Clinical Case Manager Resume Samples

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M Beahan

Michel

Beahan

70385 Sonia Valley

Philadelphia

+1 (555) 549 9011

70385 Sonia Valley

Philadelphia

Phone

p +1 (555) 549 9011

Experience Experience

Los Angeles, CA

Clinical Case Manager

Los Angeles, CA

VonRueden Inc

Los Angeles, CA

Clinical Case Manager

Manage, coordinate care, track and report on all assigned Members in the four various levels of case management: consultation, coordination, ICM, and CCM
Participates in outcome management and utilization review as assigned by supervisor/manager
Maintain ongoing dialogue with supervisor and other health providers to ensure effective implementation of health treatment plan
Maintains ongoing dialog with supervisor and other health providers to ensure effective implementation of health plan
Assist in collection of outcomes information, annual analysis and other reporting and initiatives
Direct Patient Care: Provides back-up staffing for UHS clinic nurses
Perform other related duties as assigned

Los Angeles, CA

Clinical Case Manager / PRN

Los Angeles, CA

Green Inc

Los Angeles, CA

Clinical Case Manager / PRN

Job Specific: Clinical Case Manager RN
Monitors and provides documentation of identified variance days for tracking and trending
Stays current with education related to CMS and HCA billing compliance mandates, monitors and ensures that facility is compliant
Actively utilizes and complies with facility principles of good communication and customer service standards, including use of AIDET as developed by the department
Discharge Planning and Continuity of Care
Facilitates delivery of Patient Information and Choice Letter to assure documentation of patient/family involvement with discharge planning and choice of post-discharge service providers
Facilitates the ordering and delivery of specialized medical equipment, orthotics and prosthetics as ordered by the attending physician

present

Dallas, TX

Clinical Case Manager / Days

Dallas, TX

Jacobson, Toy and Kertzmann

present

Dallas, TX

Clinical Case Manager / Days

present

Coordinates the integration of social services/case management functions into the patient care, discharge and home planning processes with other hospital departments, external service organizations, agencies and healthcare facilities
Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals
Utilization Review, Quality and Compliance Monitoring
Conducts concurrent medical record review using specific quality indicators and clinical decision support criteria as approved by the medical staff, TJC, CMS and other regulatory agencies and document findings
Serves as liaison with Physician Performance Improvement (PPI) to ensure the reporting of quality indicators and care concerns
Reviews all new admissions daily against inpatient screening criteria and communicates necessary changes in status designation to ordering physician and Patient Access
Identifies all observation patients with observation alert sticker, reviews status no less frequently than daily, and communicates directly with the attending physician if severity of illness and intensity of service meet criteria for inpatient admission or when observation hours threaten to exceed 48 hrs

Education Education

Master’s Degree in Social Work

University of Tennessee

Master’s Degree in Social Work

Skills Skills

Ability to make generalizations, evaluations, or decisions based on sensory or judgmental criteria
Ability to work with people beyond giving and receiving instructions
Ability to make independent judgments without supervision
Ability to deal with periodic pressures and levels of responsibility
Ability to perform under stress when confronted with emergency, critical, or unusual situations
Proficiency in Microsoft Office
Excellent verbal and written communication skills
Established commitment to multicultural competencies
Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills
Demonstrated work experience to influence and negotiate to effectively manage patient care and health care outcomes

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Clinical Case Manager Resume Examples & Samples

Provide comprehensive assessment of the patient’s treatment needs and personal support systems
Maintain ongoing dialogue with supervisor and other health providers to ensure effective implementation of health treatment plan
Maintain and utilize a referral database, and coordinate care with other service providers involved in patient’s treatment plan
Periodic re-evaluation and revision of the plan as necessary over the life of the patient, which may include patient specific advocacy and/or review of utilization of services
Education:Bachelor’s degree in social work, psychology, nursing, or related human services field or equivalent combination of education and experience
Work Experience:Two to three years job related experience in mental health
Certifications:N/A
Skills:This job requires demonstrated ability to communicate, problem solve, and work effectively with people; excellent organizational skills with the ability to manage multiple priorities simultaneously; strong analytical skills; knowledge of applicable state and federal regulations; in depth knowledge of case management tools; ability to take initiative and see tasks to completion; excellent verbal and written communication skills; skilled at establishing and maintaining positive and effective work relationships with coworkers, patients, and providers; ability to maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPPA); knowledge of office related computer applications
Preferred Education:Master’s degree in social work, psychology, nursing, or related human services field
Preferred Certifications:Licensed Clinical Social Worker (LCSW), Licensed Independent Clinical Social Worker (LICSW), Registered Nurse (RN), Licensed Mental Health Counselor (LMHC), Licensed Professional Counselor (LPC), or Certified Case Manger (CCM)
Preferred Skills:Experience with facility-based and/or outpatient psychiatric disorder treatment center preferred

