Manager, Care Management Resume Samples

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E Oberbrunner

Earl

Oberbrunner

4471 Mayert Walk

Chicago

+1 (555) 608 7838

4471 Mayert Walk

Chicago

Phone

p +1 (555) 608 7838

Experience Experience

Los Angeles, CA

Manager Care Management

Los Angeles, CA

Pagac, Emmerich and Hoeger

Los Angeles, CA

Manager Care Management

Assists with hiring, orienting, evaluating and supervising performance of the care management and social work staff
Acts as liaison with other review-related and discharge planning related functions and communicates with departments as necessary to ensure coordination of related processes and functions
Provides input into the department budget, policies and procedures. Assists in the development of department practices and procedures for utilization review and discharge planning, ensuring compliance with managed care contracts and Medicare regulations
Establish relationships with post acute care providers
Analyzes productivity and other outcome measures to identify opportunities for continuous improvement
Manages information systems to maximize the efficiency of discharge planning
Develops and monitors routine data quality validation

Phoenix, AZ

Manager, Care Management

Phoenix, AZ

Torp and Sons

Phoenix, AZ

Manager, Care Management

Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
Administer the process for handling authorizations received from non-participating providers
Responsible for development and monitoring key operational aspects such as budget, Care Management metrics, human resource planning and customer service
Responsible for the day to day operation and performance of the care management team providing care management services to EmblemHealth members
Manages and assumes responsibility for day to day operations of utilization management, care coordination and discharge planning activities
Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staff
3-5 years acute care hospital setting

present

Houston, TX

MSW Care Manager Care Management

Houston, TX

Herman, Von and Ritchie

present

Houston, TX

MSW Care Manager Care Management

present

Performs discharge planning/post-acute care coordination to include
Provides consultation to, and educational programs for, healthcare team members regarding the impact of psycho-social factors on illness
Master of Social Work
Provides patient/family education, adjustment-to-illness counseling, grief counseling and crisis intervention. Provides education to patients/families/caregivers regarding resource options and coping with diagnosis, treatment and prognosis
K. Assistance with Advance Directives, as necessary
Collaborates with the RN Case Manager to address barriers that may impact or delay the patient’s discharge plan
May serve as a field instructor for social work students

Education Education

Bachelor’s Degree in Nursing

University of Illinois at Chicago

Bachelor’s Degree in Nursing

Skills Skills

Knowledgeable with quality improvement processes
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
Advanced Ability to effectively present information and respond to questions from families, members, and providers
Good computer skills (word processing and other relevant software.)
Excellent verbal and written communication skills
Intermediate Ability to work in a fast paced environment with changing priorities
Ability to maintain high level confidentiality
Intermediate Ability to lead/manage others
Advanced Knowledge of healthcare delivery

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15 Manager, Care Management resume templates

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Manager, Care Management Resume Examples & Samples

Manages and develops direct reports who include supervisory and/or exempt professional personnel, including but not limited to hiring, focal point reviews, PiPs, terminations, etc
Develops and implements care management workflows and policies & procedures
Establishes objectives, schedules, and manages cost data for Care Management department
Coordinates activities of unit to meet contractual company deadlines and resolve interpersonal conflicts
Chairs Care Management committees as applicable
Maintains current knowledge of care management topics and acts as the unit’s subject matter expert (SME) on care management at department and company meetings
Performs special projects as necessary
Required Intermediate Microsoft Outlook Intermediate to high level efficiency in Microsoft Office including Outlook, Word and Excel

Manager, Care Management Resume Examples & Samples

Process and quality improvement skills that lead to efficient use of resources, standardized workflows and improved quality outcomes for our patients
Good working knowledge of population health and development of disease registries in order to best target at-risk patient populations through care coordination efforts
Ability to organize, analyze and use data with the expectation that all goals and outcomes will be data driven
Excellent EHR skills
Promote and model professional and leadership behaviors
While having approximately 11 direct reports, this individual will also be responsible for working most closely with Fairview Health Network (FHN) primary and specialty care clinic leaders (FMG and Independent) and payer partners
At all times this role must work to promote professional – clinical development of the direct reports as well as fostering a culture of respect, teamwork, dignity, compassion, integrity and service. Ability to innovate and collaborate while maintaining a high level of independence and self direction is a must
Oversee staff orientation and mentoring
Ability to multi-focus and be able to re-establish priorities as operations dictate
Must have good working knowledge of the MDH Health Care Home Model and the role that care coordination plays
Ability to use data strategically to evolve care coordination model and services
MN Registered Nurse License
BSN or BAN
5+ years nurse experience
Process improvement and/or project management experience
Must have proven experience with care coordination/case management
2+ years supervisory experience
Strong EHR experience and data analytics capabilities
Basic understanding of population health strategies
2+ years’ management experience
Clinical leadership and management skills
Technical, adaptive, interpersonal, and problem solving skills and the ability to think analytically/critically
Ability to be strategic and operational
Health Care Home knowledge preferred

