Case Management Specialist Resume Samples

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J Ondricka

Jimmy

Ondricka

1272 Durgan Pine

Philadelphia

+1 (555) 259 5192

1272 Durgan Pine

Philadelphia

Phone

p +1 (555) 259 5192

Experience Experience

New York, NY

Case Management Specialist

New York, NY

Moen-Nikolaus

New York, NY

Case Management Specialist

Maintain strict employee confidentiality
Responsible for development and standardization of Sponsor and Child Abuse and Neglect Checks on potential sponsors for unaccompanied children who may be in immigration proceedings
Interface with the respective Federal and State-level Criminal History and/or Child Protective Service agencies throughout the U.S
Conduct necessary research on policies and procedures regarding state Child Protective Service Checks – Child Abuse and Neglect Checks
Respond to email requests in a timely manner
Evaluate various database searches for potential sponsor information
Produce graphical and written reports on findings and statistics

New York, NY

Msw-case Management Specialist

New York, NY

Friesen, Russel and Jakubowski

New York, NY

Msw-case Management Specialist

Proficiency in all Microsoft Office applications, including Word and Excel
Familiarity with medical terminology and/or ICD-9 codes
Proficiency in all Microsoft Office applications, including Word, Excel and Outlook
Independently makes decisions based on information provided by the employee and the health care provider and supporting documentation
Advising and counseling people managers about the leave of absence policies and legal implications
Coordinate with the HR Service Center to provide direction and validate an employee’s payroll and benefits while they are on leave (15%)
Work closely with internal contacts, HR business partners, legal contacts, other members of the Employee Relations team, and third party vendors (10%)

present

Philadelphia, PA

Senior Case Management Specialist

Philadelphia, PA

Funk-Williamson

present

Philadelphia, PA

Senior Case Management Specialist

present

Is proficient in the use of Sales Logix and in producing data specific reports upon request
Raises own performance expectations and goals to support entrepreneurial approach to the business
Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services. Represent Genzyme in all venues in a professional manner
Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, medical, sales, corporate accounts, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators
Consistently monitors systems and processes and recognizes when it is time to try new approaches
Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested
Assists in obtaining insurance approval for enzyme replacement therapy, and proactively plans for maintenance of coverage by working with the patients and their family, healthcare providers, insurance companies, specialty pharmacies, and Genzyme Colleagues

Education Education

Bachelor’s Degree in Nursing

Tulane University

Bachelor’s Degree in Nursing

Skills Skills

Make outbound phone calls to providers to verify admission, obtain clinical information and discharge information
Document all calls and attach clinical information received
Create and send out written correspondence—including denial letters- to providers and members
Manage databases and caseloads using Microsoft Excel, Word and other programs
Assist the Utilization Management team with various clerical and administrative tasks as necessary
Participate in special projects as assigned by the Case Management Frontline Leader or Clinical Operations Manager
6 Months Limited Term
Knowledge of workers' compensation laws and regulations
Excellent oral and written communication, including presentation skills
PC literate, including Microsoft Office products

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Case Management Specialist Resume Examples & Samples

