Manager, Case Management Resume Samples

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CM
C Muller
Cyrus
Muller
43072 Jamil Passage
Detroit
MI
+1 (555) 389 4146
43072 Jamil Passage
Detroit
MI
Phone
p +1 (555) 389 4146
Experience Experience
07/2015 present
Chicago, IL
VP, Senior Manager Case Management
Chicago, IL
VP, Senior Manager Case Management
07/2015 present
Chicago, IL
VP, Senior Manager Case Management
07/2015 present
  • Define and implement consistent architecture and technology governance practices for BOW throughout the planning and delivery cycles. Provide both technology and architecture oversight and governance as part of this process
  • Lead architecture efforts that promote and implement greater architectural consistency and technology sharing across BOW
  • Be a key contributor to the overall technology strategy and ensuring the realization of goals such as reuse, infrastructure simplification, cost management and flexibility
  • Build strong cross-organizational relationships and effectively influence staff across the IT organization and broader enterprise
  • Define conceptual approaches and solutions architecture for BOW applications and integration among applications and services
  • Create conceptual and software architecture documents using industry best practices for documenting architecture. Consider both business and technical audiences
  • Provide cross-application subject matter expertise for BOW solutions
08/2011 02/2015
Boston, MA
Manager, Case Management
Boston, MA
Manager, Case Management
08/2011 02/2015
Boston, MA
Manager, Case Management
08/2011 02/2015
  • May perform case management operational activities during periods of peak workload or to support business continuity
  • Ensures team meets established performance metrics and performance guarantees
  • Directly responsible for the daily activities of the global case management team who perform ICSR case management activities
  • Develop, implement and maintain compliance with policies and procedures regarding medical case management
  • Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries
  • Manages the maintenance of the coding conventions and collaborates with the safety data management team to ensure safety database configurations are accurate
  • Performs other activities as directed by department management
10/2005 03/2011
Los Angeles, CA
Manager Case Management
Los Angeles, CA
Manager Case Management
10/2005 03/2011
Los Angeles, CA
Manager Case Management
10/2005 03/2011
  • The Manager of Case Management works in conjunction with other members of the interdisciplinary care team using a proactive approach to facilitate effective and efficient patient care during the hospital stay
  • Clinical operations across the continuum of care (assessing, planning, implementing, coordinating, monitoring and evaluating)
  • Case management and coordination of care
  • Takes lead role in setting direction and participating in or developing new programs
  • Sets team direction, resolves problems and provides guidance to members of the team
  • Adapts departmental plans and priorities to address business and operational challenges
  • Manage clinical operations across the continuum of care to include assessing, planning, implementing, coordinating, monitoring and evaluating health care delivery
Education Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
Georgetown University
Bachelor’s Degree in Nursing
Skills Skills
  • 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 peers and management
  • Intermediate Ability to drive multiple projects
  • Intermediate Ability to implement process improvements
  • Intermediate Ability to work in a fast paced environment with changing priorities
  • Intermediate Knowledge of medical terminology and/or experience with CPT and ICD-9 coding
  • Advanced Ability to effectively present information and respond to questions from families, members, and providers
  • Intermediate Ability to lead/manage others
  • Advanced Knowledge of healthcare delivery
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15 Manager, Case Management resume templates

1

Manager / Case Management Resume Examples & Samples

  • Nursing License; RN
  • Bachelor’s Degree in Business, Finance, a related field or work equivalent experience with familiarity handling Medicare guidelines
  • At least 3 years experience in Case Management, preferable Special Needs Population and Transitions of Care
  • Comprehensive knowledge of all Microsoft Office applications, including Word, Excel and Access
2

