MS office products including Word, Excel, and Outlook
- Must have reliable transportation, a valid and unrestricted driver’s license and proof of insurance
- The ability to travel to members’ homes, and other locations within the service delivery area
- Previous STAR+PLUS experience
- Home Health Case Management experience with Medicare or Medicaid populations a plus
- Experience managing members with chronic disease processes and
- Experience working with community resource organizations preferred
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Case Manager Resume Examples & Samples
- Enforces program expectations, rules, and behavioral standards
- Coordinates and develops appropriate service plans through the utilization of various identified resources to assist the client in making the transition from a residential placement or institution to the community in lieu of incarceration
- Assist clinician in developing service plans and aftercare plans which may include utilizing services such as Alcohol and other Drugs (AOD), legal, behavioral, medical, educational, vocational, family, and psychosocial for each client and update and monitor such plans in a timely manner
- Supervises client activities and prepares required reports of the behavior and progress of clients
- Supports clients and their families in completing any court ordered conditions including restitution, community service, or specific counseling needs and assessment
- Coordinates efforts with the courts, probation department, schools, employers, job training, recovery programs, counseling, family, or other social service agencies and community programs to meet the clients’ individualized needs
- Assist clinician in maintaining regular contacts with referral agency staff assigned to each client in order to maintain communication and consistency with client and family treatment to meet contractual or licensing obligations and ensure regulatory compliance with outside referral agencies
- Develops and maintains resources for clients including a community based resource listing and curriculums. Facilitate groups daily for clients to include a regular schedule of client curriculums and informative materials
- Attends and acts as advocate or liaison to client court hearings, school meetings, and reviews
- Coordinates transportation for clients as needed for program/facility related meetings and activities as needed
- Develops a weekly work schedule to best service each client. Coordinates with clinical staff regarding optimum client services. Arrange and conduct visits with the client and family at the facility, home, and community based locations before and after release
- Maintains confidentiality of information as it relates to client information
- Facilitates an hour individual session weekly to assigned clients’ on caseload
- Maintains bi-weekly contact with client’s guardian
- Facilitates a weekly phone call with each client on caseload
- Supports the Abraxas philosophy and mission and promotes the Seven Key Principles of care
- Demonstrates appropriate use of Safe Crisis Management techniques and skills
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Case Manager Resume Examples & Samples
- Coordinate service delivery ensuring continuity of care
- Be knowledgeable about in and out of plan benefits
- Assist members in accessing care by educating providers and members
- Obtain signed releases of information from members via on site, face to face collaboration with providers and members
- Identify individual limitations, deficits, and strengths and aggressively attempt to provide patients with what they need in relation to medical, behavioral and social needs
- Help reduce the negative consequences to the individual when there is a lack of follow up and participation in treatment
- Educate providers about Beacon’s Case Management program inclusive of the referral process
- Collaborate with hospital liaisons at the local Community Mental Health Centers and Emergency Service Teams to assist in expedited linkage to diversionary levels of care for members
- Attend/participate in acute care discharge planning meetings, as appropriate
- Participate in daily rounds, when applicable
- Participate in monthly meetings with Manager of Clinical Operations and/or team lead to discuss feedback from providers/members regarding the continuum of care. Additionally, assist in identifying gaps in covered services
- Coordinate referrals to Medical Management Case Management, as appropriate, and assist with identification of and outreach to medically compromised members
- Assist in the collection of outcomes information, annual analysis, and other reporting and initiatives
- Case Managers are required to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management and must be a licensed behavioral health clinician. Re-verification to occur in accordance with state licensure standards
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Case Manager Resume Examples & Samples
- Obtain appropriate clinical review on all admissions, to determine medical necessity for acute hospitalization and SNF and sub-acute admissions
- Visit contracted hospitals to include Queen of the Valley Hospital, Foothill Presbyterian Hospital and Citrus Valley Intercommunity Hospital on a regular basis to assist with patient throughput, develop relationships with hospital staff, and assist hospitalist with tasks necessary to facilitate a timely discharge
- Liaison with Medical Director for review of all acute inpatient cases daily
- Interface with hospital discharge planners, home health agencies, skilled nursing facilities, extend care facilities and DME providers to ensure continuity and smooth transitions of care after discharge
- In person and/or telephonic interface with patients and families during the discharge planning process
- Attend daily rounding meetings and report on all inappropriate admission weekly
- Effectively advise and manage admission statuses of Inpatient and Observation
- Actively participate in referrals to appropriate Disease Management Programs and identify/’report patients with high risk needs that would benefit from our case management programs
- Conduct retrospective review of all 1 and 2 day LOS admissions, and report findings at monthly UM meeting
- Conduct routine reviews of ER utilization, and report recommendation for system improvements to supervisors and UM committee
- Interfaces with hospital and CHM Case Managers to ensure timely workup/management/and discharge of patients through the acute and SNF stay
- Coordinates transfers to/from contracted hospitals and facilities
- Report daily to on-call services all pending cases with defined plan of care for each patient pending transition
- Obtains medical records as needed for those patients hospitalized on weekends and/or holidays that may require retrospective reviews for levels of care and discharge information
- Functions as clinical resource to Utilization/Quality/Outreach Management Coordinators
- Refers high-risk cases to the Outreach Program for continued case management and coordination of care
- Fosters positive interaction and relationships with all internal departments and staff
- Performs other assigned duties / special projects on an as-needed basis
