Care Management Resume Sample

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Aiden Runte
351 Auer Dale,  New York, NY
+1 (555) 637 5569

Work Experience

Director, Care Management
04/2016 - PRESENT
San Francisco, CA
  • Understands and self-manages to support facility/CIN-level success goals, including improvements in quality, cost of care and member experience for the facility/CIN’s population
  • Maintains current knowledge of care management topics and acts as the unit’s subject matter expert (SME) on care management at department and company meetings
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
  • Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Commitment to and role model of DaVita’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors in every day performance and interactions
  • Build the infrastructure within existing Sharepoint “shells” for each Care Management team (3-4) including
  • In conjuction with the local Care Management Committee Provider Chair, leads activities related to the utilization review process
Care Management Coordinator
08/2009 - 01/2016
Los Angeles, CA
  • Expertise with various software applications/databases (i.e., Microsoft Office)
  • Problem solving – moderate complexity
  • Work autonomously with minimal supervision in various settings
  • Basic care coordination concepts
  • Oversees the operations of care management support staff in their day to day functions within a department
  • Monitors and evaluates the effectiveness of programs and procedures and recommends and/or implements changes as indicated
  • Reviews production and quality data to ensure accuracy and consistent application of policies and procedures
Care Management Assistant
08/2006 - 03/2009
New York, NY
  • Ensures appropriate levels of care and utilization of medical facilities and services within the parameters of the patient’s benefits and/or CMC decisions
  • Responsible for identification of learning needs regarding the ability of the staff to assist in other areas of the multidisciplinary health care team and participate in development and implementation of in-services and resource materials to promote education and mutual understanding
  • Responsible for monthly reporting statistics for department
  • Assist with recruitment and selection of new staff, including training, mentoring, staff competencies, performance reviews, discipline and discharge
  • Assist with and/or conducts staff meetings, assuring policy and procedures are adhered to and when necessary, modified to address changing strategic objectives
  • Performs audits of staff documentation and calls to maintain accuracy and quality standards
  • Apply the CARE model of leadership to position responsibilities (Coaching Accountability, Relationship; Engagement)
  • Familiarity with basic medical terminology and ICD-9 and CPT coding


North Carolina Central University
2002 - 2006
Bachelor's Degree in Nursing

Professional Skills

  • Strong interpersonal, oral and written communication skills: effective interpersonal and problem solving skills
  • Strong leadership skills to identify opportunities to improve operating efficiency, increase revenues and effectively control expenses, and grow the business
  • Strong organizational skills with the ability to work well under pressure with conflicting priorities
  • Organized, demonstrated excellent team management skills
  • Two years of related healthcare work experience that demonstrates the attainment of the requisite job knowledge skills/abilities required
  • Excellent communication, customer service, and phone skills, as well as the ability to build trust and credibility while working independently
  • Excellent conceptual, organizational, and problem solving skills

How to write Care Management Resume

Care Management role is responsible for interpersonal, organizational, customer, leadership, medical, health, training, multimedia, general, word.
To write great resume for care management job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Care Management Resume

The section contact information is important in your care 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
  • Email
  • Telephone number

Work Experience in Your Care Management Resume

The section work experience is an essential part of your care 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 care 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 care management position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Care Management resume experience can include:

  • Strong customer service skills, strong phone skills
  • Ten years multidisciplinary clinical experience including 7 years case management experience and two years management level supervisory experience
  • Strong computer skills to include Microsoft Word, Microsoft Office and Excel
  • Effective employee management skills are necessary
  • Excellent organizational, analytical and interpersonal skills required
  • Strong Utilization Review, discharge planning and case management experience from an acute setting

Education on a Care Management Resume

Make sure to make education a priority on your care management resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your care 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 Care Management Resume

When listing skills on your care 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 care management skills:

  • Demonstrated leadership skills: Excellent interpersonal skills and ability to develop and lead multidisciplinary teams
  • Excellentconceptual, organizational, and problem solving skills
  • Experience with a medical management application and the ability to work effectively with multiple computer programs.(Flow Cast, EMR, Sales Force, etc.)
  • Strong communication skills to articulate needs, requirements and strategies
  • Excellentpublic relations and communication skills
  • Demonstrated experience with interviewing and selecting staff, mentoring new teams, conducting new employee training, and onboarding is required

List of Typical Experience For a Care Management Resume


Experience For Director, Care Management Resume

  • Care management experience in an acute care setting/environment or comparable experience
  • Care Management experience including one year experience in a supervisory/management role
  • Strong working knowledge of managed care functional areas, including terms and definitions
  • 3-years’ experience in a variety of acute patient care settings including ICU or intermediate care units, Medical-Surgical Nursing and/or Home Health
  • Experience working in multiple systems to support clinical operations related to UM, CM, DM
  • Experience in the following areas: Managed Care, Provider Relations or Clinic Operations
  • Experience working in a call center environment

Experience For Care Management Coordinator Resume

  • Experience in utilization management, case management, discharge planning, disease management and other cost/quality management programs
  • Professional utilization management clinical review experience
  • Maintaintracking and monitoring of assigned referrals at all levels of review forinstant retrieval
  • Understanding of quality improvement: Adept at data collection, interpretation, and use for decision-making
  • Using the medical software criteria, establishes the appropriate level of care NICU/newborn care for continued stay
  • Understanding of CT ALSA compliance

Experience For Director of Care Management Resume

  • Working knowledge of NCQA/CMS regulations, policies and procedures
  • Working knowledge of SQL or similar database languages
  • Willing to act and is not immobilized by fear of failure
  • Assist in planning, consulting and evaluating nursing care for patients with diabetes throughout the continuum of care
  • Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed

Experience For Manager of Care Management Resume

  • Assists with staffing/scheduling activities, soliciting input from managers
  • Participates in recruitment, selection, hiring, orientation, counseling and evaluation of staff
  • Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
  • Identify complex learning needs and health teaching
  • Acts as the discharge planning contact for the patient and family during hospitalization
  • Responsible for planning and implementing assigned market and regional market success initiatives with each market care management and operations team
  • Provides coaching and counseling to improve productivity of staff members
  • Works closely with Medical Director on case specific review as well as trending and planning for improvement in outcomes

Experience For Care Management Assistant Resume

  • Monitor high risk patient’s scheduled appointments contacting patient same day for “no show or cancelled” rescheduling immediately
  • Coordinates, reviews and maintains data for reporting purposes and for weekly preparation and analysis of trending reports
  • Participates in making presentations to participating providers, state and federal agencies, community groups and other interested parties
  • Facile understanding of criteria sets (e.g. MCG, Interqual) requirements and practices, including third party requirements
  • Oversight of all UM/CM/DM functions including operations, staffing, program development and system requirements
  • Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
  • Ensures the team's understanding and use of information system capability and functionality
  • Expertise with various software applications/databases (i.e., Microsoft Office). Problem solving – moderate complexity
  • Collaborates with the Director to develop action plans to address areas needing improvement and methods to track variances for the care and services delivered

Experience For Senior Medical Director of Care Management Resume

  • Provides follow-up for hospitalized patients, ensuring subsequent agency referral
  • Actively participates in department meetings and operations including process development or improvement
  • Manages multiple inquiries and presents referral based on location and services provided; appropriate follow up on active or pending inquires
  • Coordinates with referral sources on bed availability, new product and services; maintains current database of existing and potential referral sources
  • Care Coordination Steering Committee
  • Provides coaching for performance success, recommends merit increases, and consistency executes disciplinary actions
  • Monthly reporting to the manager of all development initiatives
  • Develop reporting systems for CM activities to outside audiences, physician oversight committees

Experience For Care Management Supervisor Resume

  • Development of timelines, action plans and reporting
  • Provide outreach and scheduling for renewal medications and associated needed test/lab
  • Document all encounters with patient in EMR and Salesforce. And/or enters all referral activity into the computer system according to THPG policy and procedure
  • Provide healthcare coaching, medication education, and disease-specific education
  • Provide operational oversight of care coordination, discharge planning, clinical documentation
  • Actively manages the Care Management budget including all post-acute charity services provided to patients for a safe discharge
  • Notifies attending physician, treatment team, and others as needed