Clinical Case Manager / PRN Resume Examples & Samples

Financial Assessment and Coordination
Utilization Review, Quality and Compliance Monitoring
Risk Management/Patient/Customer Safety: Demonstrates patient/customer safety according to policies and procedures
Job Specific: Clinical Case Manager RN
Demonstrate an understanding of HCA's "Patients First" safety initiative through strictcompliance to all safety protocols and procedures

Clinical Case Manager Resume Examples & Samples

Established commitment to multicultural competencies
Candidate must possess strong clinical skills, and experience in handling crisis situations
Strong interpersonal skills required
Experience in a college counseling center
Coordination of referral services and triage

Clinical Case Manager Resume Examples & Samples

Work requires knowledge of
Community resources for multi-generational psychosocial needs, including financial, housing, mental health, substance abuse, domestic violence and bereavement
Adult and Child Protective Services
Medicare & Medicaid policies and criteria
Private insurance
Medical, legal and financial implications for patients
Advance directives
"Do Not Resuscitate" orders
Patient assistance programs for free or reduced cost medications
Psychological pain and addictions
Alternative methods for addressing pain (such as mindfulness, guided imagery, and relaxation techniques)
Working knowledge of the DSM 5 (or most recent DSM)
Grief & bereavement counseling and resources
Procedures for

Clinical Case Manager Resume Examples & Samples

Identification of all assigned ICM Members
Managing, coordinating care, tracking and reporting of all assigned Members in the four various levels of case management: consultation, coordination, ICM, and CCM
Collaboration with Community Support Programs (CSP)
Phone coverage as needed on the Crisis Calendar Rotation with the health plan
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

Clinical Case Manager Resume Examples & Samples

Managing, coordinating care, tracking and reporting of all assigned ICM Members
Utilization Review for designated ICM Clients in Massachusetts and New York for all levels of care
Telephonic collaboration with provider and state agencies regarding ICM members and systems meetings as needed
Telephonic collaboration with Members
3 years in a behavioral health clinical setting
5-10 years’ experience working with case management
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
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 or RN All case managers must practice within the scope of their license

Clinical Case Manager Resume Examples & Samples

The successful hire will be responsible for the review of Long-Term Disability (LTD) and Short-term Disability (STD) claims with complex medical conditions referred for medical assessment; clarification of limitations/ restrictions; and/or case management
Work closely with the STD/LTD Claims Team to identifying appropriate claim referrals and effectively assessing claims to ensure they reach the appropriate claim outcome
Collaborate with Rehabilitation Case Managers; Ability Analysts; Employees, Policyholders, Healthcare Providers, and Vendors to facilitate and coordinate case management strategies to facilitate a potential Return to Work
Periodically participate and facilitate training programs and/or presentations
At least 3 years of current clinical experience in an acute care, orthopedic, rehabilitation; industrial medical settings; behavioral health settings, or current experience as a disability case manager
Clinical ability to assess claims with complex medical histories which may include claimants with subjective diagnoses, co-morbid conditions, etc
Strong written/ verbal communication skills; computers and Microsoft Office programs
Accurate clinical assessment and analytical skills, ability to make sound judgments and to accurately document activities, and the desire to learn about the insurance business
Prior experience in facilitating RTW for disabled employees, knowledge of return to work best practices, ergonomics, FMLA, and related Human Resources is desired
Must keep current in area of expertise and acquire CEU's as necessary to maintain certification

