Case Management Coordinator Resume Sample
Makenzie Effertz
13896 Thalia Isle,
New York,
NY
+1 (555) 114 1711
Work Experience
Case Management Coordinator
09/2016
-
PRESENT
Los Angeles, CA
- Through the use of clinical tools and review of member specific health information/data, conducts comprehensive assessments of referred members needs/eligibility and, in collaboration with the members care team, determines an approach to resolving member issues and/or meeting needs by evaluating the members benefit plan and available internal and external programs/services and resources
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues
- Using advanced clinical skills, performs crisis intervention with members experiencing behavioral health or medical crisis and refers them to the appropriate clinical and service providers for thorough assessment and treatment, as clinically indicated. Provides crisis follow up to members to help ensure they are receiving the appropriate treatment/services
- Provide case management services to a select group of assigned patients in accordance with department standards, policies, and procedures
- Act as a resource for other employees. Train or communicate instructions to other employees, assign and adjust resources as needed, and inspect work to separate acceptable work from unacceptable
- Serve as a contact person in the absence of a supervisor or director. Contributes to performance appraisals for assigned staff
- Two years responsible clerical experience in the health care field, with some knowledge of hospital systems
- Time spent on phone and computer
Case Management Coordinator Outpatient
12/2011
-
04/2016
Boston, MA
- Time spent doing face-to-face visits
- Two years experience in medical office setting
- Communicates continually with patients, other departments (clinic managers, providers, workers compensation, risk mgmt, human resources), contract employers, referral network providers and workers compensation carrier case managers to ensure that appropriate plans and protocols are being followed and that the patient is discharged from care with a timely and appropriate return to work status
- Maintains current open and discharged case files in internal computer database
- Monitors and tracks all referral activities within the companys ancillary and specialist referral network
- Reports drug screen results to employers and records results in database
- Exhibits professionalism, responsibility and accountability for assigned work while working within peers, subordinates, supervisors or working independently
- Licensed Alcohol and Drug Counselor (LADC) State of Minnesota
Case Management Coordinator PRN
11/2005
-
09/2011
Houston, TX
- Knowledge of financial and utilization review software, including ECIN, InterQual and Kepro
- Identifies and assigns initial Complex pts to appropriate level of care and providers
- Notifies multiple specialists, providers, nursing agencies, medical supply companies, insurances and works closely both inside and outside the Chop organization
- Discusses all medical and social needs to provide the highest quality of medical care
- Improve the quality of coordination of care to enhance patient outcomes and satisfaction
- Assesses the patient and family for continuing care needs to develop, implement and evaluate an effective discharge plan in collaboration with the multidisciplinary team. Uses knowledge of usual length of stay to initiate a plan for discharge
- Completes the interventions necessary for discharges to home with self-care, home with services or short term skilled nursing facility placement. Assembles necessary referrals, discharge summaries and pertinent information for discharge to home,placement, or transfer prior to the day of discharge
- Receive phone calls and field basic questions; escalate critical issues to appropriate staff for resolution
- Update Managed Care grids to intranet and communicate changes to the appropriate centers timely
Education
Antioch University Seattle
2001 - 2005
School's Degree in Psychology
Professional Skills
- Utilize clinical tools and information/data review, conduct comprehensive assessments of referred members needs/eligibility and determines approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services
- Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and address complex clinical indicators which impact care planning and resolution of member issues
- Uses advanced clinical skills, performs crisis intervention with members experiencing a behavioral health or medical crisis and refers them to the appropriate clinical providers for thorough assessment and treatment, as clinically indicated
- Application and/or interpretation of applicable criteria and clinical guidelines, standardized case management plans, policies, procedures, and regulatory standards while assessing benefits and/or members needs to ensure appropriate administration of benefits
- Uses holistic approach consults with supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary view in order to achieve optimal outcomes
- Helps member actively and knowledgably participate with their provider in healthcare decision-making Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs. Monitoring, Evaluation and Documentation of Care
- Outstanding communication, interpersonal, and organizational skills
How to write Case Management Coordinator Resume
Case Management Coordinator role is responsible for health, security, training, database, payroll, immigration, research, insurance, travel, software.
