Medical Case Manager Resume Samples

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A Pfeffer

Albina

Pfeffer

80263 Tremaine Spur

Phoenix

+1 (555) 158 4396

80263 Tremaine Spur

Phoenix

Phone

p +1 (555) 158 4396

Experience Experience

Dallas, TX

Medical Case Manager

Dallas, TX

Halvorson, Block and Lang

Dallas, TX

Medical Case Manager

Develops, manages and directs staff to ensure the delivery of department specific products and services; establishes work standards and monitors progress
Recruits, develops and manages human resources in order to create a high performing results oriented staff
Ensures personnel receive orientation, initial and on-going technical training
Manages performance management program including establishing and communicating objectives, providing on-going coaching, and conducting performance reviews; identifies performance problems and initiates disciplinary actions
Manages salary (and non-salary) budgets, makes recommendations to Management concerning promotions, terminations and staffing authorizations
Acts as a technical expert and resource for staff which includes usually maintaining the highest level of authority within department specific office/unit; refers problems and issues out of authority level to Regional/HO Management
Assists Management and other departments with new business and/or renewal presentations and periodic service calls

Houston, TX

Senior Medical Case Manager

Houston, TX

Leuschke-Padberg

Houston, TX

Senior Medical Case Manager

May perform other related duties as assigned
May meet with employers to review active files
Reviews cases with supervisor monthly to evaluate file and obtain direction
Valid Registered Nurse (RN) licensure
Advanced knowledge to exert positive influence in all areas of case management
Local Field Case Management Travel entails 70% of work time.
Local Field Case Management Travel entails 70% of work time

present

Los Angeles, CA

Remote Senior Medical Case Manager

Los Angeles, CA

West and Sons

present

Los Angeles, CA

Remote Senior Medical Case Manager

present

May assist supervisor/manager in review of reports, staff development
Performs various duties including vocational evaluation, counseling, medical assessment and coordinate return to work
May recommend and facilitate completion of peer reviews and independent medical examinations by obtaining and delivering medical records and diagnostic films notifying patients
Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation goals and return to work
May review files for claims adjusters and supervisors
May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards
Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client

Education Education

Bachelor’s Degree in Nursing

West Virginia University

Bachelor’s Degree in Nursing

Skills Skills

Basic knowledge of statistics (statistical analysis and database maintenance)
Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable
Strong attention to detail
Communication and collaboration with other payers (when applicable) to create a collaborative approach to care management and benefit coordination
The ability to work as a member of the Forte, Inc. team
Great interpersonal skills
Excellent communication skills (written and verbal)
Highly organized
The ability to work as a member of the Wellcomp team
Able to multitask efficiently and effectivel

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13 Medical Case Manager resume templates

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Medical Case Manager Resume Examples & Samples

Strong familiarity with quality assurance guidelines and application, i.e., medical chart review and analyses, monitoring of health care markers, monthly reports
Basic knowledge of statistics (statistical analysis and database maintenance)
Microsoft Office/Suite (Word, Excel, etc.)
Able to multitask efficiently and effectivel
Previous Medical/Clinical and Case Management experience

Medical Case Manager Resume Examples & Samples

Develops, manages and directs staff to ensure the delivery of department specific products and services; establishes work standards and monitors progress
Recruits, develops and manages human resources in order to create a high performing results oriented staff
Ensures personnel receive orientation, initial and on-going technical training
Manages performance management program including establishing and communicating objectives, providing on-going coaching, and conducting performance reviews; identifies performance problems and initiates disciplinary actions
Manages salary (and non-salary) budgets, makes recommendations to Management concerning promotions, terminations and staffing authorizations
Acts as a technical expert and resource for staff which includes usually maintaining the highest level of authority within department specific office/unit; refers problems and issues out of authority level to Regional/HO Management
Ensures appropriate compliance with all legislation, corporate policies, and programs; may periodically conduct desk audits
Assists Management and other departments with new business and/or renewal presentations and periodic service calls
Implements new and revised policies and procedures
Performs additional duties and/or is assigned special projects as requested
5+ years of experience in a similar role or function
CCM Certification
Management experience in Case Management
Worker's Compensation experience