- Prevent and avoid harassment and discrimination. Respond promptly to any complaints in accordance with policy in employee handbook
- California Registered Nursing License, or LVN with additional relevant clinical experience
- Minimum 2 years case management, utilization / discharge planning experience in an IPA, Group, Hospital/Health Plan environment, or other qualifying clinical experience
- Preferred knowledge of Milliman or Interqual guidelines
- Preferred knowledge of EZ-Cap information system preferred
- Proof of auto insurance
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Case Manager Resume Examples & Samples
- Effectively manage assigned caseload of medical/disability cases within company and regulatory guidelines
- Communication with claimants, medical professionals, claims staff and others to obtain information necessary to make sound medical decisions. In addition, responds to various written, telephone and/or in-person inquiries regarding status of case
- Current unrestricted registered nurse (R.N.) license in the state where the position is based and other assigned states as required by law
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Case Manager Resume Examples & Samples
- Proven clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care
- Healthcare and/or managed care industry experience
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Effective communication skills, both verbal and written
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment
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Case Manager Resume Examples & Samples
- Education: Graduate of accredited school of nursing
- Professional Experience:Minimum of one (1) year of utilization review, discharge planning, and/or hospital case management experience required. Knowledge of community resources preferred
- *ELIGIBLE FOR UP TO $7500.00 SIGN ON BONUS"
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Case Manager Resume Examples & Samples
- Complete initial chart reviews and patient handbooks with newly admitted residents
- Communicate with therapists to anticipate and report any foreseeable problems regarding the continued stay or discharge planning of residents
- Document all external and internal contacts and relay patient information according to company and governmental guidelines, maintaining appropriate confidentiality
- Maintain ongoing list of referral sources and aftercare providers for residents
- Coordinate with the therapist, physician, and other treatment team members, to ensure that referral sources, aftercare providers, and other involved parties receive appropriate communication
- Attend treatment team meetings for assigned residents, as needed, to provide and collect information pertinent to the progress, needs and discharge planning of residents
- Complete reviews of charts and communicate with unit staff and therapists to provide utilization review information to UR department as requested
- Coordinate discharge planning and aftercare arrangements for all assigned residents. This includes scheduling of aftercare appointments and coordinating discharge-related meetings as needed
- Respond to any emergency situation involving patients in treatment
- Attend staff meetings as required and perform duties as a positive role model for patients and colleagues
- Utilize chain of command in all aspects of program and follows organizations policies and procedures
- Perform professional community relations by ensuring all written and verbal information is clear, concise, legible, and accurate
- Participate as a team member by cooperating with co-workers demonstrate compromise and expression of opinions as appropriate
- Completing other duties as assigned, related to coordination of resident care
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Case Manager Resume Examples & Samples
- Three to five years of post-licensure care management experience
- Experience in completion of assessment, care plans, care coordination and issue resolution
- Motivational Interviewing experience preferred
- Electronic case management and medical record experience
- Demonstrated skills in the areas of negotiation, communication (verbal and written), conflict, interdisciplinary collaboration, management, creative problem solving, and critical thinking
- Knowledge of healthcare reimbursement , Utilization Management, discharge planning, Disease Management
- Basic knowledge of Medicare, Medicare Advantage Plans, Commercial Plans, Texas Department of Insurance regulations and health plans
- A Knowledge of NCQA standards in Primary Care Medical Home and Care Management, as well as Accountable Care Organization
- Engage and provide care management to identified patient populations
- Provide care management telephonically or face to face in the clinical practice setting
- Travel to additional clinics to facilitate face to face care management as indicated
- Complete required assessments
- Create a personalized care plan for each patient involved in care management to resolve barriers to care, build additional education or contingency planning and engage with social support systems as appropriate
- Coordinate with health plan clinical programs as appropriate
- Complete all necessary care coordination and or assessment activities as outlined in the care plan
- Attend clinical round meetings on assigned patients involved in care management
- Follow NCQA Care Management accreditation standards
- Document all patient care activities into electronic database
- Meet required Key Performance Indicators
- Pass Quality Audit metrics
- Coordinate and cooperate with other members of the care management team
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Case Manager Resume Examples & Samples
- Reviewing plan with residents/clients on a weekly basis and documenting progress or revisions so that they are gaining the life skills necessary to make a successful re-entry into the community
- Assisting residents to establish personal budget, locating suitable housing, enrolling in educational and vocational programs and participating in family and community activities, as appropriate; ensuring that they are working towards financial independence
- 2 years of work experience in a related field; familiarity with community corrections systems and current community corrections practices
- Familiar with community work force needs, public and private agencies and employment services
- Strong basic math skills
- Ability to work with computers and the necessary software typically used by the department
- Short- and long-term disability
- Stock purchase program
- Direct deposit
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Case Manager Resume Examples & Samples
- Proactively identifies members that may qualify for potential case management services
- Develops and implements a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs
- Performs ongoing monitoring of the plan of care to evaluate effectiveness and suggests changes accordingly
- Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members
- Conducts face to face or home visits as required
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Case Manager Resume Examples & Samples
- Perform telephonic case management intervention services
