Care Manager Resume Samples
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Care Manager Resume Samples
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LS
L Spinka
Lester
Spinka
78476 Leuschke Causeway
Detroit
MI
+1 (555) 632 2791
78476 Leuschke Causeway
Detroit
MI
Phone
p
+1 (555) 632 2791
Experience
Experience
Dallas, TX
Care Manager
Dallas, TX
Grimes-Farrell
Dallas, TX
Care Manager
- Builds, develops and maintains a positive and collaborative relationship with local providers by establishing a local presence
- Develop working relationships with primary contractor (Axis Point Health), nurse care managers, discharge planners, and peers
- Identification of all assigned Care Management Telephonic collaboration with providers and county agencies regarding members in Care Management
- Assists the Supervisor and/or manager in special assignments (i.e. program and process improvements, recommendations for training, etc
- Address member and provider issues telephonically. The majority of the Clinical Care Managers work is done telephonically
- Partner with the licensed nursing staff to plan, develop, organize, provide and execute individualized restorative therapy programs
- Works with the chair of the department and the Director of Care Management to develop standards and education around medical necessity
San Francisco, CA
RN Care Manager
San Francisco, CA
Kulas Group
San Francisco, CA
RN Care Manager
- Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement
- Assist in the development of network protocols and processes for care management of high risk and rising-risk patient population
- Assists with the orientation of new Healthcare Management personnel and contributes to the ongoing networking of expertise with co-workers
- Work with Clinical Manager to develop and streamline workflows and processes for current case criteria as well as future case criteria
- Provide support to clinical teams and collaborate with business partners, health plans, hospitals, vendors, providers, family and support network
- Establishes patient care management plans, interventions, treatment goals, and self-management goals
- Organizes work and develops strategies for adapting to a constantly changing workload or when confronted with unseen situations
present
Philadelphia, PA
Msw-care Manager
Philadelphia, PA
VonRueden-Feeney
present
Philadelphia, PA
Msw-care Manager
present
- Basic knowledge of complex care management and care management principles
- Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
- Comply with performance and reporting standards as defined by Humana Corporation
- Understand clinical program design, implementation, management, monitoring and reporting
- Licensed in Social Work if residing in ID, MN, NM, NV, ND, SD, UT, WY, CT, MD, KY, MI, OK, LA, AL
- Core business hours are 8-4:30 Monday – Friday with possibility of working Saturdays. 2 Late Start dates a month 10:30 – 7
- Proactive telephonic outreach to eligible Humana members and engage participation in Humana At Home Complex Care Management program
Education
Education
Bachelor’s Degree in Nursing Preferred
Bachelor’s Degree in Nursing Preferred
Northern Illinois University
Bachelor’s Degree in Nursing Preferred
Skills
Skills
- Knowledgeable of Community Resources and Alternate Care facilities
- Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
- Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
- Ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs
- Excellent Interpersonal skills and ability to work effectively and independently
- Able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines
- Detail oriented with strong organizational, planning, and problem solving skills
- Strong medical skills and knowledge
- Strong admissions knowledge
- Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner
15 Care Manager resume templates
Read our complete resume writing guides
1
Care Manager Resume Examples & Samples
- 3+ years of clinical experience with a focus in managed care, including disease or case management
- MAPD experience
- Able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines
- Able to understand and apply coverage guidelines and benefit limitations
- Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer’s disease and other disease-related dementias) in an ethnically diverse, dual-eligible aging population
- Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner
- Comfortable with conducting home visits and commuting within the service area
- Basic computer skills and demonstrates a willingness to learn more advanced skills
- CCM or CCP certification
- MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME)
- Bi/multilingual ability
2
Orthopedic Care Manager Resume Examples & Samples
- PT License
- Minimum of 3 years of clinical work in orthopedics, physical rehab or case management
- Experience in an outpatient or inpatient setting
3
Emergency Department Care Manager Resume Examples & Samples
- 2+ years of experience
- ED clinical background and experience
- Available weekends
- Great clinical skills
- Knowledgeable of assessments
- Strong Med/Surg background $
- Experience in care management
- Interqual/Milliman
4
Transition Care Manager Resume Examples & Samples
- MSN and/or DNP
- NJ Nurse Practitioner (NP) or Advanced Nurse Practitioner Nurse (ANP) license
- Experience as an Advanced Nurse Practitioner (ANP) with ICU and/or ER experience
- Previous Counseling / Advising experience
5
RN Care Manager Resume Examples & Samples
- New York Registered Nurse License
- Strong clinical and assessment skills
- Self-motivation, organization and flexibility
- Commitment to improve care in underserved populations
- Collaborative work style
- High level of accountability
- Home care, long term care, care management experience
6
Assistant Patient Care Manager Mixed Medicine Unit Evenings Resume Examples & Samples
- Charge and leadership experience
- Med-Surg clinical background
- 3-5 years of experience
7
Integrated Care Manager Resume Examples & Samples
- AAS
- 5+ years of Hospital or Managed Care
- Knowledge of the case management and utilization review process $
- LTHHC experience
8
Care Manager Resume Examples & Samples
- Registered Nurse licensure in New York State
- A minimum of two (2) to three (3) years of clinical experience in a certified Home health agency (CHHA), Lombardi program and/or MLTC
- Excellent communication, written and analytical skills
- Basic knowledge of computer systems $
- Bachelor's Degree (BSN)
9
Senior Care Manager Resume Examples & Samples
- Serves as a point of contact for internal and external clients including: screening phone calls, ensuring client messages are communicated to the appropriate client service staff, and following up with clients, when appropriate
- Provides general administrative support to partners, including but not limited to
- High School Diploma/GED required; College coursework/degree preferred
- A minimum of 2 years of experience in an administrative role is required
- Experience in a professional services firm preferred
- Capability to work in a fast paced environment and under pressure
- Advanced skills with Microsoft Office, specifically Outlook & Excel
- Experience in accounting procedures preferred
- Flexibility with overtime to meet deadlines
- Strong organizational skills
10
Point of Care Manager Resume Examples & Samples
- Bachelor's Degree in Medical Technology
- NYS Medical Technologist license
- Familiar with either CAP or NYS Point of Care (POC) requirements
- Experience as a Chemistry Supervisor, Hematology Supervisor, Coagulation Supervisor, or CORE lab supervisor
- Able to multi-task and enjoy working in a fast-paced, team environment
- Point Of Care (POC) experience
11
Care Manager Resume Examples & Samples
- 2+ years of Clinical background and experience
- Strong Medical/Surgical background
- Knowledgeable with assessments, and work in a fast-paced environment
- Highly organized $
- Care Management experience
- PRI certified and have Utilization and/or Concurrent Review experience with an acute care facility
- Psych experience
12
Clinical Care Manager Resume Examples & Samples
- Develop/manage the patient care transition process which includes coordinating, facilitating and assisting patients throughout the episode of care
- Serve as clinical resource with expertise in musculoskeletal patient care management and serve as liaison regarding services for this patient population
- Oversee the process for clinical pathway development, staff training, and data collection and reporting
- Act as a positive role model as a nursing leader
- 3+ years of related experience as a medical/surgical nurse
- 2 years of UM or case management experience
- Strong ability to develop, guide, motivate, nurture, and coach others
13
Utilization Managment Care Manager Resume Examples & Samples
- Dealing with Medicaid/Medicare members, perform pre-admission, 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
- Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to insure integrity of member services
- Identify opportunities and facilitate member transfers to: a) hospital of enrollment/other appropriate in-network hospital when hospitalization occurs out-of-network; or b) hospital of enrollment when hospitalization occurs at another network hospital
- 5+ years relevant UM or Case Management experience
- RN, LPN, AAS
- Supervisory experience/skills
14
Care Manager Resume Examples & Samples
- LMSW, LCSW, Mental Health Counselor, or RN license
- Experience with mental health and substance abuse
- Psych, Discharge Planning, Chemical Dependency, CCM, Case Management, Behavioral, Ambulatory
- CASAC
15
Care Manager Resume Examples & Samples
- 5+ years RN experience
- 2+ years experience in women's health
- Care management experience in prenatal service/obstetrical care management
- IVF experience or IVF case management experience
- Proficiency in Utilization Review, OB/GYN, IVF/Infertility, and Case Management
- Warm
16
Orthopedic Care Manager Resume Examples & Samples
- 3+ years of experience in an Outpatient, Orthopedic, or Acute Care setting
- NYS Physical Therapist (PT) license
- Previous Managed Care and Pain Management experience
- Pediatric background
17
Hospital Care Manager Resume Examples & Samples
- 2+ years of Medical-Surgical experience
- Hospital Case Management experience
- Utilization and/or Concurrent Review experience
- Knowledge of Discharge Planning
- Broad Clinical background
18
Care Manager Resume Examples & Samples
- Advocates for the members’ needs, addresses concerns and resolves
- Facilitates the completion of Medicaid and other benefits programs eligibility application process for members and monitors the process
- Attends a minimum of one networking event each month to promote AEC services within the community
- Bachelor’s Degree in Social Work, Sociology, Psychology, Gerontology or a related field
- Two or more years of case management experience
- Valid Driver’s License and current auto insurance
19
Msw-care Manager Resume Examples & Samples
- Complete needs surveys regarding psychological, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care
- Coordinate community care and services as deemed appropriate
- Work collaboratively with other members of the Humana At Home Interdisciplinary team-to include: Humana At Home Care Managers, Field Care Managers, and Community Health Educators
- Understand clinical program design, implementation, management, monitoring and reporting
- Master’s degree in Social Work (MSW)
- Licensed in your residential state
- Minimum 3 years of care/case management experience with adults
- Knowledge of community health, community resources, and social service agencies
- Ability to interact effectively with multi-disciplinary team members
- Self-starter who is able to multi-task and prioritize
- Must have a separate room with a locked door that can be used as a home office to ensure you and our members have absolute and continuous privacy while you work
- Must have accessibility to high speed DSL or Cable modem internet for your home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance form Humana systems is 10M X 1M
- Ability to work a full-time (40 hours minimum) flexible work schedule
- Previous work with vulnerable adults or geriatric population
- Central and Mountain times zones a plus
20
Msw-care Manager Resume Examples & Samples
- Licensed in your residential state (ND, SD, NV, UT, LA, AL, OK)
- Ability to work a full-time (40 hours minimum) Monday - Friday
- Central and mountain time zones would be a plus
21
Home Visit Field Care Manager Resume Examples & Samples
- 3 years of experience in home case/care management
- MUST LIVE within 10-15 MILES of Hampton, VA
- Registered Nurse with a valid nursing
22
RN Field Care Manager Resume Examples & Samples
- Valid Registered Nurse (RN) with no disciplinary action in the stateof TEXAS
- One year of field based eldercare with Home Care and/or caremanagement environment
- This role is considered to patient and is a part of Humana At Home Tuberculosis(TB) screening program. If selected for this role you will be required to bescreened for TB
- Valid driver’s license in the state if Texas, care insurance andaccess to a vehicle
- Proficient in Microsoft applications such as Outlook, Word, Excel andPower Point
23
Care Manager Resume Examples & Samples
- PRI certification
- Utilization and/or Concurrent Review experience within an Acute Care facility
- Knowledge with assessments and discharge planning
- Computer savvy
- Excellent communication skills (written and verbal)(
- Working knowledge of Interqual / Milliman
24
Care Manager Resume Examples & Samples
- Facilitate efficient care coordination and plan for patients' needs
- Evaluate patient medical necessity according to clinical criteria
- Communicate with payers
- At least 1 year of hospital experience as a Nurse Case Manager
25
Care Manager Resume Examples & Samples
- Graduate of an accredited 4 year nursing program
- Current RN license to practice professional nursing with no restrictions
- 3+ years of clinical experience with focus in managed care, including disease or case management
- Ability to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines
- Understands and is able to apply principles of Care Management and Person Centered Service Planning
- Home Care, Long-Term Care, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME)
- Bilingual in English and a second language
26
Care Manager Resume Examples & Samples
- NYS RN License
- MLTC Home Care experience
- MS Office proficiency
- Uniform Assessment System (UAS) trained
- Bilingual in French/Creole
27
Care Manager Resume Examples & Samples
- 2+ years of previous Home Care experience
- Management experience with Registered Nurses (RNs)
- UAS experience
- Bilingual (English and Spanish / Russian)
- Managed Long Term Care (MLTC) experience
28
Care Manager Resume Examples & Samples
- 2+ years of current Clinical Nursing and/or Social Work experience
- MSW and/or BSN
- Previous experience with Home Care and Case Management
- Knowledge of Medicare and Medicaid programs an advantage
- Knowledge of Chronic Disease Management
- Experience in performing clinical assessment
- Solid clinical assessments skills
- Microsoft Office/Suite proficient (Outlook, Word, Excel, etc.)
- Experience with Home Care, Case Management
- Medicare / Medicaid Managed Care experience
- Experience working with a Geriatric population or equivalent experience
29
Orthopedic Care Manager Resume Examples & Samples
- 3+ years of Clinical experience working in Orthopedic, Physical Rehabilitation, or Case Management
- Bachelor's Degree in Physical Therapy (PT)
- Previous experience in an Outpatient or Inpatient setting
30
Care Manager Resume Examples & Samples
- Visits members in assisted living facilities as assigned by supervisor to assist the care manager in member satisfaction and ensure they are receiving the approved services
- Documents all interventions, interactions and observations in the members file
- Assists Care Manager by making and documenting monthly update calls to home members
- Provides administrative assistance in the coordination of services with network providers and informal services to ensure requested services are provided in a timely manner
- Assists as needed in member Medicaid application process and resolution of pending issues to ensure efficient and timely Medicaid eligibility
- Tracks Medicaid appointments and follows up to ensure members do not lose eligibility
- Enters member care plan update/action data into database system (Q)
- Provides coverage for on duty responsibilities on the branch and covers front desk as needed
- Shadows care managers on quarterly, annual, semi-annual and orientation visits as assigned by supervisor
- Participates in care management training programs
- Bachelors Degree in Social Work, Sociology, Psychology, Gerontology or a related field
- Three months to one year case management experience
- Valid Drivers License and current auto insurance
31
Msw-care Manager Resume Examples & Samples
- Complete needs surveys regarding psychosocial, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care
- If applying to work with members in the following states OK, NV, NM, SD, ND, UT, MN, WY, ID applicant must possess an active unrestricted license to practice social work
- Central, Mountain and Pacific Time Zones
32
Care Manager Resume Examples & Samples
- Coordinate, negotiate, procure, and manage the care of patients by incorporating a focus on care coordination across the acute care continuum
- Review and evaluate patient's medical records to determine the appropriateness and medical necessity for admission and continued hospitalization
- Evaluate appropriate clinical resource utilization
- Assess the patients for transitioning to the next appropriate level of care
- Collaborate with the healthcare team to ensure the achievement of quality outcomes for patients/families
- 1+ years ED experience and understanding of admissions criteria
- BSN, RN
33
Care Manager Resume Examples & Samples
- 3+ years of experience in Care / Case Management, Disease Management and/or Population Management, Utilization Review, Quality Assurance, Discharge Planning, or other Cost Management program
- NYS Licensed Medical or Clinical Social Worker (LMSW or LCSW) with current license in the state of practice
- Previous experience with CPT and ICD-9 coding
- 3+ years of Clinical experience with a strong Medical / Surgical background
- Previous experience in a Managed Care setting
34
Orthopedic Care Manager Resume Examples & Samples
- New York State Physical Therapy License
- 3+ years of clinical experience in orthopedics, physical rehab or case management
- Prior experience in either an inpatient or outpatient setting
- Compassionate and detail-oriented
- Exceptional interpersonal and organizational skills
- Polished and professional phone demeanor
35
Home Visit Field Care Manager Resume Examples & Samples
- Minimal Bachelor’s degree in Social Work
- Progressive experience working in a medical or related field
- Current valid social worker license
- Ability to be licensed as a social worker in multiple states without restrictions
- Master’s degree in Social Work or related field
- Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
36
Care Manager Resume Examples & Samples
- New York State Registered Nurse license
- MLTC
- Adult Psych home care experience
37
Emergency Department Care Manager Resume Examples & Samples
- 2+ years of Emergency Department experience
- Ability to handle high volume of patients
- PRI-certified
38
Orthopedic Care Manager Resume Examples & Samples
- 3+ years of Clinical work experience in Orthopedics, Physical Rehabilitation or Case Management
- Experience in an Outpatient and/or Inpatient setting
- Previous Pain Management experience
39
Hospital Care Manager Resume Examples & Samples
- Registered Nurse with an ASN or BSN
- Broad spectrum of clinical background
- 2+ years of Medical-Surgical clinical experience
- Ability to multitask
- Experience with assessments
- PRI certified or willing to get certification
40
Care Manager Resume Examples & Samples
- Active New York State Registered Nurse license
- Bachelor’s Degree in Nursing, Social Work or other behavioral health professional license
- 3 years’ health care or managed care experience
- Demonstrated knowledge in Case Management $
- 2 years’ ADHC experience
- 2 years’ management experience in AADHP care management at an integrated delivery system, hospital system or community-based organization
- Knowledge of Article 49-Utilization Review Process
41
Msw-care Manager Resume Examples & Samples
- Prefer CST, PST & GMT and AL, LA or NM
- Must be a Licensed Social Worker if you reside in ID, MN, NM,NV,ND, SD, UT, WY, CT, MD, KY, MI, OK, LA, AL
- Your schedule will be set anywhere between 8:00 AM - 8:00 PM in order to meet our members needs
- Option to work flex schedule with emphasis on late starts
42
Msw-care Manager Resume Examples & Samples
- Prefer CST, PST & GMT and OK or WY
- Licensed in Social Work if residing in ID, MN, NM, NV, ND, SD, UT, WY, CT, MD, KY, MI, OK, LA, AL
- Your schedule will be set anywhere between 8am-8pm in order to accomodate members needs
43
Care Manager Resume Examples & Samples
- 3 years of experience managing Registered Nurses
- Case management of assessment experience
- Prior UAS experience
- Prior Managed Long-Term Care experience
44
Care Manager Resume Examples & Samples
- 2+ years of experience as a case manager
- PRI Certified
- Higher education
45
Care Manager Resume Examples & Samples
- Minimum of two years experiences as a medical assistant or certified nurse assistant, or health related field, and/or degrees in psychology, health education, or social work
- Intermediate to advanced computer skills and experience with Microsoft Word and Excel
- Social Work experience a plus
46
Care Manager Resume Examples & Samples
- 3+ years of Case Management and/or Home Care experience
- Uniform Assessment System (UAS) experience
- Previous experience working within a Managed Long-Term Care setting
- Bilingual (English and Spanish or Russian)
47
Care Manager Resume Examples & Samples
- Bachelor's Degree in social work, nursing, social science, and/or psychology
- AA/AS in health or human services field with 3 years' of relevant work experience or Bachelor's Degree in a non-related field with 5 years' of post-bachelor's relevant work experience
- Experience working with one of the following communities: chronic disease including HIV/AIDS; substance user; mentally ill; LGBTQ
- Consistent team player capable of effectively operating within organizational structure
- Ability to use Microsoft Word and Excel
- Bilingual in English and Bengali or Hindi
48
Care Manager Resume Examples & Samples
- Associate's Degree in Nursing from an accredited program
- Bilingual, English and Spanish
- Experience with Utilization Management guidelines for Medicare and Medicaid
- Experience managing large case loads
- Ability to troubleshoot or explain basic hardware and software errors and work with a Technician remotely to perform step-by-step repairs
- Accurate typing skills
- Ability to pass Uniform Assessment System (UAS) training
- CCM or ANCC Case Management certification
- Fluency in speaking Mandarin/Cantonese
- 3 years of US-based work experience as a licensed Registered Nurse
- Experience working with the frail adult or elderly population
- Knowledge of current community health practices for the frail adult population and cognitive impaired seniors
- Knowledge of InterQual
- Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors
- Care management knowledge
- Experience managing member information in a shared network environment using paperless database modules and archival systems
- Experience with multiple Medicaid managed care plan products
49
Care Manager Resume Examples & Samples
- 3+ years of relevant work experience
- Associate's Degree in Social Work, Nursing, Social Science, or Psychology
- Experience working with one of the following communities: chronic disease including HIV/AIDS; substance abuse; mentally ill; and LGBT
- Bilingual in English and Spanish, Bengali, or Chinese
- Proficient in Microsoft Work and Excel
- 5+ years of relevant work experience
- Bachelor's Degree in a non-related field
50
Care Manager Resume Examples & Samples
- Active and unrestricted New York State Registered Nurse license
- 2+ years of case management experience with the geriatric population
- Experience providing care in the home setting
- Experience working within a managed care environment
51
Care Manager Resume Examples & Samples
- Comfortable working with children and adolescents
- 1+ year of experience working in a hospital or outpatient setting providing care to children/adolescents and their families
- Familiarity with foster care
- Experience coaching/educating children/adolescents and families on health-related topics and managing follow-up/coordination with multiple providers/stakeholders
- Able to manage time effectively
- Knowledge of Microsoft Excel
- Comfortable using an electronic health record
52
Care Manager Resume Examples & Samples
- Accountable to the owners of the business
- Achievement of targets and delivery within budgets
- Management of staff and responsibility for their workload
- To ensure successful operation of quality control systems
- Implementation of complaints procedure
- To participate in the growth and development of the business, locally and regionally through various marketing exercises
- To be able to develop and maintain the quality control system
- To have a strong knowledge of the requirements of the Care Standards regulations
- To be able to create and maintain administrative systems
- To be able to recruit, select and effectively supervise a dispersed workforce
- To be able to establish and maintain effective working relationships
53
RN Care Manager Resume Examples & Samples
- Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
- Identifies potential candidates for individual case management services and executes the screening and case management process
- Implements, coordinates and monitors efficient care for targeted patients using a variety of health care delivery systems as appropriate. The delivery systems can include acute, long-term acute care, subacute, skilled nursing and rehabilitation settings, as well as, surgery centers, home health agencies and other settings
- Works closely with patients at the time of enrollment to identify those who are currently high cost/high utilizers or at-risk for high/cost utilization
- Assesses the new patient’s situation, provides information about health care options, serves as guide and advisor to the patient and his/her family, and establishes and molds a long-term relationship with the primary care physician and the patient
- Works with the primary care physician to establish protocols for routine and preventive care for the patient which reflect accepted standards of care
- Researches and selects care options as appropriate. May make recommendations of alternative medical care and alternative non-medical services for approval and authorization by the primary care physician
- Supports utilization management decisions with nationally recognized medical management criteria
- Refers all cases that do not meet applicable criteria or have potential quality of care issues to the Physician Advisor
- Maintains a comprehensive, computerized medical and social history for assigned patients. Information will be used for such activities as patient assessment, care planning, patient/care evaluation, case tracking and risk predictions, as well as, cost analysis
- As a member of the care delivery team, works to facilitate patient compliance and ensure continuity of care per the team’s “care plan” throughout the patient’s tenure in the Program
- Regularly assesses and evaluates the effectiveness and quality of services. (i.e., home health care agencies) and treatments provided to patients by analyzing outcomes (clinical, functional, and financial) and reports (utilization, cost, etc.)