Experience For Supervisor, Care Management Resume

  • Integrates information obtained from the patient's chart and from communications with various sources when discussing the level and intensity of care needed
  • Provide planning and direction for the operation of UMMG care management program
  • Participates in CQI activities and provider training, and participates in professional development activities
  • Provides accurate information concerning benefits and coverage to staff or other persons as required
  • Provides oversight of the teams providing clinical reviews, service authorization, and care coordination for all Community Care members
  • Responsible for providing after-hours call support and supervision as required by the scheduled personnel

Experience For Care Management Specialist Resume

  • Knowledge of Federal and State regulations related to discharge planning and patient's rights
  • Work collaboratively across the care continuum, including ambulatory care providers, home care, community services, and other post-acute services
  • Current New York State nursing licensure
  • Identifies inpatient admissions no longer meeting criteria for NICU or transitional level of care and refers care to plan Medical Directors for evaluation
  • Adheres to guiding principles of the organization
  • Manage data and generate reports using current computer programs

Experience For Director, Care Management Operations Resume

  • Provide both phone and face to face Behavioral Activation and Structured Problem Solving Treatment
  • Registration and/or appointment scheduling
  • Membership in a related professional organization, pursuing advanced educational preparation or certification
  • Not applicable Prolonged sitting and data entry
  • Keeps abreast of governmental rules and regulations as pertains to case management, CMS auditors, and discharge planning
  • Comfortable implementing new workflows and technology
  • Agency Affiliated Counselor or one of the following
  • Three (3) years management in acute care setting required

List of Typical Skills For a Care Management Resume


Skills For Director, Care Management Resume

  • Demonstrated experience working with and educating NP’s and PA’s
  • Ten years of healthcare experience working in a clinical setting and three years of management experience
  • Management/supervisory experience or experience leading/working on project teams
  • Utilization review/case management experience or social work experience in an in-patient acute care setting
  • Demonstrated experience in leading clinicians, clinical operations, care management, utilization review, or other closely related quality programs
  • Communicates timely and effectively with the Patient Financial Services Department to ensure appropriate and accurate billing
  • Care / Case Management experience; 3+ years of experience in a Supervisory role
  • Work effectively as a member of a management team in a large health care organization

Skills For Care Management Coordinator Resume

  • Effectively plan, organize, manage staff and direct a busy acute care division in a large health and hospital system
  • Proficient with computers and keyboard skills, telephone etiquette and general knowledge of office equipment
  • Curiosity and improvement mindset: A systems thinker with process improvement skills to analyze, implement, and evaluate new ideas
  • Basic computer skills in a Windows environment required
  • Experience of progressive healthcare experience
  • Exceptional communication skills on all levels
  • Prior experience with Mcg Care Guidelines, Touchwork, IDX, Meditech

Skills For Director of Care Management Resume

  • Previous experience with Allscripts, Touchwork, Meditech, Enterprise and/or IDX experience highly
  • Five years’ experience in both Utilization Management and Case Management, three years supervisory/management experience required
  • Manages and evaluates appropriate staff levels, assignments, skills, learning needs and deployment of all staff
  • Effectively hire, orient and supervise Care Management staff
  • Collaborate effectively with ACUs (Ambulatory Care Units), ancillary services, care management and commercial payer group
  • Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding and provides ongoing comprehensive training and regular feedback

Skills For Manager of Care Management Resume

  • Experience working in a clinical healthcare setting
  • Experience translating and executing a strategic plan
  • Experience utilizing medical terminology in a professional work setting
  • Experience in creating and implementing outcome measures of new programs
  • Experience navigating the NYC & NY State systems of care, including Home & Community Based Services (HCBS)
  • Nursing experience (three of which were in an acute care setting)
  • Strong clinical background in nursing
  • Prioritize task by importance delivering assignments in a timely manner
  • Proven leadership qualities including ability to train, motivate, coach, manage, and supervise a staff of professionals