- Conduct assessments and develop treatment plans to provide benefit and mental health education, to coordinate services, and manage behavioral health care needs
- Manage complex case loads and ensure documentation and case information is updated timely
- Participate in quality improvement initiatives
- Awareness of and/or willingness to learn about the U.S. military lifestyle
- Attention to detail and computer proficient
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Case Manager Resume Examples & Samples
- Manages a client caseload using principles of the What Works system. Conducts risk/need assessments and creates individual treatment plans for each assigned client. Meets regularly with clients and documents clients progress or regress in Company database
- Collects client fees on an on-going basis when required. Notifies the Program Manager of delinquent fees
- Monitors client compliance with alcohol and/or drug counseling when required
- Trains newly hired case manages to ensure they have the tools and information necessary to perform their jobs in compliance with company policies
- May testify in court regarding clients compliance with court orders
- May screen clients at jail for entry into the program
- May be required to learn and develop proficiency in Client Administrators duties, including opening and closing the office, and performing client intakes, check-ins, breath analysis and drug screens, to provide backup when necessary
- One to two years experience providing services to adult or juvenile treatment populations
- Up to three years experience may be required for Re-Entry Offices
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Case Manager Resume Examples & Samples
- Orienting residents upon arrival at facility to provide smooth assimilation into program including having them complete paperwork, take facility tours or introducing to other residents
- Assisting in verifying residents'/clients’ jobs to ensure residents'/clients’ employment is suitable under established program plan; counseling unemployed residents/clients by providing guidance in obtaining employment in cooperation with the Job Developer
- Associates and Bachelor's degree (Criminal Justice, Social Services) and one (1) year of general work experience
- High school diploma or GED and 2 years of work experience in a related field; familiarity with community corrections systems and current community corrections practices
- Must be able to react quickly and appropriately in an emergency situation
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Case Manager Resume Examples & Samples
- Performing ongoing reviews on your portfolio of claims to ensure that each Claim is proactively maintained and progressed
- Providing advice, making recommendations and compiling reports for our Clients
- Requesting, reviewing, awarding tenders and monitoring the repair process
- Liaising with all parties involved in the Claim process in order to progress the Claim
- Reporting both formally and informally to Customers & Clients on Claim progress
- Arranging payments and managing the financials of each Claim
- Administrative and other duties as requested by your reporting manager
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Case Manager Resume Examples & Samples
- Manages/coordinates an active volume of cases by providing information and coordination to customers worldwide in a multicultural population
- Establishes patient centric goals and interventions to meet the member’s needs
- Interfaces with the member, family members/caregivers, and the healthcare team, as well as internal matrix partners
- Balances business needs with patient advocacy
- Assesses member’s health status and treatment plan and identifies any gaps or barriers to healthcare
- Coordinate care for customers by reviewing medical and claim information, ensure compliance with approved services and fees and discuss cases with hospital staff and physicians
- Establishes a documented patient centric case management plan involving all appropriate parties (client, physician, providers, employers, etc), identifies anticipated case results/outcomes, criteria for case closure, and promotes communication within all parties involved
- Work with Cigna physicians to evaluate complex cases and receive appropriate clinical expertise on diagnosis and treatment plans
- Responsible for delivering to customers clinical programs including case management, chronic condition management, lifestyle coaching, pre assignment assessment and any other program delivered by global clinical operations
- Coordinate care with other nurses around the world when a need for local or regional expertise is important for better care or to comply with regulations
- Maintains accurate workflow and process documents
- Adheres to professional practice within scope of licensure and certification quality assurance standards and all case management policy and procedures
- Serve as clinical liaison to Clients
- Bachelor in Nursing, 3-5 years of experience in international clinical management
- Languages required: English and French Bilingual
- Demonstrated organizational and leadership skills
- Demonstrates problem-solving and analytical skills
- Ability to act as an “advocate” for the customer while complying with internal policies and procedures and contractual/legal compliance requirements
- Ability to operate personal computer, proficient with Microsoft office products, call center software, and a variety of software
- Ability to build solid working relationships with staff, matrix partners, customers and providers
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Case Manager Resume Examples & Samples
- LICENSE/CERTIFICATION
- Current Colorado LPN or Registered Nurse Licensure
- OTHER REQUIRED SKILLS AND ABILITIES
- PHYSICAL ABILITIES
- Vision sufficient to read medical records, instruments, documentation, and visual changes in client condition
- Hearing sufficient to interact with client who may be unable to speak at normal voice level
- Mobility (including lifting, bending, stooping, reaching) and dexterity sufficient to assist clients and handle required instruments
- See Physical Demands Assessment
- Important notification to applicants as of Nov. 20, 2014: Effective Jan. 1, 2015, Centura Health will no longer hire tobacco users in Colorado and Kansas. The change to our policy does not apply to associates hired on or before Dec. 31, 2014. Centura Health is an Equal Opportunity Employer, M/F/D/V
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Case Manager Resume Examples & Samples
- Must have a Bachelor’s degree from an accredited university or college with at least 30 semester hours or 45 quarter hours in either development of human behavior, child development, family intervention techniques, diagnostic measure of therapeutic techniques such as social work, psychology, sociology, guidance, and counseling. Other Requirements: Must be 21 years of age or older. Appointees will be required to possess a driver's license valid in the state where the work site is located only if the operation of a vehicle, rather than employee mobility, is necessary to perform the essential duties of the position
