Case Management Resume Sample
Nels Stokes
3630 Wehner Walks,
Detroit,
MI
+1 (555) 637 0535
Work Experience
Director of Case Management
07/2017
-
PRESENT
Boston, MA
- Work closely with Client Management Sector Heads and GBM Banking Coverage teams to understand volumes and types of requests incoming to Case Management team
- Manage the capacity of the Case Management team and ensure timely execution of all incoming tasks to the queue, using tracking provided by the Task Management Tool or other systems
- Act as a control point for the Case Management team to ensure that incoming tasks are within the Target Operating Model of the Banking Middle Office (BMO), and develop a strategy for migrating any tasks that seem to be outside this remit
- Partner with the Client Management team to provide timely support to the Coverage teams
- Major emphasis on the maintenance on effective and rigid control environment ensuring quality and adherence is never compromised
- Participate in the development of pharmacovigilance agreements, contracts and MOU’s with licensees, commercial agents and business partners
- Strategic leadership, definition and accountability for Celgene Global individual case report evaluation and management
- Ensure Celgene sustains excellent global regulatory safety requirement compliance
- Create resource requirement projections, development of capacity model and manage resources
Case Management
12/2013
-
06/2017
Philadelphia, PA
- Ensure creation and ongoing development of ICSR group process metrics and compliance metrics
- Create, sign off and maintain policies, guidelines, SOPs and WPs for ICSR processing
- Hire, manage, mentor, orientate, and develop ICSR
- Support implementation of HR processes and initiatives
- Clarify and codify boundaries, support and handoffs with GDSRM
- Support internal and external auditing of GDSRM
- Support the development and realization of the GDSRM department’s vision and long range plan
- Support development and execution of global safety staff education and training
- Establish and maintain supportive relationships with Celgene affiliates and business partners
Supv Case Management
12/2009
-
07/2013
Chicago, IL
- Budget formulation and management for Case Mgmt and Evaluation department
- Ensure adherence/compliance and adapt processes for ICSR submission documents as legislation changes dictate
- Direct Celgene Case Mgmt and Operations staff
- Provides administrative and clinical leadership to all case management staff
- Establishes goals, objectives and performance standards for the department in accordance with CMSA and other applicable industry standards and state and federal requirements
- Develops strategies and programs to achieve goals, as evidenced by positive quality clinical and administrative outcomes
- Develops and implements policies and procedures supporting quality patient driven care coordination through efficient and effective case management
- Guides, mentors, motivates and engages the staff in assessing, planning, implementing and improving comprehensive care management practices including case management, discharge planning, and specific programs that are client driven
Education
Strayer University - White Marsh Campus
2004 - 2009
Bachelor's Degree in Nursing
Professional Skills
- Critical thinking skills, effective written and oral communications skills, strong self-initiative and interpersonal skills
- Excellent written and verbal communication skills; strong interpersonal skills; ability to collaborate effectively
- Strong and influential face to face and written communication skills (including consultation, presentation, training and workshop facilitation skills)
- Demonstrated skills as a leader managing staff and and strong clinical skill in the practice setting
- Possesses strong personnel management and team building skills that result in a high performing team and excellent Associate job satisfaction
- Prioritized work assignments, multi-task and manage time efficiently. Excellent problem solving skills
- Excellent interpersonal skills and the ability to communicate effectively both orally and writing
How to write Case Management Resume
Case Management role is responsible for leadership, interpersonal, case, computer, health, insurance, research, basic, training, planning.