Manage and coordinate all aspects of Case Management with the employee, the Contact Center, other internal partners, and with third party administrators to mitigate legal risk and provide advice and counsel to employees, people managers and human resources contacts as appropriate. (75%)*
Using critical thinking skills and knowledge of policy and legal requirements to review and assess medical documentation to determine if an employee’s request is qualifying within the scope of the leave type
Comply with federal, state, and municipal laws surrounding FMLA and other leave laws, as well as short term disability policy and long term disability plan
Independently makes decisions based on information provided by the employee and the health care provider and supporting documentation
Advising and counseling an employee through the complex aspects of the leave of absence process. This can be a very in-depth conversation advising an employee about their payroll and benefits while on leave as well as the different type(s) of leaves available to them
Advising and counseling people managers about the leave of absence policies and legal implications
Review and coordinate accommodation requests by engaging in an interactive conversation with the employee, understand their needs, as well as finding an appropriate solution for their accommodation request. This may include organizing and/or ordering a product to meet the employee’s needs. More often than not, this process takes exceptional critical thinking and analysis skills to determine the best solution
Coordinate requested ergonomic assessments with our preferred vendors. Once the ergonomic assessment is complete, the Case Management Specialist communications recommendations to the employee’s manager. In the event equipment is needed for a reasonable accommodation, orders any necessary products/equipment
Coordinate with the HR Service Center to provide direction and validate an employee’s payroll and benefits while they are on leave (15%)
Work closely with internal contacts, HR business partners, legal contacts, other members of the Employee Relations team, and third party vendors (10%)
Maintain strict employee confidentiality
Bachelor’s Degree in Human Resources, Social Services, or 2 or more years in an HR/Leave of Absence position
Excellent MS Office skills
One year experience in an employee contact position in an HR group/department
Familiarity with reading, interpreting, and administering policies and/or practices
Ability to stay calm when communicating with a distressed caller
Subject matter expert in Short Term Disability, Long Term Disability, FMLA, and state/local leave laws
3+ years of experience in HR and/or Leave Administration/Reasonable Accommodations
1+ years of experience with SAP software
Experience working with an HRIS/payroll system in the past 5 – 7 years
RBC maintains consistently high credit ratings: S&P: AA-; Moody’s: Aa3; Fitch: AA; DBRS: AA (as of July 31, 2014)
Based on market capitalization, RBC is the 12th largest bank in the world and the fifth largest in North America. (Bloomberg as of August 20, 2014)
RBC employs more than 79,000 employees who serve more than 16 million personal, business, public sector and institutional clients through offices in Canada, the U.S. and 40 other countries

Case Management Specialist Resume Examples & Samples

Nine (9) months experience in a direct patient care setting
Ability to type 25 wpm with accuracy
Proficient in using a computer to accurately enter and extract data, send and receive email, calendar appointments, and use task lists as will be using a variety of computer software programs
Ability to read, write, hear, and verbally communicate in English to the degree required to perform the job
Demonstrated ability to efficiently manage own time with minimal supervision
Willingness to act and dress in a professional manner at all times
Must be able to travel in accordance with any requirements of your job (if MMC and/or own vehicle used on MMC business, must possess valid California Driver's License and upon request proof of liability insurance)
AA Degree in a business/health related field
Experience in Case Management support role
Experience with word processing and data management including Midas Care Management, EPIC and other MS Office Suite products

Case Management Specialist Resume Examples & Samples

Must have experience in or a combination of the following
One or more years direct patient care or health education in an inpatient, skilled nursing, home health or related setting. Hospital experience preferred
Knowledge of alternate levels of care including criteria required for payment and applications processes
Experience drafting and issuing denial letters per regulatory and HMO guidelines
Knowledge of applicable laws and regulations, government and insurance benefits, especially Medicare, Medi-Cal
Knowledge of individual and family development over the life span and the influence of cultural and spiritual values in health care
Knowledge of data collection techniques and methods of analyzing and reporting data

Case Management Specialist Resume Examples & Samples

Responsible for development and standardization of Sponsor and Child Abuse and Neglect Checks on potential sponsors for unaccompanied children who may be in immigration proceedings
Interface with the respective Federal and State-level Criminal History and/or Child Protective Service agencies throughout the U.S
Conduct necessary research on policies and procedures regarding state Child Protective Service Checks – Child Abuse and Neglect Checks
Respond to email requests in a timely manner
Evaluate various database searches for potential sponsor information
Produce graphical and written reports on findings and statistics
Prepare technical reports summarizing investigative findings
Manage large amounts of information
Receive and prepare written responses and/or processes requests for information
Education at the Associate level and/or equal work experience
Must be able to obtain and maintain a favorable background investigation
Should be familiar with Spanish and/or willing to learn
Sensitive to other cultures and ethnic groups
Must be willing to travel out of state 5-10% of the year for care provider site visits, state agency visits and training presentations
Proficient knowledge of Microsoft Office (Outlook, Excel, Access, Power Point,
Word)
Customer-friendly service skills – especially in communication to overcoming obstacles
Motivated self-starter, able to work independently with limited supervision