Medical Case Manager Recurring Seasonal Resume Examples & Samples

Strong knowledge of the ADAAA and EEOC laws and regulations, with the ability to apply that knowledge in own practice, with the ability to serve as a resource to other team members and business partners
Maintains highest standards of current disability related laws and certification guidelines in order to stay current in practice
Demonstrates how to apply reasonable accommodations based on the individual’s disability needs and how to partner with others in the guidance and assistance that the RN should provide
Recognizes disability and personal needs as it relates to medical conditions and how to assist others both internal to and external of the team and advise accordingly
Holds the highest of standards as it relates to knowledge of and application of practices to assisting persons with disabilities and how they should be accommodated in the workplace
Consistently demonstrates the Walt Disney Company’s commitment to its Cast Members through stewardship and partnership practices
Current, unencumbered Florida Nursing License
Degree in Nursing with a minimum of 2 years related experience
Knowledge of ADAAA, EEOC and application of related laws and regulations
Demonstrated experience interacting with all levels of Cast Members (hourly, salaried, executive)
Ability to work well and maintain professionalism under pressure
Strong organizational, written & verbal communication / documentation skills
Previous Medical Case Management experience
Proven Guest Service / Client Management skills
Proven conflict management & problem solving skills
Ability to multi-task in a proficient, efficient manner with solution-oriented and critical thinking work habits in a fast-paced environment
Ability to influence without authority / persuasion skills
Ability to establish strong working relationships in a virtual environment
Proficient software knowledge with Microsoft Suite including Word, Excel, Outlook
Medical and Workers’ Compensation knowledge
EMR (Electronic Medical Records) system knowledge and documentation standards
Theme Parks and Resorts Operations Knowledge
Nursing Degree from an accredited School of Nursing

Medical Case Manager Team Leader Resume Examples & Samples

Bachelor's Degree in related field with 3 year of post-bachelor’s full time work experience; Advanced Degree in a related field may substitute 1 year of post-bachelor experience
Experience in working with at least one of the following communities is required: people living with HIV/AIDS, immigrants, Community of Color, Lesbian, Gay, Bisexual and Transgender persons, Chronic Diseases, SMI
Independent and good team player
Ability to use common office software (Word, Excel, and Power Point)
Ability to use electronic medical record
Fluency in Spanish or one Asian language
Familiarity with eClinical Works

Medical Case Manager Resume Examples & Samples

1+ year of Case Management experience
Bachelor's Degree in Healthcare, Psychology, Social Science, Social Work
Experience in working with at least one of the following communities: people living with HIV/AIDS; Asians and Pacific Islanders; immigrants; Lesbian, Gay, Bisexual and Transgendered persons; and, families with children
Microsoft Office/Suite proficient (Word, Excel, Power Point)
Ability to use Electronic Medical Record
Familiarity with eClinical Works and AIRS

Senior Medical Case Manager Resume Examples & Samples

Demonstrates ability to meet or surpass administrative requirements, including productivity, time management, quality assessment (QA) standards with a minimum of supervisory intervention. Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer. Coordinates return to work with patient, employer and physicians
May perform job site evaluations/summaries. Prepares monthly written evaluation reports denoting case activity, progress and recommendations in accordance with state regulations and company standards
Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for rehabilitation of the client
Travels to homes, health care providers, job sites, and various offices as required to facilitate return to work and resolution of cases
May perform other related duties as assigned

Medical Case Manager Resume Examples & Samples

Demonstrates ability to meet administrative requirements, including productivity, time management and quality improvement standards, with a minimum of supervisory intervention
Maintains contact and communicates with insurance adjusters to apprise them of case activity, case direction or receive authorization for services. Maintains contact with all parties involved on case, necessary for case management for the client
Utilizing experience and medical resources interprets medical records and test results and provides assessment accordingly. Utilizes nursing process, case management standards of practice guidelines and Broadspire's Quality Improvement Guidelines in providing medical case management services
Meets monthly production requirements and quality assessment requirements to ensure a quality product
Travels to homes, health care providers, and various offices as required facilitating return to work and resolution of cases. (Approximately 70% of a Medical Case Manager's position is spent in local travel)

