Case Manager Resume Example

I'm 33-old Behavioral Case Manager Services Director with over 9 years of expirience in Conceptual knowledge of U.S. Navy IT Policies and Guidance, SAP applications knowledge is and Knowledge of the health insurance industry. Certified in and . Ability to work collaboratively and a team player.

• Demonstrated ability to work independently and under occasional stressful circumstances
• Accountability: Meets established expectations and takes responsibility for achieving results; encourages others to do the same
• Develops, implements and documents teaching specific to the patient population served by the Health Care for the Homeless team
• Must live within a commutable distance (50 minutes or 50 miles) of the greater St Louis, MO area
• Provide individual case support for CSF on large and/or complex cases with the goal of helping Advisors place new business
• Initiates and participates in consultative and collaborative relationships to enhance patient care

• Risk Management/Patient/Customer Safety: Demonstrates patient/customer safety according to policies and procedures
• Responsible for the acceptance, investigation, and timely resolution of complex complaints received from FOS and COSL
• Assesses for barriers to care, provides care coordination and assistance to member to address concerns
• Uses clinical tools and information / data review to conduct comprehensive assessments of referred member's needs / eligibility
• Provides proper notification of absence or tardiness within established departmental time frames

• Responsible for the acceptance, investigation, and timely resolution of complex complaints received from FOS and COSL
• Develops and collects reports and data, and trends utilization of health care resources
• Must have reliable transportation, possess a current Nevada driver's license and maintain personal insurance coverage
• Performs other related duties as assigned or requested. Displays flexibility, cooperation and characteristics of a team member
• Responsible for participation in orientation, on-going education programs and successful completion of competency requirements

• Making “welcome home” calls to ensure that discharged member receive the necessary services and resources
• Assist the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans
• Completing follow ups with advisors in an attempt to get needed requirements in and/or cases back on track
• Facilitate adherence to quality metrics determined by quality programs e.g. UAMS, NCQA, CMS

• Troubleshoots equipment problems and relays technical problems to the Program Manager for resolution
• Read, analyze and interpret information in medical records, health plan documents and financial reports
• Conducting regular visits at home or nursing facilities for a caseload of hospice patients
• Supports consumers in selection of best physician and facility to maximize access, quality, and to manage healthcare costs