Senior Case Management Specialist Resume Examples & Samples

Assesses patients’ needs and develops action plans that provide for the introduction and continuation of enzyme replacement therapy while coordinating the exchange of all patient-related information with internal and external customers
Maintains comprehensive understanding of the reimbursement process, billing/coding nuances, dose calculations, insurance plans, payer trends, financial assistance programs, charitable access, and related resources
Maintains up-to-date knowledge of the resources available at the regional level, including alternative resources, and applies this knowledge in way that best supports patient care
Educates patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate and maintain enzyme replacement therapy, case management services and relevant disease/product information as necessary
Exhibits a leadership role within the optimization team. Able to consistently identify complex patient specific issues and develop action plans accordingly. Demonstrates accountability for action plan execution, and energetically drives for success and results
Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services. Represent Genzyme in all venues in a professional manner
Consistently monitors systems and processes and recognizes when it is time to try new approaches
Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested
Consistently maintains accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required

Case Management Specialist Resume Examples & Samples

Ability to effectively gather data from various sources for reporting and analysis
Ability to effectively utilize data and systems tools available
Ability to streamline and automate processes
Ability to coordinate interdepartmental activities
Must be able to maintain confidentiality
Experience with SAS Enterprise Guide, Hyperion BrioQuery, Microsoft Access, or MicroStrategy a plus
Experience with SQL a plus
Should be proficient with Salesforce case logging and JIRA

Case Management Specialist Resume Examples & Samples

Make outbound phone calls to providers to verify admission, obtain clinical information and discharge information
Document all calls and attach clinical information received
Create and send out written correspondence—including denial letters- to providers and members
Manage databases and caseloads using Microsoft Excel, Word and other programs
Assist the Utilization Management team with various clerical and administrative tasks as necessary
Participate in special projects as assigned by the Case Management Frontline Leader or Clinical Operations Manager
Proficiency in all Microsoft Office applications, including Word, Excel, Outlook and PowerPoint
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 if 10Mx1
Familiarity with medical terminology and/or ICD-10 codes
At least one years experience working for an HMO with a strong understanding of IPAs and Medical Groups
At least one years experience in case management or utilization management

Case Management Specialist Resume Examples & Samples

Assist in the establishment and development of relationships that help to facilitate effective case management
Provides appropriate information to patients, their families, physicians, health care professionals, and insurance carriers on the coverage and benefits of all Sanofi’s renal products
Point of contact for assigned sales region for reimbursement related questions related to Sanofi’s Renal products
Manage assigned sales region workload and travel schedule on an ongoing basis
Perform Verification of Benefits (VOBs) and claim confirmations for patients who are clinically appropriate for Sanofi’s Renal products
Facilitate Prior Authorizations, Formulary Exceptions, and/or other step edit requirements for all of Sanofi’s renal products
Enter patient information into Sales Logix database for individual and multiple patient insurance verifications in a timely and accurate manner
Communicate results of verification of benefits to Clinical Science Specialist(s) and work as a team to ensure patient(s) access therapy
Develop positive, ongoing relationships with healthcare professionals, Clinical Science Specialists, Regional Business Directors, Renal Clinical Consultants, National and Corporate Account Directors and customers
Proactively partner with Clinical Science Specialist to identify and address Renal Healthcare Professionals’ needs; identify where Renassist can contribute to, and support, individual business plan
Interact via phone with pharmacies, insurance companies, professionals, and Renal Business Unit colleagues
Conduct field presentations, conference calls, WebEx sessions and/or trade show representation to educate customers on Renassist Services; promote Renassist Services, review project results, and/or provide customer support
Participate in National, Zone and Regional Sales Meetings
Maintain a current, proficient understanding of the Medicare Part D Benefit and Prescription Drug Plan (PDP) benefits
Keep current on all Sanofi Renal products reimbursement issues across US (i.e. State Pharmacy Assistance Programs, alternative funding, government programs, state-specific carriers, etc.), including Commercial Insurance, State Medicaid and Federal programs
Collaborate to troubleshoot and resolve reimbursement-related issues with Renassist team members, professionals and insurance companies
Participate in SalesLogix Testing Sessions on system changes, upgrades, and enhancements
Comply with HIPAA regulations
Participate in SalesLogix testing of system enhancements and upgrades
Participate in department task forces/trainings designed to increase efficiency of Renassist department
Assist team with overflow of work when required
Verifications for Sanofi’s Renal products in a timely manner
Answer and address calls from the Renassist Helpline; document all pertinent information on caller into SalesLogix database
Provide territory coverage for colleagues out of office
Required travel 30%