- Provides individual client focused reports accentuating case management activity and outcome
- Establishes a network of community resources (i.e., hospital discharge planners, AIDS counselors) necessary for providing appropriate care to patients
- Serves as a program advocate by conducting training sessions, offering presentations, visiting providers, etc
- Negotiates rates with vendors according to company policies and procedures
- Facilitates the flow of claims through the Healthcare Management Department
- Provides input (data, analysis or opinion) to the evaluation of the Program’s overall effectiveness
- Make recommendations for system development from a user’s perspective
- Assists with the orientation of new Healthcare Management personnel and contributes to the ongoing networking of expertise with co-workers
- Participates in Quality Management initiatives
- Complies with Healthcare Management policies and procedures and conforms to American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission standards while performing the job function
- Reviews and signs CoreSource Confidentiality Attestation at the time of employment and at each annual performance review
- Maintains active state nursing license and continuing education requirements and submits original copies of each to be photocopied for the employee file
- Other duties as assigned by a Healthcare Management Supervisor or Director of Healthcare Management
54
Care Manager Resume Examples & Samples
- 5+ years of Clinical experience
- Experience working with the Mental Health and/or Psychiatric population
- Utilization Review or Discharge Planning background
55
Care Manager Resume Examples & Samples
- Active New York State Registered Professional Nurse license
- 1 year of care management experience
- 2-3 years of total nursing experience
- Experience working in any of the following areas: Geriatrics, Discharge Planning, Case Management, Assessment, Acute, Sub-Acute, Long-Term Care (LTC), Health insurance, Home care environment, Homeless population, Addiction, Foster care
- Experience managing large caseloads
- Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling)
- Ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs
- Intermediate skills with a Corporate email system including using and sharing calendar rights, MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database)
- Experience working with a frail adult or elderly population
- Care management knowledge, including the concepts and philosophy and relevant standards of patient care
- Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP)
56
Care Manager Resume Examples & Samples
- Education: Bachelors Degree in Nursing
- Experience: Three years of Clinical Nursing Experience
- License: RN License in the state of Michigan
- Skills & Abilities: Knowledge of chronic disease, evidence-based guidelines, prevention, wellness, health risk assessment, and patient education. Excellent assessment and triage skills Ability to manage complex clinical issues utilizing assessment skills and protocols Ability to affect change, work as a productive and effective team member, to be flexible, and adapt to needs/priorities Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals. Demonstrates strong leadership qualities including communication skills, organizational skills, problem solving and decision-making skills
57
Care Manager Resume Examples & Samples
- Previous Managed Long-term Care (MLTC) and Uniformed Assessment Systems (UAS) experience
- 1+ year of Healthcare experience
- Bilingual (English and Spanish or Mandarin / Cantonese)
58
Care Manager Resume Examples & Samples
- Review clinical documentation to determine initial and ongoing eligibility for long term care benefits
- Appropriately set follow up dates for ongoing benefit eligibility as prescribed by current protocols
- Ongoing monitoring of claims for high risk activity
- Professional clinician with a minimum of bachelor degree in nursing
- Current R.N. licensure without restrictions in state of practice
- 3+ years experience working with geriatric and chronic illness
- Work within the Long Term Care industry desirable
- Geriatric and health care system knowledge
- Demonstrated ability and experience in performing comprehensive ADL/Cognitive assessments and care plan development
- Awareness of global demographic trends and impact upon LTC population
- Ability to work within multi-disciplined teams
- Adaptability in a fast paced corporate environment
59
Care Manager Resume Examples & Samples
- Responsible for Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations
- Interacts continuously with member, family, physician(s), IDT members, and other providers, utilizing clinical knowledge and expertise to determine medical history and current status. Assesses the options for care, including use of benefits and community resources, in order to update the Person Centered Service Care Plan
- Maintains accurate records of care management activities in the EMMA system, using clinical guidelines
- Required A Bachelor's Degree in Nursing or related field may be required in certain states based on specific contracts
- Required Intermediate Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express
60
Care Manager Resume Examples & Samples
- Deliver training presentations to assigned client and may deliver clinical sessions based on client need
- Provides telephonic assessment and referral and/or short-term problem resolution and referral for members or their family members who contact us for assistance
- Assesses members for risk issues and creates safety plans when appropriate
- Consults with supervisors, managers and/or human resource professionals who contact us for guidance regarding increasing the likelihood of members using our services
- Provide back to work conference at client company for employee returning to work and an absence due to treatment
- Provide consultation to assigned client for optimal EAP participation and utilization
- Make recommendations toward goal of reaching diverse populations of employees at client organization
- Review training materials and make recommendations for high quality trainings
- Represent EAP at outreach opportunities
- Build relationships with various stakeholders (union, if applicable, wellness champions, HR, etc.)
- Submit data when requested so that results can be tracked and compiled into reports for client
- Participate in EAP Update Meetings with client and account management upon request
- May conduct Critical Incident Stress Debriefings or serve on committees upon client request
- 5 years of experience providing direct clinical services
- Ability to understand uniqueness of on-site role and working on team
- Presentation skills and a proven track record conducting on a variety of EAP-related topics
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RN Care Manager Resume Examples & Samples
- Knowledge of care management and resource/utilization management
- Ability to monitor, assess and record patient progress against a plan of care
- 2+ years of related experience
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Care Manager Resume Examples & Samples
- Active New Jersey State Registered Nurse or Practical Nurse license
- 5 years of clinical experience
- Experience with EMR systems such as centricity and/or IDX
- Working knowledge of Medicaid/Medicare
- Experience with population management and value-based services
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Care Manager Resume Examples & Samples
- Education: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred
- 2+ years of clinical nursing experience in an acute care setting and 1+ years of case management experience in a managed care setting
- Licenses/Certifications: Current state’s RN license
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Care Manager Resume Examples & Samples
- Graduate from an Accredited School of Nursing – minimum of Associate’s degree in Nursing is mandatory, Bachelor’s degree in Nursing preferred
- Current Louisiana RN license is required
- 2+ years of current clinical nursing experience in an acute care setting
- OB/ NICU (neonatal intensive-care) and labor/delivery experience REQUIRED
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Care Manager Resume Examples & Samples
- Experience with discharge planning, concurrent review & Interqual
- Case Management experience BSN preferred
- Knowledge about discharge planning, concurrent review, and computer skills (Excel)
- Experience working with Managed Care (Medicaid/Medicare)
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Care Manager Resume Examples & Samples
- Assess 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
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
- Provide patient and provider education
- Facilitate member access to community based services
- Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
- Actively participate in integrated team care management rounds
- Identify related risk management quality concerns and report these scenarios to the appropriate resources
- Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
- Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
- Direct care to participating network providers
- Perform duties independently, demonstrating advanced understanding of complex care management principles
- Licenses/Certifications: WA State RN License
- 1+ years of Case Management experience
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RN Care Manager Resume Examples & Samples
- Pre-Admission Counseling
- Contacts patients with upcoming hospital admissions and discusses expectations
- Assesses patient's condition to understand illness or injury and evaluate ability to follow treatment plan
- Advises patients of probable length of stay and helps anticipate and arrange for services at discharge
- Admission Care
- Works with physicians and hospitals to enforce treatment plans and orders
- Ensures patient receives specialty care and tests as ordered
- Contacts medical team members to discuss patient's course of progress and needs
- Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars
- Evaluates need for and authorizes equipment, supplies, services
- Identifies problems and instructs patient and family in proper care and refers patient back to physician or other health care team members
- Identifies plateaus, improvements, regressions and depressions, and counsels accordingly
- Coordination of Care
- Conducts hospital visits
- Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information
- Authorizes recommended modalities of treatment. Investigates and suggests alternatives
- Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers
- Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services
- Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs
- Coordination of Financial Services
- Assesses patient's benefit plan coverage and limitations
- Negotiates rates for provider services by contacting multiple providers and comparing specialty item costs, researching and identifying required equipment, and pursuing contracts
- Suggests medical alternatives that accomplish treatment plan goals
- Post Discharge Follow-up
- Contacts patients within 48 hours of discharge to ensure sufficient support for full recovery
- Ensures proper receipt of equipment, home health and other services
- State Driver's License
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Care Manager Resume Examples & Samples
- Telephonic**
- In conjunction with the PCP, member, member’s family, and other pertinent members of the Interdisciplinary Care Team (IDT), CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services. Assesses short-term and long-term needs and establishes care management objectives
- Functions as a mentor for newly hired Care Managers
- Assists the Supervisor and/or manager in special assignments (i.e. program and process improvements, recommendations for training, etc
- May serve as a representative on interdisciplinary clinical care teams and cross functional workgroups
- Required 5+ years of experience in A clinical acute care position(s), preferably in home health, physician’s office, or public health
- Required 3+ years of experience in Current care/case management
- Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
- Intermediate Demonstrated written communication skills
- Advanced Knowledge of healthcare delivery
- Required Certified Case Manager (CCM)
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Care Manager Resume Examples & Samples
- Graduate from an Accredited School of Nursing
- Bachelor’s degree in Nursing preferred
- Current state’s RN license
- Other Details: Competitive Compensation Package with Benefits, PTO, 401k, W-2 only, no 1099s or Corp to Corp
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Care Manager Resume Examples & Samples
- Review services with interested practices and assist in enrolling them in the CCM program
- Educate provider offices on CMS CCM reimbursement schedule under CPT code 99490
- Provide all services necessary in order to execute an electronic care plan
- Determine an individual’s health and educational needs as a result of inbound and outbound phone calls, and review of medical records with patients
- Maintain communication with patients to measure no less than 20 minutes per month
- Collaborate with the patient's provider to facilitate appropriate physical, behavioral and social services
- Review care plans and make changes as necessary
- Provide patients with information regarding medical questions/concerns
- Ability to work collegially with staff members from multiple offices
- Ability to manage multiple patients simultaneously
- Ability to build and maintain relationships with patients, families and client providers
- Examples of CM activities may include educating newly diagnosed patients about the disease and treatments; managing therapies; and drug administration and side effects
- The following types of professionals will be eligible to serve as an Altarum Care Manager: Registered Nurse, Licensed Practical Nurse, Licensed Social Worker (Bachelors or Masters), Certified Medical Assistant, Certified Community Health Worker
- Minimum of 3 years’ of experience as a Care Manager or Case Manager
- Ability to provide transportation to client provider practices (mileage reimbursement available)
- Medicare/Medicaid experience
- Experience with multiple EHR/EMR systems
- Clinical or Care Management experience, Certified Care Manager preferred
- A background in geriatric care, family medicine and/or long-term care (home health, hospice, public health, assisted living)
- A background and ability to work with populations with special needs
- Competence and experience with electronic charting
- Self-directed with the ability to work independently and in groups
- Exceptional time management skills, with a high level of individual initiative
- Detail oriented with strong organizational, planning, and problem solving skills
- Can be depended upon to effectively plan and organize multiple assignments to ensure workload’s completion, yet flexible enough to handle changing schedules
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RN Care Manager Resume Examples & Samples
- Proactive telephonic outreach to eligible Humana members and engage participation in Humana At Home care management programs
- Works Collaboratively with other members of the Humana Cares Interdisciplinary team-to include; Humana Cares Managers-Social Services, Field Care Managers and Community Health Educators
- Additional responsibilities as deemed appropriate by Humana Cares leadership
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Care Manager Resume Examples & Samples
- Licenses/Certifications: Active Current state’s RN License without restrictions
- 2+ years of clinical nursing experience in a clinical, acute care (med/surg, pediatrics, ICU, ER, Telemetry, LTACH) or community setting
- 1+ years of Case Management experience in a managed care setting (CM in a hospital or with a HH Agency)
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Care Manager Resume Examples & Samples
- Works with physicians and hospitals to enforce treatment plans and orders.
- Ensures patient receives specialty care and tests as ordered.
- Contacts medical team members to discuss patient’s course of progress and needs.
- Arranges for and coordinates health care team services.
- Evaluates need for and authorizes equipment, supplies, and services.
- Identifies problems and instructs patient and family in proper care and refers patient back to physician or other health care team members.
- Identifies plateaus, improvements, regressions and depressions, and counsels accordingly.
- Maybe require to perform on site review
- Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information.
- Authorizes recommended modalities of treatment. Investigates and suggests alternatives.
- Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers.
- Facilitates beneficiary transfers among regions and collaborates with hospital care teams.
- Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs.
- Assesses patient’s benefit plan coverage and limitations.
- Suggests medical alternatives that accomplish treatment plan goals.
- Ensures proper receipt of equipment, home health and other services.
- Assesses compliance with medications and follow-up appointments.
- Assists patient in coordinating transportation and other basic needs, and in navigating the health care system.