VP, Senior Manager Case Management Resume Examples & Samples

  • Create an architecture strategy for BOW that furthers an integrated customer experience and promotes the development of common services and capabilities across the BOW enterprise
  • Define and implement consistent architecture and technology governance practices for BOW throughout the planning and delivery cycles. Provide both technology and architecture oversight and governance as part of this process
  • Lead architecture efforts that promote and implement greater architectural consistency and technology sharing across BOW
  • Understand and promote the role of architectural best practices; communicate effectively with all key constituents and actively promote the needs and benefits of governance, architecture and standards
  • Be a key contributor to the overall technology strategy and ensuring the realization of goals such as reuse, infrastructure simplification, cost management and flexibility
  • Build strong cross-organizational relationships and effectively influence staff across the IT organization and broader enterprise
  • Develop the architecture community within BOW and mentor architects in the development of their skills
  • Define conceptual approaches and solutions architecture for BOW applications and integration among applications and services
  • Create conceptual and software architecture documents using industry best practices for documenting architecture. Consider both business and technical audiences
  • Collaborate with development groups and software vendors to identify and define solutions for complex, global business requirements
  • Collaborate with internal partners to define application standards, conventions and best practices including compliance with security requirements
  • Provide cross-application subject matter expertise for BOW solutions
  • Participate in application capacity planning and facilitate application proof of concepts
  • Oversee the evaluation and selection of 3rd party software packages as well as the design of standard application configuration of these packages
  • Multi-task in complex, global environment while focusing on architectural success of multiple projects
  • Minimum of 7 years of experience as a Technology Solutions Architect
  • Bachelor’s degree in related information technology field
  • Experience with architecting and developing solutions for highly scalable, highly available systems
  • Experience in architecting multi-tiered solutions based on architectural best practices
  • Experience with service oriented architecture (SOA), Enterprise Service Bus (ESB) technology and other middleware technologies
  • Experience with web solution architectures
  • Strong strategic thinker with an ability to communicate your vision
  • Creative thinking and approach, essential to collaboration with BOW customers, product groups and account management to determine solutions that further the business and align with business plans and technology strategies
  • Outstanding analytical skills; able to critically evaluate the information gathered from multiple sources
  • Strong facilitation and listening skills
  • Ability to represent technical and business issues and solutions to multiple levels internally and externally to support strategic organizational plans
  • Highly effective written, verbal and presentation skills
  • Interpersonal skills that lend themselves to effectively negotiating priorities and resolving conflicts among project stakeholders
  • Excellent architecture documentation and modeling skills
  • Strong software development, design and application architecture skills
  • Significant Retail Banking experience
3

Manager, Case Management Resume Examples & Samples

  • Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes
  • Promote compliance with federal and state regulations and contractual agreements
  • Develop, implement and maintain compliance with policies and procedures regarding medical case management
  • Develop, implement, and maintain case management programs to facilitate the use of appropriate medical resources and decrease health plan financial exposure
  • Facilitate on-going communication between case management staff, members, contracted providers, and subsidiaries
  • Develop staff skills and competencies through training and experience
4

Manager, Case Management Resume Examples & Samples

  • Develops and implements case management workflows and policies & procedures
  • Partners & collaborates with other departments cross functionally regarding case management and/or Clinical Services initiatives
  • Directs work assignments, measures results and initiates personnel actions as required
  • Develops, implements and manages process improvement initiatives
  • Coordinates activities of unit to meet contractual company deadlines and resolves interpersonal conflicts
  • Proactively monitors appropriate metrics to drive up efficiency
  • Chairs case management committees as applicable
  • Maintains current knowledge of case management topics and acts as the unit’s subject matter expert (SME) on case management at department and company meetings
  • Required A Bachelor's Degree in Nursing or Health Administration
  • Required or equivalent work experience In Nursing in a clinical setting and/or MCO
  • Required: RN Mental Health Nurse Practitioner, RN Missouri Mental Health Clinical Nurse Specialist, or a Missouri Licensed Psychologist) –
  • Required 5+ years of experience in An acute clinical care setting and/or MCO related experience
  • Required 3+ years of experience in Case management
  • Advanced Knowledge of healthcare delivery
  • Advanced Ability to effectively present information and respond to questions from families, members, and providers
  • Intermediate Ability to implement process improvements
  • Preferred Certified Case Manager (CCM)
  • Required Intermediate Healthcare Management Systems (Generic) Intermediate to high level efficiency in Visio preferred
  • Preferred Intermediate Microsoft Visio
5