Case Management Specialist Resume Examples & Samples

Develops and configures systems specifications that address business requirements, processes, and that fit within architecture standards
Involved in planning of system and development deployment as well as responsible for meeting software compliance standards
Evaluates interface between hardware and software, operational requirements, and characteristics of overall system
Establishes and documents system parameters and formats, ensures hardware and software systems compatibility, and coordinates and/or modifies system parameters in terms of existing and projected computer capacity and capabilities
Revises existing systems and tests functionality of the system to correct deficiencies and maintain more effective data handling, data integrity, conversion, input/output requirements, and storage
May document testing and maintenance of system updates, modifications, and configurations. May act as a liaison with other business functions

Case Management Specialist Resume Examples & Samples

Manages the Care Coordination process while balancing the needs of individual patients with the business necessities of Genzyme and US Genetics
Assesses patients' needs and develops action plans that provide for the introduction and continuation of enzyme replacement therapy while coordinating the exchange of all patient-related information with internal and external customers
Developing a comprehensive understanding of the reimbursement process, billing/coding nuances, dose calculations, insurance plans, payer trends, financial assistance programs, charitable access, and related resources
Gaining knowledge of the resources available in specific regions, including alternative resources, and how they can be best utilized to support patient care
Learning to educate patients, family members, health care providers, and others regarding insurance options and limitations, insurance requirements necessary to initiate and maintain enzyme replacement therapy, case management services and relevant disease/product information as necessary
Working towards a leadership role within a cross-functional dynamic team, including medical and sales, focused on identifying complex patient specific issues, developing action plans accordingly, and executing these action plans
Building professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, medical, sales, corporate accounts, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators
Maintain accurate data on each individual, their insurance, coverage approvals, on-going coverage requirements and all patient and provider interactions. Coordination of information with all customers is required

Case Management Specialist Resume Examples & Samples

Independently manages, tracks and/ or routes all legal documents and requests received by TPMG Legal
Provides litigation and matter management support to TPMG attorneys and staff
Works with In-House Counsel, Legal Department Staff, Outside Counsel and internal clients
As required, obtains and organizes documents, conducts research and drafts responses to subpoena and other discovery requests, drafts other correspondence and documents as requested
Provide moderate to highly complex support to In-House Counsel and department
Manages and independently prepares responses to regulatory and licensing agencies on behalf of TPMG
Maintains database of cases, matters and actions
Prepares reports
As relevant to a particular matter receives and independently reviews and closes professional liability cases, determines whether reports to licensing agencies are required, and prepares the required reports
Tracks and ensures that reporting requirements are met
Oversees the litigation hold process for TPMG Legal
Researches and prepares documents on applicable state and federal statutes and regulations, case law and regulatory agency rulings
Acts as client representative on behalf of TPMG as requested
Compiles, analyzes and summarizes data and produces reports regarding legal matters, department operations and other information