Clinical Case Manager / PRN Resume Examples & Samples

Proactively ensures that required clinical justification is provided to third party payers to obtain recertification for continued hospitalization and treatment and that transfer of this information, together with days approved and contact information is provided timely to the PAS and CVO via computerized insurance review documentation
Proactively initiates expedited appeals process with payers and communicates with denials management regarding anticipated or verified denials and cooperates with denials management to provide additional clinical information for appeals
Collaborates with clinical staff in the development and execution of the plan of care and achievement of goals
Facilitates interdisciplinary patient care rounds and/or conferences to review treatment goals, optimize resource utilization, provide family education and identify post-hospital needs
Conducts concurrent medical record review using specific quality indicators and clinical decision support criteria as approved by the medical staff, TJC, CMS and other regulatory agencies and document findings
Serves as liaison with Physician Performance Improvement (PPI) to ensure the reporting of quality indicators and care concerns
Identifies all observation patients with observation alert sticker, reviews status no less frequently than daily, and communicates directly with the attending physician if severity of illness and intensity of service meet criteria for inpatient admission or when observation hours threaten to exceed 48 hrs
Communicates with treating physicians at regular intervals throughout hospitalization of the patient to develop an effective working relationship, while assisting physicians to maintain appropriate costs, utilization of resources, and discharge plans commensurate with the patient's available resources
Monitors and provides documentation of identified variance days for tracking and trending
Stays current with education related to CMS and HCA billing compliance mandates, monitors and ensures that facility is compliant
Collaborates with interdisciplinary care team, service liaisons, patient and family in the assessment and coordination of discharge planning needs, delivery of post-discharge services and transition of the patient from an acute level of care to the discharge setting
Facilitates the ordering and delivery of specialized medical equipment, orthotics and prosthetics as ordered by the attending physician
Facilitates referral process of next level of care
Attends and actively participates in monthly staff meetings, and attends called departmental meetings when necessary
Actively utilizes and complies with facility principles of good communication and customer service standards, including use of AIDET as developed by the department

Clinical Case Manager Resume Examples & Samples

Telephonic Case Management and coordination of care
Utilization Review for designated ICM Clients in Massachusetts for all levels of care
Experience working in case management
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 or RN. All case managers must practice within the scope of their license

Clinical Case Manager Resume Examples & Samples

Master’s Degree in advanced practice nursing (MSN)
Current NYS License OR National Certification as Nurse Practitioner
Multi-lingual preferred
Critical care or ICU experience
Bachelor’s Degree in Nursing (BSN)
NYS RN License
At least 5 years of related experience
Flexible scheduling and the ability to work with a team
Professional who presents well with high profile clients and senior leadership

Clinical Case Manager Resume Examples & Samples

3-5 years of direct clinical practice experience post RN or post masters degree, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility; Required
Case management and discharge planning experience; Preferred
Managed care/utilization review experience; Preferred
Strong medical background; Required
Crisis intervention skill; Preferred

Clinical Case Manager Resume Examples & Samples

Provide comprehensive assessment of the patient's treatment needs and personal support systems
Maintain and utilize a referral database, and coordinate care with other service providers involved in patient's treatment plan
Education:Bachelor's degree in social work, psychology, nursing, or related human services field
Preferred Education:Master's degree in social work, psychology, nursing, or related human services field

Clinical Case Manager Resume Examples & Samples

At least two years of experience working with children and families. It is preferred that one of that two years’ experience involve work with abused and neglected children
Familiar with the Florida Child Welfare system
Must use critical thinking to prioritize daily task and duties to ensure the needs of community partners and families in crisis are met
Must have be able to navigate multiple job specific databases
Must possess college-level writing skills
Ability to deal with periodic pressures and levels of responsibility (required)
Ability to make independent judgments without supervision (required)
Ability to make generalizations, evaluations, or decisions based on sensory or judgmental criteria (required)
Twenty (20) hours continuing education is required per year during employment in this job

Clinical Case Manager Resume Examples & Samples

3-5 years of direct Social Work experience, e.g., hospital setting or alternative care setting such as ambulatory care or outpatient clinic/facility; Required
Case management and discharge planning experience; Preference
Crisis intervention skills; Preference
Ability to research and coordinate Community Services throughout the United States; Preference
Excellent Computer Skills; Required
Excellent Time Management Skills; Required
Licensed Clinical Social Worker (LCSW); Required

Clinical Case Manager Resume Examples & Samples

At least two (2) years of experience working with children and families (required) with one (1) year of that experience involving work with abused and neglected children
Ability to perform under stress when confronted with emergency, critical, or unusual situations
Ability to deal with periodic pressures and levels of responsibility
Ability to make independent judgments without supervision
Ability to make generalizations, evaluations, or decisions based on sensory or judgmental criteria
Ability to work with people beyond giving and receiving instructions
Adaptability to perform a variety of duties, often changing from one task to another of a different nature without loss of efficiency or composure