To write great resume for case management job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Case Management Resume
The section contact information is important in your case management resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Case Management Resume
The section work experience is an essential part of your case management resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous case management responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular case management position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Case Management resume experience can include:
- Relevant work experience in case management experience with strong emphasis in utilization review
- Demonstrates cultural competence to work effectively, respectfully, and sensitively within the clients cultural context
- Excellent client-ready and client facilitation skills
- Experience working in and deep Know Your Customer (KYC) knowledge and understanding with exposure to AML and financial crime
- Experience managing a variety of case management models using an interdisciplinary team approach
- Broad clinical training and work experience sufficient to provide background in clinical management, continuing care and transitions of care
Education on a Case Management Resume
Make sure to make education a priority on your case management resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your case management experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Case Management Resume
When listing skills on your case management resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical case management skills:
- Management experience and/or 2 years as a Case Manager with demonstrated and effective leadership skills are required
- Demonstrated computer experience with solid keyboarding skills
- Demonstrated the ability to effectively prioritize multiple tasks and deadlines; work independently
- RN able to demonstrate excellent communication skills and ability o work collaboratively with all members of the health care team
- Demonstrated skills in leading and facilitating work efforts
- Multitask, prioritize, and effectively adapt to a fast-paced changing environment
List of Typical Experience For a Case Management Resume
1
Experience For Director of Case Management Resume
- Strong and sophisticated relationship building and account management skills
- Develop and maintain effective ongoing communication and effective working relationships with physicians, support team, supervisors and patients
- Comprehensive experience of building, engaging with and managing teams
- Provides and serves as a resource to staff between physicians, clinical and financial staff, demonstrating excellent oral and written communications
- Identify, select, structure, and prioritize process improvement projects, ultimately implementing changes to meet program requirements
- Supports the Medical Management/Utilization Management Committee in its activities and ensures staff is skilled in applying standard clinical guidelines
- Strong benefits package including medical, dental, vision, life, AD&D, STD, and LTD insurance; HAS, 401K; PTO; and more
2
Experience For Case Management Manager Resume
- Knowledge of local community health and social service agencies, programs and resources, and experience arranging community resources for patients
- Experience working with refugees under the age of 17
- Exercise good judgment and tact in relating to third-party payers, physicians, and patients
- Demonstrated the ability to deal with problems involving several concrete variables in standardized situations
- Case Management experience working with people who have physical disabilities, are elderly or have behavioral health needs
3
Experience For Director Case Management Resume
- Three (3)years of relevant management and Case Management experience in an acute care setting
- Valid Texas Nursing License
- Case management and discharge planning experience is required
- Experience working with people who are elderly or have a physical disability is required
- At least three (3) years of work experience in a medical case management setting
- Excellent ability to navigate Midas and understand Corporate education related to UR Standards
4
Experience For Manager of Case Management Resume
- Strong knowledge of Utilization Review processes and payor requirements
- Extensive management and clinical experience
- Experience in patient data, healthcare staff documentation related to patient care, regulatory and payer requirements, and budgetary and operations data
- Five (5) or more years’ experience at a Director/Executive level in a relevant field
- Designs appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access and cost-effective outcomes
5
Experience For Director, Case Management Resume
- Develops appropriate and fiscally responsible plan of care with targeted interventions that enhance quality, access, and cost-effective outcomes
- 2 Establishes partnerships with site Experience of Care champions in order to align BPCI efforts with patient satisfaction outcomes
- Provides leadership direction and support to facilitate optimal and cost effective patient outcomes
- Utilization Management and/or hospital-based case management experience
- Ensure that timely and effective discharge and transition needs assessment and plans are complete, safe and appropriate
- Demonstrate understanding of competency-based criteria for case management
- Acute care nursing case management experience required
6
Experience For Case Management Coord Resume
- Experience in healthcare compliance management
- Recognizing and conducting training needs on reconciliation related activities with internal partners worldwide
- Planning / timing of reconciliation with Pharmacovigilance Agreement lead and external partners
- Training and mentoring as backup to Lead as needed
- Ongoing work with CM Funding Specialists to proactively identify access issues for patients who desire treatment with an Alexion approved therapy