Case Management Specialist Resume Examples & Samples

Provides appropriate information to patients, their families, physicians, health care professionals, and insurance carriers on the coverage and benefits of all Genzyme’s renal products
Point of contact for assigned sales Zone for reimbursement related questions related to Genzyme’s Renal products
Collaborate with internal case managers on travel requests on an ongoing basis
Communicate results of verification of benefits to health care professionals and Clinical Science Specialist(s) and work as a team to ensure patient(s) access therapy
Develop positive, ongoing relationships with healthcare professionals, internal case managers, Clinical Science Specialists, Regional Business Directors, Renal Clinical Consultants, National and Corporate Account Directors and customers
Keep current on all Genzyme Renal products reimbursement issues across US (i.e. State Pharmacy Assistance Programs, alternative funding, government programs, state-specific carriers, etc.), including Commercial Insurance, State Medicaid and Federal programs
Verifications for Genzyme’s Renal products in a timely manner
Expected travel 50%

Case Management Specialist Resume Examples & Samples

Assume total case accountability from submission of application through policy delivery and acceptance
Manage client expectations regarding service requests, processing, and deliverables
Prioritize incoming service requests and inquiries from New Business Coordinators, life producers, agency contacts, GAs and internal and external partners, while maintaining service levels for case issuance
Demonstrate a sense of urgency in all interactions, while maintaining a high level of professionalism and quality
Build strong relationships with business partners (Underwriting, Legal, Compliance, Licensing and Compensation, etc.) to provide superior service
Ensure the effective use of procedures in accordance with business practices and compliance with state and federal regulations
Conduct all business interactions with honesty and integrity; maintain confidentiality of all personal and medical information and adhere to privacy guidelines
Proactively recognize problems and work collaboratively to recommend process improvements to enhance customer service, increase efficiency or reduce unnecessary steps/hand-offs
Contribute to the growth of functional and conceptual knowledge by participating in cross-training initiatives
Available to work overtime when demand necessitates
Ability to collaborate with internal and external clients to find a best solution for both the client and MassMutual
Strong drive for results, problem solving skills and attention to detail
Must be able to multi-task and work in a fast paced, high pressure environment
Ability to contribute to a positive work environment by acting as a team player and assisting others in meeting service standards
Display flexibility and adaptability to changing priorities and competing demands
Demonstrate sense of urgency in all interactions and prioritize work effectively
Know the customer well and demonstrate superior customer services skills
Respectful of others; attentive to their ideas, concerns and time
Keep commitments
4+ months of Case Management experience within a Life Underwriting department
Candidate must have the ability to work in the US without requiring sponsorship

Case Management Specialist Resume Examples & Samples

Bachelor's Degree from an accredited educational institution preferred
Two years recent inpatient clinical experience in an acute care facility preferred
Previous Case Management, discharge planning or utilization review experience preferred
Completes an initial screen of all patients within 24 hours of admission utilizing InterQual criteria to identify needs related to utilization management and/or discharge planning. Refers appropriate cases to Social Work based on established referral criteria and professional judgment
Introduces self to the patient/family, explains the Specialist, Case Management –RN role, and provides patient/family with a business card
Integrates the discharge planning/coordination and utilization review functions in the case management role
Collaborates with all members of the multidisciplinary team to facilitate the case management and care coordination processes for the assigned caseload
Evaluates patients for appropriateness of admission type and setting, utilizing a combination of clinical information, screening criteria, and third party information
Validates admission criteria with third party payers (including onsite and telephonic Case Management Specialists) as well as Primary Care and Attending Physicians. Recommends alternative care sites where appropriate
Administers HINN’s (Hospital Issued Notices of Non-Coverage) as appropriate

Case Management Specialist Resume Examples & Samples

Performs admission and concurrent review activities through assessment and evaluation of patient medical records to facilitate timely care delivery and efficiency while minimizing cost to the patient and the Medical Center
Monitors the clinical status for patients ensuring that the therapeutic services are being administered at a specific level of care
Advises physicians regarding appropriateness of admission based on Interqual Criteria; and facilitates appropriate level of care. May require assistance in facilitating pursuit of alternate level of care