Manager, Care Management Az-tempe Resume Examples & Samples

Specific understanding of medical management tools is necessary
Proficiency with Windows-based applications is required
Ability to travel is required

Manager, Care Management RN Rancho Cordova Resume Examples & Samples

Demonstrates progressive patient management expertise required
Must have a can-do attitude and a proven successful track record in assessment, planning, implementation, coordination, monitoring and evaluation of the management of member?s care
Must be goal oriented; able to participate in a team environment with other motivated associates to move toward a common goal
Must have the ability to work in an environment of continuous process improvement

Manager Care Management Resume Examples & Samples

Assists with hiring, orienting, evaluating and supervising performance of the care management and social work staff
Arranges schedules, evaluate caseloads and makes daily assignments
Evaluates and addresses educational needs of staff, conducts performance improvement management and issues corrective action as needed and ensures consistent applications of policies and compliance
Provides input into the department budget, policies and procedures. Assists in the development of department practices and procedures for utilization review and discharge planning, ensuring compliance with managed care contracts and Medicare regulations
Analyzes productivity and other outcome measures to identify opportunities for continuous improvement
Manages information systems to maximize the efficiency of discharge planning
Develops and monitors routine data quality validation
Acts as liaison with other review-related and discharge planning related functions and communicates with departments as necessary to ensure coordination of related processes and functions
Establish relationships with post acute care providers
Serves as a clinical subject matter expert for teams lead by other disciplines
Minimum three years of experience in utilization management, case management, or discharge planning and three years clinical experience required, with at least three years of experience in a hospital/health care setting, including experience with data collection and performance improvement activities preferred
Previously supervisory experience in the field of care management or social work preferred

Manager, Care Management Resume Examples & Samples

Ensure a timely acknowledgement and response to all authorization documents received providing appropriate feedback to address processing issues
Administer the process for handling authorizations received from non-participating providers
Respond to provider inquiries that have been received by the escalation and case resolution department in a timely manner
Communicate with provider and / or office staff, various health plans administered and / or other employees to research and verify information provided on authorization documents when appropriate using a professional, courteous and cheerful manner
Supervise the process for accurate additions of new patients to the patient database
Facilitate team staff meetings in order to review and implement processes that allow for smooth and efficient operations
Review with management individualized reports reflecting daily production and quality in order to accurately measure and monitor predetermined company, position and individual goals
Work together with all staff members, as well as other departments, to resolve issues and assist each other
Must have one of the following: current, unrestricted Licensed Social Worker (LSW, LCSW, LICSW) OR Registered Nurse for the state of Massachusetts
3+ years managerial / supervisory experience
Proficient in Microsoft Office suite, highly proficient in MS Excel
Managed care experience in a Care Coordination role
Bachelor’s degree in Nursing OR Master’s degree in Social Work

Manager, Care Management Resume Examples & Samples

Knowledgeable with quality improvement processes
Understanding of medical terminology
Good computer skills (word processing and other relevant software.)
Must possess and maintain current health care professional licensure as a Clinician (RN, LCSW, LMFT)
Current/minimum of 3 years of utilization review/case management experience or social work experience in an Inpatient Acute Care hospital setting
Must have driver’s license and personal vehicle
3 years of experience in discharge planning from a hospital
Bachelor of Science in Healthcare field preferred

Manager, Care Management for Wellmed Resume Examples & Samples

Plans, organizes and oversees staff to ensure timely completion of um determinations, discharge planning and case management assessments
Monitors and oversees the reporting of all quality issues to medical management leadership for referral and reporting to health plans as appropriate
Current unrestricted RN license in the applicable state
In and / or out-of-town travel required as deemed necessary by business need
Prior multi-site regional operations management responsibility