- Must have and maintain current, valid and unrestricted RN License that meets licensure requirement for the state in which you practice
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Care Manager Resume Examples & Samples
- Extensive care coordination experience
- Experience providing service coordination and information, linkages, and referrals for community-based services
- Proven self-management abilities
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Care Manager Resume Examples & Samples
- 2+ years of experience in a Clinical Acute Care position; 1+ year of experience in Care / Case Management
- Microsoft Office/Suite proficient (Excel. Word and Outlook)
- Previous experience in Home Health, Physician's office or Public Health setting
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Care Manager Resume Examples & Samples
- Clinical Social Worker license
- Discharge planning experience, ideally in home or long-term care
- Strong admissions knowledge
- Geriatrics and home care experience
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Care Manager Resume Examples & Samples
- Provides on-going program planning and management, develops region-wide protocols, and promotes standards of care for clients with, or at-risk, for genetic/ congenital conditions
- Develops and implements a plan of care for complex, high risk patients
- Initiates and participates in collaborative research projects, written articles, and professional presentations
- Identifies and promotes improved innovative clinical practice based on new knowledge and research in field of specialization, using a broad scope of nursing expertise
- Maintain up-to-date knowledge of current activities in genetics and recommends/ implements enhanced clinical practice standards for the department and the region
- Minimum two (2) years of previous acute nursing experience required
- Prior clinical nurse specialist/administrative/teaching experience preferred
- Previous computer experience preferred
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Care Manager Resume Examples & Samples
- 2+ years of experience within a Managed Long Term Care setting
- Uniform Assessment System (UAS) background
- Bilingual (English and Chinese or Russian)
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Care Manager Resume Examples & Samples
- Responsible for the maintenance, filing, archiving and monitoring of all paper records/storage areas (including all satellites)
- Insures that all documentation related to substance abuse and mental health treatment/programming has been completed, submitted, etc. in a timely and qualitative manner. This includes verifying client eligibility and program admission, completion and submission of program reports, insuring that all in-house documentation is in compliance with program requirements, etc
- Regularly monitors, reviews, audits program records to insure compliance with all regulatory (e.g., ISMART), accreditation (COA), and program specific expectations (e.g., House of Mercy protocols, HUD) in a timely and qualitative manner
- Participates in House of Mercy’s Performance Quality Improvement Program as an active member
- Provides ongoing monitoring/audits to insure compliance with time sensitive expectations related to: Physical Exams/TB testing; consents/releases of information; ISMART reports; Permanent Housing documentation; and, Outpatient/Continuing Care chart requirements
- Responds in a timely and qualitative manner to all requests for client related information insuring that all confidentiality and protected client/patient expectations are adhered to. Insures that all appropriate informational release situations are invoiced at the allowable fee. Keeps the information release billing guide updated and current with industry/regulatory standards
- On an ongoing basis, keeps House of Mercy Management Team informed on overall facility compliance with regulatory/accreditation standards and expectations
- On a timely basis, monitors and insures compliance of all discharged charts prior to archiving them
- Monitors and insures compliance of all House of Mercy provider documentation prior to their scheduled departure from the organization
- Participates in assigned public relations and media efforts to promote House of Mercy; attends community and informational meetings to keep House of Mercy current and to network with other agencies; attends training on relevant topics to stay current in meeting requirements of licensing and other regulations, and to obtain information to better serve clients
- Attends and participates in team meetings and training sessions as scheduled or appropriate
- Works on special projects as assigned. Participates on committees as appropriate and performs related duties as required
- Maintains an awareness of and adheres to mandatory child and dependent adult abuse reporting laws
- Maintains an awareness of and adheres to Federal confidentiality laws
- Maintains communications, on a professional level, with all co-workers, department staff, referral sources, vendors, donors, and residents
- Performs additional duties as assigned
- Bachelor’s degree in a human services related discipline from an accredited four-year program, required
- Valid Driver’s License required, must meet Mercy’s Motor Vehicle Safety Standards, must be at least 18 years of age and be eligible to drive per Iowa state law
- CADC certified with the State of Iowa or certified within nine (9) months of hire
- Ability to understand medical terminology and communicate effectively with healthcare professionals
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RN Care Manager Resume Examples & Samples
- Educate patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or medications
- Dedication, above all, to caring for patients suffering from complex chronic conditions
- Experience with geriatric or end of life care preferred
- Valid Driver’s license
- Ability to interface effectively with culturally diverse patients and communities, providers, management, and employees of the organizations
- Ability to exercise objectivity and good judgment relating to difficult and emotionally-charged situations
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Care Manager Resume Examples & Samples
- Works closely with hospitals, clinics, health care facilities and agency clinical and administrative personnel to ensure patient care is seamless, efficient, effective and appropriate
- Interacts with customers, professionals, and the community to achieve continuity of care, coordination of services and to document plan of care
- Prepares and submits agency and employee activity statistical reports
- Makes evaluative/consultative visits in numerous settings, and provides supportive counseling and/or counseling referrals for client and family as needed
- Develops and maintains accurate case records of each referred customer/patient and documents fully and accurately
- Functions as liaison for patient/family in navigating the continuum of care. Serves as patient advocate
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Care Manager Resume Examples & Samples
- 2+ years of Care and/or Case Management experience
- Experience working with the Geriatric population and patients dealing with Dementia
- Previous experience working with Disability and/or Rehabilitation Programs
- Public Health, Community-based or Home Care background
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Care Manager Resume Examples & Samples
- Participates in defining, maintaining and interpreting care management standards of practice
- Assesses and educates patients and families on community agencies and resources
- Educates and reinforces the early identification of changes in patient condition and changes in care transition plans
- Assumes responsibility for own professional growth and is willing to share knowledge with coworkers and other health care providers
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Care Manager Resume Examples & Samples
- A master’s degree in a clinical field that meets Washington State’s Mental Health Professional criteria and possess (or obtain within one (1) year of employment) Washington State mental health professional licensing is preferred
- At least two (2) years of clinical experience such as direct care, care coordination or case management in either public or private healthcare operations serving adults and/or youths
- Proficient in computer use/applications commonly used in this field/trade/position including Microsoft Office software
- Possess and maintain a valid driver’s license. Pass and maintain a clear background record as required by contractual requirements for healthcare organization under state and federal contracts
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Care Manager Resume Examples & Samples
- Represents the Company in a professional manner, following all Company policies and procedures
- Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
- 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
- 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
- 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
- Ability to read, speak, write, and understand the English language fluently
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RN Care Manager Resume Examples & Samples
- Provides concurrent medical management as needed to ensure medical necessity and compliance with applicable medical policy and health plan benefits
- Develops alternate plans and assist patients and Providers to navigate the healthcare system optimizing benefits. Refer services to networked Providers when possible
- Identify and address opportunities for quality improvement in all aspects of serving our customers. Assist in planning and implementation of systems changes and procedures to achieve overall organizational objectives
- Preferred- Two (2) years’ experience providing case management and/or utilization review functions within health plan or integrated system
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Care Manager Resume Examples & Samples
- Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements. Report findings to the Director, Medical Management, Vice President of Medical Management, Medical Director and Center Manager
- 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
- Assist with the monitoring of utilization management and make recommendations as necessary
- Experience with Case Management
- Ability to perform case management
- Ability to explain medical instructions to center personnel
- Ability to establish and maintain effective working relationships with JSA, Health Plans, and local personnel
- 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, get along with coworkers and management, and deal effectively and professionally under pressure
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Care 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
- Assist with the contestation of Part A and Part B /claims as needed
- 3 to 5 years of recent clinical nursing experience
- Ability to travel locally at times for coverage of Care Managers at Clinic locations
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Care Manager Resume Examples & Samples
- Monitors utilization of hospitalized and skilled nursing home members and assists with discharge planning needs
- Reviews all non-urgent referral requests for medical necessity using approved criteria, and selection of participating providers
- Assists with education and collection of data for HCC coding and STARS/HEDIS measures. Identifies members to refer to the JSA Disease Management/High Risk Programs
- Reviews medical and pharmacy claims monthly and discusses findings with the PCP. Conducts monthly meetings with physicians and office staff to review utilization data, pharmacy opportunities, high cost members, network and health plan updates
- Works in conjunction with the Provider Relations Reps to provide excellent service for Affiliate Primary Care Physicians
- Minimum: Clinical experience required physician office or managed care experience
- Ability to monitor the utilization of hospitalized and skilled nursing home members
- Ability to assist with discharge planning needs
- Ability to explain managed care principles to physicians and center personnel
- Ability to read, writes, speak and understand the English language fluently
- Ability to communicate effectively, get along with coworkers and management, perform effectively and professionally under pressure
- Travel within the JSA service area required
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RN Care Manager Resume Examples & Samples
- Assure compliance with HCFA guidelines and covered service guidelines
- Participate in QI projects. Attend Care Management Meetings
- Preferred: Managed care experience
- Ability to perform Care management
- Ability to travel locally
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Care Manager Resume Examples & Samples
- Minimum 2 years' relevant experience working with individuals with active, serious mental health issues/conditions
- The ability to work cooperatively and collegially within a diverse environment
- Demonstrated ability to establish rapport quickly with a wide range of people from diverse social, cultural, or socio-cultural backgrounds
- Knowledge of community resources for middle aged adults
- Experience providing culturally competent services for middle-aged men
- Experience treating middle-aged male patients using short-term models of individual psychotherapy/counseling
- Experience assessing and intervening when individuals present in crisis
- Skills to perform in-depth analysis of medical records (electronic and/or paper) to obtain accurate, relevant clinical information, and to convey that information to other clinical team members in a concise, informative manner
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RN Care Manager Resume Examples & Samples
- Provides care management (CM) and care coordination to both QI community and institutional members. Completes the Face to Face Health Functional Assessment and Service plan. Care management is provided across the continuum of health care needs - the community, hospital, skilled nursing facility or institution
- Maintains required documentation using KPHC electronic health record. Updates members' service plan, updates and documents assessments and health care in medical records to indicate progress, changes and continuity of care
- Works closely with the Member Care Services Associate to navigate home community based services, supplies and equipment for LTSS needing members
- Promotes Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for members 0-20 years of age. Works closely with Member Care services Associates for EPSDT tracking and audits
- May provide direct patient care per DHS Face to Face HFA requirements
- Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed
- One (1) year Case Management experience in a hospital or clinical setting
- One (1) year recent experience in a clinical area or equivalent preferred
- Community case management experience preferred
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RN Care Manager Resume Examples & Samples
- This is an office position at 1 East Washington Street, Phoenix, AZ*
- Conduct project / product management activities
- Monitor, evaluate and communicate process improvements
- Coordinates Clinical Functions with the UHC Community Plan programs
- Assess barriers to care and assist members to address concerns
- Provide support to clinical teams and collaborate with business partners, health plans, hospitals, vendors, providers, family and support network
- Develop workflow activities & activities for designated programs
- Provides monthly statistics and reports on assigned clinical programs
- Results-oriented, self-starter with ability to learn quickly, adapt to changing priorities and multi-task
- 5+ years clinical, behavioral or case management experience
- Self-directed in work case load
- A background working with the AZ Regional Behavioral Health Authorities
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Care Manager Resume Examples & Samples
- Ensure open communication regarding patient interactions with physicians and office staff
- Help patients with problems in arranging referrals, screenings, and test procedures
- Screen and refer as appropriate for depression and other psychological treatments
- Assume an advocate role on patient’s behalf with the carrier to coordinate benefit management for appropriate supplies and services for the patient in a timely fashion
- Identify and utilize cultural and community resources; establish and maintain relationships with identified service providers
- Coordinates care with external disease management or case management organizations
- Provide medication management, including medication reconciliation and making recommendations to primary care for medication changes based on evidence-based protocols
- Collaborate with primary care to establish and update a shared care plan
- Provide support for improving health behaviors and self-management skills: Goal Setting, Action Planning and Problem Solving
- Provide more intensive follow-up during care transitions and other high-risk periods
- Provide information and education regarding screenings and test results
- Care Managers play an important role in supporting quality improvement for chronic care, such as participating in and supporting planned and group visits, and development of new forms and procedures
- Care Managers play a key role in providing clinical and self-management support training to non-RN and other practice staff as needed
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Clinical Care Manager Resume Examples & Samples
- Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes
- Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
- Helps member actively and knowledgably participate with their provider in healthcare decision-making
- Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs
- Utilize
- This position requires the candidate to be located in Cincinnati, OH as home visits are a part of the job requirements**
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Care Manager Resume Examples & Samples
- Extensive knowledge of community resources/services
- Complete telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider and for emergency, urgent, and routine referrals
- Coordinates with other Care Managers within VO as well as within other facilities/agencies to ensure that patient comprehensive treatment needs are met
- Coordinates member’s service needs with community agencies
- Provide education to member about Behavioral Health and/or Substance Abuse Diagnosis and medication management
- Provide clinical guidance and support to assist member in achieving their goals
- Prepares for and participates in all clinical rounds and clinical
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Care Manager Resume Examples & Samples
- Analyzes specific utilization problems. Plans and Implements solutions that directly influence quality of care and financial liability
- Interacts with physicians and other members of the provider clinical team for discharge planning
- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope, practice and experience
- Experience in TAY, older adults with MH/SA conditions, SMI, SUD, co-occurring disorders (MH with SUD, IDD or physical health); MATI, etc. preferred
- Experience and knowledge with the following preferred
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Care Manager Resume Examples & Samples
- Collaborates and coordinates with providers and/or members of the treatment team to evaluate clinical appropriateness of treatment and interventions, and assist with the management of treatment across the continuum of care
- Works to ensure treatment provided is timely, and designed to meet the member’s individual needs
- Works with providers and facilities to monitor and evaluate care at regular intervals to ensure progress towards goals
- Uses Beacon Health Options’ clinical policy and procedures to administer benefits as designed by the member’s plan
- Documents clinical data and certification decisions into the appropriate system, consistent with established guidelines and policies
- Excellent written and verbal communications skills required
- Excellent PC Skills
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Care Manager Resume Examples & Samples
- Working online in various clinical information systems, the Care Manager collects clinical data from the caller that is sufficient to make appropriate referrals, level of care recommendations, and certification decisions
- The Care Manager collaborates with providers to determine adequate and essential levels of care and to facilitate transfers to appropriate facilities and providers
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply Beacon Health Options criteria and render certification decisions that are within the scope of practice that is relevant to the clinical areas under review. Utilizes professional knowledge to apply Beacon Health Options and contract-specific criteria in render certification decisions. Applies Beacon Health Options policies and procedures consistently
- Strong customer service orientation and excellent written and verbal communications skills
- Ability to function in interdisciplinary setting
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Care Manager Resume Examples & Samples
- Directs members to an appropriate therapist or provider and reviews care on a regular basis to determine whether treatment meets criteria for medical necessity
- Coordinates with other Care Managers to assure that patient comprehensive treatment needs are met
- Completes telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
- Empowers providers to coordinate member care whenever possible, directly coordinates member care when necessary
- Manages Intensive Case Management (ICM) case load as assigned
- Ensures continuity of patient care through contact with providers
- Assists in managing treatment waiting lists through member engagement and provider contact
- Utilizes rounds and case consultations to Clinical Supervisor and Medical Director for cases outside criteria or not progressing
- Negotiates with provider if treatment does not meet criteria and refers cases to an MD or Senior Clinical Consultant if unable to compromise with the provider
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply criteria and renders certification decisions
- Refers cases that do not meet criteria and need non-decision to Medical Director
- Monitors local service center compliance with HIPAA Privacy and Confidentiality Standards and recommends corrective action as needed to regional manager
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Care Manager Resume Examples & Samples
- Provide beneficiaries and external customers with accurate information regarding benefits and utilization management practices, in accordance to Policies and Procedures and Standard Operational Procedure (SOP)
- Reviews the ABA initial behavioral plan, psychometric testing standards, and progress report(s) submitted by treating provider(s). Determines if all TRICARE standardize components are indicated such as support targeted skills, goals and objectives that are measurable, time limited and appropriate for beneficiaries
- Reviews ECHO referrals received through all reports, directly referred by fax, telephonic, or web based pend system. Verifies that beneficiary meets ECHO criteria. Attempts to contact eligible beneficiaries/families to offer ECHO services in compliance with TRICARE, VO and URAC standards and timeframe. Open referral or factually deny as appropriate
- Demonstrates a working knowledge of the benefits of the Extended Care Health Option (ECHO) and Autism Spectrum Demonstration (ASD) and application requirements. For beneficiary’s approved for ECHO benefits, authorize appropriate provider(s) for services under ECHO (such as respite care and Durable Equipment) and for ASD ABA Reinforcement in accordance with Standard Operational Procedures (SOP)
102
Care Manager Resume Examples & Samples
- Ensures integration of care and effective utilization of resources through review of existing documentation, discussion of services with providers and members, application of clinical guidelines and appropriate authorization of services
- Responsible for initial and concurrent clinical review and authorization of medically necessary services for assigned contracts
- Documentation and Coding Entries - Demonstrates thorough, relevant clinical documentation and accurate coding on electronic health record computer screens
- Contractual Adherence - Adheres to contract specific work flows and related policies and procedures. Attention to detail and accuracy of completed work is essential
- Emergency Call Management – Triage members calling in crisis for immediate clinical assessment and referral to appropriate care
- Excellent telephonic customer service skills and computer skills are required
- Successful candidate must have proven track record of customer service, strong work ethic and be prepared to support teammates in the mission of excellent service to providers and members
- This is an exempt position and the successful candidate will be considered essential personnel for call center coverage and operations support
103
Care Manager Resume Examples & Samples
- Complete telephone and in-person assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider and for emergency, urgent, and routine referrals
- Coordinates with other Care Managers within Beacon as well as within other facilities/agencies such as primary care physicians and specialists to ensure that patient comprehensive treatment needs are met
- Prepares for and participates in all clinical rounds and clinical meetings and as needed in person meetings at the Manhattan office
104
Care Manager Resume Examples & Samples
- Identification of all assigned ICM Members
- Independent and individualized assessment of members enrolled in ICM
- Development of a member centric care plan in collaboration with the member and his/her treatment team
- Managing, coordinating care, and identifying strategies to meet care plan goals of assigned ICM Members
- Collaboration with community based providers
- Utilization Review for designated ICM Clients for diversionary levels of care
- Assist in collection of outcomes information, annual analysis and other reporting and initiatives
- Telephonic collaboration and coordination with provider and community agencies regarding ICM members and care planning meetings as needed
- Urgent and crisis calls
- Treatment Record Reviews
- Utilization Review of non-ICM members as needed
105
Care Manager Resume Examples & Samples
- Managing, coordinating care, tracking and reporting of all assigned Members in care management
- Telephonic collaboration with provider and county agencies regarding members in treatment
- Collaborate with Primary Care Physician (PCP), Behavioral Health Professionals (BHP), and other members of the health care team, including health plan medical care managers and others to arrange and coordinate services for the member and optimize the member’s ability to engage in the appropriate plan of care
- Urgent calls
- Telephonic collaboration with Members
- Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint
106
Care Manager Resume Examples & Samples
- Reviews for medical appropriateness of psychiatric and substance abuse treatment utilizing ValueOptions’ clinical criteria, policies and guidelines
- Generates the appropriate correspondence within established timeframes
- Provides appropriate referrals and assistance to members and providers in an effort to promote timely, quality care in the most appropriate treatment setting
- Utilizes clinical rounds and case consultation with clinical supervisor, peer advisors and/or medical director for cases outside the criteria or those that are not progressing
- Documents rounds consults as required in the system
- Refers cases formally to the peer advisor when unable to render a certification decision using ValueOptions’ clinical criteria and guidelines
- Documents VSP cases as required per standards
- Assists facilities in transition and discharge planning. Ensuring appropriate discharge plans
- Assists with activities to promote continuous quality improvement in the department
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Care Manager Resume Examples & Samples
- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope and practice and experience
- Provides information to members and providers regarding mental health and substance abuse benefits, and community treatment resources
- Interacts with providers and facilities in a professional, respectful manner that facilitates the treatment process
- Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria
- Complies with Beacon’s standards for documentation of clinical information, clinical contacts and authorization of care
- Schedules outpatient appointments as necessary based on urgency and clinical need
- Assists with NCQA, URAC and other QI initiatives
- Experience in SMI, SUD, co-occurring disorders
108
Care Manager Resume Examples & Samples
- Participates in assessment of member needs and develops a person centered service plan (PCSP) of care to address identified needs. Utilizes whole person focus when assessing needs including behavioral, physical, psychosocial, and activities of daily living
- Develops, coordinates and assists with implementation and facilitation of services for community support and services program members as defined by the PCSP
- Responsible for facilitating and coordinating with the inter-disciplinary team to review the PCSP and ensure access to services and active care team participation. Collaborates with FIDA program member/family, physician and all members of the healthcare team, both internally and externally
- Coordinates the delivery of high quality-cost effective care based on the members’ needs and the integrated support and services model supported by clinical practice guidelines established by the plan
- Advocates for the FIDA services member/family among various sites to coordinate resource utilization and evaluation of services
- Bi-Lingual Spanish/English Preferred
- Knowledge of treatment care resources as well as available levels of care, ability to relate effectively with behavioral health and medical treatment providers, including MLTSS Members, family members and other professionals
- Must be authorized to drive and have a valid license
109
Care Manager Resume Examples & Samples
- Coordinates with the member and provider to assure that members’ comprehensive treatment needs are met
- Completes telephone assessments and referrals; gathers demographic and clinical information to connect member with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply VBH-PA criteria and renders authorization decisions. Refers cases that do not meet criteria and need non-authorization decision to Peer Advisor
- Applies utilization management policies and procedures for determination of initial, concurrent and retrospective review
- Utilizes clinical rounds/supervision and case consultations with Clinical Supervisor/Manager and Peer Advisor for cases that do not meet medical necessity criteria
- Previous managed care experience preferred
- Must have prior experience in settings that include inpatient, partial, and/or outpatient care
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Care Manager Resume Examples & Samples
- Completes intakes with callers to connect them with both clinical and non-clinical resources to address issues presented. Strong use of motivational counseling strategies to assist callers in following through with accessing resources. Ability to identify additional resources beyond counseling to assist callers in resolving concerns
- Participates actively as a team member to take on projects, utilizes rounds and case consultations with Clinical Supervisor/Manager/Director and Medical Director for direction and for increasing scope of knowledge
- Maintains productivity standards by effective management of calls, adherence to schedule, and developing in-depth knowledge of client and procedural nuances
- Uses technology both as a tool for documentation of case interactions and for providing relevant information to callers as a means of self-education
111
Care Manager Resume Examples & Samples
- 2+ years of experience in a clinical acute care position(s)
- 1+ year of experience in care/case
- Healthcare Management Systems (Generic) knowledge
- Proficient in Microsoft Office, particularly Excel
- Experience in in home health, physician’s office or public health
112
Care Manager Resume Examples & Samples
- Conduct advising interactions via phone and through secure messaging
- Review results of health screenings and wellness activities with program members, and make effective lifestyle recommendations that lead to meaningful behavioral changes
- Deliver diabetes-related presentations through webinars and workshops
- Design and evaluate diabetes-related programs
- Maintain a thorough knowledge of applicable Viverae policies and procedures
- Associates or Bachelor degree in Nursing or Bachelor of Science degree in Nutrition
- Registration through the Commission on Dietetic Registration (RD) orUnrestricted Texas RN license preferred
- 2 - 3 years nursing experience in a hospital setting, acute/direct care, or as a telephonic Case Manager/Disease Manager
- Certified as Diabetic Educator (CDE) required
- Certified Case Manager preferred
- Experience in health promotion/wellness a plus
- Able to use Microsoft Office Suite (Word, PowerPoint, Excel), email and the Internet
- Must be able to work a 20 hour per week consistent schedule (working hours/schedule can be set by Care Manager anytime Monday-Thursday 7a-7:30p and Friday 7a-6p but must be the same schedule each week). One late night per week until 7:30p is required - excluding Fridays)
113
Care Manager Resume Examples & Samples
- Carries a caseload consistent with contract expectations. Perform on-site case management at targeted community locations
- Coordinate service delivery ensuring continuity of care
- Be knowledgeable about in and out of plan benefits
- Engage hard to reach members in case management transitioning cases to office based case managers as appropriate
- 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
- Access case management software systems remotely from provider sites to expedite referrals to case management and educate providers with referral information for other services, providers, and overall care continuum.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
- Collaborate with hospital liaisons at the local Community Mental Health Centers and with emergency service teams (including local emergency rooms) to assist in expedited linkage to care for members
- Attend/participate in acute care discharge planning meetings as appropriate
- Participate in daily rounds from provider sites, when applicable
- Participate in meetings, as needed, 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
- Identify opportunities for collaboration with providers, state agencies, and other community organizations
- Supports the development of solutions for issues and presents recommendations to the Manager of Clinical Operations and/or Clinical Director
- Works with members, providers and community stakeholders to ensure that members receive education, coordinated services and advocacy that support optimal clinical outcomes
- Assist in the collection of outcomes information, annual analysis, and other reporting and initiatives
- Educate providers, state agencies, and other community organizations regarding Beacon case management and the continuum of care