Msw-case Management Specialist Resume Examples & Samples

Case management experience preferred
Healthcare utilization review, discharge planning, and/or social work experience preferred
Prefer bi-lingual or multi-lingual skills
Follows through on identified issues appropriately according to laws, regulations, established standards and criteria, and policies and procedures
Performs retrospective reviews on discharged patients in response to third party payor requests and for quality review purposes

Case Management Specialist Resume Examples & Samples

Performs initial and ongoing clinical assessment via telephone calls to client (injured employee), employer, physician and attorney as indicated; assesses client's situation for psychosocial needs, cultural implications and support systems in place
Creates a case management plan based on the assessment with measurable goals and objectives utilizing evidence-based criteria; monitors ongoing progress toward these goals and objectives; implements plan through case management interventions and communication with all parties to reach desired goals and objectives
Evaluates need for alternative treatment
Negotiates appropriate level and intensity of care and disability duration with providers through use of medical and disability duration guidelines, adhering to quality assurance standards,
Negotiates and coordinates a prompt return to work with employer
Measures interventions to determine the outcome of the case manager's involvement to include clinical, financial, variance, quality of life, and client satisfaction; maintains accurate record of management including costs, savings and demographic data
Provides case direction and supervision to field case specialists when on-site intervention is required; ensures quality and appropriate service delivery
Communicates effectively with handling claims examiner, client, claimant, attorney and supervisor
Maintains client's privacy and confidentiality, promotes client safety and advocacy; and adheres to ethical, legal, accreditation and regulatory standards
Knowledge of workers' compensation laws and regulations
Excellent oral and written communication, including presentation skills

Case Management Specialist Resume Examples & Samples

Bachelor’s degree and at least three years of directly relevant experience in a medical office setting, or combination of education and relevant experience. Three to five years of experience in a relevant health and safety-related field is also acceptable
Broad knowledge of the California Workers’ Compensation, insurance carrier and authorization referral processes
Knowledge of the full continuum of care available to patients, inter-relationships of the care components, and their effective integration
Ability to understand and fluently use medical and related technological terminology
Ability to collect and record data, evaluate data and statistics, using MS Excel data analysis and graphing/charting tools. Maintain effective reporting systems
Ability to monitor and ensure the patient’s access to the appropriate level of care, the right healthcare providers, and the correct setting and services to meet the patient’s needs, promoting coordination and continuity in the patient’s healthcare
Working knowledge of federal and state rules and regulations, including OSHA, Cal-OSHA, FMLA, HIPAA, GINA, and medical record-keeping
Excellent customer service skills, including strong interpersonal skills, with the ability to initiate, develop, and maintain positive, strong and collaborative relationships with a wide variety of individuals within the department and the campus community, and with external organizations
Demonstrated excellent communication skills in English. Ability to present information clearly and succinctly verbally, in writing, and in presentations
Ability to work successfully both independently with minimal supervision and as a member or lead of a team; Ability to take initiative and ownership of projects from inception through completion
Ability to routinely and independently exercise sound judgment in making decisions, seeing guidance from the supervisor or SUOHC Medical Director as appropriate
Excellent organizational skills, as demonstrated by the ability to prioritize tasks efficiently and work well under pressure in a fast-paced, multi-tasking environment. Ability to tolerate ambiguity with patience and good will
Excellent attention to detail and thoroughness in accomplishing assigned tasks; pride in performing the job correctly and completely
Strong self-motivation; proactive, high-energy, enthusiastic, “can do” work ethic; ability to handle potentially stressful situations
Expertise with managing interactions with regulatory agencies and effective communication with agency inspectors to resolve conflicts or citations, if required
Current HIPAA certification or willingness to obtain certification
Valid non-commercial California Driver’s License or willingness to obtain and maintain one
One or more years of experience with medical office administration and/or workers’ compensation claim administration
Current California MA, RN, or similar license
Successful MIE or comparable electronic medical health record experience
Ability to interpret data and provide trend analyses a plus