Manager, Care Management Resume Examples & Samples

Supports case management operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring, and evaluating)
Oversees care management functions and ensure compliance with application of criteria from approved standardized guidelines, government mandated regulations and contractual agreements, to include NCAQ, URAC, and CMS
Ensures team meets established performance metrics and medical cost reduction goals. Includes timely reporting of monthly KPIs
Adapts departmental plans and priorities to address business and operational challenges
Oversees the team’s daily staffing requirements to meet program standards
Implements and interprets organizational policies and procedures, reviews work of staff to ensure that policies and guidelines are appropriately applied
Interviews, hires, and retains staff to meet the needs of the department
Monitors appropriate utilization of resources, overtime, supplies and mileage. The information listed above is not comprehensive of all duties / responsibilities performed
Bachelor of Science in Nursing (BSN) required (Four additional years of experience beyond the required years of experience may be substituted in lieu of a bachelor’s degree)
CCM certification or proof that certification has been obtained within one year of hire date
Five or more years of healthcare experience to include experience in a managed care setting, hospital setting and / or physician practice setting
Three or more years of demonstrated supervisory or management experience with responsibility for team performance management
Ability to establish and maintain effective working relationships with employees, managers, healthcare professionals, physicians and other members of senior administration and the general public
Data mining, analytical and reporting skills required. Must be able to review and interpret data to make recommendations to senior-management
In and /or out-of-town travel required as deemed necessary by business need
Solid experience with MS office including Word, Excel and Outlook with proficient ability to navigate in a Windows environment
Master’s Science in Nursing

Manager, Care Management Resume Examples & Samples

Assists in the development and implementation of new or revised programs, policies or procedures. Monitor progress, develop recommendations for improvement, and monitor action plans to ensure the integrity of the programs are maintained and deadlines are met. Assist with integrating HP programs across the Health System and vendors as needed
Conducts regularly scheduled team meetings to communicate key information, engage staff in daily operations, and provide ongoing staff education
Consistently recognize staff contributions through performance evaluations and nomination for system and health plan staff recognition programs. Complete performance evaluations within departmental timeframes
Ensure adherence to department guidelines related to orientation of staff and documentation of staff competency including compliance with government training requirements
Facilitate detailed case reviews with appropriate Health Plan team members including medical directors and other members of the interdisciplinary team to identify barriers to care and initiate appropriate team coordination. Assist staff in making referrals to community or governmental agencies to coordinate levels of service across all Health Plan functional areas. As appropriate manage and assist with discharges or transfers to appropriate level of care
Monitor, coach and report staff activity and productivity; Assist with analysis and monitoring of key financial and utilization targets and trends. Complete quality audits and team reports within departmental timeframes
Provide staff with applicable regulatory guidelines related to their departmental expectations (I.E. NCQA, DPW, CMS). Consistently monitor and work with internal compliance departments to ensure adherence
Supports supervisors with problem-solving and managing case referrals and work flows according to established program descriptions. Utilize evidence based practice to support improvement in care / health / utilization management
Masters degree in nursing or related field required
Minimum 2 years of nursing experience required
Minimum 4 years of care management experience required
3 of experience in a managed care environment preferred
Previous behavioral health experience a plus
Prior management, supervisory, or leadership experience required
Ability to analyze data and identify trends
Proficiency with Microsoft Office products
Excellent interpersonal and communication skills (verbal and written)

Clinical Case Manager, Care Management .DV Resume Examples & Samples

Bachelor Degree in Nursing and three years of experience in hospital-based nursing
Five years of experience in care management, utilization management, case management, discharge planning or other cost/quality management program
InterQual
Interpersonal skills to work productively with all levels of hospital personnel
Verbal and written communication skills to communicate effectively with diverse populations including employees, patients and their families

Manager, Care Management Resume Examples & Samples

Bachelor’s Degree in Nursing
Current License in the state of employment
3-5 years acute care hospital setting
Demonstrated supervisory and leadership ability
1 year recent hospital-based Utilization Management and/or Care Management experience (Preferred)

MSW Care Manager Care Management Resume Examples & Samples

Interpersonal skills that promote teamwork
Critical thinking and problem-solving skills
Ability to analyze complex technical data and complex interpersonal dynamics in brief time
Proficiency in the daily use of standard office equipment such as computer, phone, fax, pager, copier etc. and skill in utilizing Microsoft Word and Outlook tools
Acute care hospital experience (Preferred)
Current valid State of Florida LCSW (Preferred)
Case Management certification highly desirable - ACM (Accredited Case Manager), CCM (certified Case Manager) (Preferred)

RN Case Manager Care Management Resume Examples & Samples

Superior clinical skills to determine appropriate clinical and other information for medical necessity reviews and identify appropriate mechanism to address delays or variation for expected care practices (Preferred)
Significant knowledge and understanding of availability of community and post-acute resources and related payer requirements (Preferred)
Master’s degree in Nursing (Preferred)
Minimum of two years of utilization review/case management experience and a minimum of one year of experience in discharge planning in an acute care setting highly desirable (Preferred)
Active Florida State license as a Registered Nurse

