Medical Case Manager Resume Sample
Sheldon Koepp
458 Maude Keys,
Philadelphia,
PA
+1 (555) 799 9558
Work Experience
Medical Case Manager
03/2017
-
PRESENT
Detroit, MI
- Conduct a thorough and objective evaluation of the client’s current status including physical, psychosocial, environmental, financial, and health status expectation
- Compare the client’s disease course to established pathways to determine variances and then intervene as indicated
- Routinely assess client’s status and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments in the care plan, providers and/or services to promote better outcomes
- Routinely assess client’s status and progress; if progress is static or regressive, determine reason and proactively encourage appropriate adjustments to care, providers and/or services to promote better outcomes
- Case Management Prefered
- Responsible for overall quality services and oversight of each case and /or site in the assigned area of Fairfield County. Monitors services of physician and other related medical providers/services to assure quality standards of care are evident
- Consistently demonstrates the Walt Disney Company’s commitment to its Cast Members through stewardship and partnership practices
Field Medical Case Manager
08/2014
-
11/2016
San Francisco, CA
- Demonstrated ability to handle complex assignments and ability to work independently
- Thorough understanding of jurisdictional Workers Compensation statutes
- Advanced communications and interpersonal skills in order to conduct training, provide mentorship, and assist supervisor in general areas as assigned
- Highly skilled at promoting Field Case Management (FCM) products and services internally and externally
- Collaboration between Providers and payers of the Member’s physical and behavioral health services, including Physicians and other physical and behavioral health care Providers, TennCare, and Department of Intellectual/Developmental Disabilities (DIDD)
- Assess, implement, monitor, and evaluate available resources in an effort to promote quality, cost effective outcomes while meeting the individual’s health needs
- Set goals and time frames for goals appropriate to individual in accordance to case type requirements
Remote Senior Medical Case Manager
04/2009
-
05/2014
Los Angeles, CA
- Anticipate the needs of members by continually assessing and monitoring the member’s progress toward goals, care plan status, and re-adjust goals when indicated
- Acts as an advocate for the injured worker with all parties while maintaining the injured worker’s privacy and safety; Adheres to Wellcomp's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
- Participates in the collection of outcome information and Wellcomp’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
- Maintains continuing education requirements per state license requirements. Maintains an updated and working knowledge of workers’ compensation and federal laws that impact the delivery of health care and return to work
- Follow the client’s case from the onset, and monitor the medical condition until the client is cleared for travel either by commercial air or if medically necessary, air ambulance
- Carry out accountabilities and objectives within the framework of Travel Guard’s TCF (Treating Customers Fairly), TCP (Travel Compliance Protocol) & Training & Competence policies
- Acts as an advocate for the injured worker with all parties while maintaining the injured worker’s privacy and safety; Adheres to Forte's confidentiality policies and procedures. Follows ethical, legal, and regulatory standards
- Participates in the collection of outcome information and Forte’s Quality Improvement process to determine the impact of case management activities on timely injury recovery, medical treatment, return to work, claim costs, and both injured worker and client satisfaction. The result achieves desirable outcomes for all
Education
Ohio State University - Marion Campus
2003 - 2008
Bachelor's Degree in Nursing
Professional Skills
- Organizational skills to multi-task, set priorities, and efficiently complete assigned work
- Demonstrated ability to be flexible with client’s priorities, evolving needs, and goals
- Recent acute care experience or recent experience with home care, insurance company, nursing home or hospice care
- Recent experience in acute care, skilled nursing facility, insurance, home care or hospice
- Effective interpersonal skills to facilitate communication with various members of the health care team, patients, and their families
- Demonstrated critical thinking and problem solving ability
- 12 months experience in home and community-based services, case management, or a related healthcare setting
How to write Medical Case Manager Resume
Medical Case Manager role is responsible for microsoft, training, reporting, health, iphone, research, litigation, compensation, education, insurance.