- Knowledge of basic theory and practice of human behavior and problems of group living. Knowledge of the nature of common behavior and mental health disorders of childhood and adolescence, and the appropriate responses. Knowledge of programmatic approaches to behavioral management including the principles of behavior modification. Knowledge of individual and group counseling techniques. Ability to maintain an attitude of objectivity and open-mindedness concerning new approaches and methods of dealing with children's problems. Ability to keep abreast of new ideas, attitudes and skills relevant to working with problem children. Ability to think clearly and act appropriately in an emergency or potentially dangerous situation. Ability to understand complex concepts of learning and behavior modification and their application to the client population served. Ability to participate in recreational activities. Knowledge of the rules and equipment used in popular games, sports and other leisure activities and their therapeutic applications
- Ability to learn to utilize various types of electronic and/or manual recording and information systems used by the agency, office, or related units. F. Physical Requirements & Work Environment: Talking: Ability to express and exchange ideas via spoken word during activities in which they must convey details or important spoken instructions to others accurately, sometimes quickly and loudly. Hearing and Vision: Ability to perceive the nature of sounds with no less than 40 dB loss at Hz, 1000 Hz and 2000 Hz with or without correction. Ability to receive detailed information through oral communication. Work requires a minimum standard of visual acuity with or without correction that will enable employees to complete clerical tasks, and observe youth. Dexterity: Ability to stoop, kneel, crouch, reach, push, pull, lift, grasp, and be able to perceive the attributes of an object such as size, shape, and temperature. Movements frequently and regularly required using wrists, hands and/or fingers. Physical Strength: Ability to exert up to 50 pounds of force occasionally. Position is mainly sedentary work (office work), but may on occasion include physical force execution. Employee may be subject to temperature changes, but the employee is not substantially exposed to adverse environmental conditions as the work is predominantly inside. Language: Ability to write complex sentences, using proper punctuation, and ability to communicate in complex sentences using normal word order with present and past tenses. Processing and Reasoning: Ability to exercise self-control in potentially volatile situations such as in verbal and physical confrontations. Must be able to work and concentrate amidst distractions and noise. Ability to assist youth with problem solving and maintaining self-control in volatile situations. The work environment characteristics described are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions. While performing the duties of this position the employee is occasionally exposed to outside weather conditions as they relate to travel. The noise level is usually moderate as the primary work environment is a standard office setting. Work environment may involve exposure to noise, dust, fumes, dangerous machinery, chemicals, body fluids, falling objects, and aggressive verbal and physical behavior from students and weather and temperature extremes. Persons with mental or physical disabilities are eligible as long as they can perform the essential functions of the job after reasonable accommodation is made to their known limitations. If the accommodation cannot be made because it would cause the company undue hardship, such persons may not be eligible.People who applied for this job also applied for
- Case Manager (MGA), Okeechobee, FL
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Case Manager Resume Examples & Samples
- Education: Graduation from a program of nursing, BSN preferred
- Licensure/Certification: Current state Registered Nurse license or licensure from a state within the Nursing Compact
- Experience: Minimum of 3 years clinical experience in cardiovascular nursing preferred. Two years of case management experience preferred
- Essential Technical/Motor Skills: Able to operate various types of audio-visual equipment, performs various office support skills, and work with computer entry and report generation
- Interpersonal Skills: Must be able to interact and communicate with all levels of staff, physicians, patients, and families in an effective manner, exhibiting tact, enthusiasm, and patience. Must be able to be sensitive to cultural and bilingual issues
- Essential Physical Requirements: Requires full range of body motion including handling and lifting, manual and finger dexterity, and eye-hand coordination. Able to stand and walk for long periods of time. Able to lift/push/pull patients to transport and/or reposition. Able to lift and carry equipment and supplies of 10 pounds or more. Demonstrates corrected vision and hearing in the normal range. Abel to work under stressful conditions and irregular hours
- Essential Mental Abilities: Able to comprehend and interpret complex clinical subject matter related to specialty. Able to read, write and comprehend instructions at a college level
- Essential Sensory Requirements: Able to respond to visual, auditory and other senses by patients, families, staff and physicians in a professional manner. Able to palpate pulses, hear heart and breath sounds manually and electronically
- Exposure to Hazards: Requires exposure to communicable diseases and potentially contaminated body fluids and hazardous materials. OSHA risk factor: Category I. Possible risk of physical injury due to moving machinery and supplies
- Age-Specific Criteria: Must demonstrate and maintain current knowledge and skills necessary to provide care/ services to the age of the patients served in the hospital facility. Must also possess the ability to assess data and interpret the appropriate information needed to identify each patient's requirements relative to their specific needs
- Other: Understands the mission and vision of the hospital. Operates within the concept of patient focused care. Evolves into an effective team member. Must adhere to dress code; good grooming and personal hygiene habits; and strict adherence to attendance policies. Maintains knowledge of and conforms to hospital policies and procedures. Employee must maintain satisfactory level of knowledge and skill in Age Specific Competencies for the appropriate patient population
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Case Manager Resume Examples & Samples
- Manages patient cases from the beginning of the referral to final resolution including appeal approvals
- Leads coordination efforts between multiple parties including but not limited to patients, providers, physicians and their staff, treatment center billing departments, insurance companies, and patient assistance programs
- Reviews case upon receipt of referral to determine appropriate next steps based on defined process
- Contacts patients / caregivers to discuss copay assistance programs as needed
- Places follow up calls to patients / caregivers to retrieve program documentation including but not limited to patient authorization / consent form, obtaining missing information, and retrieving denial letters
