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Assists management in collaborating with Health Services, Operations and Information Technology
departments to ensure full integration of case management reporting throughout the organization.
Organize and manage eligibility case load and follow timelines. Provides case management services
to a caseload of assigned participants, assisting them to remove both real and self-perceived barriers
that interfere with obtaining employment. Conduct assessments and develop treatment plans to
provide benefit and mental health education, to coordinate services, and manage behavioral health
care needs. Performs risk, psychosocial and transitions assessments as indicated, collaborating with
interdisciplinary team according to craft treatment plans consistent with evidence-based care
guidelines. Skills: Data Entry, Microsoft Office, Management Skills. Pending or obtained
certification in Case Management, Certified Diabetes Educator (CDE), or other applicable Clinical
specialties. Position is subject to a criminal background investigation and pre-employment drug
screen. Proficient in Microsoft applications (Word, Excel, Access). Maintain confidentiality of
member, attendant and staff information. Tracks and trends barriers to care; makes recommendations
and develops action plans to improve processes and systems. Documents Avoidable Delays in Midas.
Excellent communication skills, both verbal and written are required. Strong knowledge in Microsoft
Office applications - Word, Excel, Access, PowerPoint. Know, understand, follow, and implement
DaVita safety and security policies and procedures. To get hired, a proper resume is essential, and
the resume examples we’ve created can help show you the way. Associate’s degree in Behavioral
Health or health related field. Develop working relationships with customers and monitor
engagement and progress. Working knowledge of principles of utilization management. Determine
staffing plans that promote the most effective use of all teammates; ensure coverage during
teammate absences. Monitors, controls, and evaluates the quality and quantity of the staff
effectiveness and work products; recruits, orients, coaches, develop, supervise, and evaluates direct
reports that contributes to staff retention within the department. Each of these functions supports the
CM department goals: improved patient satisfaction and patient outcomes, decreased length of stay
and decrease unit cost. Excellent Interpersonal skills with the ability to influence others. Evaluates
and assess observation patients for appropriateness in observation status. Please make sure you have
typed your email address correctly so we can send you the checklist. Monitors and controls the use
of healthcare resources to achieve desired patient outcomes, decrease length of stay, and decrease
resource utilization. Must be able to demonstrate initiative and the ability to work in a fast paced
environment with proficiency in multi-tasking and prioritization. Ensures continued availability
(recertification) of financial resources throughout the residents stay. Must have experience with
industrial interpretation with respect to regulatory expectations. Help direct reports overcome any
organizational obstacles encountered during projects Manage all teammate employment activity such
as hiring, promoting, job performance, evaluations, and disciplinary actions with appropriate
approvals as required. Our team conducts original research to understand the job market better, and
we pride ourselves on being quoted by top universities and prime media outlets from around the
world.
Personal Working effectively to tight, rolling deadlines with minimal supervision. Develop and
maintain written systems to track projects and activities. Experience working with the needs of
vulnerable populations who have chronic or complex bio - psychosocial needs. Ensure that
departmental computer workstations left unattended are properly logged off or the password
protected automatic screen-saver activates within established facility policy guidelines.
Communication with senior leadership staff from clients including elected officials. Participate in
special projects and performs other duties as assigned. Acting as an escalation contact for day to day
issues from the global teams and business. Assesses learning needs related to case management
practice and implements appropriate educational activities to expand knowledge base. Typing skills
for typing reports and correspondence. Demonstrates an ability to be flexible, organized and
function under stressful situations. Prior work experience in clinical social work position is required;
preference for mental health experience. Maintains knowledge of resources and facilities available to
patients and family members. Collaborate and consult with key stakeholders and members of student
support networks, on and off campus to develop a coordinated, multidisciplinary approach for
responding to, advocating for, and supporting students, including coordinating with hospitals for
intake, discharge planning and follow up care Maintain a comprehensive overview of students
identified as being in distress. To convey your soft skills, make use of the cover letter to go more in
depth. 6. Add Other Sections to Your Case Manager Resume You’ve got a good case manager
resume so far. Required Intermediate Microsoft Word Proficient in Microsoft Office including Excel,
Word, PowerPoint, Access and Outlook Express. Measures the effectiveness of interventions as
identified in the members care plan. Skills: Cognitive Behavior Therapy; Crisis Intervention; Trauma
Informed Care; Cultural Sensitivity Training. Installing electronic monitoring equipment on ISAP
Program Participants as necessary and monitoring compliance with electronic monitoring program.