To write great resume for medical case manager job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Medical Case Manager Resume
The section contact information is important in your medical case manager 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 Medical Case Manager Resume
The section work experience is an essential part of your medical case manager 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 medical case manager responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular medical case manager position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Medical Case Manager resume experience can include:
- Typing skills required, computer skills required include comfort level in learning new and complex programs, proficiency in Microsoft office (Word, Excel)
- Strong skills in dealing with difficult and challenging personalities and situations are essential
- Strong customer service, collaborative, problem-solving, time management, and organizational skills
- Strong interpersonal, time management and organizational skills
- Valid driver’s license and good driving record with no traffic violations
- Demonstrates excellent customer service, and respect for customers, co-workers, and management
Education on a Medical Case Manager Resume
Make sure to make education a priority on your medical case manager resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your medical case manager 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 Medical Case Manager Resume
When listing skills on your medical case manager 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 medical case manager skills:
- Strong communication, documentation, clinical and critical thinking skills and problem-solving skills are essential
- Strong problem-solving, decision-making, and negotiating skills are essential
- Experience working with high risk pregnant women OR experience working with chronic condition adult populations OR experience with pediatrics
- Excellent computer skills, and ability to collect data as assigned for reporting purposes
- Effective time management to be able to multi-task, prioritizes to meet varying tasks and deadlines and delegate
- Valid driver’s license in good standing (no more than 5 points)
List of Typical Experience For a Medical Case Manager Resume
1
Experience For Field Medical Case Manager Resume
- Valid driver’s license and good driving record in compliance with CorVel’s policies
- Effectively communicates to CM Supervisor, Manager and/or Sr Director CM all problems, issues and/or concerns as they arise
- Recent clinical experience, preferably in rehabilitation
- Strong cost containment background, such as utilization review or managed care helpful
- Participates in self-development, through training, mentoring, content specific training, as well as feedback to line-manager on progress
- Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate case management goals to include RTW
2
Experience For Medical Case Manager Bluecare Selectcommunity Resume
- Independently approaches problem solving by appropriate use of research and resources
- Assist in redirecting members to in network providers for services
- Interacts with all personnel in a professional and appropriate manner in order to achieve the objectives of the department and company
- Reviews case records and reports, collects and analyzes data, evaluates injured worker/disabled individual’s medical status, identifies needs and obstacles to medical case resolution and RTW by providing proactive case management services
- Facilitate timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician, and employer. Coordinate RTW with injured worker, employer and physicians
3
Experience For Remote Senior Medical Case Manager Resume
- Maintains contact and communicates with claims adjusters to apprise them of case activity, case direction or secure authorization for services. Maintains contact with all parties involved on case, necessary for case management the injured worker/disabled individual
- Makes referrals for Peer reviews and IME’s by obtaining and delivering medical records and diagnostic films, notifying injured worker/disabled individual and conferring with physicians
- Utilizes clinical expertise and medical resources to interpret medical records and test results and provides assessment accordingly
- Meets monthly production requirements and quality assessment (QA) requirements to ensure a quality product
- Reviews cases with supervisor monthly to evaluate files and obtain directions
- Upholds the Crawford and Company Code of Business Conduct at all times
- Facilitates a timely return to work date by establishing a professional working relationship with the client, physician and employer. Coordinates return to work with patient, employer and physicians
4
Experience For MA Medical Case Manager Resume
- Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation goals and RTW
- Three years of Workers’ Compensation case management with ability to independently coordinate a diverse caseload ranging in moderate to high complexity
- Independently approaches problem resolution by appropriate use of research and resources
- Individuals who conduct initial clinical review possess an active, professional license or certification
- Facilitates a timely return to work date by establishing a professional working relationship with the injured worker/disabled individual, physician and employer. Coordinates return to work with injured worker/disabled individual, employer and physicians
- Renders opinions regarding case cost, treatment plan, outcome, and problem areas and makes recommendations to facilitate rehabilitation case management goals to include RTW