- Up to 50% of travel required
- 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 at a minimum of every 3 years
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Care Manager Resume Examples & Samples
- Coordinates with other Care Managers within the organization as well as within other facilities/agencies to ensure that patient comprehensive treatment needs are met
- Have extensive knowledge of community resources/services
- Prepares for and participates in all clinical rounds
115
Care Manager Resume Examples & Samples
- Identification of all members eligible for Case Management
- Outreach and engagement of identified members
- Independent and individualized assessment of members enrolled in Case Management
- Managing, coordinating care, and identifying strategies to meet care plan goals of members enrolled in Case Management
- Utilization Review for members admitted to inpatient and non-24 hour levels of care
- Telephonic collaboration and coordination with provider and community agencies regarding Care Manager members and care planning meetings as needed
- Site visits to high volume inpatient providers and complex case treatment team meetings
- A current valid unrestricted NY license in behavioral health (LCSW, LMHC, LMFT) or Nursing RN
- Minimum of three (3) years of combined direct behavioral health clinical and/or managed care experience
- Current, valid and unrestricted independent licensure for practice required with proof on date of hire. Re-verification will take place no less than every 3 years
- Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information for the purposes of care management and coordination
- Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills
- Care 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 or RN. All case managers must practice within the scope of their license
116
Care Manager Resume Examples & Samples
- Assess the needs of students in regards to campus and community resources and make the appropriate referrals
- Assist students to plan, coordinate, advocate and navigate through referred services on campus
- Follow up with students and clinical staff in regards to referral services and conduct ongoing assessment to determine continued needs
- Collaborate with campus and community programs/services and advocate for students and their needs as appropriate
- Collaborate with campus partners, staff/faculty, and parents as appropriate
- Maintain continuity of care for students by providing support and coordination of care and services with other mental health professionals
- Coordinate, maintain and update the campus and community referral database
- Providing assessment and time-limited counseling services for individuals and couples
- Managing clinical crisis and triage services
- Providing group counseling services through a general therapy group or a group that addresses a specific clinical issue or the needs of a particular population of students
- Providing outreach and clinical services that address the needs of the general student population as well as the needs of traditionally underserved populations
- Participating in psychological emergency and trauma response
- Training/supervising doctoral interns, practicum counselors and undergraduate paraprofessional service providers
- Participating in other outreach, training, and consultation team activities
- Participating in various Student Affairs activities and committees
- Demonstrated experience functioning at a high level as a generalist counselor in a diverse setting is required
- Demonstrated interest, expertise, and experience in case management in a mental health setting is required
- Previous experience in a college counseling center preferred
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Care Manager Resume Examples & Samples
- Associate's Degree with 2+ years of experience or Bachelor's Degree
- 3 years of relevant clinical experience within a Home Health function
- Experience screening for common mental health and/or substance abuse disorders
- Experience caring for children in the welfare system
- Experience working with the underserved, transient populations
- Familiarity with brief, structured intervention techniques
- Knowledgeable in psychosocial treatments
- Registered Nurse or Social Worker license
118
Care Manager Resume Examples & Samples
- Assist patients through the healthcare system, while supporting self-management of disease
- Provide patient education in self-management
- Assist patient in understanding their plan of care and anticipated outcomes
- Coordinate with community partners and other healthcare entities for continuity of care
- Participate in community outreach and sponsored community events
- Participate in data collection to help monitor health outcomes
- May supervise student volunteer or student clinical experience
- Attend required meetings
- Have the ability to communicate effectively in English & Spanish to meet the needs of the clinic constituents
- Have the ability to communicate effectively verbally and written form
- Be proficient in Microsoft applications to include Outlook, Office Word, PowerPoint, & Excel
- Exhibit a positive professional demeanor at all times when working with patients
- Ability to work in a team setting or individually with little to no supervision
- Ability to think critically to meet goals and timelines
- Ability to be a self-starter, be self-innovative, be self-disciplined,
- Exhibit confidence in communicating working with patients, families, team, and community
- Have experience working with electronic medical records (EMR)
- Have experience working community partners and developing relationships
- Have at least 3 years experience working with patients in a medicalmbulatory healthcare setting
- Be BLS certified
119
RN Care Manager Resume Examples & Samples
- Location/Facility – Baylor Scott & White Hillcrest Medical Center
- Associate’s Degree in Nursing Required
- Texas RN License Required
- 2+ Years’ Experience Required
120
Care Manager Resume Examples & Samples
- 2+ years of clinical nursing experience in an acute care or community setting and 1+ years of case management experience in a managed care setting is required
- Current state’s RN License is required
- Long Term Acute Care Experience or Home Health Experience translates well into this position (preferred)
- Previous Medicare experience (preferred)
121
Care Manager Resume Examples & Samples
- Conduct comprehensive patient assessments to include: psychosocial needs, functional needs and patient understanding of their chronic conditions in order to identify gaps and barriers to optimal care
- Act as a patient advocate by coordinating with and referring to health plan(s) utilization and disease management program(s) where appropriate
- Assess clinical information to develop an individualized care or transition plan, as appropriate, to address services necessary to safely transition the patient to the community, including but not limited to, patient needs related to housing, transportation, availability of caregivers and other transition needs and supports
- Develop collaborate care plans, in conjunction with physician, patient and health plan to address and achieve immediate and ongoing needs and goals, especially those patients identified as high risk
- Coordinate with patient’s primary care provider, specialists, and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care
- Routinely assess and monitor patient’s status, needs, and progress. If progress is static or regressive, determine reason and proactively encourage appropriate adjustments in their plan of care, providers and/or services to promote better outcomes
- Maintain current knowledge of disease processes, treatment protocols and evidence-based guidelines
- Consistently and thoroughly document activities and interactions
- Educate patient and/or caregivers regarding treatment plan(s), medication use and adherence, preventive care and self-management skills
- Monitor and encourage utilization of covered services including, physical health, behavioral health, and/or home and community based resources as a cost-effective patient alternative
- Develop, implement, and evaluate targeted program strategies to improve health, functional, or quality of life outcomes, such as disease management or pharmacy management
- Minimum of three years’ experience in a physician practice, acute care hospital and/or care/disease management program required
- Three to five years of experience in care management, disease management, population health management or other related health care environments preferred
- Strong clinical knowledge of chronic disease pathophysiology, treatment, patient assessment, and patient/family/support system education required
- Excellent verbal and written communication skills, including strong presentation skills required
- Skills and experience in establishing and maintaining effective working relationships with physicians, patients, staff, teammates and the public preferred
- Must be PC proficient with knowledge of Microsoft Office Suite including: Excel, Outlook, Word and PowerPoint
122
Care Manager Resume Examples & Samples
- Responsible for initiating contact with a designated minimum number of assigned members; explaining and enrolling them in the care management organization. This may involve phone contact, written contact and/or face to face contact in the community in order to reach members
- Responsible for meeting the required face to face direct contact hours with Members in the community
- Once members have been enrolled, conduct, convene, and lead treatment planning/care coordination meetings in community with collaterals. Utilize individual Member medical, behavioral, pharmacy and utilization data to co-create, with Members’ individual crisis plans and coordinate their care
- Implements the comprehensive plan of care. Build relationships and assist members and families/supports in understanding and carrying out treatment care plans with a primary emphasis on meeting members face to face and in the community
- Represents the department as an active contributing member and/or in a leadership or project management role on projects and initiatives, such as performance incentive teams, committees, and task forces, as determined appropriate by the supervisor
- The position requires excellent communication skills, both verbal and written, and the demonstrated ability to relate effectively to behavioral health and medical treatment providers, Members and family members, and other professionals involved in the treatment of the Member
- Familiarity with and ability to effectively utilize computer technology is also required
123
Care Manager Resume Examples & Samples
- Conduct prospective, concurrent, and retrospective review of active patient care on-site or telephonic, where assigned. Review patients' clinical records within 48 hours of SNF admission. Review patient referrals within the specified CM policy time frame
- Communicate authorization/denial for services to appropriate parties. Communication may include patient (or agent), attending/referring physician, and facility administration as necessary
- Initiate and/or oversee data entry into IS systems on all patients within 24 hours of patient contact. Maintain accurate and complete documentation of care rendered including LOC, CPT code, ICD 10, referral type, date, and etc
124
Clinical Care Manager Resume Examples & Samples
- Telephonic assessments, collecting sufficient clinical information to make appropriate referral and certification decision for emergency/urgent referrals that require alternate levels of care
- Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible.Screen incoming subscriber and provider calls/inquiries and take data to initiate cases
- Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions
- Facilitates coordination of care with other managers to assure continuity of care
- Strong customer service orientation and excellent written and verbal communication skills required
125
Care Manager Resume Examples & Samples
- Maintains a caseload of higher level of care cases(IP, RTC, PHP, IOP) and, completes concurrent reviews, scheduling MD-MD reviews as needed and coordinates with facility discharge planner on post discharge follow up care
- Participate in scheduled staff meetings and trainings
- Current California Licensure as a Registered Nurse
- Have either a current, valid, unrestricted independent license in behavioral health or nursing (RN) and practice within the scope of their licensure
- Advanced level of PC skills required
126
Care Manager Resume Examples & Samples
- Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria
- Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria
- Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
- Provides information to members and providers regarding mental health and substance use benefits and community treatment resources
- Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources
- Identifies and refers high risk members to care management
- Recognizes quality of care issues and reports them appropriately through internal and external processes
- Interacts with providers and facilities in a professional, respectful manner
- Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards
- Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
- Participates in clinical rounds
- Make timely referrals for community based services
- Document care management activities in FlexCare according to Beacon Standard Operating Procedures
- Demonstrate flexibility and creativity in the design of innovative and individualized care plans in order to achieve maximum effectiveness and optimal outcomes for members and their families
- Participate in member/family meetings to support integrated efforts and collaboration with the health care team
- Provide assistance, advocacy, and empowerment to members in efforts to achieve optimal health
- Clinicians are required to be educated in current principles, procedures of behavior health care. Managed care and state specific expertise and knowledge of community resources experience preferred
127
Care Manager Resume Examples & Samples
- Completes UAS and other relevant screening and assessment tools in the member's home
- Develops, implements and monitors the care plan, assisting members in obtaining reasonable accommodations when appropriate
- As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings
- Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures
128
Care Manager Resume Examples & Samples
- Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria
- Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
129
Body Care Manager Resume Examples & Samples
- 1-2 years of experience with body care and/or related experience
- 1-2 years of experience supervising others, preferred
- Ability to manage changing priorities
- Possesses a sense of urgency in the completion of tasks
- Possesses excellent customer service skills
- Ability to stay focused with the task at hand
- Must be cashier trained
- Proficient in MS word, excel and outlook
- Previous experience in a retail environment; natural foods background a plus
130
Care Manager Resume Examples & Samples
- Manage crisis calls from individual and corporate clients
- Assess risk
- Create safety plans
- Determine appropriate next steps to minimize risk
- Performs initial triage of calls and performs crisis stabilization, where warranted
- Frequently makes decisions to adjust his/her schedule to manage crisis calls and determine and provide appropriate critical clinical intervention
- Assess members for risk issues and creates safety plans
- Follows up on cases in accordance with Division Standard Operating Procedures (SOP)
- Participates in clinical reviews and collaborates with supervisor for treatment plans for high risk cases
- Coordinates and provides on-site Critical Incident Stress Debriefing (CISDs) 24/7 as needed
- Responds to after hours and weekend crisis calls for assistance
- Performs other duties as assigned assisting in creating SOPs, making recommendations, etc
- Minimum 3 years of mental health experience required preferably in a health care environment
- Experience assessing and referring individuals seeking care for variety of mental health issues including substance abuse concerns
- Proven track record performing case management responsibilities
131
Care Manager Resume Examples & Samples
- Identification of all assigned Care Management Telephonic collaboration with providers and county agencies regarding members in Care Management
- Manage, coordinate care, track and report all assigned Member in Care Management
- Maintain accurate information in Beacon’s clinical documentation systems as directed
- Telephonic collaboration with provider and county agencies regarding members in care management
- Participate in systems meetings as needed
- Collaborate with Primary Care Physician (PCP), behavioral health professionals, County personnel, and other members of the health care team, including health plan Medical Care Managers, pharmacies, community based providers and others to coordinate services and optimize the member’s ability to engage in the appropriate plan of care
- Develop a member-centric care plan in collaboration with the member
- Oversee the plan of care for each assigned member, adhering to documentation timelines
- Conduct an assessment of health needs, and monitor and evaluate care outcomes
- Respond to urgent and crisis calls
- Other duties assigned
- Educated in current principles and procedures of behavior health care. Knowledge of managed care and state specific expertise preferred
132
Care Manager Resume Examples & Samples
- Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental HEalth or Substance Abuse Services for all levels of care using established criteri, guidelines and policies
- Builds positive professional rapport with providers and communicates effectively
- Utilizes rounds and case consultations woth Clinical Supervisor, Peer Advisor for cases outside criteria or not progressing
- Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity of patient care
- Maintains confidentiality, ethical and professional standards, adhering to Clinical Policy and Procedures and Benefit Plan requirements
- Microsoft operating systems
- Carelink and/or MHS
- CANVAS/PRISM
133
Care Manager Senior Resume Examples & Samples
- Performs concurrent reviews with treatment team providing ABA services
- Performs initial case requests for autism services, behavioral health and ABA. Reviews all submitted materials and consultation with treatment team providers. Reviews IEP, psych testing and other case evaluation materials
- Provides information to members and providers regarding mental health and autism benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria
- Interacts with the company's Medical and Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
- Leads or participates in activities as requested that help improve Care Center performance, excellence and culture. Supports team members and participates in team activities to help build a high-performance team. Demonstrates flexibility in areas such as job duties and schedule in order to aid Care Center in better serving its members and to help the company achieve its business and operational goals. Assists Care Center efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies
- Maintains an active work load in accordance with Care Manager Performance Standards. Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Assists network by identifying gaps in the network and quality providers. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process
134
Senior Care Manager Resume Examples & Samples
- Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation. Provides telephone triage, crisis intervention and emergency authorizations
- Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Magellan Health Services policies and procedures, and criteria
- Interacts with the company's Medical or Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
- TRF's to be reviewed by Master's level Care Manager only. RN's may perform all other related duties
135
Expert Care Manager English Resume Examples & Samples
- Provides Expert Care help desk coverage via telephone, email and internet for all Expert Care customers
- Keeps all customer-specific documentation and Knowledge@Ariba content items updated for their assigned customers
- Acts as an internal advocate for customer-specific application needs – championing customer’s interests within Ariba
- Assists customer’s Expert Care contacts with understanding of new features and functionality due to product upgrades
- Assists customer’s Expert Care contacts with knowledge of known product defects and workarounds
- Coordinates communication regarding site issues and outages including site upgrades
- Fluency in English' English and French
- Minimum of three years of related experience, preferably supporting or implementing Ariba products in a customer-facing environment
136
Care Manager Resume Examples & Samples
- Works in a high-volume, clinical call center environment, answering inbound calls to assist members access mental health, substance use and employee assistance programs
- Conducts brief telephonic, clinical assessments to determine appropriate level of care, per Beacon Health Options/ValueOptions of California (VOC) criteria for medical necessity, and connects callers accordingly
- Must be knowledgeable about care resources and levels of care available
- Coordinates with other Clinical Care Managers to assure that patient comprehensive treatment needs are met
- Maintains individual productivity and performance standard, as well as the telephone service standards with are in effect at the time; Maintains positive working relationships with internal and external co-workers and customers to ensure optimal efficiency of service; Maintains confidentiality and ethical and professional standards at all times
- Strong customer service orientation, excellent written and verbal communication skills
- Knowledge of Microsoft Communicator/Skype for Business (Instant Message usage)
137
Pain Management Lcsw Care Manager Resume Examples & Samples
- Completes relevant screening and assessment tools to determine member readiness, level of risk and need for chronic pain case management
- Develops, implements and monitors the individualized Chronic Pain Plan, with specific, quantifiable goals and desired outcomes for members who meet criteria for intensive chronic pain case management
- Follows guidelines of the Chronic Pain Case Management Program with respect to engagement, enrollment, case management activities, and discharge
- Gathers and summarizes data for reports
138
Care Manager Resume Examples & Samples
- Conduct participant standardized assessments, including the verification of medical history and document all responses within a web-based software system accessible to the entire care team
- Conduct telephonic education of self-management strategies for specific chronic diseases or other health conditions (asthma, diabetes, cardiovascular disease, COPD, or maternity)
- Develop individualized care plan for disease management participants as indicated by program protocols
- Remain current in the key patient educational concepts for self-management of specific chronic diseases or other health conditions (asthma, diabetes, and cardiovascular disease, COPD, or maternity)
- Participate with team on case conferences as scheduled to ensure support from colleagues in optimizing strategies to assist our members
- Coordinate disease management activities with the respective health plan teams by referring to UM, MCM, MS, HE as necessary to support the wellness of the member. Contact the participants' PCPs as necessary to support the member in the disease management program
- Meet department goals and metrics
- Corporate Disease Management – Provide DM services for all programs - CA, UT, WA, MI, NM, TX, OH, MO, FL, WI
- Bachelor's degree in health education or other related health science fields
- At least two-years experience conducting patient teaching related to chronic disease within an acute facility, ambulatory medical group practice, or community outpatient clinic required
- At least one- year experience working with culturally diverse and low-income populations
- Managed care experience is highly desirable
139
LVN, Care Manager Resume Examples & Samples
- Minimum: At least 1 year of recent clinical experience
- Preferred: 3 to 5 years of recent clinical nursing experience
- Thorough understanding of LVN scope of practice
140
Pastoral Care Manager Resume Examples & Samples
- Recent Supervisory experience required
- Bachelor's Degree in related field required
- Certified by the National Association of Catholic Chaplains or College of Chaplains preferred but not required
- Two(2) years of related work experience preferred
141
Clinical Care Manager Resume Examples & Samples
- Case management and discharge planning experience
- Crisis intervention skills
- Knowledge of Microsoft Office suite
- Experience working in the field highly preferred
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Care Manager Resume Examples & Samples
- Address member and provider issues telephonically. The majority of the Clinical Care Managers work is done telephonically
- Respond to member’s crisis by providing crisis counseling, refers to providers or community resources to assess member needs, and reviews requests for service authorizations for designated services
- Provide prior authorizations, peer reviews and referrals to facilities, providers and group practices and other services as appropriate
- Provide comprehensive evaluation and treatment planning by providing concurrent reviews and discharge planning for continuity of care to members
- Present and review cases with the Medical Director and Associate Medical Directors to promote member treatment and after care
- Basic computer skills, PC and Win Fax
- Knowledge of MS Applications
- Knowledge of AIS systems
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Care Manager Resume Examples & Samples
- Assists with education and collection of data for HCC coding and STARS/HEDIS measures
- Identifies members to refer to Disease Management and /or High Risk Programs
- Ability to establish and maintain effective working relationships with Health Plans, and local personnel
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RN Care Manager Resume Examples & Samples
- Has 2 years nursing experience or 1 year of Hospice experience
- Has current BLS certification
- Hospice nursing experience is preferred
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Transitional Care Manager, Team Lead Resume Examples & Samples
- Responsible for the direct supervision of the transitions team including clinical and non-clinical staff
- Provides clinical oversight and supervision to non-registered nurse staff
- Works in conjunction with the Manager of Care Management on training and team development
- Designs transition of care plans with the patient. Collaborates with the patient/family, hospital team, primary care team, specialists, SCHN Medical Director, Extended Care Case Managers, Social Workers, Wellness Coordinators and other Steward Health Care Network programs, community services, and other members of the health care team to ensure safe transitions of care, effective coordination of services, and full understanding and execution of the care plan
- Actively reviews available reports, considers care management (CM) impact; recommends and makes modifications to the plan of care, as needed
- Maintains required medical documentation for case management activities in the system's care management module (electronic medical records), according to the standards of work
- Meets regularly with each direct report individually to review cases and provide coaching and mentoring; conducts regular staff meetings
- Identifies staffing needs to support the organization and develops staffing strategies to ensure appropriate coverage to meet daily and unexpected requirements
- Follows standards of work and consistently maintains department established caseloads and timeframes for case completion. Participates in the refinement of and development of new standards of work
- Responsible for implementation, monitoring and adherence of time off policies and procedures
- Identifies on-going educational needs and opportunities for staff based on the requirements of the position and specific needs of the individual
- Develops plans for corrective action in areas identified for improvement
- Evaluates processes, identifies problems, and proposes improvement strategies to enhance the delivery of care for patients throughout continuum of care. Maintains awareness of key performance indicators/metrics and manages caseload through appropriate management of medical expenses. Coordinates interventions to prevent adverse events such as ED visits, hospital admissions and readmissions
- Meets regularly 1-1 with the Manager of Care Management to review caseload and discuss barriers/challenges and review performance compared to current targets/expectations
- Demonstrates leadership that creates and fosters a culture of continuous improvement in the department
- Documents and reports all quality and patient safety events by recording and adhering to all of Steward Health Care Network's safety reporting guidelines
- Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures
- Must exhibit excellent critical thinking skills, problem solving, interpersonal, and good patient interviewing skills
- Highly motivated and self-directed
- Ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care
- Ability to lead and motivate others to execute a plan in a rapidly changing environment
- Demonstrated ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands
- Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve outcomes
- Strong current working knowledge of care management and health care across the continuum
- Ability to utilize tools for the effective documentation of the care management process
- Ability to work effectively in a team
- Ability to travel to attend chapter POD meetings as necessary and to visit select practice sites for meetings with patients, PCPs and other members of the care team
- Attend staff meetings and education offerings both in person and via teleconference as required
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LVN, Care Manager Resume Examples & Samples
- Implements current policies and procedures set by the Care Management department
- Reviews patients’ clinical records of acute inpatient assignment within 24 hours of notification
- Reviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy)
- Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with attending physician when applicable
- Prioritizes patient care needs. Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan
- Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement or home health follow-up
- Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with physician and other team members to ensure that care plan is successfully implemented
- Attends all assigned Care Management Committee meetings and reports on patient status a defined by the region
- Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families
- Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues
- Follows patients on ambulatory care management programs, including CHF and home health, in order to optimize clinical outcomes
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Neurology Integrated Care Manager Resume Examples & Samples
- Achieve assigned sales goals by interacting with HCP’s to educate and drive demand for Eisai’s Epilepsy Brands
- Analyze the local environment and identify/understand influencers within the assigned ECE accounts, translate knowledge into actionable market insights to develop customer plans that optimize brand positioning, drive demand and improve patient outcomes
- Develop internal cross functional relationships with sales, market access, medical, HEOR and other necessary cross-functional team members to ensure a high level of integrated planning to facilitate collaboration and the exchange of information including ECE customer knowledge
- Develop and maintain relationships with key stakeholders within accounts (e.g., KOLs, Medical Director, Quality Director, C-suite, Director of Pharmacy, Industry Relations, etc.) and identify opportunities for further engagement
- Monitor progress in accounts and evolve action plans as appropriate (contacts, plan execution, volume growth, and market share); Manage overall commercial performance of accounts
- Align budgets and resources to account(s) in a way that optimizes return on investment
- Partner with local representatives and DMs to ensure pull-thru and progress of the plans and goals built for the surrounding communities of the ECE
- Accountability and adherence to corporate, FDA, and PDMA guidelines
- BA/BS Degree required; MBA or advanced degree in a related field preferred
- 7-10 years of previous specialty pharmaceutical, biotech, or medical marketing/sales and account management experience required
- Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in local area required/highly preferred
- Understanding of integrated health system operations and integrated care delivery models, including economics, supporting processes and behaviors
- Knowledge of IDN needs, population health management, ACOs, and risk-based payment models; Understanding of the application of HEOR
- Understanding of the processes for developing formularies, protocols, and order sets, and how they are used to influence treatment decisions at the physician level
- Thorough clinical understanding of the epilepsy therapeutic area preferred, including in-patient and out-patient care management
- Ability to develop and manage relationships, and tailor communications to a variety of audiences in both a B2B and clinical context, especially at C-Suite level (e.g., executive presence)
- Understanding of the market access and reimbursement landscape, hospital buying process, hospital contracting process,
- Entrepreneurial nature and ability to think strategically and creatively to influence, meet, and adapt to changing customer needs
- Demonstrated ability to develop account budgets and conduct account sales analysis
- Ability to effectively collaborate with a variety of stakeholders, internal and external to the organization
- Ability to meet the travel requirements of the role based on assigned ECE’s
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Associate Director Neurology Integrated Care Manager Resume Examples & Samples
- Lead their NICM team in deriving, validating, and leveraging customer and account insights on a regular basis. Work with NICMs to develop solutions that best address those needs while facilitating involvement of the necessary business personnel inclusive of support, service, and resource management in order to meet key account performance objectives
- Responsible for gaining and applying a deep understating of relevant markets, business models, strategic priorities, future direction, financial drivers and leadership profiles of key customers within Epilepsy Centers of Excellence accounts. This includes understanding and engaging in key local and national, health care issues/strategies, customer issues/trends and best practices to establish credibility beyond product and therapeutic areas
- Take an active leadership role with NICMs to ensure the development and pull through of Strategic Account plans consistent with achieving regional and corporate goals
- Cultivate effective relationships with Key C-Suite and administrative roles within an account (CEO, CFO, CMO, Pharmacy Director, Medical Director, Case Management, Dir. of Quality, Industry Relations, etc.)