Must possess a Bachelor's or Associate level degree from an accredited school of nursing. Ensure
integrity of departmental database by thorough, timely and accurate entry, consistent with regulatory
protocols and effectively manage case resolution inbox everyday. Review submitted applications for
compliance with the program guidelines and policies. Ability to actively manage and deliver on
client expectations around project activities, timelines, deliverables, outcomes, etc. Ensures accurate
documentation of clinical information to determine and support medical necessity criteria,level of
care and contract benefits. Coordinate with the Case Manager Supervisor and with DHS to complete
the service plan authorization process. Skills: Management Skills, Coordinating Skills, Developing
Skills. We've condensed their insights into this step-by-step checklist, and packed it with insider
tools and strategies you won't get anywhere else. Essential Mental Abilities: Able to comprehend
and interpret complex clinical subject matter related to specialty. Intermediate Other Ability to
understands the business and financial aspect of case mgmt in a managed care setting. Assists with
appropriate disciplinary action and performance improvement of staff members as needed. Address
teammate relations issues appropriately and escalate as necessary.
Resume Examples See perfect resume samples that get jobs. Manage underwriting tasks such as
following up with the member and insurer, requesting and obtaining forms and medical evidence, as
required and maintaining file records. Experience Preferred: Experience in post-acute settings.
Ability to obtain CPR certification within 60 days of employment. Skills: Microsoft Office,
Counseling, Case Management, Electronic Medical Records. Previous utilization management,
medical records, case management or unit clerk experience required. If you've ever received a
seemingly auto-rejection email after you've applied online, it's safe to assume a computer rejected
you (and a recruiter didn't even see it)! Bachelor's Degree (social services field preferred). Facilitates
clinically appropriate admissions to hospital services, congruent with needs and resources of
individual. Coordinates community resources, with emphasis on medical, behavioral, and social
services. How? Talk up the nursing, psychology, and counseling coursework in a way that makes
them certain you’re the one for the job. Develops workflows and processes that support accurate and
timely responses to issues. Solid understanding of client due diligence processes and client lifecycle
management including KYC, tax and regulatory obligations. Plan the operation and workflow for
the SPOC function to ensure objectives are met. Perform on-site clinical assessments of potential
patients. Collaborate with the operational team to assist in hiring, disciplinary action and
competencies of the team members in the neighborhood. Participate in managing the organization's
complaint and grievance process. Identifies patients with the potential for high risk complications
and makes appropriate referrals acting as an advocate for the individual’s healthcare needs.
Coordinate and carry out CADD renewal process with coverage, business, and compliance.
Identified community resources, programs, and other services for clients if needed. 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. Must be able to work in a fast
paced, ever changing environment. CT Licensed Registered Nurse or eligible to be licensed.
Performs intake assessment on patient within 24 hours of admission (patients meeting screening
criteria). Awarded “Award of Service Excellence (AOSE)” by the CMSA for 2016. Maintains
optimal continuum of patient care through efficient and effective planning, assessing and
coordination of healthcare services. Evaluates discharge planning needs on admission review.
Maintain communication with facility business office and CBO to ensure accurate census and
payment of managed care and Medicare residents. Must also have high speed internet access and
experience with remote access, set-up, and troubleshooting technical issues when working remotely.
Assists with discharge documentation with pertinent information for follow-up providers (such as
contact information, address, appointments times, etc.).
Cover Letter Templates Find the perfect cover letter template. Serve as a liaison for the CHF
program and function as a member of the CHF team. Working with patients, families, physicians,
and outside agencies to establish, coordinate, and complete a discharge plan. Knowledge of all
Utilization Management processes, expectations, and requirements. Maintaining a working
knowledge and professional relationship with community wide post-acute care providers. Perform
benefit investigations with insurance companies as required. Report on emerging trends so that they
can be addressed and where suitable, learnings can be leveraged nationally. Electronic case
management and medical record experience. Bachelor's Degree (social services field preferred).