- Makes appropriate use of Wellcomp physicians for adjuster support, peer-to-peer consultation and as professional resources; Makes appropriate use of Wellcomp clinical and information systems staff to deliver exceptional service to direct and indirect customers
5
Experience For Senior Medical Case Manager Resume
- Assess, plan, implement, coordinate, monitor and evaluate medical services
- Provide professional opinions on all medical cases assigned including return-to-work coordination, medical treatment plan management, disability and causation analysis
- Liaise with medical professionals including doctors, nurses, clinics and hospitals
- Provide medical training to all lines in the Claims department
- Number of Case Handling
- Assess medical claims in compliance with the terms and conditions of the relevant insurance Policy
- Conduct assessment and medical investigation
- Conduct telephonic, field-based, medical, vocational and catastrophic case management
6
Experience For Medical Case Manager Recurring Seasonal Resume
- Provide Pre-injury management advice and development plan
- Handle high volume of daily inquiries
- Active participation in investigation and direct settlement negotiations
- Participate in Ad hoc Claims projects
- Reviews case records and reports, collects and analyzes data, evaluates client's medical status and defines needs and problems in order to provide proactive case management services
- Render opinions regarding case costs, treatment plan, outcome and problem areas, and makes recommendations to facilitate rehab goals and RTW
- Facilitate timely return to work date by establishing a professional working relationship with the client, physician, and employer. Coordinate RTW with patient, employer and physicians
- Peer reviews and IME’s by obtaining and delivering medical records and diagnostic films, notifying patients’ and conferring with physicians
- Independently approach problem resolution by appropriate use of research and resources
7
Experience For Medical Case Manager Team Leader Resume
- Current clinical experience in an acute care, orthopedic, rehabilitation, industrial medical settings, behavioral health settings or current experience as a Disability Case Manager
- Explain complex medical conditions and ability to communicate with attending physicians to identify current limitations/restrictions as it relates to the workplace
- Valid RN licensure in the state(s) the incumbent wors in
- Comprehensive assessment and updating of the employee’s medical status, analyze and synthesize the medical information to develop an appropriate plan of care
- Promotes individual's self-advocacy skills to achieve maximum self-sufficiency
- Strong clinical background in orthopedics, neurology or rehabilitation
- Strong cost containment background, such as utilization review or managed care
8
Experience For Medical Case Manager Resume
- Identify the critical/complex medical issue(s), estimate the disability duration and determine an action plan including healthcare/medical treatment goals
- Consult and collaborate with physicians, supervisors, treatment providers, disabled employees and staff to decrease fragmentation of care, improve quality of care, control costs and promote return to health
- Assess community, workplace and vendor resources; ensure that services are appropriate, cost effective, timely and supportive
- Document activity in succinct claim notes in a timely and efficient manner
- Attend home visits, hospital visits, doctor’s appointments, departmental and stakeholders meetings when appropriate
9
Experience For Field Medical Case Manager Resume
- Recent knowledge of disease processes and recognition of their distinctive cost patterns and unique range of available therapies and interventions, current trends and developments in medicine and their application and levels of services
- Certified Case Manager (CCM), Certified Occupational Health Nurse (COHN) or related accreditation is required. If not certified, application for certification is required within two years of hire with successful completion within three years of hire
- Collaborate with the STD/LTD Claims Team to identify appropriate claim referrals and effectively assess claims to ensure they reach the appropriate claim outcome
- Periodically participate and facilitate training programs and/or presentations ad hoc
- Provides medical case management to individuals through communications with the patient, the physician, other health care providers, the employer and the referral source
- Evaluates patient’s treatment plan for appropriateness, medical necessity, and cost effectiveness
- Attends doctors, other providers, and attorney’s visits. Attends hospital and/or long-term facility discharge planning conferences, et cetera for the purpose of determining appropriateness of care and developing an effective long-term care strategy. Initial home visit for initial evaluation
10
Experience For Medical Case Manager Bluecare Selectcommunity Resume
- Heavy travel required; valid driver’s license and good driving record with no traffic violations required
- Utilizes their medical and nursing knowledge to discuss the current treatment plan with the physician and discuss alternate treatment plans
- Assesses rehabilitation facilities for appropriateness
- Performs or manages architectural assessment of patient’s home
- Researches medical and community resources for medical and community resources for patients with catastrophic or chronic diagnoses, such as but not limited to, AIDS, cancer, spinal cord injury, diabetes, head injury, back injury, hand injury, burns, et cetera
- Interface with claims staff, attorneys, physicians and their representatives, and advisors/clients and coworkers