- Recruit, develop, train, coach, assess, motivate and retain talent to achieve Neurology portfolio goals
- Develop and present in conjunction with the NICM sound clinical, pharmaco-economic and business presentations to appropriate customers based on mutual needs/benefits
- Maintain open communication throughout the organization by partnering with relevant cross functional departments to provide leadership and insights that lead to strong relationships and the development of appropriate business strategies that support brand(s) objectives in ECE accounts
- Review and analyze product performance at the regional level and communicate account performance broadly with key internal stakeholders
- 7-10 years of previous pharmaceutical, biotech, or medical marketing/sales and account management experience required
- Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in geographic area highly preferred
- A minimum of 4 - 5 years successful experience leading and coaching teams in the pharmaceutical industry (within IDN’s, Epilepsy Centers preferred)
- Understanding of integrated health system (IDNs) operations and integrated care delivery models, including economics, supporting processes and behaviors. This includes, population health management, value based care and understanding of the application of HEOR
- Thorough clinical understanding of the epilepsy therapeutic area preferred, including in-patient and out-patient care management Ability to develop and manage relationships, and tailor communications to a variety of audiences in both a B2B and clinical context, especially at C-Suite level (e.g., executive presence)
- Understanding of the market access and reimbursement landscape, hospital buying process, hospital contracting process, processes for developing formularies, protocols, and order sets, and how they are used to influence treatment decisions at the physician level
- Entrepreneurial nature and ability to think strategically and creatively to lead, influence, meet, and adapt to changing needs of both internal NCM team and external customers
- Ability to effectively lead collaborations in a dynamic environment with a variety of stakeholders, internal and external to the organization
- Ability to meet the travel requirements of the role of up to 60%
- Must be able to organize, prioritize, and work effectively to meet deadlines within in a constantly changing environment
- Strong understanding of healthcare regulatory and enforcement environments along with demonstrated integrity on the job
- Essential Elements for Success
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Care Manager Resume Examples & Samples
- 2 year’s clinical experience in an acute care setting
- Strong case management skills
- 2 years of managed care case management experience
- Medicare and MLTC managed care experience
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Clinical Care Manager Resume Examples & Samples
- 50-75% of field based travel is required
- One of the following licenses is required: Registered nurse (RN) with unrestricted active state license; BSN preferred; OR a state licensed independent practice behavioral health clinician (e.g. LCSW, LPC, LMFT, PhD, or Psy.D)
- Case management and discharge planning experience is strongly preferred
- Managed Care experience is strongly preferred
- Crisis intervention skills preferred
- Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation
- Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding
- Knowledge of community resources and provider networks
- Familiarity with local health care delivery systems
- Familiarity with IPA (Independent Practice Association) is preferred
- Behavioral Health experience is a plus
- Strong communication skills, written and oral
- Ability to travel in the field required
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P/T Clinical Care Manager Resume Examples & Samples
- Completes telephone assessments and referrals, gathers demographic and clinical information as necessary for voluntary and management-referred employees, as well as urgent and emergent EAP referrals
- Responds to client organization requests for services:Mandatory/Management referrals of employees under performance improvement plans or conditional work agreements. Intake, monitoring and case management to conclusion of treatment plan
- Will facilitate all tracking necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC)
- Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets ValueOptions criteria for medical necessity
- Establish and deliver knowledge about care resources and levels of care availability
- Must possess the ability to function in an interdisciplinary setting
- Must have knowledge and experience using management information systems
- Must be knowledgeable about care resources and levels of care availability
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Care Manager Resume Examples & Samples
- Provide holistic assessment and care and complex care planning and management services
- Coordinate amongst all Interdisciplinary Care Team (ICT) members to develop the Individualized Care Plan (ICP) and oversee ICP implementation by the Care Coordinator
- Be available to the health plan and community based Case Management provider agencies for consultation when issues with regards to behavioral health management or treatment arise
- Facilitate clinical policies implementation and maintenance, assess training and development needs for, and identify clinical resources and tools to improve program effectiveness and quality. S/He will be responsible for maintaining accurate information in Beacon’s and the Health Plan’s clinical documentation systems as directed
- Identify, assess, and holistically manage complex behavioral health cases for those members who are in the dual eligible program as appropriate
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Clinical Care Manager Resume Examples & Samples
- Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required
- Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required
- Ability to work both independently and as part of a team required
- Strong written and verbal communication skills required
- Behavioral Health experience preferred
154
Clinical Care Manager Resume Examples & Samples
- Independent license in Behavior Health (AZ) required
- 2 years in case management experience required
- Critical areas to succeed - organization, critical thinking, collaboration and time management
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Technical Care Manager Resume Examples & Samples
- Collaborate with Spectrum Care teams to identify trends in call/service reasons, resolution times, customer satisfaction results and report findings and to understand the impact of product launches, new promotions and policy and process changes
- Assist in the development and implementation of tactics in support overall Care strategy
- Maintain the Care processes and coordinate modifications through the customer care leadership team
- Manage integration and execution of new products, services and marketing campaigns
- Develop, maintain and enhance highly efficient and effective customer service deliver including coordination of information flow to and from key customer touch points and Care operations teams
- Support Corporate goals by facilitating innovations that promote continuous improvement and result in improved service delivery and/or reduced operating expenses
- Reinforce a culture of Care through the delivery of high performance customer care
- Identify trends and improve processes including more effective workflow, integration and productivity
- Assist with planning, budgeting, implementation and cost controls
- Identify Care technology improvements and trends that will drive a cost effective, positive customer experience
- Provide executive summary of monthly key performance metrics
- Implement initiatives to drive performance in Care, Sales and other key metrics
- Coach and develop direct reports and others as needed
- Participate with cross-functional team members in issue identification, process impacts, and solution development discussions
- Build relationships with all departments to ensure alignment of projects to maintain a positive customer experience
- Work closely with Field Operations to reduce contact rates and drive single contact resolution to customer complaints or problems
- Prioritize initiative and operational work to ensure resources are properly allocated to achieve business objectives
- Influence by defining best practices, identifying technologies and contributing to knowledge capital to support strategic Care direction
- Build awareness of both Spectrum and industry best practices, be a recognized leader in the broader organization
- Assist in maintaining technical and procedural documentation and standard operating procedure manuals including online media as needed
- Champion the adoption of tools and processes that conform to Care standards and best practices as defined Care and Organizational leadership
- Provide advice and assistance in the planning, implementation, and evaluations of modifications to existing operations, systems, and procedures
- Ability to work in fast-paced environment while maintaining a high level of employee morale
- Excellent planning and organization skills with ability to implement/track and deliver on quantitative goals/metrics
- Problem solving and decision-making capabilities; strong analytical skills
- Ability to collaborate and drive results in a matrix-management environment
- Minimum five years experience in a Customer Care management role
- Ability to become BASA/FASA certified
- Experience in a high volume, inbounds contact centers
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RN Care Manager Resume Examples & Samples
- Graduate from an accredited Associate’s or Bachelor’s of Science Degree in Nursing program required; BSN preferred
- Graduate of an accredited BS program in Nursing preferred
- Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts
- A minimum of 3-5 years recent clinical experience required, and 1-3 years of recent acute, Inpatient Care Management experience required
- Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans
- Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand the physical and psychological characteristics of illness; ability to assist individuals with the development of short- and long-term health goals
- Ability to understand the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings
- Ability to understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities
- Knowledgeable on how to access and evaluate the available resources to meet a client's needs; able to develop new resources
- Excellent interpersonal, verbal, and written communication and negotiation skills
- Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement
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Care Manager Resume Examples & Samples
- Serves as a Care Manager for a designated group of patients
- Performs admission review on inpatients hospitalized longer than 48 hours and subsequent concurrent reviews using approved tools to determine severity of illness and intensity of service to ensure appropriateness of level of care. This includes intakes from outside referral sources and consult from other departments within the hospital (i.e. Emergency Room, ICU, Med/Surg, Behavior Health and Outpatient Services)
- Certifies all managed care and commercial admissions requiring approval by the insurance carrier on the next business day after admission and performs concurrent phone calls as indicated by insurance carrier to ensure hospital reimbursement
- Organizes individual patient care meetings with multidisciplinary team members and the patient/family to evaluate progress and to identify and resolve problems that may interfere with a positive patient outcome
- Assesses discharge planning needs to ensure a safe, timely and efficient discharge
- Arranges for community services (including short and long term placement) prior to discharge to meet patient’s needs with recognition and documentation of patient choice of service providers
- Provides patient education and advocacy as needed
- Identifies variances during the patient’s stay in order to evaluate and improve processes that effect the efficiency and quality of patient care
- Demonstrates effective use of hospital and community resources within established reimbursement guidelines
- Initiates physician advisor reviews on all cases not meeting established criteria for admission and/or continued stay to insure appropriate utilization of services
- Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure an optimal patient outcome
- Communicates denials from third party payors to the physician, and/or Chief of Service or designee and the Director to ensure a timely appeals process. Reports known and/or suspected underutilization, overutilization or inappropriate scheduling of services to Director and/or UM Administration
- Keeps abreast of all current rules, regulations, policies and procedures related to Utilization Management and Discharge Planning
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Care Manager Resume Examples & Samples
- 1+ year of related Case Management experience
- Master's Degree in Nursing and/or Social Work
- NYS Licensed Master Social Worker (LMSW) and/or Licensed Clinical Social Worker (LCSW)
- Previous experience as a Care Manager
- Experience with Medicaid population and/or persons with Physical Disabilities
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Integrated Care Manager Resume Examples & Samples
- Initiates contact with members identified for the ICMP; explaining the care management program and completing an enrollment and assessment of members to engage them in the program. Engagement activities may involve outreach by phone, mail, and face-to-face contact in the community in order to reach members
- Implements an individualized and comprehensive plan of care using a care management software program to document member goals and track plan process
- Builds relationships and assists members and families in understanding and carrying out treatment care plans with a primary emphasis on meeting members face-to-face in the community
- Develops written and oral clinical case presentations to deliver to ICMP staff, MBHP supervisors and physician advisors in one-to-one and group settings
- Promotes and facilitates specific communication and coordination of care with Members and their PCC Plan Primary Care Practitioner(s) and Behavioral Health Provider(s)
- Participates in discharge planning activities that include aftercare referrals and referrals to community resources when engaged ICMP Members are being discharged from inpatient psychiatric or medical hospitalizations
- Consults with providers to assist Members with transportation, pharmacy, and daily living needs as they relate to individualized care plans
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Lead / Complex Care Manager Resume Examples & Samples
- 4+ years of Clinical experience
- Current NYS Registered Nurse (RN) license
- Previous experience with Healthcare Plans
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Care Manager Resume Examples & Samples
- As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management
- Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services and case management
- Reviews the healthcare information with healthcare team. Reviews the admitting diagnosis/problems with the healthcare team. Monitors the course of patients and the adherence of this course to clinical pathways or the patients' treatment plan
- Reviews the plan with physician, primary nurse and other members of the team as appropriate and insures that communication is taking place with patient and family
- Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations
- Facilitates communication within the health care team and with the primary care physician and other disciplines to coordinate patient's progress through clinical pathways or the patient's treatment plan
- Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient's treatment plan
- Optimizes the efficiency of hospital systems which impact quality and/or length of stay
- Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan
- Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations
- Identifies trends, themes, and consistent barriers and work collaboratively with healthcare team
- Intervenes when necessary to correct delays and to address any barriers for patients
- Utilizes information obtained from various resources available to
- Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team
- Collaborate with health care team to initiate referrals to the appropriate service and/or provider, ensuring that adequate insurance coverage and reimbursement are obtained
- Identify patients who are likely to have unmet insurance and resource needs and communicate with healthcare team members and other appropriate departments
- Communicate as needed with third party payors regarding the patient's progress with the treatment plan
- Collaborates with case manager and representatives from third party payor regarding services available when barriers are identified
- Review admissions daily to ensure appropriateness
- Assist clinicians in documenting the appropriateness of admissions and continued stays
- Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials
- Appeal of inappropriate insurance denials
- Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include
- Identifying service, treatment and funding options
- Advocating for individual needs as indicated
- Identifying gaps in the treatment and/or discharge plan
- Utilizing knowledge of internal and external resources to meet patient needs
- Identifying barriers to wellness within the treatment plan
- Coordinating and scheduling interdisciplinary meetings with the patient and family regarding discharge needs and the plan
- Ensures and/or coordinates counseling and teaching for discharge preparation
- Ensures that the discharge plan provides a continuum of care with the appropriate outpatient physician and needed services
- Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through
- Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum
- Ensure that appropriate services are provided and that necessary certifications for these services are carried out
- Works collaboratively with PSM and unit leadership team to actively involve clinical nurses in the assessment and planning for patient's discharge to facility
- Along with other members of the health care team, acts as a patient advocate
- Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk
- Educates patients and families regarding the care manager role, as needed
- Facilitates and ensures open communication among the health care team and the patient/family
- Performs miscellaneous duties as required or requested
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Care Manager Resume Examples & Samples
- Formulates and implements a psychosocial care plan that addresses member identified needs by assessing member/family needs, issues, resources and care goals
- Works in interdisciplinary team to assist with complicated and high risk cases to foster positive outcomes
- LMHC, required
- Minimum of three (3) years experience in two (2) or more of the following: case management, discharge planning, advocacy, outreach, screening, referral, supportive counseling, required
- Knowledge of third party payer requirements, required
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Care Manager Resume Examples & Samples
- Receives and responds to Behavioral Telehealth consult requests
- Conducts initial psychosocial assessment through Telehealth interview with patient, family and/or significant others to determine patient condition/needs
- Reports on patient to Attending Psychiatrist for psychiatric evaluation
- Receives behavioral care plan from attending Psychiatrist to coordinate treatment
- Coordinates necessary resources to move patient along continuum in a timely manner and performs administrative aspects of care management
- Completes documentation in accordance with policies and procedures of the organization, State and Federal regulations
- Excellent computer skills required: rapid typing and rapid learning of new software (8+ EMRs in use simultaneously)
- Flexibility to work weekdays and weekends, days and overnights. Cannot be days-only or nights-only or weekends-only
164
Care Manager Non-rn Resume Examples & Samples
- Conducts initial psychosocial assessment of members through interviews of member, family, significant others to determine support structure, religious needs, emotional and psychological needs, needed community resources and barriers to successful transitions
- Collaborates with healthcare team involved in patient’s care to enhance care plan and integration of services. Contributes to the understanding of social and emotional elements of patient’s life related to their diagnoses and treatment
- Current, valid New York State Driver’s license, required
- Ability to communicate well and effectively interact with members and families. Sensitive to cultural diversity and low literacy issues in care provision
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Clinical Care Manager Resume Examples & Samples
- Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care
- Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care
- Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations
- Document all activities in the Health Plan's care management tracking system following Health
- Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers
- Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers
- Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate
- Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate
- Minimum 1 year of health insurance experience required
- 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
- High level of oral and written communication skills
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Behavioral Clinical Care Manager Resume Examples & Samples
- Clearly and effectively communicates with the project team, residents and faculty, PCPs, Pharm D staff, and specialty providers via written, electronic and oral reports
- Convene multidisciplinary case conferences, implementing and leading group visits, working closely with the Family Medicine Residency faculty and residents to create new outreach programs to service-intensive patients (including home visits). Learn and establish working relationship with mental and behavioral health community resources
- In conjunction with support staff and medical team, maintains an accurate and up-to-date registry/database of all patients. Work with IT staff for data mining, data review, and presentation of data for meetings and publication as well as for tracking outcomes and quality improvement/research projects. Prepares quarterly grant reports for the Foundation and individual grantors of the Project
- Provide leadership to the Integrated Project staff (three LCSW's at the three Family Health Centers), including planning, directing, and implementation of project initiatives. Contribute to the development and achievement of the project goals and objectives, and continually evaluate processes to ensure that services are delivered in an effective and culturally competent manner
- Systematically screen patients for depression and unhealthy substance use using evidenced based screening instruments assigned by the project
- The clinical care manager will assure that direct service staff meets funding source requirements, monitor productivity/case load, track no shows/cancellations, as well as all outside referrals, and continually assess, and revise service delivery processes as needed to assure payment for services
- The clinical care manager will be invested in his/her own professional development by reading, attending appropriate conferences, and taking the initiative to be informed of developments and changes in the field, the results of recent studies, national standards, and the activities of similar organizations
- The clinical care manager will directly supervise the LCSW staff at each of the three health centers. In addition, he/she will work closely with, family medicine residents, medical students, and nursing/front office staff on behalf of the health center patients as well as in an education role. He/she will be required to communicate and monitor performance and productivity standards, appraise performance and implement a staff development plan that enhances service, and/or the learning experience of students and residents
- The clinical care manager will ensure efficient operations by scheduling staff coverage sufficient to maintain responsive services, designing and improving processes that continuously improve patient care services, auditing records and other documents for accuracy and timely completion in order to meet requirements, preparing information and reports for internal management and quality control using an electronic information system (Epicare) and excel or access databases
- Uses a variety of educational materials, brief intervention techniques and community resources to engage and increase patient motivation to manage their chronic behavioral and medical conditions
- Uses standardized intervention techniques and community resources to support patients in achieving their goals: In collaboration with patients and their primary care provider and LCSW staff, develop initial treatment plan for care and stepped care plan to achieve patient derived outcomes of care. Provides ongoing evaluation of patient's progress throughout the acute, continuation and maintenance phases of the Stepped Care Model and coordinates with collaborative care team to augment care as needed. Establishes relapse prevention plan and follow-up schedule with patient to monitor patients' progress throughout the maintenance phase. Review caseload weekly with psychiatrist, focusing on patients not adequately improved within specified timeframe and when needed assist patient in scheduling appointment with the psychiatrist or any type of mental health referral
- Master's degree in Social Work, Psychology or related field OR
- Licensed Psychiatric Nurse
- Three (3) years of progressively responsible experience in social services required
- One (1) year of supervisory experience recommended
- Clinical and management experience in behavioral health and knowledge of chronic medical conditions is imperative
- Experience working in a primary care setting, and collaborating with family medicine residents is a plus
- Training in the three evidenced based practices will be provided at no cost to the Behavioral Specialist
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Precert Care Manager Resume Examples & Samples
- Assist with moving members to in network facilities or coordinating with appropriate Community Care contracts regarding approval for out of network service utilization
- Assumes responsibility for completion of acute and non-ambulatory precerts and application of appropriate medical necessity guidelines. Precerts include adult and child/adolescent members from all Community Care being admitted to mental health and substance use disorder services, as well as afterhours/weekend completion of precerts for UPMC Health Plan Commercial and SNP lines of business
- Consults with appropriate physician advisors as needed for case collaboration and care planning
- Coordinates, reviews, and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports to address member incidents, provider deficiencies, and quality of care concerns
- Demonstrates advanced level of computer operation with electronic medical record systems and Microsoft Outlook, Word, and Excel Programs, as well as advanced typing proficiency
- Develops specific clinical interventions and coordinates with the assigned Community Care contract and care management team for members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care
- Identify need for and facilitate linkages for members and families between primary care and behavioral health providers and other social service or provider agencies to develop and coordinate service plans
- Independently problem solves based on advanced-level knowledge of the service delivery system, clinical treatment, diversion resources, and the provider network for adult and child/adolescent members for behavioral health and SUD providers from the requested region, member services policies, members' rights and responsibilities, and the operating practices of the organization
- Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services. Is able to provide members, providers and other stakeholders with accurate information concerning benefits and coverage
- Participates in professional development activities to further clinical skills and knowledge. Works as part of a team providing clinical expertise and knowledge to member services and other care management staff
- Receives and responds appropriately to complex calls, including Afterhours/Weekend Employee Assistance Program calls, triage calls, and provider or member complaints. Ensures accurate, thorough, and correct documentation of these calls
- Responds to deadlines and has work completed on or before deadline 95% of the time
- Utilizes supervision with team coordinator and clinical manager regularly
- Pennsylvania Licensure in health or human services field (LSW, LCSW, LPC, LMFT) and masters degree OR licensed RN (BSN preferred)
- Minimum of three years of relevant clinical experience
- Experience with both adult and child/adolescent populations and mental health and substance use disorder services strongly preferred
- Certification in substance use disorders helpful. PCPC 3rd Edition, ASAM, and Confidentiality Training preferred
168
Licensed Pro Care Manager Ccbh Resume Examples & Samples
- Attends case conferences, interagency and provider treatment planning meetings for assigned members
- Conducts all clinical reviews, service authorization and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services
- Encourages coordination of care with primary care physician and other service providers integral to the member's life
- Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans
- Makes authorization determinations for medically necessary services independently, within the scope of the practice of held licensure