- Constantly keeps physician and physician’s team updated on status of the case
- Ensures timelines and customer commitments are met
- Facilitates and manages coordination of the product and ancillary supplies needed for treatment, documenting and managing all communication during the process
- Minimizes obstacles to coverage by using judgment to successfully plan next steps
- Makes informed, methodical decisions throughout a very complex process
- Assists customers to navigate healthcare insurance reimbursement issues through education, information, and exceptional communication
- Constantly updates the tracking system to ensure timely and smooth coordination for the patient and providers
- Coordinates with internal quality, supply chain and other internal teams to resolve issues
- Supports the Operations Program Manager on program initiatives and departmental goals
- Answers incoming hotline calls as needed
- Enters case data into the program system
- Responds to internal team member case-related questions
- Participates in daily informal check-in’s with team
- Attends weekly team meeting
- Responds to emails from internal and external customers that need to be addressed immediately by a case manager
- Fields customer complaints and responds in a timely manner
- Travels, attends, and presents at customer and patient meetings as requested
- Three or more years of reimbursement / patient services experience preferably in a pharma / biotech or health services environment specializing in oncology
- Strong understanding of the healthcare insurance reimbursement market
- Previous experience working in a pharmaceutical patient assistance program preferred
- Submit cover letter, resume, and a minimum of three professional references
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Case Manager Resume Examples & Samples
- Identification and tracking of all assigned CM Members
- Conducts independent assessment and re-assessment of members enrolled in CM in compliance with program standards
- Development of a comprehensive care plan to address areas or risk and/or need as identified via the assessment; updates the care plan as clinically indicated
- Maintains on-going contact with the member/ guardian
- Provides continuum of quality care through mainly telephonic outreach, education, crisis intervention and other clinically based activities to plan members as specified in their treatment plans
- Collaborates and coordinates with member’s medical/health and community based providers (including the PCP, medical professionals, behavioral health specialists, or others as needed) regarding the member’s treatment/discharge needs and plan of care
- Collects clinical data and maintains accurate records of activities information into database for tracking and metrics purposes
- Collaborates with the care management team to review care management process for members to ensure needs of members are met
- Occasional, in person outreach and engagement of members
- Assist with NCQA and URAC initiatives, including but not limited to ensuring compliance with NCQA MBHO QI9
- Provide Service Coordinator to HMSA QUEST members with a behavioral health special health care need as needed
- 3 plus years of Case Management experience
- Educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management
- Ability to prioritize and manage multiple projects and assignments
- Knowledge of client's rights, state and federal laws, and regulations, such as those relating to health services, confidentiality, and consent issues for the targeted population
- Knowledge of HIPAA and other privacy regulations
- Ability to work independently, handle multiple assignments and prioritize workload
- Ability to seek help in managing workload, when appropriate
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Case Manager Resume Examples & Samples
- 30% - Provide day to day oversight and coordination of case load to ensure all case elements and tasks are completed timely and ensure cases move through the process as required
- 30% - Act as single point of contact responsible for prior authorization and appeal processing communications to patients, healthcare providers, field reimbursement representatives and other external stakeholders
- 20% - Communicate patient benefits and responsibility timely and accurately. Assess and refer patients appropriately for special programs/services when appropriate
- 5% - Performs quality checks on cases and reports trends to leadership
- 5% - Responsible for good housekeeping techniques, adhering to quality and production standards while complying with all applicable company, state and federal safety and environmental programs and procedures. Other duties as assigned
- 5% - Report Adverse Drug Events that have been experienced by the patient in accordance pharmaceutical requirements
- 5% - Recognize a product quality complaint and forward caller/written information to a manufacturer.Bachelor's Degree - Other (Required)
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Case Manager Resume Examples & Samples
- 1+ year of experience in the social services field
- Strong verbal/written communication and interpersonal skills
- Ability to work independently, multitask and prioritize
- Familiarity to Microsoft Office, including Outlook, Work, and Excel
- Experience handling domestic violence cases
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Case Manager Resume Examples & Samples
- 3-5 years of acute care clinical experience, intensive care nursing desired
- Self motivated, can work autonomously and ability to work with an interdisciplinary team
- Computerand statistical experience highly desired
- Must be able to work in a fast paced, ever changing environment
- Attention to detail and concentration
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Case Manager Resume Examples & Samples
- LCSW, LMSW, LPC or LAPC
- Intervenes in appropriate systems as a patient advocate
- Involves patient and/or family in the treatment planning process and subsequent reviews
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Case Manager Resume Examples & Samples
- Responsible for implementing and coordinating all case management, psychosocial, and quality of life activities relating to cases across the continuum of care including consultant referrals, home care visits, use of community resources and alternative levels of care
- Provides psychosocial interventions through resource identification, program development and other means
- This position may specialize within a disease area and may serve in a consultative role to other health care professionals
- Minimum of 3 years experience in medical social work or case management required
- Licensed Master Social Worker (LMSW) required
- Complies with all state requirements in the state where job duties are performed
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Case Manager Resume Examples & Samples
- 2+ years of prior experience in Case Management
- NYS Licensed Master Social Worker (LMSW) and/or Licensed Clinical Social Worker (LCSW)
- Previous experience work with the Behavioral and Community Health population
- Previous experience in a Healthcare and/or Managed Care setting