To write great resume for case management coordinator job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Case Management Coordinator Resume
The section contact information is important in your case management coordinator 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 Coordinator Resume
The section work experience is an essential part of your case management coordinator 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 coordinator 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 coordinator position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Case Management Coordinator resume experience can include:
- Strong communication skills and the ability to communicate both verbally and in writing effectively
- Three (3) years of experience in Case Management working with commercial and government operated payors, Case Managers, and Clinicians
- Demonstrates initiatives in developing, implementing and analyzing quality improvement activities and outcomes of the department
- Experience communicating, interpreting and processing information
- Experience entering and retrieving information using database systems
- Perform discharge planning and identifying alternate treatment programs that provide medically necessary potentially cost effective services
Education on a Case Management Coordinator Resume
Make sure to make education a priority on your case management coordinator 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 coordinator 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 Coordinator Resume
When listing skills on your case management coordinator 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 coordinator skills:
- Computer literacy and demonstrated proficiency with MS Office Suite and strong keyboard navigation skills are required
- Strong organizational skills and the ability to maintain information in a logical and easily accessible manner
- Good customer service skills and the ability to portray a positive image of the department and hospital
- Proficiency with MS Office Suite and strong keyboard navigation skills; Required
- Experience in clinical setting and 1 year experience in case management
- Interpersonal skills and the ability to communicate with individuals at various levels both internally and externally
List of Typical Experience For a Case Management Coordinator Resume
1
Experience For Case Management Coordinator Outpatient Resume
- Conducts audits as assigned completing accurate records preparing graphical reports for Committees and Departmental meetings
- Collaborate on a regular basis with Managed Health Services on any outstanding contract updates needed
- Assign inmate work and housing assignments at the facility level
- Enters data and processes referral authorization requests, to include appropriate coding and quantities
- Answers incoming calls from Providers, IPAs, Medical Groups and other internal and external calls and assists on the queues as needed
- Monitors the Fax Inbox and appropriately distributes incoming faxes. Ensures that internal compliance security measures are met
- Verifies member eligibility before processing authorizations
- Assists with scheduling and payroll
2
Experience For Substance Abuse Case Management Coordinator Resume
- Serves as resource person to department personnel, including delivery of the Important Message from Medicare
- Transcribes timely and accurately communications (minutes & meeting notification)
- Respectfully answers telephone and responds to questions exercising discretion and judgment or relays complete and accurate information to appropriate person
- Assist with the creation and deployment of regular educational offerings to the facility/center based Care Managers
- Run daily reports in order to be used by Care Management Support team to proactively identify opportunities in facilities/centers; assist with follow up efforts based on reported data as needed
- Support the Transitional Care Program as requested, to include follow up phone calls and arranging follow up primary care physician appointments
- Perform concurrent review in accordance with accepted department criteria
- Consulting with physicians, providers, members, and other resources, as appropriate, to assess, plan, facilitate implementation, coordinate, monitor, and evaluate options and services required to meet an individual’s health needs
- Using communication and available resources to promote quality, cost effective outcomes; serving as liaison to physicians, and members; serving as preceptor for less experienced staff
3
Experience For Case Management Coordinator MSW Resume
- Monitor and lead the communication processes; ensure Case Managers and other staff follow communication protocols, processes, and procedures
- Serve as the CURP Coordinator for Blue Cross Blue Shield of Alabama; maintain an up-to-date knowledge of guidelines and ensure the Case Management staff is informed of new or revised guidelines
- Serve as the primary liaison between designated commercial payors and St. Francis Hospital
- Ensure authorization numbers are available for claims reimbursement by the Business Office
- Facilitate and coordinate request for appeals and denial decisions for inpatient cases
4
Experience For Case Management Coordinator PRN Resume
- Assist with Case Manager patient assignment
- Notify all Medicare HMO’s of admissions to the hospital; provide required information as needed
- Monitor and maintain the Hospitals compliance with issuance of Medicare notices
- Communicate claim authorization and denial information to the appropriate Case Manager
- Document activities and information in the database system; log communications and activities to include authorizations and denials
- Aide the Hospital Appeals Coordinator; provide all necessary information
- Provide discharge, dispositions, and admittance dates upon request
- Provide authorizations and denial information to multiple physician offices
5
Experience For Prenatal Screening Case Management Coordinator Resume
- Document surgery authorizations and denials, and approval stipulations; notify/follow up with Registration when are not documented as required
- Coordinate the department work schedule
- Collaborate with Case Manager on contact to new patients/patient representatives when Program Member initiated emergently
- Collaboration with Case Managers on contact to enrolled patients/patient representatives in line with the outreach program of OneSource
- Appropriate documentation of CM/CMC interactions in system of record
- Send/obtain patient enrollment forms (consents) as appropriate
6
Experience For Inpatient Case Management Coordinator Resume
- Enter labs and related information into Documentation system
- Performs insurance co-verifications on enrolled members
- Introduction of the OneSource CM Program as appropriate (initial contacts to providers) and answer basic clinical and program inquiries
- Supports Case Manager Team in routine issues
- Conducts appropriate follow-up and facilitates access to appropriate case management support services
- Other tasks as needs identified by management
- Clinical, technical and scientific knowledge and aptitude in complex disease state
- Coordinate with department heads and administrative staff on case management issues