Manager, Case Management Resume Examples & Samples

  • Sets team direction, resolves problems and provides guidance to members of the team
  • Manage relationships with physician practices
  • Manage implementation of new physician practices and deployment of resources
  • Collaborate with cross functional teams on practice specific strategies to improve Medicare Stars ratings
  • Case management and coordination of care
  • 5+ years of experience as a Registered Nurse in an outpatient setting, hospital setting, acute care, direct care experience or as a telephonic Case Manager for an insurance company
  • Available to travel at least 30% of the time
  • Case Management experience
6

Manager, Case Management Resume Examples & Samples

  • Bachelor’s degree in Nursing or equivalent experience
  • 3+ years’ case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience
  • Thorough knowledge of case and/or utilization management and clinical nursing
  • Familiarity with Medicaid managed care practices and policies, CHIP, and SCHIP
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects
  • Supervisory experience including hiring, training, assigning work and managing the performance of staff
  • Managed Care Experience is a plus
  • Required - Unrestricted RN license in applicable state(s)
  • Case Management Certification (CCM) preferred
7

Manager Case Management Resume Examples & Samples

  • Five or more years clinical experience required, hospital setting preferred
  • Three to five years UM/CM experience required
  • One to three years charge/lead/supervisory/management experience required, in UM/CM department role preferred. Able to demonstrate leadership and management skills
8

Manager, Case Management Resume Examples & Samples

  • Ensures patient/personal safety by maintaining a safe and therapeutic environment and adhering to Safety Program and Infection Control Programs
  • Supports hospital and departmental Performance Improvement Goals
  • Demonstrates and promotes Plaza Medical Center of Fort Worth’s Mission and Values philosophies
9

Manager Case Management Resume Examples & Samples

  • Determines department staffing needs, coordinates the hiring, assignment, training and supervision of all Case Managers and Social Workers. Facilities the ongoing training and continuing education of staff and completes staff evaluation in accordance with hospital policy
  • Assists in developing all department/service policies and procedures, assuring compliance with all regulatory agencies. Coordinates staff education/compliance with these policies
  • Assists in developing the department’s goals/objectives in concert with the hospital mission, vision and values; educates staff to the goals/ objectives and provides periodic feedback as to the success in meeting these
  • Prepares and presents pertinent data to the Case Management committee (i.e. targeted DRG’s by LOS and cost/case, pertinent payment/resource issues, etc.)
  • Assists in the management of the Case Management program, which includes monitoring the appropriateness and medical necessity of admissions, continued stay and discharge planning
  • Maintains department employee files within the Case Management department to include but not limited to competencies, new employee orientation checklist, equipment checklist, in-service attendance, signed job description, annual feedback, and active license documentation
  • Education: Graduate of an accredited diploma, associates, or baccalaureate degree nursing program
  • Experience: Minimum of 3 years of Case Management experience
  • Employee completes initial and ongoing training and competencies as defined by service line, facility and department/unit which are specific to the needs of the patient population served (if applicable)
  • Preferred: Case Management supervisory experience
  • Required: Current Texas licensure as a Registered Nurse
  • Preferred: Bachelors of Science
10

Manager, Case Management Resume Examples & Samples

  • License/Certification: Unrestricted RN license in applicable state(s)
  • 3+ years case management experience and recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience
  • Previous experience as a lead in a functional area, managing cross functional teams on large scale projects or supervisory experience including hiring, training, assigning work
  • Automobile insurance
11

Manager Case Management Resume Examples & Samples

  • Takes lead role in setting direction and participating in or developing new programs
  • Current, unrestricted RN license in the state of Delaware
  • 3+ years of managerial/supervisory experience
  • 3+ years of experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
  • Bachelor's degree in Nursing
  • A background in managed care
  • Experience/exposure with discharge planning
12

Manager, Case Management Resume Examples & Samples

  • 3+ years case management experience
  • Recent nursing experience in an acute care setting particularly in medical/surgical, pediatrics, or obstetrics and management experience
  • Unrestricted RN license in applicable state(s)
  • Valid driver's license and automobile insurance
13