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Case Manager Resume Examples & Samples
- Proactively engage with service users with the aim of sustained rehabilitation
- Manage a caseload of the less complex/lower risk cases based on evidence-informed assessment/s, including Risk of Serious Recidivism (RSR) score
- Demonstrate and provide evidence of understanding protected characteristics and working to meet specific requirements
- Monitor service user progress for the duration of sentences imposed by the court
- Perform specialist elements of posts including delivery of group programmes/interventions (accredited/non accredited) and specialist support
- Comply with, and contribute to, children and adult safeguarding duties, promoting the welfare of children and adults and alerting relevant colleagues and stakeholders should any risk be identified
- Demonstrate collaborative working within the Flex Team; sharing practice and skills, promoting a team ethos
- Proactively responsible for developing and maintaining relationships and networks to ensure appropriate support and engagement with service users
- Assess and actively manage risk and take responsibility for recognising when risks need to be escalated and action taken
- Responsible for recording and record keeping in line with company policy and procedures
- Perform other duties commensurate with the post as from time to time may be determined by the line manager, Director or above
- Promote and support community engagement and integration through working at multiple sites in local communities as required, including at partnership agency premises
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Case Manager Resume Examples & Samples
- Strong interpersonal communication skills to effectively interface with program stakeholders (employees, community contacts, government officials and program participants)
- Ability to clearly articulate program rules, instructions and court orders
- Ability to compose succinct, accurate written reports
- Demonstrated sound judgment and even temperament. Ability to maintain self-control in stressful situations, such as interpersonal confrontations or emergencies, or defuse hostile or unstable situations
- Demonstrated tact when interacting with the public
- Ability to display cultural sensitivity and understanding
- Basic knowledge of immigration laws, regulations and procedures
- Computer proficiency including Microsoft Office and the Internet
- Ability to interpret electronic monitoring messages and daily summary reports
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Case Manager Resume Examples & Samples
- End to end resolution of complex customer issues 75%
- Understanding of compliance with corporate and industry regulations and protocols preferred
- Call Center and data analytics experience preferred
- Demonstrated negotiation, analytical and problem solving skills
- Superior time management and organizational skills, detail oriented with strong administrative follow-up and follow-through
- Knowledge of medical terminology, health care environment, therapeutic and product related knowledge
- Understanding and compliance with corporate, divisional, departmental and program specific standard operating procedures
- Ability to represent McKesson and our client in a positive, professional manner
- Ability to work independently and as part of a team, and as a self-starter
- Demonstrated results orientation
- Ability to perform simple to intermediate calculations (e.g., calculate customer payment terms, etc.)
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Case Manager Resume Examples & Samples
- This posion will be onsite in Sacramento
- 3-5 years of direct patient care or patient education in an inpatient, outpatient, ambulatory or home health setting
- Hospital or ambulatory case management or disease management
- Team leadership in a clinical nursing environment
- Proficiency and clinical work within the areas of cardiac telemetry, treatment of arrhythmias Previous ICU experience a plus
- Strong familiarity with the etiology and current therapeutic modalities in the areas of cardiac, pulmonary and diabetic care
- Experience with electronic health records and computerized patient care systems – Epic experience desirable
- Previous clinical experience in more than one level of care, i.e.: Intensive Care, Med-Surg, ED, Home Health, etc., strongly preferred
- Previous case management experience is preferred
- Experience using InterQual is strongly preferred
- Broad acute clinical background (experience in more than one population and level of care) strongly preferred
- General knowledge of illnesses, current treatments and their physical and psychosocial sequelae
- Specific knowledge in the areas of cardiac diseases, COPD, congestive heart failure, diabetes, asthma, hyperlipidemia and hypertension
- Applicable laws and regulations regarding government and commercial insurance benefits including basic knowledge of governmental (Medicare, Medi-Cal, etc.) healthcare reimbursement systems is required, as well as advanced knowledge of healthcare reimbursement systems: HMO, PPO, Capitated agreements, PPS, etc., is preferred
- General knowledge of coding and DRG assignment process is preferred
- Motivational Interviewing or Shared Decision Making techniques
- Available health care and community resources appropriate for populations served
- Individual and family development over the life span and the influence of cultural and spiritual values in health care
- Data collection techniques and methods of analyzing and reporting data
- Ability to use clinical knowledge to identify potential quality of care issues, delays in service, and post-acute care needs required
- Intermediate level computer skills are required
- General typing skills (35 WPM) required
- Must be able to effectively communicate with, and promote cooperation between, multiple people including: patients and their families; physicians, nurses, social workers, etc
- Able to orchestrate successful, complex discharge plans
- Must be able to develop an organized work plan in a high-volume environment with rapidly changing priorities
- Ability to work independently with a minimum of direction, anticipate and organize workflow, prioritize and follow through on responsibilities
- Must have strong clinical assessment and critical thinking skills necessary to provide utilization review/discharge planning services appropriate to patients with complex medical, emotional and social needs
- Interpersonal relationship development, problem-solving, conflict resolution, presentation, time management, positive personal influence and negotiation skills
- Ability to work respectfully and creatively with clients of diverse functional abilities, social, economic, and cultural backgrounds to support both client autonomy and client safety
- Demonstrated skills in motivating, mentoring, coaching and redirecting clients in order to achieve compliance with various necessary medical, social and functional interventions
- Leadership skills to delegate provide direction/guidance to staff and hold others accountable
- Strong clinical assessment and critical thinking skills necessary to provide care-planning and medication adjustments based on algorithms appropriate to patients with complex medical, emotional and social needs