- Provide technical assistance and serve as a resource for the facility and Bureau of Prisons staff on case management issues
7
Experience For Zzz. Case Management Coordinator Resume
- Supervise, select, and train all staff assigned to the case management and countroom areas
- Serve as a coordinator for the U.S. Parole Commission, U.S. Probation and Pretrial Services, and the Federal Courts
- Administer, manage, and control the inmate release process at the facility. Coordinate with and obtain Bureau of Prisons approval for all inmate releases
- Maintain quality control for all documentation and official correspondence prepared by case management staff that requires the signature and approval by the warden
- Monitor the victim/witness notification and the financial responsibility programs to ensure compliance in these areas. Serves as the facility coordinator of these areas as well
- Serve as the facility liaison and coordinator of activities involving the Immigration and Naturalization Services (INS) Department
8
Experience For Substance Abuse Case Management Coordinator Temp Resume
- Serve as the Chairman or as a member of the Unit Discipline Committee (UDC) and as a member of the Inmate Work and Performance Pay Program Committee
- Identifies non-contracted providers and requests Letter-of-Agreements when requested
- Requests support documentation from IPAs / Medical Groups as requested by the UM Nurses, Medical Directors, or Management
- Processes Extensions and Denial Letters, when needed
- Monitors the Turn Around Timeframes
- Contacts facilities identified by the UM Nurses/Manager/Director/Medical Director to research any issues (i.e. contract, discharges, services provided)
- Prepare Utilization Review Reports as necessary
- Assists the Claims Department, when requested
9
Experience For Case Management Coordinator Resume
- Maintains confidentiality of information between and among health care professionals
- Review hospital admissions information and enter/update inpatient, SNF, home health and DME referrals as necessary
- Print and distribute daily census
- Seek and accept referrals for target patient populations, i.e. fragile seniors, catastrophic and transplant cases, frequent utilizer of ER and inpatient services, and patients diagnosed with specific diseases (cancer, asthma, COPD, AIDS, etc.)
- Act as a liaison, gather information and track all patients referred to the ACM/disease state management programs
- Assist in coordinating care for specific high risk/high cost patient population, including referrals to community resources, facilitation of medical services, referral to ancillary providers, etc
- Document all patient specific information in appropriate information systems
10
Experience For Case Management Coordinator Outpatient Resume
- .Communicates status with case management staff and arranges for patient transfer. Functions as a key point of contact between case management staff, admissions and payers
- Participates in clinical performance improvement activities, including the development of clinical paths, patient/family education programs, collaborative practice groups, Six Sigma, and other quality initiatives. Identifies and recommends improvement opportunities
- Completes and records in computer database all phases of utilization review and negotiates with payers to achieve necessary level of care and/or arrangements to facilitate the patient's timely transition through the continuum of care
- Uses data to better understand strengths and weaknesses of the hospital and department, and to determine needs, decisions, and strategies in relation to continued stay. Responsible for managing continuous stay and authorization for payment purposes
- Provide general support in the composing and typing of correspondence and reports on a variety of general and technical topics, some of which are highly confidential in nature, based on verbal or written instructions or on knowledge of policies and procedures
List of Typical Skills For a Case Management Coordinator Resume
1
Skills For Case Management Coordinator Outpatient Resume
- Make good judgments and prioritize work with limited information or in stressful situations
- Computer Skills in outlook, excel and word documentation
- Professional and courteous telephone manners and communication skills
- Responds to variations in daily workload by evaluating task priorities according to department policies and standards
- Experience maintaining client and staff confidentiality
2
Skills For Substance Abuse Case Management Coordinator Resume
- Experience responding to inquiries about specific program information and services
- Experience in a community mental health center and/or crisis service response in higher education or other setting
- Case management and discharge planning experience required with Child and Adolescents
- Case Management experience working with people who have physical disabilities, are elderly or have behavioral health needs is required
- Previous Long Term Support Services experience working with the elderly and/or special needs population; Required
3
Skills For Case Management Coordinator MSW Resume
- A strong understanding of ethical consideration and boundaries; Required
- Experience working with people who are elderly or have a physical disability
- Effective in managing time, resources and workload
- Set own priorities and to work independently
- Experience in an IPA or other healthcare company
- Experience in Utilization Management or Case Management (required)
- Travel in the field (~25-75%), personal vehicle, valid drivers license, and proof of insurance is required
- Excellent Medical, Dental, Vision, and Prescription Drug Plan
- Experience in medical case management, behavioral health, social services or appropriate related field equivalent to program focus
4
Skills For Case Management Coordinator PRN Resume
- Experience in behavioral health, social services or appropriate related field equivalent to program focus required
- Experience in behavioral health, social services or appropriate related field equivalent is required
- Pediatric RN experience,
- College graduate or some college experience acceptable
- 2+ of years experience in behavioral health, social services or appropriate related field equivalent to program focus
- Care Management experience, preferably in the community
- Case management Coordination experience
5
Skills For Prenatal Screening Case Management Coordinator Resume
- Experience in behavioral health, social services
- Care Coordination experience is required
- Pediatric RN experience
- OR prior work as an RN Care Coordinator or RN Case Manager
- Social service or case work and discharge planning experience required
- Experience working with people who are elderly or have a physical disability is required
- Experience in behavioral health or social services required
- Register Nurse (RN) with current, valid, unrestricted license in state of operations or reciprocity
6
Skills For Inpatient Case Management Coordinator Resume
- Clinical experience of direct clinical care to the consumer
- Experience in health insurance/managed care
- PC proficiency to include Word, Excel, MS Outlook and database experience
- PC proficiency to include Word, Excel, Lotus Notes and database experience
- PC and database experience.