Manager, Case Management Resume Examples & Samples

  • Ensures compliance to all contractual and NCQA requirements
  • Current, unrestricted RN license in the state of Wisconsin
  • 3+ years managerial/supervisory experience or 5+ years of case management experience with increasing responsibility
  • 3+ years experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
  • Knowledge in CMS and State regulations
14

Manager, Case Management Resume Examples & Samples

  • 3+ years Case Management experience
  • Thorough knowledge of Case and/or Utilization Management and clinical nursing
  • Unrestricted RN license in Florida
15

Manager Case Management Resume Examples & Samples

  • 3 + years of managerial experience or 2+ years’ of case management experience in case in acute care, home care or managed care
  • 3+ years’ experience in a hospital setting, acute care, direct care experience or experience as a telephonic Case Manager for an insurance company
  • Strong organizational skills and multitasking abilities
16

Manager, Case Management Case Management Resume Examples & Samples

  • Work Services employees at assigned site. This includes hospital based, clinic services, outpatient settings as well as the emergency department. Develops and sustains case management or social work policies and procedures in collaboration with other Case Management/Social Work Services site managers. Manages and participates in other policies in impacting utilization, reimbursement, patient care and safety as well as general hospital discharge planning performance. Creates and performs the annual appraisals for case managers and ED / clinic social workers and completes all progressive counseling and documentation as appropriate
  • Financial - Develops, recommends, and implements goals and policies for the resource management of Case Management Social Work Services, including budgeting and allocation of human resources, capital expenses, physical facilities, and supplies. Develops and maintains financial contracts with Executive Health resources utilization management support. Staffing - Recruits, develops, coaches, mentors, counsels, evaluates, and retain staff within appropriate Human Resource policies and guidelines. Maintains effective orientation / mentoring program to meet / exceed utilization and licensing guidelines. Reimbursement - In conjunction with the Medical Advisors, assures that patient stay management is appropriate to the acute care setting and resource effective
  • Facilitates processes to refine physician' s understanding of payer needs and alternate patient care options. Provides leadership education and decision-making on issues of use of length of stay fund and charity resources. Facilitates cost effective use of medical services and compliance with external regulations regarding discharge planning procedures, medical necessity, and allowable benefits. Oversees and manages all audits pertaining to medical necessity for denial and appealable status
  • Master's Degree in Social Work or graduate from accredited school of nursing
  • Social Work license (of LISW or LISW-S) or RN License through the State of Ohio
  • Minimum of five years' experience in the field of medical social work or clinical nursing care, with at least two years of management experience
17

Manager, Case Management, Sacramento Resume Examples & Samples

  • Requires a BA/BS in a health related field; 5 years of clinical experience; or any combination of education and experience, which would provide an equivalent background
  • Current, unrestricted RN license in applicable state(s) required
  • Certification as a Case Manager is preferred
  • For URAC accredited areas the following applies: Requires a BA/BS; 5 years of clinical care experience; or any combination of education and experience, which would provide an equivalent background
  • Current and active RN license required in applicable state(s)
  • Certification as a Case Manager from the approved list of certifications and a BS in a health or human services related field preferred
  • Managers who have directly supervised the case management process for three or more years must hold a certification as a case manager and meet continuing education requirements to maintain licensure and certification
  • Candidate must reside in the Sacramento area to meet with Hospitals, Providers and community partners
18