- Monitors and evaluates effectiveness and outcome of treatment and service plans and recommends, modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care
- Possesses excellent clinical skills with sophisticated understanding of the over-all needs of individual members assigned to him or her
- Utilizes supervision with medical director and clinical manager regularly
- Works as part of a team providing clinical expertise and knowledge to member services and other care management staff
- Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented
- Pennsylvania Licensure in health or human services field and masters degree OR licensed RN (BSN preferred) OR Licensed Behavior Specialist (For BHRS levels of care only)
169
Clinical Care Manager Team Lead Resume Examples & Samples
- Leads the clinical and member services teams by directing the activities of team members and draws upon accreditation standards, medical necessity criteria, and clinical expertise to manage all aspects of the ASO
- Serves as the primary liaison between the ASO and the County in discussions specific to level of care determinations, medical necessity evaluations, and second opinions
- Establishes goals and objectives for the ASO clinical and member services teams and individual team members’ roles and responsibilities
- Troubleshoots issues and submits recommendations to the ASO Clinical Manager and Program Director
- Assists with the design, development, and modification of workflows for the ASO clinical and member services teams in collaboration with the County
- Works with providers to ensure available resources are being used in a timely and cost effective manner
- Experience in supervising other
- Educated in current principles and procedures of behavior health care.Knowledge of managed care and state specific expertise preferred
- Strong interpersonal skills and good written and verbal communication skills
170
Jmc-care Manager Resume Examples & Samples
- Current Registered Nurse (RN) license issued by the State of California
- A professional Degree in related Healthcare discipline
- BART or BLS at time of hire with commitment to get BART w/in 6 months of hire date
- Prior case management experience in large,acute care Hospital
- Proficiency in Information Systems,databases, and computer programs including MS Office: Word, Excel, Outlook, PowerPoint, etc
- Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
- Must possess strong interpersonal skills,leadership, negotiation skills, and knowledge of hospital operations
- BSN - MSN
171
Care Manager / Utililization Review Resume Examples & Samples
- Admission and continued stay reviews to ensure that care meets the clinical needs of the clients and reduces financial risk to the facility
- Participates in measures to improve the delivery and utilization of care and to evaluate the effectiveness of these. Enters all authorizations into the MS4/Midas daily
- Expert in documentation, communication, teamwork, and customer service. Advocates for internal and external customers including the client, family, physician, Treatment Team and Managed Care Organization
- Works in partnership with the Physician through rounds and staffing to facilitate compassionate patient communication and advocacy, effective Treatment Team planning and timely discharge planning
- Provides a strategic link between the Managed Care Organization, Treatment Team goals and the financial aspects of care
172
Area Tire Care Manager Resume Examples & Samples
- Provide exceptional customer service and verify that tire care employees are doing the same
- Recognize and resolve customer issues or complaints by determining optimal solutions in a timely manne
- Collaborate with local District Manager to effectively manage employee turnover and retention. Recruit, hire, train, evaluate and coach employees. Make personnel changes as necessary
- Responsible for having familiarity with talent stop to ensure onboarding of new employees is happening properly
- Utilize the Learning Management System and other necessary training tools to verify that training is complete and consistent. Responsible for following up on training regularly
- Address employee issues in an appropriate and timely manner. Utilize the progressive discipline policy to manage employee issues. Collaborate with the local District manager as necessary to manage employee issues
- Ensure proper labor management and effective scheduling at each tire care location
- Delegate tasks as needed and follow-up with employees to ensure that tasks are being completed
- Verify proper invoicing and payment processing for services performed at each location
- Effectively manage fleet of tire care trucks and ensure each location is taking proper care of tire care truck, and providing routine safety training to prevent accidents in the tire care truck
- Identify areas of opportunity on the monthly P&Ls and 13 weeker reports and implement plans to correct any issues
- Ensure each tire shop facility is clean, organized and secure
- Ensure HAZCOM Manuel and Safety Data Sheets are being updated regularly
- Promote safety-first work practices. Maintain a safe facility and use safety first practices to remain accident free
- Maintain personal grooming standards
- Other duties assigned by your supervisor
- Skills
173
Rn Transitional Care Manager Resume Examples & Samples
- One (1) year of clinical experience in post-acute care setting preferred
- Prior case management, utilization review, and discharge planning experience preferred
- Certified Case Manager (CCM) or Board Certification in Nursing Case Management (RN-BC) preferred
- Admissions experience preferred
- Must implement the standards of practice for care management, ethical performance, and functions relevant to coordination of care
- Must be able to read, write, speak, and understand the English language
174
Clinical Care Manager Resume Examples & Samples
- Support the development and implementation of care management activities for high risk patients such as those who are not meeting desired clinical outcomes, who have frequent hospitalizations or ER visits, and those with uncontrolled multiple chronic conditions in the ambulatory setting
- Develop comprehensive care plans and document progress and interventions in the Electronic Health Record (EHR)
- Develop and implement a patient risk stratification model that aims to identify patients with chronic disease who are at risk and may require focused care management support to achieve the patients’ optimal health goals
- Collaborate with Data Analyst to create, use, and maintain a care management reporting structure that identifies patients who are likely to benefit from care management services and is able to track the progress of eligible patients who are receiving care management services
- Targeted clinical assessments, medication reconciliation, psychosocial and self-management assessment and support, multi-disciplinary care planning, identification of relevant social determinants of health, and ongoing treatment plan adjustment and evaluation
175
LVN Medication Care Manager Resume Examples & Samples
- Overseeing coordination of residents’ health and wellness needs
- Have a current state license as a Practical Nurse/Vocational Nurse
- Ability to handle multiple priorities
176
RN Care Manager Resume Examples & Samples
- Provides discharge/transition assessments
- Participates in system-wide development of clinical best practice pathways
- Provides patient education materials, order sets, and implements successfully
177
Memory Care Manager Resume Examples & Samples
- Conduct pre-residency assessments and screening of potential residents and make recommendations for appropriate level of residency in conjunction with the Admissions Committee and other team members
- Evaluate the psychosocial and activity of daily living (ADL) needs of residents in Memory Care and coordinating care and services as needed
- Monitor the successful engagement of activities for residents with cognitive impairment throughout the Continuum of Care
- Lead a holistic, Person-Centered approach to assessment and service/care planning
- Work with interdisciplinary team to communicate with residents and families before plan of care is changed (when possible) or when there is a change in the resident’s condition
- Partner with Assisted Living Manager to develop support groups and educational programming opportunities for residents and family members in the Memory Care neighborhood and partner with Independent Living and Post-Acute Social Workers to effectively support Residents transitioning between levels of care
- Educates residents about the importance of Advance Directives and facilitates completion of such documents
- Maintains a working knowledge and ensures compliance of Federal, State, and local regulations, as well as facility policies regarding Memory Care (and level of care – LTC or ALF)
- Social Work degree or degree in related field is required
- Greater than 5 years related experience in providing services for residents with cognitive impairment and or managing/leading a Memory Care neighborhood required
- Demonstration of progressive approaches to supporting and enhancing the quality of life for seniors with cognitive impairment
- Must demonstrate knowledge of geriatric population and the aging process; including the physical, psychological and social needs of the elderly
178
Care Manager Resume Examples & Samples
- Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team
- Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients
- Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team
- Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population
- Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues
- Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies
179
RN Care Manager Resume Examples & Samples
- Performs a comprehensive assessment on a targeted patient population as defined by MGH/MGHPO and contractual constituents
- Identifies key barriers to care and patient’s ability to manage their health and wellness through initial and on-going assessments
- Develops and ensures the implementation of a comprehensive plan of care in conjunction with the patient’s PCP, appropriately utilizing the menu of services for patients, as well as, insurance approved, community and practice-based and MGH services
- Ensures that all elements critical to the plan and trajectory of care have been communicated to the patient/family and members of the Interdisciplinary Team
- Communicates and collaborates with care teams during the various points of transition of care and monitors patients in non-acute facilities in collaboration with the iCMP Care Team
- Attends patient/family Team meetings as appropriate
- Identifies patients/families with complex psychosocial and non-medical discharge planning issues and refers to and collaborates with other iCMP team, members as appropriate
- In collaboration with iCMP team, monitors the patient’s progress and plan of care with the aid of internal and external utilization and quality guidelines. Identifies, documents, and reports issues and system barriers
- Facilitates and participates in iCMP team meetings, team conferences, and case review meetings
- Graduate of an accredited clinical program is required. (for RNs: BSN strongly preferred; new grads must have BSN)
- 3 years of clinical experience strongly preferred; Case Management experience preferred
180
Care Manager Resume Examples & Samples
- Provide coordinated care management services to persons with psychiatric disabilities and other chronic behavioral and physical health conditions in accordance with agency/SBU, NYS OMH, NYS DOH, Health Home, Suffolk County DMH and Medicaid guidelines and regulations, policies and procedures
- Care Management services are provided to clients in the field which requires use of one's own vehicle for travel to/from appointments and for transporting clients as necessary
- Perform Health Home services and support agency clients in the development and fulfillment of life and recovery goals in an individual and group format
- Assist clients to improve health outcomes and to increase independent control over their lives and become active and contributing members of their community
- Complete required client and program record keeping and documentation in accordance with professional standards and the guidelines and regulations stipulated by the NYS DOH Health Home Initiative, the NYS OMH Suffolk County Division of Community Mental Hygiene and the Office of Compliance and Audit for SBU
- Develop systematic and comprehensive knowledge of client rights and entitlements, community, behavioral and physical health, other resources and referral and grievance procedures
- Develop practices in accordance with the advocacy/empowerment theoretical model, operating from a client-centered, strengths and recovery-based social work practice orientation
- Develop necessary education and skills to assume the role of the Care Manager in the Medicaid Health Home Initiative
- Participate in outreach activities to potential and former clients
- Provide health education to client community and take leadership in implementing community based programs and initiatives and advocacy-oriented projects, to organize and educate others on health and recovery oriented issues and obstacles faced by client population
- Attend required and recommended component, staff, in-service and web-based training, meetings and activities
- Participate in critical reflection of one's practice and provide feedback and support to staff and colleagues
- Perform other duties and responsibilities assigned by the agency Director and in specific those necessary for the successful conversion of the agency's case management program to the Medicaid Health Home Initiative
181
R.N Transitional Care Manager Resume Examples & Samples
- Interact with all levels of nursing and other departments to assure effective utilization of resources meet the physiological and safety needs of the patient and their families
- Coordinate the transfer of patients as instructed by the Medical Director or PCP
- Contact RN/Social Worker at the hospital or facility receiving the patient, to communicate plan of care
- Arrange direct admissions to hospitals and placement in nursing homes. Assist PCP in placing patients in skilled nursing facilities
- Proficiency with computers including Microsoft products, Word, Excel, and Outlook
- Ability to travel locally, within the Greater Tampa Area, up to 75%
182
Care Manager Resume Examples & Samples
- Respects the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practices within the scope of ethical principles
- Utilizes outcomes data to improve ongoing care management services
- Be enthusiastic, innovative, and flexible
183
Clinical Care Manager Resume Examples & Samples
- An RN license for Arizona is required
- 3-5 years of clinical practice experience is required
- Strong organizational skills are required
184
Clinical Care Manager Resume Examples & Samples
- Minimum of 3-5 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
- Some familiarity with the Spanish language required
- Active, unrestricted RN License for State of FL required
- Experience with the adult population highly preferred
- Discharge Planning experience preferred
185
Clinical Care Manager Resume Examples & Samples
- Minimum of 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
- Home Care experience is preferred
- Program of All-Inclusive Care for the Elderly (PACE) is preferred
- Certified Home Health Aide (CHHA) is preferred
186
Expert Care Manager SAP Ariba English Resume Examples & Samples
- Works with designated contacts from the customer to answer their functional questions regarding supported Ariba products
- Conducts site visits (maximum of two per year) to the customer to better understand their support needs
- Provides monthly customized reports to the customer of their Ariba Customer Support activity in a format and including data as agreed with the customer, which may include service request status and updates, categorization of issues raised, identification of recurrent issues and related training needs, service level tracking, etc
- Fluency in English or English and French
- Ability to work effectively under pressure
187
RN Care Manager Resume Examples & Samples
- Experience with INTERQUAL or Milliman
- Electronic Medical Record (EMR) experience; Cerner strongly preferred
- One year of care management experience in a hospital setting; three years of hospital based care management experience preferred. An equivalent combination of education and/or experience may be considered
- Knowledge of admission and continued stay criteria
- Knowledge and skills necessary to evaluate appropriate care for patients from neonates to geriatrics
- Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS
- Excellent interpersonal skills and the ability to effectively communicate verbally and in writing providing excellent customer service
- Computer literacy and proficiency in Microsoft Windows
- Basic proficiency with MS Office (Outlook, Word, Excel, PowerPoint, Publisher)
188
Licensed Pro Care Manager Resume Examples & Samples
- Demonstrates excellent clinical, written and oral communication skills
- Demonstrates knowledge of clinical treatment, case management and community resources
- Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care
- Identifies provider issues and recommendations for improvement
- Independently problem solves based on advanced-level knowledge of the service delivery system, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization
- Maintains contact with and refers members to community based case management services as appropriate
- Participates in CQI activities and provider training
- Responds to member and provider complaints according to Community Care's policies and procedures
- Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members
- Experience in managed care strongly preferred
- Certification in substance use disorders helpful
- Supervisory or other leadership experience in behavioral health also preferred
189
Lead Med Care Manager Resume Examples & Samples
- Checks for medication updates with Resident Care Director (RCD) or Wellness Nurse
- Partners with community team to ensure community is in compliance with OSHA requirements and promotion of Risk Management programs and policies; adherences to safety rules and regulations
- Reports all unsafe and hazardous conditions/equipment immediately
- Utilizes the Sunrise Problem Resolution system
- Minimum of one (1) year experience working with seniors in assisted living, home health, independent living, hospital or long term care environment and desire to serve and care for seniors
- Medication Management Certified with a successful completion of Sunrise University mediation management training
- Demonstrates leadership competencies
- Ability to make choices, decisions and act in the resident's best interest
190
RN Care Manager Resume Examples & Samples
- Assesses for appropriateness of level of care setting from admission through discharge
- Identifies patients requiring care management and takes the lead as care manager for those requiring intervention, especially with clinically complex cases
- Conduct on-site review of medical records at clinical facilities according to organization standards
- Maintain frequent telephone contact with clinical service providers to perform defined duties and facilitate communication between the organization and the provider
- Document UR/case management activities such as precertifications, concurrent and retrospective reviews
- Consult regularly with other organization staff to review treatment plans when level of clinical care requires further clarification
- Maintain a tracking system and clear, concise records for monitoring and reviewing cases
- Prepare documentation/case synopsis upon closure of cases as required by clients
- Provide phone crisis intervention services and precertification evaluations for inpatient hospitalization and other levels of care
- Provide consultation and training to providers regarding authorization procedures and utilization review for a specific course or nature of treatment
- Contribute to policy review and procedure development and evaluation
- Performs other duties as assigned, some of which may be essential to the job
- BSN required within 5 years of employment
- Minimum of 3 years of clinical nursing experience, required
- Knowledge and experience with managed care, required
191
Cost of Care Manager Resume Examples & Samples
- Requires a BS/BA degree; Financial, Business, and Leadership acumen; at least 5 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background
- MBA, MHA, MA preferred. PMP or Six Sigma Green Belt preferred
- Prior experience with provider network contracting, provider networks, claims, finance, and operations preferred
- Medicaid business experience preferred
- Knowledge of FACETS, WGS, or other claims software systems
192
Care Manager Resume Examples & Samples
- Prior Managed Long-term Care experience
- Demonstrated home care knowledge
- Bilingual, English and Russian or Cantonese/Mandarin
193
Care Manager Resume Examples & Samples
- As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management. 1.1. Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services and case management. 1.2. Reviews the healthcare information with healthcare team. Reviews the admitting diagnosis/problems with the healthcare team. Monitors the course of patients and the adherence of this course to clinical pathways or the patients' treatment plan. 1.3. Reviews the plan with physician, primary nurse and other members of the team as appropriate and insures that communication is taking place with patient and family. 1.4. Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations. 1.5. Facilitates communication within the health care team and with the primary care physician and other disciplines to coordinate patient's progress through clinical pathways or the patient's treatment plan. 1.6. Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient's treatment plan
- Optimizes the efficiency of hospital systems which impact quality and/or length of stay 2.1. Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan. 2.2. Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations. 2.3. Identifies trends, themes, and consistent barriers and work collaboratively with healthcare team 2.4. Intervenes when necessary to correct delays and to address any barriers for patients
- Utilizes information obtained from various resources available to: 3.1. Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team. 3.2. Collaborate with health care team to initiate referrals to the appropriate service and/or provider, ensuring that adequate insurance coverage and reimbursement are obtained. 3.3. Identify patients who are likely to have unmet insurance and resource needs and communicate with healthcare team members and other appropriate departments. 3.4. Communicate as needed with third party payors regarding the patient's progress with the treatment plan. 3.5. Collaborates with case manager and representatives from third party payor regarding services available when barriers are identified. 3.6. Review admissions daily to ensure appropriateness
- Assist clinicians in documenting the appropriateness of admissions and continued stays 4.1. Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials. 4.2. Appeal of inappropriate insurance denials
- Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include: 5.1. Identifying service, treatment and funding options; 5.2. Advocating for individual needs as indicated; 5.3. Identifying gaps in the treatment and/or discharge plan 5.4. Utilizing knowledge of internal and external resources to meet patient needs; 5.5. Identifying barriers to wellness within the treatment plan; 5.6. Coordinating and scheduling interdisciplinary meetings with the patient and family regarding discharge needs and the plan; 5.7. Ensures and/or coordinates counseling and teaching for discharge preparation
- Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through. 7.1. Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum. 7.2. Ensure that appropriate services are provided and that necessary certifications for these services are carried out
- Along with other members of the health care team, acts as a patient advocate. 9.1. Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk. 9.2. Educates patients and families regarding the care manager role, as needed. 9.3. Facilitates and ensures open communication among the health care team and the patient/family. 9.4. Performs miscellaneous duties as required or requested
194
Care Manager Resume Examples & Samples
- Collaborates with multiple departments within UPMC (e.g. Fiscal, Patient Access, DEC, and PBS)
- Completes accurate, timely, and thorough documentation in the Psych Consult Care Management application
- Completes pre-certification and continued stay reviews within the designated MCO timeframes
- Coordinates MD-MD reviews with the MDs and CM administrative staff
- Demonstrates proficiency in Psych Consult Care Management, Psych Consult Provider, Medipac, & SharePoint
- Displays a positive attitude and be a helpful team member within the CM department
- Documents pertinent clinical information on the Care Management Abstract
- Effective communication with WPIC management regarding authorization challenges, MCO changes, disposition challenges, updates regarding cases in denial, etc
- Gathers and maintains current patient progress from unit documentation, treatment team meetings, disposition meetings, etc
- Maintains a thorough understanding of Care Management standards and processes as defined the various managed care organizations
- Participates in departmental performance improvement projects
- Participates in telecons, grievance hearings, and DPW pre-hearings/hearings
- Reviews and completes MA late pick-ups
- Writes letters for provider appeals, member grievances, & DPW requests
- Master’s degree prepared – OR – Registered Nurse
- 3 years clinical experience required
- Behavioral health background preferred
195
Body Care Manager Resume Examples & Samples
- Exemplifying integrity, responsibility, and excellence and adhering to all policies
- Creating an inviting, full and shopable department
- Ordering for the body care department and maintaining accurate inventory levels
- Managing margin and overall department profitability including minimizing shrink and maximizing effective purchasing
- Ensuring all in-stock products/conditions meet company standards
- Merchandising shelves, endcaps and dynamic displays
- Managing and participating in tagging, facing, rotating, cleaning, markdowns, stocking, and backstock
- Training and monitoring department personnel including assigning and following up on tasks
- Working with other department managers to cross-train staff to accomplish all needed tasks
- Assisting in interviewing and hiring for department needs
- Working with the store manager to address performance and/or disciplinary issues within the department
- Opening and closing of store, including DSR and the closing cash process
- Handling register functions including backup cashiering, managing customer returns, addressing customer complaints, and covering register shift changes, including those for scheduled breaks
- Answering customer questions per company standards and policies, including the use of Structure/Function statements and/or statements of nutritional support
- Continually increasing product knowledge
- Using SAP and inventory management software, running and analyzing reports on BEx, emailing and utilizing other IS programs as needed
- Working a schedule based on store needs which includes evenings, weekends, holidays. Position requires working five days, 40 hours per week and attending mandatory store meetings
- 1-2 years of experience in retail experience in a grocery or retail environment preferred; natural foods background is a plus
- 1-2 years of experience supervising others preferred
196
Integrated Care Manager Resume Examples & Samples
- Knowledge of treatment care resources as well as available levels of care
- Ability to relate effectively with behavioral health and medical treatment providers
- Use of multiple clinical systems
- Desktop technology skills
197
Care Manager Resume Examples & Samples
- Provide a brief initial screen to discern risk and/or immediate intervention, and triages callers as needed to the appropriate resource
- Provides direct assistance to callers requesting information about services, including eligibility and scope of service
- Conducts assessment of the user’s need for core Employee Assistance Program and work/life services, and links to appropriate resources
- Gathers all required demographics and eligibility data from the caller, enters data into the case management system
- Knowledge of counseling principles
- Some experience in core service areas of child development, parenting, adoption, education, services for older adults, addictions, emotional well-being, work issues, and critical incident stress debriefing
- Knowledge of mandated reporting procedures
- Knowledge of case management standards
- Strong computer skills, excellent communication and telephone skills
- Ability to prioritize and multi-task in a high volume call center environment
198
Member Care Manager, Lead Resume Examples & Samples
- Act as a direct liaison between hoteliers and internal teams, in addition to being the primary point of contact for internal issues that require advanced troubleshooting
- Assist in the hiring process for new Member Care Managers
- Effectively manage hotelier expectations related to reservation contribution, service delivery, etc
- Review hotelier concerns including, but not limited to hotel operations, reservation delivery, feedback scores, quality assurance scores, sales and marketing techniques, revenue management, etc
- Implement Action Plans to achieve a solid Return on Investment (ROI), and assist team members in doing so as well
- Assist with and administer special projects when needed
- Track and record all hotelier correspondence
- Previous experience in the hospitality industry is preferred (front office, reservations, or sales background)
- Must have served in the Member Care Manager role for a minimum of one year
- Working knowledge of industry revenue production and distribution channels (OTA, GDS, FIT, Consortia, etc.)