Clinical Case Manager Resume Examples & Samples

Current state of Oregon Registered Nurse (RN) licensure and graduation from an accredited school of nursing, -or-
Master's of Social Work (MSW) degree from a school of social work accredited by the Council on Social Work education, plus a Licensed Clinical Social Worker (LCSW) licensure
3-5 years of clinical experience
Working knowledge of Medicare criteria for skilled nursing services or home health/medical equipment services
Demonstrated ability to work cooperatively in a multi-disciplinary team
Current recognition by a national professional organization in case management is required at time of hire, -or- must be obtained within 2 years of hire date
For RNs, graduation from a Bachelor's of Science in Nursing (BSN) program
Home health, skilled nursing facility and/or community health nursing (OR) clinical social work
1 year of managed care experience and/or utilization management experience

Clinical Case Manager Resume Examples & Samples

Case Management: Identifies students with both chronic and acute complex medical conditions, coordinating care as needed. Makes referrals to appropriate levels of care including on-campus partners and off-campus providers. Coordinates UHS’ wellness screening program. Manages UHS’ offsite apartment for student recuperation. Represents UHS in relevant committees and programs
Direct Patient Care: Provides back-up staffing for UHS clinic nurses
Professional Standards: Maintains proficiency in college health nursing. Ensures a warm handoff of UHS patients to campus partners. Collaborates with all members of the support team to affect optimal patient outcomes. Helps patients achieve independence. Is a patient advocate. Protects confidentiality. Pursues professional development. Seeks to expand knowledge of patient-care resources
Additional responsibilities as assigned

Clinical Case Manager / Days Resume Examples & Samples

Communicates proactively and cooperatively with Patient Access, Patient Account Services (PAS) and Central Verification Office (CVO) personnel to ensure proper pre-certification and consistency of admissions status designation between physician order and EMR
Serves as liaison between third party payers, patient access PAS and CVO to ensure communication of all pertinent information regarding level of care, billing and reimbursement
Works with the patient and family to identify alternate financial resources available to meet the cost of necessary post-discharge needs or to recommend alternate care options when necessary funding is unavailable
Treatment Planning and Coordination of Services
Ensures that patient tests are appropriate and necessary and are carried out within the established time frame and that results are promptly available
Serves as a patient advocate by enhancing a collaborative relationship to maximize the patient's and family's ability to make informed decisions
. Refers to social work cases where patients and/or family would benefit from counseling required to complete complex discharge plans
Initiates delivery of notices of non-coverage as appropriate
Reviews all new admissions daily against inpatient screening criteria and communicates necessary changes in status designation to ordering physician and Patient Access
Facilitates delivery of CMS discharge appeals rights communication to applicable Medicare patients within indicated time frame required by law
Attends twice weekly outlier meeting with Case Management Director and Medicaid Eligibility Vendor personnel to review observation admissions, extended LOS, unfunded and underfunded, and anticipated difficult discharges
Prepares and presents inservice and training programs as requested
Prefer three-five years clinical experience within an acute health care setting with recent work history in acute care case management role or related health care experience. Working knowledge of case management philosophy/process/role, needs assessment, principles of utilization review/quality assurance, use of InterQual® or other clinical decision support criteria, discharge planning, and reimbursement structures (i.e. Government and non-governmental payers)
Ability to read, analyze and comprehend complex clinical and financial data and its application to level of care criteria and discharge options; strong, broad-based clinical knowledge and understanding of pathology/physiology of disease processes; excellent critical thinking skills; assertive personality traits to facilitate ongoing physician communication; organize, prioritize and manage time efficiently. Computer literacy and familiarity with the operation of basic office equipment. Must be able to communicate effectively with a wide range of hospital personnel, physicians, patients/family members within various socioeconomic groups and representatives of varied outside agencies. Ability to communicate effectively with and know the age-specific needs of patients of adolescent, adult and geriatric age
Demonstrate an understanding of HCA's "Patients First" safety initiative through strict compliance to all safety protocols and procedures
Recognizes that variables such as age, race, nationality, culture, disease-causing vulnerabilities, socio-economic factors affect the patient populations under their care. Uses interventions appropriate to these factors (e.g. interpreter, dietary preferences, social service consult, etc)