Manager, Case Management Resume Examples & Samples

  • Education: Bachelors of Science in Nursing (BSN or equivalent academic credit requirements for a BSN clinical education and experience required) or Social Work (BSW). Master’s degree preferred
  • Experience: Minimum three (3) years’ experience in utilization management, case management, discharge planning or other cost/quality management program. Three years of experience in hospital-based nursing or social work preferred
  • Licenses/Certifications: Current and valid license to practice as a Registered Nurse in the state of Texas OR Licensed Master Social Worker (LMSW) required, LCSW preferred. Case Manager Certification required
  • Knowledge of leading practice in clinical care and payor requirements
  • Self-motivated, proven communication skills, assertive
  • Background in business planning, and targeted outcomes
  • Working knowledge of managed care, inpatient, outpatient, and the home health continuum, as well as utilization management and case management
  • Working knowledge of the concepts associated with Performance Improvement
  • Demonstrated effective working relationship with physicians
  • Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve quality outcomes
  • Assists in supervising and managing all aspects of the local level program
  • Supports growth and development of the case management program consistent with enterprise wide philosophy and in response to the dynamic nature of the health care environment through benchmarking for best practices, networking, quality management, and other activities as needed
  • Responsible for coordinating day to day operations of the program at the unit level
  • Assists in identifying and achieving optimal targeted financial outcomes via the inpatient case management process
  • Participates in departmental personnel functions (hiring, firing, etc.) in conjunction with the Director of Case Management
  • Provides input to annual and interim performance appraisal reviews for the professional and non-professional staff in department
  • Acts as liaison to facilitate communication and collaboration between all care partners (physicians, hospitalists, community care managers, nurses, community resources, etc.)
  • Responsible for leading a high performance team of “system thinkers” who incorporate leadership principles and vision in performing the functions of case management
  • Uses data to drive decisions, plan, and implement performance improvement strategies for case management
  • Ensures safe care to patients, staff and visitors; adheres to all Memorial Hermann policies, procedures, and standards within budgetary specifications including time management, supply management, productivity and quality of service
19

Manager Case Management Resume Examples & Samples

  • Manage clinical operations across the continuum of care to include assessing, planning, implementing, coordinating, monitoring and evaluating health care delivery
  • Set team direction, resolve problems and provide guidance to members of the team to ensure they meet the established performance metrics and goals
  • Take a lead role in developing and participating in new program initiatives and innovations
  • Provide monitoring and oversight of care management and coordination of care for our members
  • Serve as a coach, mentor and advocate for staff in their development and training
  • Adhere to ethical, legal/regulatory and accreditation standards to meet business goals and objectives
  • Create an environment that supports change and models accountability for staff
  • Track and report performance metrics and identify opportunities for continuous improvement
  • Conduct team meetings, field-based shadowing of team members, caseload auditing, and implement performance improvement plans
  • Understand and use data to manage the team as well as individual performance
  • Current, unrestricted RN license in the state of New Jersey
  • Minimum of 5 years care management/care coordination experience within a medical, corporate or behavioral healthcare setting
  • 5+ years of Clinical background required
  • 3 years previous leadership experience with direct reports, with the ability to partner with staff to build high-performing teams
  • Excellent organization, communication, teambuilding, and time management skill
  • Ability to proactively partner with care team, including primary care, behavioral health, state partners, and other key stakeholders
  • Strong problem solving and decision making abilities
  • Proficiency in MS Word and MS Excel, to include the ability to create documents and spreadsheets
  • Certified Care Manager (CCM)
20

Manager Case Management Resume Examples & Samples

  • MSW, LCSW, or RN (Arizona State License required)
  • Accredited Case Manager (ACM) preferred
  • Minimum of two years acute hospital experience preferred
  • Required skills include demonstrated organizational skills, excellent verbal and written communication skills, ability to lead and coordinate activities of a diverse group of people in a fast paced environment, critical thinking and problem solving skills and computer literacy
21

Manager, Case Management Resume Examples & Samples

  • Minimum 3+ years of experience in a hospital setting, acute care, direct care experience OR experience as a telephonic Case Manager for an insurance company
  • Solid computer proficiency with basic level of experience with Microsoft Word and with the ability to navigate a Windows environment
  • Working knowledge of Medicare and Medicaid
  • Must have a reliable vehicle, a current and unrestricted driver's license and proof of insurance
  • Minimum of 3+ years of experience as a manager
  • Experience in home health or hospice
  • CBA experience (community based alternatives)
22

Manager Case Management Resume Examples & Samples

  • Conduct team meetings, field - based shadowing of team members, caseload auditing, and implement performance improvement plans
  • Minimum of 5 years care management / care coordination experience within a medical, corporate or behavioral healthcare setting
  • Previous leadership experience with the ability to partner with staff to build high-performing teams
23