- Assisting care managers in care coordination and ensuring timely authorization and delivery of approved services
7
Experience For Systems Specialist Precert & Case Management Resume
- Understanding of credentialing process
- Thriving in complex, sometimes ambiguous and fast-paced environments
- Understanding of financial services and the needs of sales professionals is an advantage
- Working knowledge of CareAdvance and Facets systems
- Understanding of medical-legal aspects of Performance Improvement
- Working knowledge of Medical Data Systems
- Plans and monitors staffing activities, including hiring, orienting, evaluating, disciplinary actions and continuing education initiatives
- Shares with Director responsibility for collecting, analyzing, evaluating and presenting clinical management and operations data to a wide range of audiences
- Facilitates continuous performance improvement by encouraging innovation, supporting risk taking, and maintaining openness to new ideas
8
Experience For National Director, Case Management Services Resume
- Implements and supports with business case staffing requests utilizing the Tenet Case Management staffing recommendations and hospital budgetary guidelines
- Provide service support, training and performance metrics/statistics to the team in addition to initiating and implementing process improvements
- Analyzes and monitors compliance with accrediting and regulatory agency standards, including JCAHO, TDH, licensing boards, etc
- Responsible for organizing and supervising staff in their departments, programs, budgets, schedules, overseeing payroll and equipment acquisition
- Maintains professional credentialing and continuing education pertaining to job description
9
Experience For Case Management Lead Resume
- Responsible for supervising, delegating and coordinating the work of exempt and non-exempt staff
- Interview, recommend for hire, ensure the training and on-boarding of new clinic staff while managing performance, feedback and placement of current team
- Works cooperatively with Health Information Management Department’s procedure in requesting and returning records for discharge dispositions
- Acts as internal consultant to all clinical areas in assuring adequate discharge planning resources
- Assists with precepting responsibilities for new hires and auditing efforts
- Work with members as appropriate by setting to develop healthcare goals and identify potential barriers to achieving healthcare goals
- To lead the KYC Service Case Management team, including the Refresh and Monitoring and the Client Service operations in Asia (Penang)
- Provides resource to staff regarding unforeseen issues and/or impediments to individual patient case management and/or discharge planning needs
- Provides resource to staff regarding clinical pathway development, monitoring, data management and related coordination of care and services whenever necessary
10
Experience For Dir-case Management Resume
- Responsible for identifying and achieving optimal targeted financial outcomes via the hospital case management process
- Pursues sharing of best practices through publication, presentation at conferences and networking with other AHN leaders throughout the system
- Provides education specific to obtaining and maintaining efficiency of patient throughput
- Works closely with the department CFO formulating the operating and capital budget, and monitors budget
- Directs operation of the case management program including budget development and monitoring
- Interviews for positions and makes recommendations for hiring and terminating staff
- Aware of and educates the staff to remain vigilant in tracking avoidable days, educate how it influences and improves discharge planning practice
- Analyze pre-admission screenings for utilization review, funding and discharge planning
- Provide education, teaching, and coaching on case management practices and policies
List of Typical Skills For a Case Management Resume
1
Skills For Director of Case Management Resume
- Registered Nurse able to demonstrate excellent communication skills and ability to work collaboratively with all members of the health care team
- Excellent computer skills for data analysis and reporting
- Excellent organizational skills for the execution of leading CM practices
- Strong communication, problem solving, negotiation and presentation skills
- Provide leadership through communication and relationship-building, a strong knowledge of the health care environment and business skills
- Excellent interpersonal skills applicable to the medical staff, administration, professional staff and outside reviewing agencies
- Demonstrated facilitation skills with a working knowledge of CQI tools and techniques
- Prior experience with electronic documentation, and experience documenting in multiple computer applications
- Demonstrates the knowledge and skills required to lead teams in group’s projects and assignments
2
Skills For Case Management Manager Resume
- Strong clinical assessment and process skills
- Strong communication skills with the ability to be a trouble shooter
- Effective interpersonal, verbal and written communication skills for
- Progressive management experience, with 2 years’ experience in case management or 5 years of Case Management experience
- Possess intermediate to advanced computer skills and experience with Microsoft Word, Excel and Outlook
- Special Skills and Experience
- Management/supervisory experience or experience leading/working on project teams
- Care coordination or discharge planning experience, in acute care hospital setting with 3 to 5 years management experience
3
Skills For Director Case Management Resume
- Hospital based Case Management experience including Utilization Review and Discharge Planning experience
- Five years Nursing experience or Master's experience, preferably in a hospital or healthcare setting
- Prior experience with Physician engagement and interaction regarding members discharge care instructions
- Prior discharge planning experience
- Strong needs assessment, utilization review and discharge planning experience
4