- Meet designated deadlines
- Drive, maneuver, navigate on a continual or almost continual basis
List of Typical Skills For a Medical Case Manager Resume
1
Skills For Field Medical Case Manager Resume
- Travel required; valid driver’s license and good driving record with no traffic violations required
- Communicate effectively whileinteracting with Case Management Specialists, Management Team, Physician Advisors and other interdepartmental contacts
- Accurate clinical assessment and analytical skills
- Demonstrated aptitude for communicating with attending physicians to identify current workplace limitations or restrictions
- 12+ months experience working with low-income individuals
- Demonstrated ability to contribute to RW quarterly and annual reporting narratives that are clear and informative
2
Skills For Medical Case Manager Bluecare Selectcommunity Resume
- Demonstrate critical independent thinking and ability to multi-task in situations where in the outcome is time sensitive
- Three years clinical experience in acute hospital setting
- Work experience in an Integrated Disability Management model involving case management of both Workers’ Compensation and non-occupational injuries
- Implements care such as negotiation the delivery of durable medical equipment and nursing services. Devises cost-effective strategies for medical care
- Valid Massachusetts Driver’s License (for outreach activities)
- Oncology experience is highly desired
3
Skills For Remote Senior Medical Case Manager Resume
- Two or more year’s workers compensation case management experience
- BA/BS or MA in related field with related work experience in work comp case management or
- Graduate of an accredited LPN or RN program and one year of related experience
- Demonstrates clear ability to work with others and promotes a collaborative environment that facilitates growth of other team members and colleagues
- Valid RN licensure in the state(s) the incumbent works in
- Maintain good relationships with Brokers, Agents and Client by regular visits and contacts
4
Skills For MA Medical Case Manager Resume
- Liaise with our service providers to ensure a timely and cost effective service
- Demonstrated customer service competencies
- Solid technical acumen with Microsoft Office: Word, Excel & PowerPoint
- Demonstrated desire to learn about the insurance business
- Successfully prioritize work load while meeting targeted deadlines in a fast-paced environment
- Serves as a liaison between the injured employee and their health care providers to ensure quality, efficient and cost effective health care services
- Working knowledge of community resources and alternate funding resources
- Performing case reviews to determine compatibility of medical condition and policy coverage,including work with the claims department
5
Skills For Senior Medical Case Manager Resume
- Reviewing and/or recommending medically necessary travel requirements in conjunction with
- Carrying out accountabilities and objectives within the framework of AIG Travel’s
- Communicating with the multidisciplinary team in the timeframes required to meet program goals and objectives
- Adapts to changing departmental needs, including but not limited to, offering assistance to other team members, adjusting schedules and assignments, etc
- Responsible for complying with all BPHC reporting requirements by maintaining accurate documentation and providing required data within stipulated times frames
6
Skills For Medical Case Manager Recurring Seasonal Resume
- Expertise in establishing working relationships with patients, their families, professionals, and the community
- Knowledge of coaching and mentoring techniques to be able to develop and support others on a day-to-day basis
- 6+ months working with HIV-positive community
- Physical ability to meet the core job responsibilities in accordance with practice setting demands for the patient populations regularly served
- Performs initial psychosocial intake for new patients using the RW Part A standard Intake Assessment Form
- Maintains patient confidentiality; is comfortable handling sensitive personal information
- Medically monitor cases via telephone contact with treating medical providers and/or review
7
Skills For Medical Case Manager Team Leader Resume
- Clear understanding of medical necessity and the importance of clinical documentation and transitions in care
- Ensure departmental policy and procedures are adhered to through regular monitoring
- Makes recommendations regarding health care resources
- Develops case management plans and establishes case management goals. Provides assessment, planning, implementation and evaluation of patient’s progress
- Maintains Billable Standard of 1.8 to 2.2 hours per case, per week, working with an average of 18-24 FCE cases per month
- Complies with all safety rules and regulations during work hours in conjunction with the Injury and Illness Prevention Program (IIPP)
- Computer proficiency and technical aptitude with the ability to utilize MS Office including Excel spreadsheets
- Develops Independent Medical Evaluation Plans. Provides assessment, planning, implementation and evaluation of patient’s progress
8
Skills For Medical Case Manager Resume
- Communicates directly with the designated Medical Director or Physician Advisor or the Chief Medical Officer regarding all care/costs that
- Manage and adjust to members across the continuum of care
- The Nurse Case Manager reports to the Director, Nurse Case Management
- Knowledge of community, social, and health resources with particular knowledge of HIV-related resources
- Sensitivity to ethnic, cultural, gender, and sexual orientation diversity, values, beliefs, and behaviors
9