- Establish and maintain regular communication with the field through effective channels, including development of a Care Management newsletter
- Promoting internal and external customer satisfaction and for appropriate resource management through the process of performance improvement
- Analyzes and monitors compliance with accrediting and regulatory agency standards, including TJC, CMS, QIO, licensing boards, etc
7
Skills For Zzz. Case Management Coordinator Resume
- Document Gathering: Assists in securing vital documents needed for transition
- Assist the Medical Consultant with obtaining clinical and discharge planning information; assist with communication to Physicians and other staff
- Monitor the budget and monthly expenditures; aide the Director in maintaining the budget and budgetary planning
- Develops and implements facility policy and procedures pertaining to management issues. Conducts training on case management topics
- Serve as the administrator of the central inmate monitoring system (CIMS) program at the facility. Provide for staff training on the CIMS programs
8
Skills For Substance Abuse Case Management Coordinator Temp Resume
- Assists the Case/Care Managers in coordinating and arranging services for members
- Assist in verifying health plan benefits and coordinating ambulatory services
- Outreach: Field-based position that provides in-person education and information to nursing facility residents and staff in Cook County
- Interdisciplinary Collaboration, Monitoring, Evaluation and Documentation of Care
- Reviews pending claims for approval or denial
- Conduct investigations, make appropriate recommendations and author corresponding reports to ensure the safety
- Provides initial departmental orientation, job training and information and confirms staff members’ abilities to fulfill job expectation
- Processes incoming enrollment forms and SMN forms for program
9
Skills For Case Management Coordinator Resume
- Follows up via phone mail and/or fax for missing OneSource enrollment information
- Identify those areas of work and standard operating procedures related to pharmacovigilance
- Monitor the inmate classification process at the facility, ensuring that applicable policy and procedures are followed
- In collaboration with the member and their care team develops and monitors established plans of care to meet the members goals
- Utilizes case management and quality management processes in compliance. 3836
- Member Evaluation: Conduct comprehensive evaluation of referred members needs/eligibility for transition to the community
- Care Plan Development: Identifies high risk factors and service needs for members
- Analyze problems and formulate plans, solutions and a course of action
- Receives urgent, routine, pre-service and retro authorization requests and processes them through the referral and authorization procedures as established by the medical group utilization department
10
Skills For Case Management Coordinator Outpatient Resume
- Researches health plan benefit and eligibility issues for each service and enters documentation of information into the managed care electronic health record module or appropriate system
- Responsible for prepping and processing referrals
- Identifies documents needed to assist the next level of reviewer in review, and health plan contracts
- Understanding of treatment programs, mental health terminology, including diagnostic categories; general knowledge of medical privacy guidelines; and ability to communicate difficult/sensitive information
- Take direction, to navigate through multiple systems-simultaneously
List of Typical Responsibilities For a Case Management Coordinator Resume
1
Responsibilities For Case Management Coordinator Outpatient Resume
- Case Management knowledge in areas of discharge planning, utilization management, care coordination, and psychosocial assessment
- Responsible for coordinating plan for members on conditional release from the Arizona State Hospital
- Assists with Observation charges for the facility
- Prepares agendas for meetings; takes and transcribes minutes of meetings in the proper format and in a timely manner
- Initiates and maintains continuity and content of databases and acts as database administrator and facility resource person
- Organizes and orders supplies, books, subscriptions and journal articles, then distributes the requisitioned supplies to the appropriate person in a timely manner
- Displays regular, punctual and dependable attendance
- Maintains Directors calendar, sends notices and reminders and notices as requested
2
Responsibilities For Substance Abuse Case Management Coordinator Resume
- Monitors and orders office and department supplies
- Assists UR nurses with authorization process and documentation
- Assists with update of department policies and processes
- Maintains data integrity per State and Federal guidelines
- Accesses Midas to run reports and extract information for Case Management
- Maintains rental bed/wound vac log. Orders and returns rental beds/wound vacs as needed