Seeking to build upon successful past experience to grow with NYCSSC as the new lead case
manager. Computer literate using Microsoft Office Suite programs. Identify individual limitations,
deficits, and strengths and aggressively attempt to provide patients with what they need in relation to
medical, behavioral and social needs. Applies case management standards, maintains HIPAA
standards and confidentiality of protected health information and reports critical incidents and
information regarding quality of care issues. Knowledge and understanding of the insurance industry
desirable. Three or more years of experience as a case manager in an acute care hospital. Utilizes
criteria and guidelines to validate medical necessity of continued stay and appropriateness of
treatment and discharge planning. Assessed specific conditions and needs of applicants to determine
appropriate services or referrals to case management. Assures that revenue, expenses, contribution
margin and FTE's meet or exceed budgeted expectations. Bachelor’s degree in management or
similar field of study required. Maintained an 85% client participation rate - exceeding contract
requirements by 33% and contributing to the office's overall success rate. Advises management and
employees regarding HR compliance requirements and disability laws, policies and processes. Also,
provide strategic oversight to identify potential additional areas for outsourcing to a vendor and lead
the vendor selection process to ensure qualifications and contract in place. Necessary These cookies
are essential for the Site's performance and for you to be able to use its features. I got many
compliments on it from senior hiring staff. Familiarity with pre-delinquent and delinquent court
procedures. Implements, coordinates, and monitors strategies for members and families to improve
health and quality of life outcomes. Tracking and monitoring variances to identify and improve
processes. Plans, coordinates and monitors comprehensive QI programs as indicated. Facilitates a
team approach to the coordination and cost effective delivery to quality care and services. Minimum
two (2) years of direct patient care experience.
Proficient with firm standard technology including Windows, Excel, Word, Lotus Notes, Intranet
and Case Management tools. Preparation of inpatient denial letters including DENC as required. The
best way to start a cover letter is with a compelling introduction. In addition, provide appropriate
interventions to optimize health and well-being. Bachelor's degree from an accredited college or
university required, preferred field of study in human services or equivalent years of experience in
employment services or human services. Ensures department responds to all service requests in a
timely and accurate manner. Provide training, supervision and evaluation of team members. Leads
daily case management operations meetings, represents department in hospital operations. Providing
ongoing training and education on clinical knowledge. At least 1-2 years experience in behavioral
health, social services or appropriate related field equivalent to program focus. (2 or more years
highly preferred!). Assist residents to establish personal budget, locate suitable housing, enroll in
educational and vocational programs and participate in family and community activities, as
appropriate, to ensure that they are working towards financial independence. Assess patient's
progress through expected hospital course. Ability to develop positive relationships with outside post
acute care agencies such as SNFs or ECFs as well as with private insurance companies, HSAG and
CMS. Assesses member’s health status and treatment plan and identifies any gaps or barriers to
healthcare. Experience as a licensed RN in one or more of the following areas: Geriatrics; Discharge
Planning; Case Management; Assessment; Acute, Sub-Acute, Long-Term Care (LTC); Health
insurance; Home care environment; Homeless; Addiction; and, Foster care. Acts as a primary case
manager for members identified as Complex as defined by Case Management Program Description.
Plus, a great cover letter that matches your resume will give you an advantage over other candidates.
Coordinate with health plan clinical programs as appropriate. Proficiency with Mortgage Servicing
Platforms (e.g. Black Knight, LPS, etc.) preferred. Manage and oversee Disease Management
program in designated market or geography. Demonstrated negotiation, analytical and problem
solving skills. Exhibit solid communication, organizational and people skills in order to effectively
drive positive case management outcomes. Provides departmental needs assessment; identifies goals,
develops and implements action plans in order to achieve objectives. Ensues coordinated, effective
resident care including admission, continued stay, and discharge requirements. Working in
partnership with the sales team, servicing team and other specialists to ensure that we provide a
joined up service to our customers at all times. Knowledge of CMS guidelines and experience
working with payor specific guidelines and contractual rules preferred. Intermediate ability to
effectively present information and respond to questions from families, members, and providers.
Adhere to policies and practices of applicable professional organizations, client hospital and
RehabCare Group. Works closely with multiple vendors (i.e., MRS, ExamOne) managing the
relationship between vendors and member. Current healthcare professional licensure as Registered
Nurse, Respiratory Therapist, Physical Therapist, Occupational Therapist or Social Worker required.