Skills For Field Medical Case Manager Resume
- Excellent skills in Microsoft applications, Outlook, iPhone Competitive salary within industry, flexible schedule, home-based office, full complement of benefits, company provided equipment
- Have an unencumbered current Registered Nurse Licensure
- CCM, CRRN, CDMS or COHN certification required
- Own Vehicle and ability to travel extensively in local territory
- Corvel is an EOE
10
Skills For Medical Case Manager Bluecare Selectcommunity Resume
- Competitive salary within industry
- Full complement of benefits
- Provide medical case management services to Part A eligible clients/families in both the clinical and home-based and/or community settings
- Assesses patients’ needs and develops flexible service plans and maintains regular updates of these plans, as needed
- Ensures that patients have and maintain HDAP coverage and other medical insurance necessary for engagement in care
- Conducts comprehensive and ongoing assessments every 6 months according to the RW Part A Reassessment guidelines and engages patients in risk reduction and positive prevention discussions and activities
- Addresses concrete service needs and encourages engagement into systems as needed
List of Typical Responsibilities For a Medical Case Manager Resume
1
Responsibilities For Field Medical Case Manager Resume
- Develops and maintains strong relationships with community resources to ensure patient access
- Creates and supports a positive and supportive working environment
- Maintains a courteous and professional attitude when working with all HI staff members and the management team
- Obtains medical records from providers telephonically or during initial phone contact. Follows up with written or electronic correspondence as necessary
- Engages in and facilitates interactive dialogue with the employee and the manager regarding accommodation and job placement
- Advocates for injured employee. Assists with getting appointments scheduled on a timely basis, with transportation issues and other barriers
- Performs telephonic and/or onsite case management activities, with members or clinics per client contracts
2
Responsibilities For Medical Case Manager Bluecare Selectcommunity Resume
- Adheres to CM program goals and objectives in health care cost containment while maintaining a high quality of health care delivery system to meet the patient's individualized health care needs through adherence to program policies and procedures
- Assess, evaluate and implement member centric care plan with time frames that meet URAC and NCQA requirements
- Assess the client's strengths, problems, prognosis, functional status, goals and need for specific services/resources, to establish short-term and long-term goals
- Educates members on any knowledge deficits relative to the complex needs identified
- Collects pertinent clinical information (including specific claims data when available), documenting findings using the HI case management information system program
- Summarizes and documents within the designated HI care management system pertinent verbal discussions with the patient/patient's legally appointed representative, family, practitioner, other health care provider or the health purchaser staff, and/or any case conferences
- Promotes alternative care and funding programs and researches available options to maximize health benefits and/or replace limited or excluded benefits
- Promotes appropriateness of resources/placement when alternative level of care is required
3
Responsibilities For Remote Senior Medical Case Manager Resume
- Communicates directly with the patient/patient’s legally appointed representative, practitioner, other health care providers and team members when appropriate to gather all clinical information to determine the medical necessity of requested or needed health care services
- Knowledgeable of URAC and NCQA requirements for Case Managers for CM accreditation
- Serves as a patient advocate when deemed applicable or as requested by the patient/patient's legally appointed representative; and,
- Provides ongoing evaluation of the individual's progress, effectiveness of the rehabilitation plan, as well as, the efficacy and appropriateness of the services provided
- Identifies any teaching required by the multidisciplinary health care team before the care/alternative level of care can be implemented
- Advocates on behalf of the individual to assure quality of care and attainment of appropriate goals
- Are beyond the dollar amount or scope allowed for the individual case manager
- Are required over a prolonged period of time and an extended authorization for care is deemed appropriate for meeting a patient's individualized health care needs
4
Responsibilities For MA Medical Case Manager Resume
- Refers cases to HI legal and/or health purchaser’s legal staff where there is a threat of litigation and/or those patients specified by the legal department for immediate referral
- Recommends, coordinates or educates regarding alternate care options for patients, families, practitioners, providers or other members of the multidisciplinary health care team
- Monitors the CM Plan at regular time intervals and/or at the time frequency dictated by the patient's level of acuity, making recommendations for change when opportunities are identified and/or as the patient's illness/health care needs improve or deteriorate
- Negotiates discounts or reduced charges when an out-of-network provider is required to manage the level of care/acuity of the case at hand and/or in accordance to health purchaser contractual requirements