Medical Case Manager Resume Examples & Samples

Registered Nurse (RN) preferred, will consider candidates with LPN and disability/case management experience
CCM, CDMS, COHN, CRRN or comparable industry certification preferred
Clinical ability to assess LTD Claims with complex medical histories which may include claimants with subjective diagnoses, co-morbid conditions, etc
Ability to explain complex medical conditions and ability to communicate with attending physicians to identify current limitations/restrictions as it relates to the work place
Negotiation skills, problem solving, plan development competencies are essential
Organizational and Change Management skills, accountability in meeting deadlines, and being a team player are also essential

Medical Case Manager Resume Examples & Samples

The definition for "routine basis" is defined as daily, weekly or at regularly schedule times
Conduct a thorough and objective evaluation of the client’s current status including physical, psychosocial, environmental, financial, and health status expectation
Report quantifiable impact, quality of care and/or quality of life improvements as measured against the case management goals
Maintain requirements of documentation and caseload as reflected in audits to meet compliance with quality standards
Conduct case screenings using applicable tools to determine appropriate levels needed to meet member needs
Certified Case Manager (CCM®) credential preferred; required to take examination when eligible. Case Managers must obtain a CCM certification within 2 years of hire as a case manager or they will no longer be able to perform case management functions
Basic PC computer skills required with emphasis on Microsoft Office applications preferred
Various immunizations and/or associated medical tests may be required for this position

Medical Case Manager Resume Examples & Samples

Routinely assess client’s status and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to care, providers and/or services to promote better outcomes
Establish measurable goals that promote evaluation of the cost and quality outcomes of the care provided when appropriate
Report quantifiable impact, quality of care and/or quality of life improvements
Participate in Inter-reviewer reliability to identify quality of care issues and criteria inconsistencies
Maintain requirements of documentation according to case type and caseload as reflected in audits to meet compliance with quality standards
Minimum of 5 years health care experience with at least three (3) years of clinical experience,
Responsible for carrying out key functions related to the success of the case management program to include acting as key liaison between the practice and the health plan
Performs functions, as necessary, for members identified as having Comorbid health conditions that meet eligibility requirements for the program
Assesses, identifies, educates, collaborates, prioritizes needs, and builds rapport and trust through education
Conducts any needed concurrent reviews to determine appropriate level of care and length of stay using established criteria
Provides on-site services as necessary
Interacts with other departments as necessary to ensure smooth transfer of member information across the continuum of care
Seeks advice of the Medical Director when appropriate
Proficiency with Motivational Interviewing and/or other behavioral change techniques
Ability to build rapport and engage members in effective dialogue related to their treatment plan
Ability to quickly identify and prioritize member needs and provide structured and focused support and interventions
Exceptional level of critical thinking, analytical and creative problem solving skills required
Exceptional level of independence, organization, and interpersonal skills required
Proficient with team-building processes and participation in cross-functional teams
Adherence to the Corporate Tuberculosis Testing Policy 025.HR.078 and Tuberculosis Procedure 025.HR.078.A (if applicable)
Must have or be able to be licensed in multiple states if required

Medical Case Manager Resume Examples & Samples

Conduct assessment and coordinate activities with the member as it relates to non-emergency transportation
Manage transportation requests for greater than 90 miles
Coordinate transportation for members with TennCare benefits
Interact with members and TennCare providers as it relates to TennCare benefits for transportation
Special Populations - The case manager for special populations has additional population specific responsibilities as outlined in program specific policies
Coordinates DIDD services with TennCare services
Collaboration between Providers and payers of the Member’s physical and behavioral health services, including Physicians and other physical and behavioral health care Providers, TennCare, and Department of Intellectual/Developmental Disabilities (DIDD)
Coordinates DSNP services as indicated
Prefer two (2) years experience as practicing nurse, nurse educator or nurse consultant in special populations ( Developmental Disabilities) specific programs in an institutional or community setting
Specialty certifications in special programs (i.e. Developmental Disabilities Nursing (CDDN), Certified Case Manager (CCM) etc.) are preferred upon employment, and Case Managers are required to obtain certification within 2 years of being hired as Case Managers
Must be able to travel up to 100% of the time – this is a telecommuter and field-based position
Performs functions, as necessary, for members identified as having high risk pregnancies, high risk infants that meet eligibility requirements for the program
Three (3) years of obstetric and/or high risk OB clinical nursing experience, neonatal, prenatal educator experience is a plus
Analyzes medical information provided by physicians and other health care practitioners to identify potential health care needs and to facilitate transition from the acute care setting
Assess, implement, monitor, and evaluate available resources in an effort to promote quality, cost effective outcomes while meeting the individual’s health needs
May perform on-site visits to members in facilities as needed to facilitate discharge planning to appropriate level of care