- Must possess and be able to demonstrate exceptional customer service and leadership skills
- Customer-oriented work approach including issue resolution/problem solving
- Ability to work independently and in a team environment, effectively helping to set and meet deadlines
- Ability to multi-task, completing priorities
- Must possess professional correspondence and written skills
- Proficient in MS Office, including Word, Excel, Outlook, and PowerPoint
- Position is located in Coral Springs, FL; however, candidate must be able to travel a minimum of two weeks per year
199
California Care Manager Resume Examples & Samples
- Completes telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent and routine referrals
- Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply national medical criteria and certification decisions that are within the scope of practice that is relevant to the clinical areas under review. Utilizes professional knowledge to apply national medical necessity criteria and contract-specific criteria in rendering certification decisions. Applies Beacon Health Options policies and procedures consistently
- Documents all clinical information in the appropriate system following appropriate policy or account specific procedures
- Maintains individual productivity and performance standards, as well as the telephone service standards which are in effect at the time
- Knowledge of treatment care resources and levels of care available
200
Care Manager Behavioral Telehealth Resume Examples & Samples
- Obtains patient information from referring healthcare team and available medical records
- Coordinates with referring healthcare team to setup appointment, space, and telecommunication technology
- Contributes to healthcare team’s, patient’s and family’s understanding of social and emotional elements of patient’s life related to diagnose and treatment
- Identifies and effectively utilizes community resources to help meet patient needs
- Monitors patient’s progress and intervenes, as necessary, to ensure care provided is patient focused, high quality, efficient, and cost effective
- Master’s Degree in Social Work or Master’s Degree in Counseling, required
- Licensed Mental Health Counselor (LMHC) or Licensed Master’s Social Work (LMSW) Required
- Previous Acute Psychiatry experience required: CPEP (preferred), Mobile Crisis, Inpatient Psychiatry, Hospital-based Outpatient Psychiatry
- Ability to communicate well and effectively interact with team members and patients
201
Care Manager Resume Examples & Samples
- Authorize Care based on pre-existing criteria and follow the member thorough discharge, step down and out patient care
- Assist with discharge planning referrals
- Receive member calls that are escalated, either from customer via crisis line or directly from the member
- Care manager may handle telephonic/web-video consultation with EAP members
- Review risk assessments and provide problem solving assistance
- Social Work License (LCSW, MSW)
- OR Licensed Professional Counselor (LPC)
- OR Licensed Marriage and Family Therapist (LMFT)
- OR PHD related field
202
Care Manager Resume Examples & Samples
- Conducts reviews for medical necessity of psychiatric/substance abuse cases utilizing professional knowledge while applying Beacon Health Options criteria consistently and render certification decisions that are within the scope of practice that is relevant to the clinical areas under review
- Utilizes rounds and case consultations with Clinical Supervisor/Manager/Director and Medical Director/Peer Advisor for cases outside criteria or not progressing
- Refers cases to Peer Advisors that do not meet criteria for decision of medical necessity
203
RN Care Manager Resume Examples & Samples
- Assesses the patient’s needs, goals, and barriers in relation to the patient’s clinical condition, psychosocial environment, and socioeconomic resources
- Assures compliance with regulatory and payor source requirements regarding patient status and case management
- Collaborates with the patient, family or other caregivers and the multidisciplinary team to design a discharge plan respective of the patient’s needs and goals. Re-evaluates and revises discharge plan of care as additional information is obtained or goals change
204
Utilization Care Manager, LVN Resume Examples & Samples
- California LVN unrestricted, active license
- Education, skills, knowledge and competencies as defined for the Utilization Management Nurse Associate Knowledge of NCQA and federal and state requirements highly desirable
- Proficient computer skills, use of Word and Outlook, Excel preferred
- 2 years managed care experience preferred 2-3 years acute clinical experience required
- This is primarily office work Requires being seated for several hours a day
- The employee regularly communicates via telephone, computer and in writing
- Non-telecommuters can expect to work in a climate controlled environment with generally quiet noise levels
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Care Manager Resume Examples & Samples
- Responsible for maintaining accurate information in Beacon’s clinical documentation systems
- Identify, assess, and holistically manage complex behavioral health cases for assigned members
- Provide health coaching and wellness education to members as appropriate
- Develop or oversee the ICP for each member in collaboration with all team members (i.e. Primary Care Providers, Behavioral Health Providers, Health Plan Case Managers), adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes
- Utilize the evidence based guides to identify problem areas
- Call Center, Customer Service experience a plus
206
Hosting Care Manager Resume Examples & Samples
- Create a productive, high-energy, and achievement oriented team environment
- Empower your teams to make the customer’s experience truly exceptional
- Promote a learning organization
- Set examples for operation in areas of personal character, commitment, organizational and communication skills, and work ethic
- Conduct one-on-one reviews on a bi-weekly basis with all supervisors to build more effective communications, bring focus to alignment of activity and outcomes, understand training and development needs, and to provide insight for the improvement of overall teams’ performances
- Perform weekly staff meetings with supervisors for personal and group learning
- Always be moving and visible on floor to have connections with employees and customers
- Be the voice of the teams to other departments – escalate issues that impact our customers or inhibit our employee’s ability to succeed
- Drive the commitment to continuous improvement for the team, department and company
- Oversee action and performance plans for individuals as well as for teams
- Assist in the development and implementation of customer programs in Customer Care Center
- Review staffing needs and monitor multiple inbound call, chat, ticket and outbound queues
- P&L Responsibility
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Clinical Care Manager Resume Examples & Samples
- Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible
- Evaluates clinical appropriateness of treatment using professional knowledge within Beacon clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions
- Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets Beacon criteria for medical necessity
208
Access Care Manager / Sjmc Pacu Resume Examples & Samples
- Previous experience in Utilization Review, Milman, Interqual highly desired*
- 2 - 4 years Clinical Healthcare (Required)
- 2 - 4 years UR or CM with working knowledge of InterQual or Milliman. (Required) 4 - 6 years Acute Hospital (Preferred)
- 4 - 6 years UR or Care Management (Preferred)
209
R N Transitional Care Manager Resume Examples & Samples
- Coordinate and evaluate the transition of care needs for patients admitted to acute facilities and skilled nursing facilities to achieve high quality care
- Communicate with hospital, attending physician and Primary Care Physician (PCP) the daily tracking of all hospital and nursing home admissions and discharges for both statistical and cost management purposes
- Communicate with Center Administrators and Care Coach on members’ discharged from inpatient facilities to assure appropriate medical care follow up
- Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements
- Verify membership eligibility prior to delivery of services
- Obtain routine updates on all nursing home patients
- Maintain daily logs of hospital admissions and discharges
- Collect, prepare and maintain data utilized for quality and utilization management
- Prepare reports as requested by management
- Active FL RN license without restrictions
- Active CPR-BLS from the American Heart Association or ability to obtain prior to start date
- Minimum of 1 year prior acute care experience or inpatient Utilization Review experience
- Ability to problem solve and take initiative to best meet patient needs
- Must be able to interact and communicate effectively with patients
- Ability to travel locally, within the Broward County Area, up to 75%
- If selected for this role, you will be required to complete and pass a background check/investigation for AHCA compliance
- Knowledge of MCG, Interqual, or CMS guidelines
- Prior Disease Management or Case Management experience
- Prior Electronic Medical Records experience
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RN Care Manager Resume Examples & Samples
- Communication. Effectively communicates with patients, family members, caretakers, physicians, other providers, and their staff on a regular basis
- Records Management. Ensures clinical information in the medical record and/or care management software is clear, complete, and reflects the patient’s true severity of illness by interacting with providers and staff to improve the overall quality of the clinical documentation
- Regulations. Maintains HIPAA standards and ensures confidentiality of protected health information
- As Assigned. Performs various duties as needed to successfully fulfill the function of the position
211
Practice Based Care Manager Resume Examples & Samples
- Assess patient's appropriateness for enrollment into the Chronic Care Management program in terms of meeting criteria, approval by PCP, and patient and families willingness to participate. This will include in depth chart review to assess patient eligibility into the Focused Care Program
- Perform telephonic outreach to all Medicare Focused Care Program eligible patients to discuss their current health state and encourage them to participate in this Medicare-sponsored program
- Documents all assessments, interventions and plans of care completely and accurately into the electronic health record
- Follows up with patient and/or care givers on a regularly scheduled basis to assess patient's medical status or compliance to plan or to offer assistance as needed
- In collaboration with the team, develops and coordinates an individualized plan of care with the patient, patient's family, health insurance plan, providers and community agencies as applicable. Involves additional providers as needed to support the individualized plan of care based on identified needs of the patient and family and/or care giver. Plan designed to promote health, close gaps in care, decrease unplanned care
- Maintains availability to patient and /or care giver as needed by phone or visit. Rotates call by phone according to systems developed in the practice for Chronic Care Management program
- Meets face to face with patients and family members as needed to build a relationship, assess the patient's medical, behavioral health and social needs, identify barriers
- Actively participates in and collaborates planned team meetings with physician office clinical staff and/or physicians to monitor patient's status, evaluate the effectiveness of the individualized plan of care, and identify new needs and strategize for next steps
- Works very closely with and maintains open communications with the Primary Care Physician of the extensive care program for direction and collaboration related to patient needs and assessment
- Two (2) years of nursing experience in an outpatient setting required
- BSN or related Bachelors degree preferred, but not required
- Experience in a physician practice and/or home health care highly desired
- Previous telephonic nursing experience a plus, but not required
- Ability to interact with physicians and other health care professionals in a professional manner required
- Must have an understanding of health care disparity issues and have the ability to interact with members from diverse backgrounds in a culturally appropriate manner
- Ability to use independent judgment and compassion when carrying out tasks
- Must be flexible with work schedule and may occasionally have to travel between offices as needed
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Behavioral Care Manager, Per-diem Resume Examples & Samples
- Uses language and behavior to promote dignity and respect
- Uses psycho-ed and self-help linkage to promote self reliance
- Understands concepts of empowerment and recovery
- Can identify major classes of psychotropic medications and their intended effect and side effects, possible interactions with other substances, and addictive potential
- Can provide behavioral tailoring and support for medication adherence
213
Care Manager Resume Examples & Samples
- Mediates, advocate and negotiates with care providers and engages additional providers when needed in order to improve individual outcomes for a Member
- Collaborates with the Department of Children and Families and the Department of Social Service as necessary to improve outcomes for a Member
- Participates in multidisciplinary team reviews when convened to review existing care plans to ensure they adequately address the complex behavioral health issues
- Responsible for the intensive care management of designated Members who meet ICM criteria in a designated DCF local area; will at times work out of a local area office when space is available
- Works no less than 20% of the time in the field providing care management services and consultation
- Builds, develops and maintains a positive and collaborative relationship with local providers by establishing a local presence
214
RN Care Manager Resume Examples & Samples
- Graduate of an accredited Associate’s or Bachelor’s of Science Degree in Nursing program required
- Graduate of an accredited BSN program in Nursing preferred
- A minimum of 3-5 years recent clinical experience required, 1-3 years of recent acute, Inpatient Care Management experience required
- Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology: establish treatment goals; establish working relationships with referral sources; develop treatment plans
- Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand the physical and psychological characteristics of illness and assist individuals with the development of short- and long-term health goals
- Ability to understand the requirements for prior approval by payer; evaluate the quality of necessary medical services, acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings
- Work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families
215
Care Manager Resume Examples & Samples
- Execute on Claims Department strategies to achieve Claims quality, customer service and operational objectives
- Manage, lead and develop claims staff
- Create an environment to provide opportunities for all associates to reach their full potential
- Develop a partnership with sales and underwriting to deliver customer service and foster agency relationships consistent with State Auto’s mission, vision and values
- May work closely with claims counsel, general counsel, and reinsurers
- Prepare and manage department budgets
- 10 years or more in property and casualty claims handling experience preferred
- 3 or more years experience in training, leading, and supervising the work of others is required
- High school degree or equivalent; college degree preferred
- Insurance designation preferred
- Basic computer skills and Microsoft applications
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Care Manager Resume Examples & Samples
- Provides telephonic member assessment as the result of inbound and outbound member phone calls
- 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 care management objectives
- Manages 60+ members based on case intensity and acuity. Specialty Care Manager case loads may vary
- Schedules or facilitates scheduling appointments and follow-up services
- Contacts members to remind them about upcoming appointments and/or missed appointments
- Some state/market care managers may be responsible for Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations
217
Emergent Care Manager Resume Examples & Samples
- Serve on the SDC LT and own the shared responsibilities for the whole strategy of staff training, development, and care
- Ensure the integration of training, development, and care into the life cycle and health of all Navigators in partnership with the Missions, ministries, networks, and departments
- Ensure consistency and quality in staff training and development throughout the organization
- Steward The Navigators Core while developing individuals for aligned organizational and personal outcomes
- Platform the strategic priorities of the NLT in staff training and development, to ensure these priorities are valued, owned, and practiced by all Navigator staff
- Execute best practices in developing all of our staff throughout their entire career with The Navigators
- Create a culture of valuing one’s unique design and encourages the pursuit of life-long learning
- Work directly with the Director of Staff Care to develop and implement emergent care resources and practices throughout the Navigator organization to effectively respond to instances of urgent need for staff in crisis
- Manage all emergent care resources and practices for The Navigators
- Lead the establishment of long term plans and practices for follow-up care after the emergent need is over, coordinating with staff and supervisors
- Manage the availability of qualified emergent care resources through godly, certified counselors, trained to meet the particular emergent (crisis) needs common to the Navigator work
- Evaluate the effectiveness of emergent care including
- Raise and maintain personal funding to meet salary, benefits, and personal ministry needs
- Directly supervise the Emergent Care staff team, and oversee and manager a network of trained, certified counselors
- Perform annual Plan and Progress Reviews (PPR) for all direct reports
- Approve expense reports for direct reporting staff
- Model The Navigators Core Leadership Model (lead, develop, care), lead with a developmental bias, and engage in lifelong learning
- Serve on additional job related teams as needed
- Belief in and adherence to The Navigators Statement of Faith
- Is strongly grounded in the Scriptures
- Master’s Degree or above in related areas of understanding and competence, or equivalent experience
- Minimum 7 years Field ministry or equivalent experience
- Navigator experience strongly preferred
- Experienced in leading and managing a team and other leaders
- Experienced in leading people development and training
- Demonstrated high collaborative ability
- Possesses high emotional and cultural intelligence
- Able to lead and develop the next generation
- Understands and has experience to lead and instruct in change leadership
- Demonstrates effective communication skills, both verbal and written
- Able to align resources to achieve strategic goals
- Has passion and conviction in developing the maturity of our staff
218
Licensed Field Based Care Manager Resume Examples & Samples
- Performing care management activities to ensure that patients move through the continuum of care efficiently and safely
- Assessing and interpreting customer needs and requirements
- Reviews cases and analyzes clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization
- Performing Clinician to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plans
- Escalates cases to the Medical Director for case discussion or peer - to - peer intervention as appropriate
- Performs anticipatory discharge planning in accordance with the patient's benefits and available alternative resources
- Collaborates with Medical peers on consideration of discharge planning needs
- Refers patients to disease management or case management programs
- Assists with the development of treatment plans
- Documents activities according to established standards
- Identifies solutions to non - standard requests and problems
- Develop plans and supportive services for patients to achieve stability and adaptive functioning to become independent
- Support mental services and integrated substance abuse treatment, supporting medication management, symptoms management, rehabilitation, crisis stabilization and psychosocial education on an outpatient basis
- Perform administrative duties related to a client's care including applications for services
- It is essential for this position to work with members at various locations, such as the streets, shelter, group home, provider’s offices, facilities and other community locations
- An RN with 2+ years of experience in behavioral health OR Licensed Master's Degree level clinician in: Psychology, Social Work, Counseling or Marriage & Family Counseling; or Licensed Ph.D. or Licensed PsyD; Licensed Marriage Family Therapist, Licensed Clinical Social Worker
- Licensure must be current and unrestricted
- 2+ years of behavioral health clinical experience in an inpatient / acute setting or outpatient setting
- Ability to convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
- Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment and to create, edit, save and send documents utilizing Microsoft Work
- Ability to work in an ever changing work environment
- Knowledge of Level of Care Guidelines (i.e. Milliman, Interqual etc.)