- Supports the functions of the case management department by maintaining tools to enhance operations such as the discharge calendar and team conference schedules
- Greets patients, families, vendors and other parties both in person and by telephone. Provides basic information regarding hospital services, department functions and general referral information
- Communicates with appropriate hospital personnel and prepares needed information for team conferences, daily huddles, family training sessions, care partner meetings, and other related meetings as requested
3
Responsibilities For Case Management Coordinator MSW Resume
- Communicates and obtains authorization of services for precertification/recertification purposes as delegates by the case managers. Communicates insurance and benefit issues to the case managers
- Prep and copy cases, prep files for legal reviews, prep packets for permanency and adoption committees, drop filing
- Ensures that adequate supplies and equipment are available in the department. Maintains and organizes department resources
- Schedules follow-up appointments and coordinates the necessary transportation
- Performs follow-up calls as applicable
- Prepares and faxes the necessary information to discharge services, including sub-acute facilities, home health, outpatient, follow-up physicians, and DME, under the direction of the case manager
- Utilizes appropriate computer systems for billing, case management documentation, census, reports, etc
- Coordinates with other departments to ensure positive fiscal management outcomes for patients
4
Responsibilities For Case Management Coordinator PRN Resume
- Register Nurse (RN) with unrestricted license in state
- License as an RN in the state of Texas (required)
- Organization, collaboration and time management required
- Some flexibility in work days is required
- Critical areas to succeed: Organization, collaboration and time management.
- Licensed Independent Clinical Social Worker (LICSW), or Licensed Mental Health Counselor (LMHC) with the Washington State Department of Health under Chapter 18.225 RCW
- Knowledge of reimbursement regulations for Medicare, Medicaid, and commercial payers
- American Case Management Certification
- Monthly Clinical Revenue audits as defined by Corporate Case Management
5
Responsibilities For Prenatal Screening Case Management Coordinator Resume
- Maintains and updates policies and procedure manuals for department
- Trends and reports avoidable days, LOS, re-admissions, and others items as requested
- Coordinates review and appeal of admission or technical denials
- Coordinates activities with the other departments to ease the availability and access to care for the patient
- Directly supervises RN Case Managers, Clinical Social Workers, Clinical Documentation Specialist, Interns and PRN staff in the Absence of the Care Management Director
- Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred members needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating members benefit plan and available internal and external programs/services
- 25-50% of travel around Miami-Dade is required
6
Responsibilities For Inpatient Case Management Coordinator Resume
- Florida Department of Elder Affairs 701B Comprehensive Assessment Certification required (or willingness to obtain this certification)
- Case Management experience working with people who have been designated as having a serious mental illness (SMI) and 1 years experience working with people who are elderly or have a physical disability
- Critical areas to succeed- organization, collaboration and time management
- OR at least 1 year of pediatric RN experience with specific patient populations including: medically complex care patients, medically fragile, technology dependent, multiple system concomitant diagnoses, patients with assigned care coordination or case management
- Reads and writes grammatically correct English
7
Responsibilities For Zzz. Case Management Coordinator Resume
- Search internet, advanced use of MS Word software required, proficiency with Excel, Pivot Tables
- Ability typewriter and calculator
- Lift in excess of 10 pounds
- Knowledge of standard office equipment, its operation and use
- Knowledge of Case Management operations
8
Responsibilities For Substance Abuse Case Management Coordinator Temp Resume
- Be detail oriented and focused
- Provide coordinated oversight of members released into the community to ensure member's are maintaining the treatment requirements of the treatment plan outlined by the PSRB board
- Attend outpatient staffing, PSRB review board meetings and coordinate care of member
- Case Manager Certification
- Notify commercial payors
- Case File Preparation
- 0 - 25%
- Advise and assist the administration with inmate population management concerns. Ensure appropriate security level inmates are assigned to the facility. Initiate inmate transfer requests to the Bureau of Prisons officials, in the event that assigned inmates do not meet security level criteria. Inform facility administration of local and national inmate population concerns
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