Medical Case Manager Resume Examples & Samples

Medically monitor cases via telephone contact with treating medical providers and/or review of medical reports
Reviewing and/or recommending medically necessary travel requirements in conjunction with treating physician and Travel Guard Physician on-duty
Performing case reviews to determine compatibility of medical condition and policy coverage, including work with the claims department
Demonstrating exemplary customer service skills, to include communicating with customers and medical professionals
Working with Assistance Coordinators to assure quality assistance services to the client by directing case management in relation to medical needs
Conferring with AIG Travel Doctor on-duty on medical cases to determine optimal direction of case management
Demonstrating clear ability to work with others and promotes a collaborative environment that facilitates growth of other team members and colleagues
Carrying out accountabilities and objectives within the framework of AIG Travel’s TCF (Treating Customers Fairly), TCP (Travel Compliance Protocol) & Training & Competence policies

Medical Case Manager Resume Examples & Samples

Licensed Registered Nurse or Social Worker in the State of WV with active, unrestricted license
3-5 years of experience in Acute or Managed Care setting
Ability to work from home with high speed internet access
Potential for travel (approximately 25% of the time)
Prior case management experience
Experience in pediatrics and home care
Experience working with chronic conditions/managed care programs/Medicaid population
Bachelor’s Degree in Nursing or Masters in Social Work
Case Management Certification (CCM)

Medical Case Manager Resume Examples & Samples

Communicate effectively. This position displays effective communication skills while performing the following functions
Customer telephonic interviewing and communication with external contacts
Interaction with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts
Knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States
The Medical Case Manager will be expected to educate members in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes
The Medical Case Manger will collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care
The Medical Case manager will collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs
Problem Solving/Latitude
The Medical Case Manager will be expected to work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member
The Medical Case Manager is expected to develop an individualized plan of care designed to meet the specific needs of each member
Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated
The Medical Case Manager will have support from the department’s Management Team and Case Management Specialists
Maintain a working knowledge of available resources for addressing identified member needs and to facilitate proactive and efficient provision of services
The Medical Case Manager will be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention in order to develop a realistic plan of care
Communication and collaboration with other payers (when applicable) to create a collaborative approach to care management and benefit coordination
The Medical case manager will maintain a working knowledge of available community resources available to assist members. The Medical Case manager will coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible
Work within a Team Environment
Attend and participate required meetings, including staff meetings, internal Rounds, and other in-services in order to enhance professional knowledge and competency for overall management of members
Participation in departmental and/or organizational work and quality initiative teams
Case collaboration with peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts
Participate in interagency and/or interdisciplinary team meetings when necessary to facilitate coordination of member care and resources
Foster effective work relationships through conflict resolution and constructive feedback skills
Attend internal and external continuing education forums annually to enhance overall clinical skills and maintain professional licensure, if applicable
Educate health team colleagues of the role and responsibility of Case Management and the unique needs of the populations served in order to foster constructive and collaborative solutions to meet member needs