- Must have the ability to work in a high-volume caseload environment and deal effectively with rapidly changing priorities
- A demonstrated ability to work constructively with a broad spectrum of health care professionals
- Assertive and creative in problem solving, system planning and management
- Advanced computer skills are required. Ability to work with databases, Microsoft Suite and EPIC
- Must have the ability to create and communicate clearly via written and oral communication using SBAR
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Case Manager Resume Examples & Samples
- Provides care coordination to members with behavioral health conditions identified and assessed as requiring intensive interventions and oversight including multiple, clinical, social and community resources
- Conducts in depth health risk assessment and/or comprehensive needs assessment which includes, but is not limited to psycho-social, physical, medical, behavioral, environmental, and financial parameters
- Communicates and develops the care plan and serves as point of contact to ensure services are rendered appropriately, (i.e. during transition to home care, back up plans, community based services)
- Implements, coordinates, and monitors strategies for members and families to improve health and quality of life outcomes. Develops, documents and implements plan which provides appropriate resources to address social, physical, mental, emotional, spiritual and supportive needs. Acts as an advocate for member?s care needs by identifying and addressing gaps in care. Performs ongoing monitoring of the plan of care to evaluate effectiveness. Measures the effectiveness of interventions as identified in the members care plan
- Assesses and reviews plan of care regularly to identify gaps in care, trends to improve health and quality of life outcomes. Collects clinical path variance data that indicates potential areas for improvement of case and services provided. Works with members and the interdisciplinary care plan team to adjust plan of care, when necessary
- Educates providers, supporting staff, members and families regarding care coordination role and health strategies with a focus on member-focused approach to care. Facilitates a team approach to the coordination and cost effective delivery to quality care and services
- Facilitates a team approach, including the Interdisciplinary Care Plan team, to ensure appropriate interventions, cost effective delivery of quality care and services across the continuum. Collaborates with the interdisciplinary care plan team which may include member, caregivers, member`s legal representative, physician, care providers, and ancillary support services to address care issues, specific member needs and disease processes whether, medical, behavioral, social, community based or long term care services. Utilizes licensed care coordination staff as appropriate for complex cases
- Provides assistance to members with questions and concerns regarding care, providers or delivery system
- Maintains professional relationship with external stakeholders, such as inpatient, outpatient and community resources
- Generates reports in accordance with care coordination goals
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Case Manager Resume Examples & Samples
- Monitor and assure implementation of complex medication regimens; provide support for patient/family. Collaborative partnership with clinicians and members of the care team. Responsibilities include assessment, analysis, planning and implementation of medication regimens and monitoring their effectiveness; maintaining and evaluating the plan of care; facilitating changes in the plan and brokerage of necessary services
- Education and supportive outreach via phone calls or office or home visits. Monitoring of CHF hotline; on call to provide patient with 24 hour/7 day access for urgent situations
- Manage appropriate information available through multiple data systems, including the CHF database to support individual case management, statistical evaluation of the CHF population, support interregional CHF documentation of management and outcomes and provide information for further planning and decision making
- Serve as a liaison for the CHF program and function as a member of the CHF team. Develop and maintain effective relationships with key stakeholders. This includes PCPs, and contract providers, contracted community resources and Kaiser Permanente services
- Monitor and evaluate quality and effectiveness of care delivered to the CHF population; identify and resolve problems to improve quality of care and service for CHF patients; participate in quality improvement efforts
- Five (5) years of recent clinical nursing and/or RN case management experience, two (2) years of which were caring for cardiovascular/congestive heart failure populations
- Clinical experience with cardiac and congestive heart failure patients; HMO's, Medicare policies and procedures
- Case management program experience; experience in providing group and individual education, phone advice experience, ACLS certification, 12 lead EKG interpretations; advanced directives and grief management. Quality management methodology, utilization management
- Spreadsheet/database/word-processing skills. Health Connect, Results Reporting, Lotus Notes
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Case Manager Resume Examples & Samples
- Meet with prospective applicants to describe the CDBG-DR programs, review applicable required materials and provide technical assistance
- Review submitted applications for compliance with the program guidelines and policies
- Conduct eligibility calculations and duplication of benefit reviews
- Maintain applicant folders and applicant data
- Coordinate with the internal staff to assign the required Environmental Reviews of Record and Historic Preservation reviews for projects
- Communication with senior leadership staff from clients including elected officials
- Travel throughout the State and visit sites of proposed projects
- A four (4) year Bachelor’s degree from an accredited university. Three (3) years of relevant experience may substitute for the degree
- At least three (3) years of experience relevant to the functional area and/or experience providing specialized advisory service, which may include construction, financial, housing, and/or related industry knowledge. Experience with CDBG housing and/or FEMA hazard mitigation and similar programs/projects is preferred
- Ability to manage effectively with or without subordinates
- Knowledge, skills, and abilities necessary to perform the job function with little to no supervision, while remaining acutely aware of timelines, meeting deadlines, and performance measures
- Ability to acquire a working knowledge of applicable rules and regulations and the ability to provide technical assistance for ReLa
- Excellent written and oral communication skills, strong analytical skills, ability to work independently, and effective interpersonal skills
- Intermediate level Microsoft Office skills; knowledge of creating tables and graphs in Microsoft Excel; ability to quickly learn new software applications