Clinical Case Manager Resume Examples & Samples

Licensure in the State of Florida with an appropriate governing body (e.g., Florida Board of Psychology; Board of Clinical Social Work, Marriage and Family Therapy, and Mental Health Counseling)
Demonstrated expertise in clinical case management
Administrative and computer application skills required to effectively implement and maintain a CM and Tracking system
Demonstrated skill in working well under pressure to prioritize and manage multiple clinical situations and coordinate these efforts as a part of a multidisciplinary team
Energy to flexibly manage the professional demands of a challenging workload while maintaining positive and healthy perspectives and relationships
Collaborative spirit of warmth, acceptance, respect, and trust towards colleagues
Demonstrated sensitivity to multicultural issues and proven ability to interact with diverse individuals and groups
Self-motivated, Self-directed commitment to high professional ideals
Experience in college mental health, including crisis assessment, brief intervention, confidentiality requirements and referral

Clinical Case Manager Resume Examples & Samples

Maintains ongoing dialog with supervisor and other health providers to ensure effective implementation of health plan
Minimum Qualification: Three years of experience working as a Registered Nurse in an acute care environment
Preferred Qualification: Five years of experience working as a Registered Nurse in an acute care environment. One year of experience working in a quality, performance improvement, utilization review or case management role

Clinical Case Manager Resume Examples & Samples

1 year of experience in case management in a hospital environment
Master's degree
Experience in a rehabilitation hospital
3 years of experience in case management in hospital environment
Must successfully pass Epic training within 30 days of employment
Facilitates ongoing re-evaluation/oversight of patient treatment or intervention program(s) and level of care, working with clinicians, physicians, service providers, educational programs, and appropriate team members to determine and maintain proper level of care
Assists in discharge timeframe and appropriate discharge placement
Communicates with external case managers, physicians, and/or payors to update on patient medical progress and produce letters of medical necessity for insurance re-certification and determine proper level of care
Performs discharge planning to facilitate a smooth transition to appropriate setting, linking family/child with community resources and providing support systems to maintain a realistic viable plan
Obtains approval and orders all equipment essential for post-discharge care
Maintains therapeutic relationship with patient and family and communicates relevant information at the patient/family level of understanding
Identifies patient/family need for services from ancillary departments and provides follow-up and referral as necessary

Clinical Case Manager Resume Examples & Samples

Identify all assigned ICM Members
Manage, coordinate care, track and report on all assigned Members in the four various levels of case management: consultation, coordination, ICM, and CCM
Provide phone coverage as needed on the Crisis Calendar Rotation with the health plan

Senior Clinical Case Manager Supervisor Resume Examples & Samples

Work under the direction of the Senior Director of Community Investment to ensure continuous quality improvement to ensure the quality of case management services and to meet the requirements of the funding source policies and procedures
Ensure oversight of program staff’s case management duties, creation of case management plans, and intervention strategies; ensure the monitoring of program activity and case notes for quality assurances
Create a collaborative, cross functioning work environment which instills a team approach to case management services and meeting organizational goals
Provide supervision, coaching and development support to direct reports through regularly scheduled meetings and evaluations; provide onboarding and training to EHS case staff to ensure understanding of client eligibility and best practices in case management
Work under the direction of the Senior Director of Community Investment to implement and monitor a strengths-based, solution-focused approach to case management for all programs and services; deliver complex case management for cases that demand higher level solutions
Verify and approve staff timesheets, leave requests, and expense requests/reimbursements for EHS case management staff
Ensuring the accurate input of information, data, case notes, etc. into client-based data systems such as MAACLink for all EHS programs; access and retrieve data as required; provide data base training and ongoing technical assistance for all users
Ensure EHS data is entered into HMIS system; provide training, ongoing technical assistance, and administrative functions for all users
Assist the Manager of EHS Programs with all reporting requirements as needed
Provide direct case management services as needed, to include screening referrals for clients in need of one time assistance; assessing clients for eligible services, and providing one time assistance; develop and implement trainings, activities, and other related services for EHS clients
Develop, support, and manage EHS Program internship opportunities
Master’s degree in social work or a related filed of study from an accredited college or university field required
Fully licensed as an LPC, LCSW, or LMHC preferred
Minimum three years’ experience as a case management supervisor or team lead required. Five years’ experience preferred
Strong written communications skills
Strong critical thinking and problem solving skills; sound judgment
Knowledge of geographic locations within demonstrated areas
Ability to type a minimum of 40 wpm
Ability to compute basic mathematical functions