- Prior Case Management experience
- Experience with social security and disability services
- A background that involves utilization review for an insurance company or in a managed care environment
- Previous experience in a telephonic, office based role
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Clinical Care Manager Resume Examples & Samples
- Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
- Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer
- Typical office working environment with productivity and quality expectations
- Bilingual a plus but not mandatory
220
RN Care Manager Resume Examples & Samples
- Develops, coordinates and implements clinical care management through partnership with Social Work Care Manager and Care Management Assistant in collaboration with clinical leadership, physicians, nursing staff, and other interdisciplinary clinicians
- Participates in psychosocial management of patients
- Facilitates plans for the transitions of patient care to the next level and location of care
- Partners with system care navigation resources and care navigators from other settings to provide continuity of care and effective transitions
- Maintains accountability for utilization management and communication with payers to assure continued stay authorization and assists with financial activities affecting the hospital stay
- Conducts review activities on a daily basis following InterQual guidelines
- Performs concurrent reviews to respond to payers
- Registered Nurse with current Minnesota license
- Associate's degree from an accredited school of Nursing required. Bachelor's degree preferred
- Minimum of one to three years working as an RN in an acute care setting including experience working with physicians and various levels of hospital personnel required
- One year of inpatient Care Management / Case Management / Utilization Review preferred
- Professional Practice: Demonstrates behavior consistent with the standards, scope of practice, ethics, and characteristics of a licensed professional
221
Care Manager Resume Examples & Samples
- Bachelor’s degree in Social Work
- 2+ years of social work experience in an acute care or community setting
- Knowledge of government sponsored managed care programs preferred
222
Care Manager Resume Examples & Samples
- Prior case management experience in large, acute care Hospital
- Utilization review/discharge planning experience
- Proficiency in Information Systems, databases, and computer programs including MS Office: Word, Excel, Outlook, PowerPoint, etc
- Fast and accurate typing and data entry skills
- Must possess strong interpersonal skills, leadership, negotiation skills, and knowledge of hospital operations
- Skilled in conflict management and resolution
- Three to five (3-5) years clinical experience or in an acute care setting
- Previous Supervisory/Management experience
- ACM and/or CCM certificate
- Experience with Epic, Midas, ECIN, Interqual
223
Care Manager Resume Examples & Samples
- RN License issued by the State of California
- BART or BLS at time of hire with commitment to get BART within 6 months of hire date
- A professional degree in a healthcare discipline
- Three (3) years of acute nursing experience
- One (1) year of Acute Case Management or Discharge planning experience
- Background in case management, utilization review and discharge planning, home care or managed care or equivalent experience
- Proficiency in Information Systems, databases, and in the use of technology and computer programs including MS Office (Word, Excel, Power Point, Outlook, etc.)
- Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice
- Excellent relationship and management skills, including a high degree of psychological sophistication and non-aggressive assertiveness
- Ability to problem solve, engage in abstract thought, and successfully manage conflicts
- Strong negotiation, organizational, delegation and task prioritization skills
- Ability to construct grammatically correct correspondence and reports using standard medical terminology
- BSN and/or MSN
- EMR, EPIC, Midas, ECIN, Interqual/Milliman, ACOEM experience
224
LPN Care Manager Resume Examples & Samples
- Minimum: Over 3 years and up to and including 5 years of experience in clinical setting demonstrating the ability to assess, document and implement the nursing care plan
- Preferred: 3 to 5 years of acute nursing experience in critical care
- Preferred: HMO experience
225
Care Manager Resume Examples & Samples
- Make clinical decisions related to assessment, referral, coordination of care, and appropriateness of care for members seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care covered by contracts
- Meet departmental standards related to clinical documentation, clinical policies and procedures, accreditation and regulatory standards and contract compliance
- Actively participate in clinical rounds/case review process, and seeks consultation with the Clinical Director and Medical Director
- As necessary, provide clinical oversight and consultation for non-clinical, unlicensed staff members
- Actively participate in designated processes for managing the care of high-risk members
- Critical thinking skills and ability to work independently
- Computer and typing skills necessary
- Must be able to work one weekend shift per month
- Potential work from home opportunity after in office training
226
Care Manager Resume Examples & Samples
- High school diploma or GED required. Bachelor degree in a human service field preferred
- Current valid (per hospital policy) US driver’s license required
- One year experience in a psychiatric or human services setting
- Basic typing skills required
227
Care Manager Behavioral Telehealth Resume Examples & Samples
- Receives and responds to behavioral telehealth consult requests
- Conducts initial psychosocial assessment through telehealth interview with patient, family and/or significant others to determine patient condition/needs
- Reports on patient to attending Psychiatrist for psychiatric evaluation
- Master’s Degree in Social Work or Counseling, required
- Licensed Master Social Worker (LMSW) or Licensed Mental Health Counselor (LMHC), required
- Bachelor’s Degree in Nursing, required. Master’s Degree in Nurse Practitioner Program, preferred
- Prior experience in one of the following areas: outreach, screening, supportive counseling, or case management, required
- Working knowledge of computer applications (i.e. Microsoft, Electronic Medical Record, etc.), required
- Ability to communicate well and effectively interact with team members and patients. Sensitive to cultural diversity and low literacy issues in care provision
228
Clinical Care Manager Resume Examples & Samples
- 3-5 years of Clinical experience
- Clinical experience in Behavioral Health
- Managed Care experience (Case Management & Discharge Planning)
- Certified Case Manager preferred (CCM)
- Associate's Degree in Nursing for a candidate with an active RN License
- A Master's Degree for a candidate with a LCSW or LPCC
- Registered Nurse License (RN)
- Licensed Clinical Social Worker (LCSW)
- Licensed Professional Clinical Counselor (LPCC)
229
Clinical Care Manager Clinical Care Manager Resume Examples & Samples
- Assume responsibility in coordinating care to assigned clients, establishing a goal directed care plan from admission to discharge which includes a comprehensive ongoing assessment of clients’ needs
- Perform on site supervisory visits to assess client, family, environment, and clinical care givers and complete follow-up documentation
- Ensure availability and proper operation of necessary equipment and supplies related to patient care
- Provide direct client care as needed
- Promote and manage expectations and satisfaction with internal and external customers
- Evaluate the quality and effectiveness of nurse practice and nursing services, analyzing appropriate data and information to identify opportunities for collaboration with all stakeholders in order to improve services and patient outcomes
- Provide nursing updates and obtain re-authorization for continued care
- Provide ongoing supervision, orientation, training, education, and evaluation of clinical field staff
- Identify professional practice standards within the organization and identify areas of strengths as well as areas for professional practice development
- Contribute to nursing education and professional development of staff, students, and colleagues
- Participate in employment decisions affecting nursing staff, including hiring and termination as appropriate
- Maintain compliance in accordance with company policies and procedures, laws and regulations, and professional standards within the state of practice
- Maintain a professional demeanor consistent with registered nurse standards of practice
- Provide best practice in delivery of nursing care to the appropriate population and adhere to the standards of professional nursing practice
- Base decisions and actions on ethical principles and foster a non-judgmental, non-discriminatory climate in which care is delivered in a manner sensitive to socio-cultural diversity
- Participate in call for after hour’s client care
- Promote an environment of quality and safe client care through participation, development, and adherence to the QA plan and associated activities and metrics
- If supervising Private Duty has a minimum of two years experience in private duty, home care, or health care and the knowledge, experience and ability to effectively administer the private duty program
- Perform other duties as assigned by supervisor
- Proof of eligibility to work in the United States
- RN licensure in designated states as appropriate
- Knowledge and understanding of compliance with adherence to regulations
- Diploma, Associate, or Bachelor degree in nursing from state accredited RN program
- Strong commitment to clinical excellence
- Ability to resolve conflicts
- Ability to assess clients and provide direct client care as needed
- Possess critical thinking skills
- Valid Driver’s license and Acceptable MVR
230
Clinical Care Manager Resume Examples & Samples
- At least 2-5 or more years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. (3 or more years is preferred.)
- Independent clinical license required, LPC, LMSW or RN
- If RN Behavioral Health is preferred
- Strong computer skills including MS Office, Excel, Word and Outlook
- Strong keyboarding skills and organization skills needed!
231
Care Manager Resume Examples & Samples
- Responsible for inpatient clinical decisions related to beneficiaries seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care using established criteria, guidelines and policies
- Responsible for building positive professional rapport with providers and communicating in a clear and timely manner
- Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are net and that there is continuity of patient care
- Carelink and or MHS
232
EAP Care Manager Resume Examples & Samples
- Applying Beacon criteria consistently to manage risk and urgent situations as well as to deliver services consistently across client organizations and individual situations
- Maintains confidentiality, ethical and professional standards, adhering to Beacon Clinical Policy and Procedures and Benefit Plan requirements
- Basic computer skills required, including Windows, Word, Outlook, Excel, keyboard and mouse operation
- Ability to function an interdisciplinary setting
233
Care Manager Resume Examples & Samples
- Assesses members to determine care coordination and case management needs for all referred members
- Completes comprehensive assessments of environmental, psycho-social and support needs
- Identifies problems/barriers for care coordination and appropriate care management interventions
- Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health
- Shares goals with members and their families as appropriate
- Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress
- Schedules follow-up calls as necessary and makes appropriate referrals to management
- Documents progress towards meeting goals and resolving problems
- Coordinates care and services with members and family members as appropriate, PCP’s, specialists and facility/vendor providers
- Collaborates with department staff to assist members in receiving quality and cost effective services
- Facilitates access to entitlement programs and/or community resources
- Monitors and documents member’s on going progress
- Participates in the discharge planning process for hospitalized members
- Assists members in the transitional process from home to a skilled nursing facility for long-term placement
- Arranges for services/appointments
- Participates on project teams as requested
- Maintains confidentiality of all company, provider and member information
- Identifies and refers potential and actual quality issues to quality management staff
- Keeps up-to-date with case management initiatives
- Attends scheduled meetings
- Obtains necessary educational requirements to maintain professional licensure and certifications
- Complies with AMFC and HIPAA confidentiality requirements to protect member personal identifiable health information
- Performs other related duties and projects as assigned
- Graduate of an accredited college or university with at least a Bachelor’s in Science degree (BSN) or equivalent education and experience
- Three (3) years practice experience
- Three (3) to five (5) years of Care Management experience preferred
- Knowledge of Windows and Microsoft Office applications
- Familiar with accreditation processes such as URAC/NCQA
- Bilingual Spanish preferred
234
Care Manager Resume Examples & Samples
- Current, unrestricted SC Registered Nurse license
- CCM credential with 2 years of hire
- Minimum 1 year of Care Management experience
- Requires relevant experience/education to work with members with complex health, behavioral health, and supports and/or psychosocial needs
235
Care Manager Resume Examples & Samples
- Active South Carolina RN license
- Minimum 5 years nursing experience in managed care and/or hospital setting working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
- Minimum 3 years of Case Management experience along with a knowledge of common behavioral health conditions is preferred
- Must have experience and be comfortable with using technology (e.g., MS Office including Outlook, Word, and Excel) and electronic medical record and documentation programs
- Obtain Certification in Case Management within two years of accepting position
236
Care Manager Resume Examples & Samples
- Complete a comprehensive initial assessment and gathers pertinent information about the member’s needs by interviewing the member, appropriate family members, physicians and other members of the Interdisciplinary Care Team to develop, monitor and evaluate the member’s Individualized Care Plan and update as needed
- Serve as an advocate for the member and acts as a liaison between the member and other community based agencies, facilities, providers, and practitioners in coordinating the member’s care
- Coordinate and perform transition planning for members transitioning between levels of care
- Monitor appropriate utilization of the member’s benefits and coordinates services with other payer sources
- Perform all other duties and projects as assigned
- Minimum 1 year of care management experience
237
Care Manager Resume Examples & Samples
- Associate's Degree, BSN desirable or Social Worker Master's Degree (LMSW)
- Registered Nurse preferred
- 1 – 3 yrs Care Management experience
- The Care Coordinator (RN/LMSW) must have relevant experience and education to work with members with complex health, behavioral health, and/or supports psychosocial needs
238
Care Manager Resume Examples & Samples
- Active Michigan RN license
- 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
- 2 + years’ experience in Behavioral Health Nursing preferred
- Minimum of 3+ years of Case Management experience preferred
- Must have experience and be comfortable with using technology (e.g. MS Office including Outlook, Word, and Excel) and electronic medical records
- Three to five years of Case Management experience preferred
- This position will require the selected candidate to go to provider offices within Wayne and Oakland counties
- Valid driver's license and car insurance
239
Care Manager Resume Examples & Samples
- Minimum 3 years’ experience in behavioral health/human services required, or other equivalent background and experience that would translate well to this position
- Must hold a valid, unrestricted state license in a behavioral health specialty or nursing; acceptable licenses include but are not limited to LBSW, LMSW, RN, LPC
- Must obtain CCM credential within 2 years of hire
- Minimum 1 year of Care Management experience is preferred
- Requires relevant experience/education to work with members with complex health, behavioral health, and psychosocial needs
240
Care Manager Resume Examples & Samples
- The hours will be Monday-Friday 9:00 AM to 5:30 PM
- Unrestricted PA RN licensure required
- Minimum of 3 years' clinical experience with an adult population in an acute care setting (e.g. Medical Surgical floor in a hospital) and/or home care required; behavioral health experience preferred
- 3 to 5 years of Case Management experience within a managed care organization preferred; telephonic case management experience preferred
- Demonstrated ability to assess and engage adult members/patients in the case management program/process
241
Care Manager, LPN 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
- Monitors inpatient, outpatient, and SNF patients and initiate patient care arrangements. Reports findings to Medical Management, Medical Director and Center Administrator
- Provides 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
- Assists with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention
- Ensures 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 Administrator
- Participates in QI projects. Attends Care Management Meetings
- Participates in patient satisfaction programs as required and follows up on all inpatient/outpatient discharges
- Assists the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans
- 1-2 years of previous care management, utilization review or discharge planning experience is preferred
- Ability to perform accurate telephonic triages, accurately record findings with follow-up
- 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 be a clinical resource for non-licensed office staff
- Ability to prioritize and multi- task in a high paced environment with good organizational skills
- Display initiative, accountability and resourcefulness
- Ability to perform care management
242
RN Care Manager Resume Examples & Samples
- Coordinate the member care, services and health benefits with members and their healthcare providers across the continuum of illness
- Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
- Maintain current and accurate documentation of enrollment in care management program
- Maintain appropriate and timely documentation of care plans, case notes, referrals, assessments and other pertinent information in documentation system
- Assist in education of members and Health Partners regarding healthcare access and benefits, and provide them with health education and wellness materials
- Maximize the member’s health, wellness, safety adaptation and self-care through effective care coordination and case management
- Participate in meetings with Health Partners to inform them of Lock-In Program and case management services and benefits available to members
- Facilitate coordination, communication and collaboration with stakeholders in order to achieve goals and maximize positive member
- RN License required
- Three to five (3 to 5) years of experience in nursing, social work or in a healthcare (discharge planning, case management, care coordination and/or community/home health) environment is required
- Five (5) or more years of clinical experience is preferred
- Three (3) or more years of Medicaid/Medicare is preferred
- Intermediate proficiency level with Microsoft Office Suite to include Outlook, Word and Excel
- Ability to communicate effectively with a very diverse group of individuals
- Ability to operate a smart phone, iPad, or other technical equipment to ensure productivity & ability to perform essential functions
- Knowledge of local, state and federal healthcare laws, regulations and environment
- Awareness of community and state support resources for population served
- Effective listening and critical thinking skills
- Adhere to code of ethics that aligns with professional practice
- Critical listening and thinking skills
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RN Care Manager Resume Examples & Samples
- Bachelor’s of Science in Nursing (BSN) preferred
- Three to five (3-5) years of experience in nursing, social work, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required
- Five (5) years or more clinical experience is preferred
- Collaborate with team members to optimize outcomes for members
- Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
- Strong advocate for members at all levels of care
- Proven track record for improving processes to make things easier for those you have served
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Care Manager Resume Examples & Samples
- Determine member and/or caregivers needs regarding financial supports, social supports, psychological supports, and counseling; provide information and referral
- Practice and adhere to departmental and state guidelines
- Managed care experience; must be able to comply with and understand complex organizational, State, and Federal guidelines
- 1 - 3 years required
- Must be NYS licensed as a Registered Nurse
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Care Manager Resume Examples & Samples
- Assess and evaluate member needs by using various data tools and resources
- Assist members and their families in the administration of their health plan benefits, promote medication compliance, align with healthcare professionals, as well as assist in shared decision-making
- Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members
- Interpret and apply case management criteria, processes, policies, and regulatory standards
- Interact with treatment providers, PCPs, and physicians as needed to support the plan of care
- Monitor for clinical quality concerns and refers appropriately
- Ability to adapt and be flexible to change
- Ability to analyze information to construct effective solutions
- Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)
- Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)
- Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)
- Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)
- Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery
- 5-10 years direct clinical experience
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Lead Care Manager Resume Examples & Samples
- Oversee the clinical aspects of Care Coordination as delivered by a pod of Intake and Assessment specialists and Care Coordination staff, which includes review and sign off of assessment of the behavioral health, psychosocial and medical needs of identified members
- Oversee and approve clinical aspects of the creation of a person centered and culturally competent Individualized Care Plans (ICP) to include problem identification, goal-setting in collaboration with members, community based behavioral health providers, primary care physicians and other interdisciplinary care team members to develop a comprehensive and integrated approach to care coordination interventions and expected outcomes
- Develop and/or oversee the ICP for each member in collaboration with all team members, adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes
- Oversee clinical aspects of the Interdisciplinary Care Team (ICT) to ensure that the member goals are being addressed from a treatment team approach and collaborating with the team to complete care plan updates as required
- Ensure member crisis plans are comprehensive and provide clinical oversight on behavioral health crises and emergencies as needed
- Excellent clinical skills with a proven ability to provide clinical supervision to non-clinicians
- Ability to prioritize and manage multiple tasks simultaneously while meeting deadlines for deliverables
- Excellent written, oral and presentation skills
- Strong organization skills, ability to multi-task, ability to manage multiple priorities and work collaboratively within a team environment
- Must be detail oriented; able to work independently in an ever changing environment
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Care Manager Resume Examples & Samples
- Minimum 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
- Minimum 2 years behavioral health experience working either clinic or inpatient setting with patients that have behavioral health conditions
- Minimum 3 years Case Management experience preferred
- Must have experience and be comfortable with using technology (e.g., MS Office including Outlook, Word, and Excel), and electronic medical record and documentation programs
- Ability and willingness to obtain Certification in Case Management within two (2) years of start date
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Clinical Care Manager Resume Examples & Samples
- RN with at least 2-5 years clinical practice experience is required, (inpatient, behavioral health mixed with clinical is preferred as well as pediatrics highly preferred, home health preferred!)
- Managed Care experience preferred !
- Bilingual a plus!
- Must have excellent computer skills including Microsoft Word and outlook and the ability to toggle in multiple windows
- Strong keyboarding experience needed
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RN Care Manager Resume Examples & Samples
- Three (3) years acute care nursing or long-term care experience required
- Must possess knowledge and skills necessary to complete the essential functions of the position
- Experience with utilization management, discharge planning and/or case management is preferred
- Must be able to communicate effectively with patients, families and all levels of health care providers
- Must possess critical thinking skills and be able to work independently with little or no supervision
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Senior Care Manager Resume Examples & Samples
- Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies
- Promote quality and efficiency in the delivery of care management services
- Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws
- Practice within the scope of ethical principles
- Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions
- Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships
- Utilize outcomes data to improve ongoing care management services
- 5-10 years of related, progressive experience in the area of specialization
- Experience in a clinical setting
- Ability to multi task and perform in a fast paced and often intense environment