Skills For Manager of Case Management Resume
- Experience in a hospital setting as a case manager with utilization review experience
- Prior experience and working knowledge of Medicare, Medicaid, managed care and commercial payor principles, and benefit coverage and limitations
- Prior experience working with uninsured populations
- Desired: Prior experience documenting in an electronic medical record (EMR)
- Provides orientation and training for new staff members and assists with the completion of Competency Skills Checklists
5
Skills For Director, Case Management Resume
- Serves as a clinical role model for staff. Maintains current skills & knowledge base in Case management and Clinical documentation
- Well-developed organizational skills with capability to manage / motivate self and others
- Assessment skills and knowledge application for all ages from newborn to geriatric
- Prior case management experience
- Prior experience with medication reconciliation
- Proficiency in basic PC skills; excel, Microsoft office
6
Skills For Case Management Coord Resume
- Acute Care Leadership experience; 2+ years of Case Management experience
- Previous clinical experience with three years management experience required
- Prior experience in UR or Case Management required
- 6+ months of customer service skills are required
- At least five years of current demonstrated experience in management and utilization management
- Interact and communicate effectively with medical staff, hospital personnel, patients, and their families
- Recent hospital case management experience or related experience required
- Clinical experience of direct clinical care to the consumer with at least 1 year of NICU experience
7
Skills For Systems Specialist Precert & Case Management Resume
- Completing prior authorizations
- Upervisory/manager experience, including managing remote teams
- Solid understanding of reimbursement structures and CMS regulations in the acute care setting required
- Experience working within the community health setting or in a health care role
- Experience using planning & commissions applications
- Prepares reports, data, and other analytical materials used in assessing the effectiveness of the department
- Review prior authorization request received from MLTSS Providers, ensuring that all pertinent clinical information is received
- Experience working with Government Clients, preferably ORR, FEMA, HHS, and/or DHS
8
Skills For National Director, Case Management Services Resume
- Experience with PC applications (word processing, spreadsheet and graphics) and data analysis/interpretation required
- Hospital discharge planning experience
- Knowledge and skill regarding basic computer processes
- Clinical experience and/or training
- Two (2) years’ experience in a nursing management position
- Thorough knowledge of JCAHO survey requirements and experience in orchestrating successful JCAHO surveys
- Establish and maintain effective working relationships at all levels both inside and outside the organization
- Three years of Utilization Management/Case Management experience, preferably in an acute hospital setting
- Strong business acumen with an understanding of the Case Management model and Medical Affairs fuction
9
Skills For Case Management Lead Resume
- Prior case management, utilization management or discharge planning
- Previous experience conducting face-to-face care management
- Health Plan experience working with large carriers
- Experience working with MCG or Interqual guidelines
- Develops strong relationships with customers (i.e. patients, physicians and supporting departments)
- Three years Case Management experience in acute care setting,
- Experience with managed care and/or working within a health plan
- Experience working with Medicare and/or DSNP
- Experience managing employees virtually
10
Skills For Dir-case Management Resume
- Experience managing diverse teams
- Three years experience in an acute care setting
- Case Management experience working with people who have physical disabilities, are elderly or have behavioral health needs
- Generally requires moderate to extensive experience in nursing, health care or related field
- Experienced in using EHR. Required to be proficient in Microsoft Office Applications (excel, outlook, word)
- Case management and discharge planning experience
List of Typical Responsibilities For a Case Management Resume
1
Responsibilities For Director of Case Management Resume
- Previous experience in working with near/off shore teams
- Develop and implement methods, policies and procedures to improve the departments efficiency and effectiveness
- Maintains an adequate number and skill mix over seven days a week to serve the patient population and meet the goals of the department
- Demonstrates an ability to perform specific competencies as identified on the Case Mgr Competency Grid
- Helps to develop and utilizes medical guidelines in an effort to provide high quality, cost effective care sensitive to the resources available
- Ensure accurate, contiguous case management records are maintained. Ensures effective provision of 24/7 Case Management support
- Preferable occupational health qualification or experience in occupational health particularly seafarers
- Maritime experience is beneficial
2
Responsibilities For Case Management Manager Resume
- Registered Nurse (RN) with current, valid, unrestricted license in state of operations or reciprocity
- Ability and willingness to travel within assigned location. Possess transportation and current, valid drivers license for applicable state
- Medicare / Medicaid experience
- Care management experience
- Experience with and functional knowledge of hospital computer and data capabilities. Proficient in Microsoft Office software programs
- Three years administrative case management related experience
3
Responsibilities For Director Case Management Resume
- Reviewing daily, weekly and monthly MI to identify potential issues
- Ensuring staff are trained in Care Management Department workflows and Hospital policies and procedures related to care management