Medical Case Manager Resume Examples & Samples

Communicate effectively while performing customer telephonic interviewing and communication with external contacts
Communicate effectively while interacting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts
Maintain knowledge of Medical Terminology and Medical Diagnostic Categories/Disease States
Educate members in order to enhance member understanding of illness/disease impact and to positively impact member care plan adherence, pharmacy regimen maintenance, and health outcomes
Collaborate with Primary Care Physicians, Medical Specialists, Home Health and other ancillary healthcare providers with the goal being to coordinate member care
Collect member medical information from a variety of sources including providers and internal records and use appropriate clinical judgment, consultation with internal Physician Advisors and other internal cross-departmental consultation to determine unmet member needs
Work primarily independently to identify, define, and resolve a myriad of problem types experienced by the member
Develop an individualized plan of care designed to meet the specific needs of each member
Be knowledgeable of and consider benefit design and cost benefit analysis when planning a course of intervention in order to develop a realistic plan of care
Communicate and collaborate with other payers (when applicable) to create a collaborative approach to care management and benefit coordination
Maintain a working knowledge of available community resources available to assist members
Coordinate with community organizations/agencies for the purpose of identifying additional resources for which the MCO is not responsible
Attend and participate in required meetings, including staff meetings, internal Rounds, and other in-services in order to enhance professional knowledge and competency for overall management of members
Participate in departmental and/or organizational work and quality initiative teams
Case collaborate with peers, Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts

Remote Senior Medical Case Manager Resume Examples & Samples

Performs various duties including vocational evaluation, counseling, medical assessment and coordinate return to work
May recommend and facilitate completion of peer reviews and independent medical examinations by obtaining and delivering medical records and diagnostic films notifying patients
Manages cases of various product lines of at least 3-4 areas of service (Workers Compensation, Health, Short Term Disability, Long Term Disability, Auto, Liability, Third Party Administrator, Catastrophic, Life Care Planning). Specifically, the case manager should be experienced in catastrophic cases plus 2-3 additional types listed above
Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation goals and return to work
May obtain referrals from branch claims office or assist in fielding phone calls for management as needed
Reviews cases with supervisor monthly to evaluate file and obtain direction

Medical Case Manager Resume Examples & Samples

Assists the treating physician in developing a written treatment plan for the injured worker, including the identity and scope of treatment by any other providers to which referrals have been made. Work with the medical providers to track progress and to modify the treatment plan as necessary until maximum medical improvement is achieved
Obtains medical reports and required work status forms. Ensures all parties receive appropriate reports
Cooperates with the treating physician to obtain a full or conditional release to return to work before injury becomes a lost time claim; Work with the treating physician to update any conditions as medical treatment progresses
Maintains constant contact with the adjuster assigned to the file through telephone calls, EMAIL and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the telephonic case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer
Makes appropriate use of Forte, Inc. physicians for adjuster support, peer-to-peer consultation and as professional resources; Makes appropriate use of Forte, Inc. clinical and information systems staff to deliver exceptional service to direct and indirect customers
Acts as an advocate for the injured worker with all parties while maintaining the injured worker’s privacy and safety; Adheres to Forte's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
Participates in the collection of outcome information and Forte’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
Become proficient in the software used in the department
Contribute to the success of the company and its posture toward customer service by a positive and professional attitude and by understanding and responding to the needs of our direct and indirect customers; Follows ethical, legal, and regulatory standards
The ability to work effectively with minimal direct supervision
The ability to plan and use time effectively
The ability to work as a member of the Forte, Inc. team
Keyboard typing and dialing of telephone require hand dexterity and the repetitive use of finger movement
Due to the nature of the position, sitting in a sustained position for prolonged periods is necessary
Must be able to operate a vehicle and to travel on a regular basis
Two or more year’s workers compensation case management experience

Medical Case Manager Resume Examples & Samples

Maintains constant contact with the adjuster assigned to the file through telephone calls, EMAIL and written reports. For each customer be aware of the limits of decision-making authority delegated by the adjuster to the case manager and respect these limits. Satisfy the documentation and reporting requirements of each customer
Makes appropriate use of Wellcomp physicians for adjuster support, peer-to-peer consultation and as professional resource; Make appropriate use of Wellcomp clinical and information systems staff to deliver exceptional service to direct & indirect customers
Participates in the collection of outcome information and Wellcomp’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
The Medical Case Manager reports to the Team Manager, Case Management and has no direct reports
Due to the nature of the position, sitting in a sustained position for prolonged periods may be necessary
Must have the ability and willingness to travel for task and/or field case management visits if within assigned geographic areas
Must possess a valid driver’s license; Must provide proof of insurance
Three or more year’s workers compensation case management experience or related field