- Fantastic responsiveness and detailed follow through
- Demonstrated clear, professional and effective verbal and written communication
- Thrives in utilizing systems and processes effectively to coordinate ever-changing scenarios
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Case Manager Resume Examples & Samples
- 3+ years of experience in an Acute Care and/or Managed Care setting; 2+ years of prior experience in Case Management
- Knowledge of Discharge Planning practices
- Understanding of Utilization Review practices
- Current knowledge of Federal, State, and Regulatory requirements guiding Case Management practice
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Case Manager Resume Examples & Samples
- 5 years experience in the healthcare industry including, but not limited to, Medicare and/or
- Medicaid program administration, insurance verification and/or claim adjudication,
- Physician’s office or outpatient billing, pharmacy and/or pharmaceutical manufacturers
- · Must be able to analyze reimbursement specific data and prepare written reports for
- Management and client communications
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Case Manager Resume Examples & Samples
- Visit contracted hospitals on a regular basis to assist with patient throughput, develop relationships with hospital staff, and assist hospitalist with task necessary to facilitate a timely discharge
- Telephonic interface with Patients and families during the discharge planning process
- Effectively advise and manage admission status’s of Inpatient and Observation
- California Registered Nursing License or LVN with additional relevant clinical experience
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Case Manager Resume Examples & Samples
- Assures responsiveness to payer systems by maintaining ongoing communication and serving as the primary contact for all external payer sources, in turn generating revenue, enhancing reimbursement, minimizing financial risk and assuring payment for the hospital. Maintains a thorough understanding of insurance coverage and benefits, providing interpretation to patients/families of their insurance and providing patient advocacy as needed
- Identifies and fulfills the requirements and needs of payer and referral sources, overseeing negotiations of continue stay rationale, length of stays, and appeals proces Initiates activities to develop positive business relationships with payers and referral sources in order to promote repeat business and represent the hospital as a quality institution
- Responsible for attending education/in-servicing on current trends in case management, policies and procedures of the organization, and changes in governmental, regulatory, and accrediting agencies to ensure compliance with standards of practi
- Carries a patient caseload
- Assures personal compliance with departmental documentation and timeliness of the same, e.: initial assessments, advanced directive, team conference reports. Conducts chart audits on a regular basis to maintain compliance, as requested by manager
- Develops and maintains updated departmental community resource materials and patient education materials. Responsible for keeping abreast of current information regarding entitlement programs patients may need to utiliz
- Identification of inter-department and intra-department performance improvement projects, and carrying out of the sam
- Coordinates with other departments to assure positive fiscal management outcomes for the patien
- Responsible for developing and maintaining effective interdisciplinary working relationships with other clinical treatment team members in order to assure clinical outcomes that are appropriate, cost-effective, and beneficial to the patien
- Master’s Degree in Social Work OR RN required
- Current valid state licensure in related clinical discipline required
- Three years of previous case management experience in a hospital setting preferred
- Certified BLS completion required
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Case Manager Resume Examples & Samples
- Responsible for attending education/in-servicing on current trends in case management, policies and procedures of the organization, and changes in governmental, regulatory, and accrediting agencies to ensure compliance with standards of practice
- Identification of inter-department and intra-department performance improvement projects, and carrying out of the same
- Coordinates with other departments to assure positive fiscal management outcomes for the patient
- Responsible for developing and maintaining effective interdisciplinary working relationships with other clinical treatment team members in order to assure clinical outcomes that are appropriate, cost-effective, and beneficial to the patient
- Master’s Degree in Social Work OR RN or LVN Nursing Degree, required
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Case Manager Resume Examples & Samples
- May perform all duties of Monitor I
- Prepare written personalized program for each resident to establish measurable criteria of expected behavior and accomplishments and a time frame for achieving specified goals. Review plan with residents on a regular basis and document progress and/or revisions
- Assist residents to establish personal budget, locate suitable housing, enroll in educational and vocational programs and participate in family and community activities, as appropriate, to ensure that they are working towards financial independence
- Monitor facility sanitation and safety. Assign daily housekeeping chores to residents to comply with facility standards
- May orient residents upon arrival at facility to provide smooth assimilation into program (e.g., have resident complete paperwork, take on facility tour, introduce to other residents, etc.)
- Verify residents' jobs to ensure residents' employment is suitable under established program plan. Counsel with unemployed residents by providing guidance in obtaining employment in cooperation with the Job Developer
- Verify residents' movement according to contract, so that the resident is accountable for his/her whereabouts in the community
- Prepare terminal/discharge report within established time parameters upon resident release to summarize program performance and to satisfy contract requirements
- Participate in staff meetings by sharing observations and recommendations regarding the facility, residents and staff relations to identify and solve problems and function as a unified team
- Maintain confidentiality obtained through job duties regarding employees, vendors, residents, outside agencies, etc., so that sensitive information is only given on a "need to know" basis
- Comply with policies and work rules as described in the company Employee Handbook and the Facility Policies and Procedures Manual, including directives of managers and supervisors in a cooperative spirit to ensure conformance to company standards
- Adhere to attendance policy; be available for all shifts; work overtime as required; to ensure adequate coverage of the program and to ensure the safety and security of the residents
- Comply with Facility safety rules; take appropriate corrective action to ensure work is performed in a safe manner and without injury to self or others