- Maintains an active role in assuring continuity of care for patients through early identification and appropriate discharge planning by close and frequent collaboration with the Health Integrated Utilization Management staff and/or hospital discharge planning/social worker staff
5
Responsibilities For Senior Medical Case Manager Resume
- Closes stabilized cases following collaboration with CM Supervisor and/or Chief Medical Officer/Medical Director
- Make referrals to additional programs as needed for graduated complex members, Disease Management, Synergy
- Identifies and resolves potential personnel/peer problems and issues proactively
- Actively participates in any CM team meetings
- Actively participates in any UM and CM committee meetings as assigned; and,
- Serves as a positive role model for peers
- Establishes a relationship with injured employee. Reviews transitional duty (TD) plan and answers EAP, WC or benefit plan questions. Identifies role of MCM to injured employee and relates the goal of providing quality medical care, access to the TD program and early return to work, resulting in a positive outcome
- Utilizes diagnosis based review criteria for determining disability duration and professional judgment to negotiate treatment plans, and realistic return to work plans with the IE and treating provider
6
Responsibilities For Medical Case Manager Recurring Seasonal Resume
- Communicates with HCPs (health care providers) at regular intervals, developing an effective working relationship. Devises care plans which include referrals for therapies and treatments and evaluation of results and plan effectiveness
- Provides HCP with the Work Status Form to document IE’s work capabilities. Informs HCP regarding the availability of TD. Describes the specific TD assignments as indicated
- Attends medical appointments with injured employee, if there are concerns that the MCM is not getting comprehensive up to date information
- Provides HCP with updates of IE’s progress made on the TD assignment
- Determines alternative approaches to care as needed for cases with identified barriers or catastrophic cases, such as home visits
- Regularly updates claims adjuster and integrates plan into overall strategy to ensure appropriateness of disability payments
- Initiates contact with IE’s manager. Purpose is to introduce role of MCM in claims management and facilitating the IEs recovery. Educates the manager in the benefits of early RTW. Encourages the manager’s buy-in in supporting early RTW. Works with manager to identify TD opportunities
7
Responsibilities For Medical Case Manager Team Leader Resume
- MCM maintains contact with IE’s manager; providing work status updates on a regular basis. Initiates a RTW plan when IE has (documented) work capacity
- Obtains IE’s job description and identifies job modifications required to ensure early RTW
- Focuses on functional ability as well as pain status. Sets realistic recovery and return to work expectations to employee and manager
- Collaborates with the Claims Adjuster on IME letters
- Uses communication form to document plan
- Documents all contacts and outcomes related to the case activity in iVOS system
8
Responsibilities For Medical Case Manager Resume
- Engages in and facilitates interactive dialogue with HR in coordination of RTW for employees who do not have job protection
- Responsible for ongoing program review via measurements of goals and outcomes. Recommends strategies for improving outcomes and maximizing program results in collaboration with the OHS Director
- Establishes metrics on progress with case management
- Summarize key clinical and administrative information, and offer preliminary recommendations
- Carrying out accountabilities and objectives within the framework of AIG Travel’s TCF (Treating Customers Fairly), TCP (Travel Compliance Protocol) & Training & Competence policies
- CPM required based on state guidelines
- Basic knowledge of medical necessity criteria and the importance of clinical documentation
- Graduate of an accredited LPN or RN program
9
Responsibilities For Field Medical Case Manager Resume
- Successful clearance of background checks, drug screen, motor vehicle report
- Daily ‘inspirational’ management and motivation of employees to consistently meet contracted SLA’s, deliver astonishing Customer Service and identify training needs where needed
- Current RN Licensure in state of operation
- CCM required to be obtained within 3 years of hire, if no nationally recognized accreditation is present at time of hire
- National certification such as CCM, CRRN COHN, required
- Are requested/required out-of-network
- 42A, YN, 0111, 3A1X1
- Medical and Workers’ Compensation knowledge
- Knowledge of Return to Work models, Family Medical Leave Act, Americans with Disabilities Act and University policies and procedures
10
Responsibilities For Medical Case Manager Bluecare Selectcommunity Resume
- An active Florida State Registered Nurse (RN)license is required
- Explain complex medical condition
- Readily able to accurately document activities
- Prior experience in facilitating RTW for disabled employees, knowledge of return to work best practices, ergonomics, FMLA and related Human Resources is desired
- An active Florida State Registered Nurse (RN) license is required
- Working knowledge of details/resources that are required to individualize a case, contain costs and maintain quality of care for persons with a catastrophic or high-cost illness or injury
- Communicate and work with a multidisciplinary team (internal and external) to facilitate day-to-day workflow; and,
- Recognize and communicate any concerns or issues to CM Supervisor in a professional and timely manner
- Case Management Certification within three years of employment required
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