Field Medical Case Manager Resume Examples & Samples

Maintains regular contact with all parties involved to facilitate communication and to provide medical and vocational management and coordination services
Arranges for prompt and appropriate medical treatment of an injured worker by qualified providers (choice of providers as per regulations); Schedules appointments to avoid delays in treatment by primary care physicians, specialists or ancillary services
Facilitate authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations to ensure appropriate treatment is not delayed
Assesses the injured worker and his/her support system and family; Makes appropriate referrals throughout the continuum of care including educational, financial, and psychological or other human services as indicated
Coordinates with the employer to develop a modified duty job for the injured worker who cannot immediately return to his/her full pre-injury employment; The job must be consistent with any physical restrictions assigned by the treating doctor; Educates the employer on the tangible and intangible benefits of accommodating the injured worker to keep him in the work force
Where a return to work with the same employer is not possible, provide vocational services to the injured worker to identify vocational goals and develop an early return to work plan
Organizes and review medical records to identify specific medical issues; Provides information and recommendations to appropriate parties
Acts as an advocate for the injured worker with all parties while maintaining the injured worker’s privacy and safety; Adheres to Wellcomp's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers’ compensation and federal laws that impact the delivery of health care and return to work
The ability to work as a member of the Wellcomp team
Vision must be adequate to view the computer screen
This may include occasional air travel and overnight stays

Medical Case Manager Resume Examples & Samples

Follow the client’s case from the onset, and monitor the medical condition until the client is cleared for travel either by commercial air or if medically necessary, air ambulance
Utilize your education, experience, assessment skills, and critical judgment to make determinations that ensure the client is receiving appropriate medical care, or take steps to arrange a medical evacuation to the nearest adequate facility as quickly as appropriate for the medical condition
Medically monitor cases by: Telephone contact with treating medical providers and/or review of medical reports
Perform case reviews to determine compatibility of medical condition and policy coverage, including work with the claims department
Communicate with customers and medical professionals
Work with coordinators to assure quality assistance services to the client by directing case management in relation to medical needs
Conferring with Travel Guard Doctor on-duty on medical cases to determine optimal direction of case management
Carry out accountabilities and objectives within the framework of Travel Guard’s TCF (Treating Customers Fairly), TCP (Travel Compliance Protocol) & Training & Competence policies
Native French, Itlalian, Spannish, Portugese or Polish speakers and fluent in English, (native language /bilingual )
Demonstrate personal expertise and knowledge in emergency/critical care, aero medical transport services, and knowledge of flight physiology is a plus
Self-motivated and able to work under pressure with a high level of responsibility
Effective time management skills, ability to multi-task, and prioritise to meet varying tasks/deadlines
Strong communicator at all levels; verbally and written to build and maintain internal and external relationships
PC skills

Medical Case Manager Bluecare Selectcommunity Resume Examples & Samples

Set goals and time frames for goals appropriate to individual
Maintain communication and collaborate with patient, family, physicians and health team members, and payer representatives
Routinely assess client’s status and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments in the care plan, providers and/or services to promote better outcomes
Establish measurable goals that promote evaluation of the cost and quality outcomes of the care provider
Conduct all needs assessment and care planning activities, and make all minimum care management contacts in the Member’s place of residence, except under extenuating circumstances
Participates in Circle of Support meetings
Interacts with DIDD providers as well as TennCare providers

Medical Case Manager Resume Examples & Samples

Validate work related injury/illness escalation or de-escalation cases. Encourage a positive environment and experience for injured or ill employees
Collaborate and maintain contact with Intel corporate and local Department of Public Health on latest occupational practices, diseases information and other health related news
Maintain up-to-date knowledge of local laws and regulations pertaining to Occupational Health, local Workers' Compensation Laws and Americans with Disabilities Act ADA where applicable
Understand and adhere to Health Insurance Portability and Accountability Act of 1996 HIPAA/privacy requirements and Intel Privacy Standards
Ensure compliance to local government and Intel's regulations and standards