Case Management Specialist Resume Examples & Samples

In collaboration with the CM, reviews daily admission data to verify inpatient insurance coverage, pre-certs, authorized days, and reviews needed. Alerts the CM to potential problems with any of the above
If the authorization/pre-cert information is missing or incorrect, the CML will contact admitting to obtain the necessary and accurate information
Utilizes EPIC and SoftMed computer systems to retrieve necessary information, inclusive of free text fields, to support the case management, utilization review process
Retrieves information for the Physician Advisors as needed
Assists, if requested by SW or CM, to schedule transportation
Assists, if requested by SW or CM, with placement calls, locating beds, determining appropriate contact person for CM or SW to follow-up
Arranges for home durable medical equipment for orthopedic patients
Completes the required home care referral forms
Works the DNFB report to determine outlier days, approved days, etc., and releases accounts as appropriate
Scans required one-day stays into the system to facilitate Physician Advisor reviews
Enters all documentation into the SoftMed system
Contacts insurance company for benefit coverage and obtains authorizations when needed including orthopedic patients
Obtains and maintains updated information about community resources
Keeps the Manager informed of any problems and/or barriers during workday related to facilitation of responsibilities
Provides patient/family with second IM notification on Monday, Wednesday and Friday
Performs office support services to facilitate efficient running of the department, i.e.; phone call management, messages, mail/correspondence, ordering supplies and assisting the screeners from other facilities
Assists the CM and SW through telephone, personal or written communications
Participates in quality improvement efforts for the department to assist in improving work efficiency, and to help meet the goals of the department. files and required documents
Performs other clerical support duties as delegated by the Director, Manager(s), CM and/or SW
Proficient computer, word-processing and Excel spreadsheet skills
Ability to learn new computer systems, i.e.: SoftMed, SMS, EPIC
Educated in the unique clinical and discharge needs of the patients
Strong time management and priority-setting skills
Self-directed with the ability to take the initiative to solve problems
3 years recent experience in a hospital or medical care setting preferred

Case Management Specialist Msw-fsed Resume Examples & Samples

Psychiatric based experience preferred
Supports the efficient processes of discharge planning in collaboration with the physicians
Takes an active role on the Interdisciplinary team in assisting in the planning for post-acute care in the least restrictive environment

Case Management Specialist Resume Examples & Samples

· High School Diploma or equivalent
· At least one year experience in acute care setting
· LPN and/or Associate Degree Preferred

Case Management Specialist Resume Examples & Samples

Understands and self-manages to support Case Management success goals, including improvements in quality, cost of care and patient experience
Identifies opportunities for improvement and actively works with healthcare and Case Management team to correct or improve results
1 - 2 years experience as a LPN, certified medical assistant, certified nursing assistant or other health related field
Experience with Indicia (formally Milliman Care Guidelines) authorization criteria preferred
Must have excellent computer skills and ability to learn new systems
Knowledge of and practical use of good business English, spelling, arithmetic, practices and the ability to communicate effectively using written and verbal skills
Must have strong organizational (time management) skills, strong interpersonal skills, the ability to handle multiple priorities with strong attention to detail
Proficient in email communications and internet usage along with basic use of Microsoft Excel and Word. Knowledge of information technology to evaluate care effectiveness (care process, outcomes and cost)

Case Management Specialist Resume Examples & Samples

Candidate must possess at least a Bachelor's/College Degree , any field
At least 2 year(s) of working experience in the related field is required for this position
Applicants must be willing to work in UP Ayala
Preferably Supervisor / 5 Yrs & Up Experienced Employees specializing in Human Resources or equivalent

Conflict Free Case Management Specialist Resume Examples & Samples

Previous experience working in a Case Management Agency providing HCBS case management
Previous experience with federal and state statutes and regulations for HCBS waivers
Experience developing, drafting, implementing and managing of purchase agreement and contract statements of work
Experience working with a variety of community stakeholders

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