- Thorough knowledge of managing applicable financials including margin
- Proficiency with regard to health insurance benefits, billing, coding, relevant state and federal laws and insurance regulations
- Knowledge of Billing and Claims Processing
- Perform and oversee needs analysis and planning
- Work with executive leadership to ensure targets are met for the annual operating plan/financial management
- Ensure teams are completing periodic reviews in line with their next review dates
- Conducts a focused assessment as it relates to a patient’s needs for discharge planning preparation
4
Responsibilities For Manager of Case Management Resume
- Provides developmental and training opportunities for team members
- Identifies staffing needs and objectives
- Ensures receipt of data/cases/reports from internal and external partners in the global safety database (including seriousness)
- Clarifies missing data/cases/reports with internal as well as external partners
- Preparation and presentation of training material
- Knowledge working with database systems
- Assesses and re-evaluates health and progress due to the dynamic nature of the plan of care required on an ongoing basis
5
Responsibilities For Director, Case Management Resume
- Initiates and implements appropriate modifications in plan of care to adapt to changes occurring over time and through various settings
- Oversees program data and provides strategic direction on impacting outcomes
- Is responsible for annual budget development, new program development, establishing department policies and procedures, department goals and objectives
- Discharge Planning and transitional care
- Integrate health care and service needs into a plan or recommendation for helping the member obtain preventive care and services
- Identify relevant community resources available based on member needs as appropriate by setting
- Holds regular departmental meetings with staff to provide updates and provides for ongoing education
6
Responsibilities For Case Management Coord Resume
- Follows the InterQual Inter-rater Reliability (IRR) Policy to determine initial and yearly competency for all employees performing InterQual reviews
- Engages with Operations team colleagues as a member of the Operations management team, promoting case management excellence at every opportunity
- Assesses and plans for capital and operating needs of assigned department(s)
- Completion of AHCA approved mental health targeted case management training
- Research and recognize concerning patient situations and support relevant staff to solve disposition issues
- Implement methods which lessen patients’ length of stay without threatening desired care outcomes
7
Responsibilities For Systems Specialist Precert & Case Management Resume
- Determine annual budget and provide suggestions to relevant executives for operating and capital budgets
- Lead, support and build on current efforts of various groups working within the department's scope of work
- Case management in a managed care setting
- Management exerience, managing a total of 50+ reports (direct and indirect)
- Need to be okay with traveling between the 2 offices (Eugene and Tigard)
- A graduate of an accredited nursing baccalaureate (BSN) program is required
8
Responsibilities For National Director, Case Management Services Resume
- Handle sensitive issues with opposing opinions, work in cross functional environment and handle projects or multiple tasks
- Flexible and able to adapt in a fast-paced and changing environment
- Self motivated, self-disciplined and holds self accountable for achieving goals and tactics in a timely manner
- Integrates and interprets data from diverse sources addressing issues of moderate to high complexity
- Maintains professional competency by attending managed care seminars, conferences, etc
- Knowledge of alternative treatment options, alternative funding programs and community services and resources
- Corp Vice President Global Drug Safety and Risk Management
- The Case Manager is responsible for the daily clinical care coordination of the patient through their entire episode of illness within Research Psychiatric Center’s healthcare system
- Direct the overall operational leadership of case management functions and staff
9
Responsibilities For Case Management Lead Resume
- Ensure compliance with Corporate, State and NCQA standards
- Report any known or suspected unauthorized attempts to access facility’s information system
- 3) Embrace Consulate Health Care’s five core values of compassion, honesty, integrity, respect and passion, and incorporate them into one’s daily job function
- Track overtime, attendance, and PTO Develop and conduct educational programs to keep teammates up-to-date on DaVita policies, new laws and regulations impacting work, and other information necessary to maintain teammates’ knowledge of department processes and goals
- Attends department staff meetings (50%) and trainings relevant to position. Participates in activities which promote personal/professional development. Serves on assigned hospital and/or unit based councils
- Provide guidance to the teams on any KYC specific queries to ensure timely completion of files
- Responsible for reporting any violations of Company policies or procedures by distributors or employees in accordance with the Company’s policies and procedures related to violations
10
Responsibilities For Dir-case Management Resume
- Experience in Sales Operations or Business Operations
- Assesses patient goals for health care as well as biophysical, psychosocial, environmental, economic/financial and discharge planning needs
- Answers to communication related to reconciliation from internal as well as external partners
- Documentation of reconciliation activities
- Generation of process-relevant documents (SOP)
- Suggestion of process improvements and optimization
- Professional assistance in projects for development of reconciliation tools
- Review of PVAs in regard to reconciliation activities
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