Clinical Case Manager, Care Management DV Resume Examples & Samples

Licensed in the State of Michigan as a Registered Nurse
Analytical ability and comprehensive knowledge base to identify opportunities for improvement and problem resolution, evaluate patient status and health care procedures/techniques and monitor quality of patient care
Fiscal skills to monitor and control costs and revenue; also a working knowledge of the revenue cycle and resulting impact of utilization management decisions

Manager, Care Management Resume Examples & Samples

Manage the delivery of services to members, ensuring services are appropriate and cost effective
Ensure compliance with government and company requirements in the care management department. Develop and implement new procedures, regulatory filings and manage compliance issues
Develop, implement, and oversee care management policies and procedures and give specific guidance to staff and departments as appropriate
Develop, implement, and maintain care management programs to facilitate the use of appropriate services and resources in order to maintain the member in the least restrictive environment
Direct the daily activities of care management staff. Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries
Develop staff skills and competencies through training and experience
Manage resolution of complaints, and assist in audits and evaluations related to the Long Term Care Program. If necessary, develop and implement corrective action plans

Manager, Care Management Resume Examples & Samples

Manage daily operations of the Care Management team including measurement of performance metrics and productivity standards; deploy strategies that will improve performance
Train employees in process operations; act as a preceptor to newly hired staff
Complete quarterly evaluations of staff as needed
Monitor team caseloads and shifts workloads accordingly to meet departmental/organizational needs
Monitor timeliness and appropriateness of documentation in clinical systems to ensure that documentation meets accreditation and regulatory standards
Ensure that team members are managing enrollees across the care continuum inclusive of behavioral health to ensure that enrollees have access to needed care and services
Serve as a clinical resource; attend Care Management rounds
Identify strategies for departmental improvements
Monitor employees’ performance regularly and coaches employees as needed
Strong leadership skills to set the tone of superior performance of the care management team
Strong problem solving and strategy execution abilities
Able to analyze problems and deploy strategies to improve performance in collaboration with the leadership team
Thrive in an environment of positive change and innovation
Manage daily performance of the care management team supporting company initiatives that improve the health outcomes for EmblemHealth enrollees
Bachelor’s degree (preferably in Nursing or related)
RN: active, unrestricted license to practice in the appropriate state
5 – 8 years clinical experience
Proven track record in leading care management team(s)
Health plan experience highly desirable

Manager, Care Management Resume Examples & Samples

Manages and assumes responsibility for day to day operations of utilization management, care coordination and discharge planning activities
Responsible for the recruitment, orientation, evaluation, counseling and disciplinary action of care management clinical and administrative staff
Reviews cases regularly with staff; acts as clinical consultant regarding care management issues; guides clinical staff with review of assessments and care plans, evaluates utilization reviews or documentation
Serves as a content expert to staff and internal departments and external partners; networks with other hospitals, nursing organizations, and professional organizations to keep abreast of changes within the profession
Assists Director in establishing, implementing and ensuring that care management policies, practices and procedures are in accordance with the Joint Commission, Title 22 and other regulatory agencies and overall hospital policies
In conjunction with VP and Director, coordinates, develops, and implements action plans to respond to areas felt to be in need of improvement related to patient flow and care coordination across the continuum

Manager, Care Management Resource Center Resume Examples & Samples

Has management responsibility for all staff within the resource center, including
Minimum 5 years' experience in UR or case
Ideal candidate will have experience with both
Experience with Microsoft office products

Manager, Care Management Resume Examples & Samples

Responsible for accurately and thoughtfully articulating the business requirements for Care Management that are aligned with the future state business objectives
Ensures Care Management quality measures and regulatory requirements are captured
Validates that the final product satisfies the requirements (s)he articulated
Determines the need for and coordinates the involvement of part-time subject matter expert resources
Ensures front-line user perspective is considered, and changes from current practice are noted and prepared for as part of training and change management
Translates subject matter terminology into business terms, and recommends alternatives to both senior management and the project team
Performs product demonstrations in a variety of settings including internal meetings and company-wide expos when called upon
Experience in Care Management with progressive management level responsibilities
Knowledge of industry best practices in Care Management and future direction/goals of Care Management at Healthfirst
Associate's Degree
Hands on experience in leading process improvement initiatives
Previous experience with software implementations
Knowledge of NCQA/URAC certification Care Management requirements
Licensed and/or registered Healthcare professional
Skilled in Microsoft Office including PowerPoint, Word, and Excel
Ability to prioritize, understand and explain trade-offs, and make timely decisions
Demonstrated ability to effectively communicate amid cross-functional departments to achieve desired outcomes