Case Manager / Case Management / Days Resume Examples & Samples

  • Creates plan for care across the continuum, integrating patient/family preferences and values
  • Monitors patient care through assessments, evaluations and/or patient records
  • Certified BLS Provider specializing in Basic Life Support credentialed from the American Heart Association (AHA) obtained within 1 Month (30 days) of hire date or job transfer date
  • Licensed Clinical Registered Nurse credentialed from the Texas Board of Nursing
  • 3 years of nursing experience required. 5 years preferred
24

Manager, Case Management Resume Examples & Samples

  • Oversee the workflow and day-to-day operations of the case management function
  • Review analyzes of activities, costs, operations and forecast data to determine progress toward stated goals and statistical/financial purposes for case management
  • Ensure compliance with federal and state regulations and contractual agreements
  • Develop, implement and maintain compliance with policies and procedures regarding medical and social case management
  • Develop, implement, and maintain case management programs to facilitate the use of appropriate medical and community resources and decrease health plan financial exposure
  • Ensure proper coordination and communication of medical service functions with other departmental functions at the business as assigned
  • Assist with provision of Medicare coverage and services
25

Manager Case Management Resume Examples & Samples

  • ADA Essential Functions
  • Bachelor’s Degree in Nursing, required. Master’s Degree, preferred
  • Current license to practice as a Registered Professional Nurse in New York State
  • Certified Case Manager (CCM), Nurse Case Manager (RN, CM), Case Manager, Certified (CMC) or Certified Professional in Health Care Quality (CPHCQ), preferred
  • Minimum of five (5) years administrative/supervisory case management experience in an acute care environment, required
26

Manager, Case Management Resume Examples & Samples

  • Provides coaching and mentoring to staff on a daily basis
  • Completes relevant HR activities such as timeoff requests, job description review, performance management activities ensuring all employees have clear goals, objectives and development plans, performance review discussions, etc
  • Ensures team execution of case management activities ensuring that the submissions and reconciliation team can submit cases to regulatory authorities and business partners’ ontime
  • May perform case management operational activities during periods of peak workload or to support business continuity
  • Directly responsible for the daily activities of the global case management team who perform ICSR case management activities
  • Manages team/personnel in daily activities include overseeing performance management, staff development plans and execution of those plans; coaching and mentoring staff to deliver high quality while meeting regulatory timelines
  • Recruits and facilitates the onboarding of staff, collaborating with Learning and Development to ensure appropriate training is assigned
  • Identifies product leads and backup product leads to ensure business continuity
  • Identifies resource needs and allocations to ensure appropriate function of the team
  • Manages daily workload for the team to ensure timely completion of data entry, triage, E2B acceptance (and failures) and case processing, ensuring that submission and reconciliation can achieve a high level of reporting compliance to health authorities and business partners
  • Closely collaborates with the Global Case Management Leader, Vendor
  • Management team, and the Submissions & Reconciliation team to ensure high quality and compliance of case management activities across internal teams and the case management vendor
  • Collaborates with medical reviewers to ensure that medical review and documentation is provided for assigned cases
  • Collaborates with the Agreements and Compliance team to support the investigation of root cause for late individual case safety reports, including implementing corrective and preventive actions, if appropriate
  • Manages the maintenance of the coding conventions and collaborates with the safety data management team to ensure safety database configurations are accurate
  • Participates in the review of regulatory intelligence to identify any changes to case management activities. As appropriate collaborates with the process, SOP and training team to make necessary internal procedural changes
  • Acts as a liaison with internal departments and external business partners on case management issues
  • Performs other activities as directed by department management
  • BS/BA degree in a health related (e.g., RN/BSN, RPh/PharmD) or biological science related field or a combination of nondegree education and 10+ years of industry experience 8+ years PV, regulatory or compliance related experience
  • Minimum 1+ years people management (direct reports) experience or 2+ years of leading project teams (no formal direct reports but responsible for team deliverables)