MA Medical Case Manager Resume Examples & Samples

Assessment – The case manager will collect in-depth information about a person’s situation and functioning to identify individual needs in order to identify members at risk for high cost medical care and develop a comprehensive case management plan that will address those needs
Implementation – The case manager will execute specific intervention that will lead to accomplishing the goals established in the case management plan
As a client advocate, seek authorization for case management from the recipient of services (or designee)
Prefer two (2) years experience in Utilization Management, Case Management or Managed Care
Excellent oral and written communication skills, with problem-solving abilities

Medical Case Manager Resume Examples & Samples

Experience working with chronic condition adult populations OR experience with pediatrics
3-5 years of experience in working in Acute Care/Managed Care/Medicaid and Medicare populations
Bilingual English/Spanish language skills
Case Management Certification
Professionally Licensed Social Worker or Nurse

Medical Case Manager Resume Examples & Samples

Care/case management, primarily for World Trade Center Health Program (WTCHP) patients with complex aerodigestive health conditions, mental health conditions, and/or cancer
Educate patients re: WTC Health Program benefits and limitations
Perform appropriate referral and disposition planning
Pre-authorize covered tests, procedures and treatments
Provide support services to patients and families
Assist in the clinic as needed

Medical Case Manager Resume Examples & Samples

Responsible for overall quality services and oversight of each case and /or site within assigned areas. Monitors services of physician and other related medical providers/services to assure quality standards of care are evident
Completes regular medical quality assurance reviews and risk management for all service recipients within assigned responsibility. Maintains functional knowledge of the programs for each person receiving services, both behavior intervention plans and skill development goals
Completes weekly reviews of medical related services/supports, medical base line documentation, dietary and adaptive equipment usage/condition, medication records, shift notes, etc
Reviews and assures appropriate billing documentation of medical and psychological services/supports meet the specific requirements of funding/contract for each individual
Graduate of an accredited RN program and one year of related experience

Medical Case Manager Resume Examples & Samples

Creates plan for care across the continuum, integrating patient/family preferences and values
Monitors patient care through assessments, evaluations and/or patient records
Advocates for resources and removal of barriers
Coordnates level of care changes/expedited reviews/HINN process; completes PRI/screen instrument to establish appropriate level of care for patients requiring alternative placement as required by NYS DOH
Refer to physician advisor clinical cases where interaction w/attending physician doesn't resolve utilization issues (ie, med necessity, approp. setting for care)
Perform commerica continuing stay reviews - conveys clinical & accurate info to payers for authorization for the pts continued acute care stys
On a concurrent basis, reviews all admissions for appropriateness of the level of care (ie, diagnostic testing & clinical procedures) utilizing Interqual Criteria
Recent experience working in an acute care setting
Recent experience with insurance payers, community resources

Medical Case Manager Resume Examples & Samples

Associate’s degree required; Bachelor’s degree in Social Work, Public Health or related field preferred
1+ years’ experience providing direct services in a community outreach setting preferred
Experience with community health issues
Experience working with maternal and child health issues and associated medical conditions preferred
Experience working with substance abuse preferred
Knowledge and skill pertaining to the delivery of substance abuse services preferred
Knowledge regarding the assessment of substance abuse disorders preferred
Knowledge of the concepts and practices associated with community health issues, particularly with pregnant women, prenatal care, parenting and other services for mothers, young children, and their families in the community served
Significant knowledge of and sensitivity to issues facing the community served
Ability to travel in and around the Greater Philadelphia region to conduct home visits and community outreach when necessary
Experience in client management procedures for determining eligibility, assessing needs, identifying resources, making referrals, following up, and documenting client interactions
Strong interpersonal skills as demonstrated by compassionate, courteous, cordial, cooperative, and professional interaction with diverse groups of co-workers, community partners, clients, and members of the community
Ability to operate a computer and use a variety of common software programs including Microsoft Office, spreadsheets, and customized databases
Effective and accurate documentation of case notes and client data according to established client management documentation procedures
Ability to organize tasks in an efficient manner and follow-up and follow-through with strong attention to detail