Skills For Care Management Assistant Resume

  • Entry Rate: $17.37+ depending on experience
  • Three years of R.N./Social Work clinical experience in focused areas working with multidisciplinary teams
  • Experience in Sales and Marketing
  • Experience in healthcare, working with providers and/or payers at a management level required
  • Experience in discharge planning from a hospital
  • Three or more years of experience working in a call center environment

Skills For Senior Medical Director of Care Management Resume

  • Experience working with DME companies or other post-acute care organizations
  • Registration and appointment scheduling experience with EPIC
  • Experience working with Durable Medical Equipment (DME) companies or other post-acute care organizations
  • Clinical license in good standing in the state of Oregon
  • Medical Management experience; preferably in a managed care setting
  • Health care information technology (HCIT) project management, sales or consulting work experience
  • Hospital discharge planning work experience

Skills For Care Management Supervisor Resume

  • Clinical leadership work experience running a Care Management department
  • 2~3 years clerical experience in a health care setting
  • Medical Assistant, Certified Nursing Assistant, or Unit Clerk experience
  • Hands-on experience implementing programs
  • Over 7 years and up to and including 10 years of experience
  • Management experience preferably in a medical group/IPA or HMO setting
  • Experience with third party contacting

Skills For Supervisor, Care Management Resume

  • Experience in third party contracting, URAC, HEDIS, and/or NCQA standards, outcome analysis, project management and data systems required
  • At least two years of experience in case/care management in an inpatient or outpatient setting, or Health Plan
  • Demonstrates a working knowledge of payer benefits (Medicare, Medicaid as well as managed care and commercial payers)
  • Progressive leadership experience in a health care setting required
  • Valid State Nursing License required; BLS required
  • Supervisory or Care Management experience
  • Previous experience with Disease Management and Utilization Review
  • Post-Master’s Supervisory experience

Skills For Care Management Specialist Resume

  • Experience as a manager or director
  • Experience in hospital UR / Care Management
  • Experience in case management with an emphasis in pediatric care
  • Prioritize and manage comprehensive projects, and implement and monitor large systems and change processes
  • Constantly demonstrates the ability to serve as a model change agent and lead change efforts
  • Exceptional case management experience

Skills For Director, Care Management Operations Resume

  • Three to five years clinical experience
  • Experience in health care with emphasis in case management
  • Coordination experience required
  • Administrative experience in healthcare industry
  • Experience with electronic medical record systems, Microsoft suite and Internet

List of Typical Responsibilities For a Care Management Resume


Responsibilities For Director, Care Management Resume

  • Effectively communicates and collaborates with departmental social workers, external liaisons and post acute care facilities
  • Educates staff regarding effective allocation of the hospital’s resources while encouraging provision of high quality patient care
  • Proven ability to understand Care Management trends and to develop initiatives designed to bend trend while insuring appropriate access to quality care
  • Demonstrates a working knowledge of payor benefits (Medicare, Medicaid as well as managed care and commercial payors)
  • Assesses daily staffing needs and Provides staffing resources to ensure efficient and effective coordination of services
  • Evaluates and ensures each facility’s level of compliance with Medicare Conditions of Participation, ensuring an effective and compliant UM committee
  • Leads the short and long-term planning process, and drives prioritization to meet the Enterprise’s financial performance goals

Responsibilities For Care Management Coordinator Resume

  • Facilitates effective and appropriate discharge plans
  • Continually updates knowledge of community services, resources, programs, and facilities in order to facilitate effective discharge plans
  • Coordinating case management by providing hands on assistance for staffing concerns, handling difficult, unusual or emergency situations
  • Ensuring and documenting attendance of mandatory education programs and overseeing departmental orientation through the use of preceptors
  • Keeping staff up-to-date on compliance with regard to compliance and meeting reporting standards

Responsibilities For Director of Care Management Resume

  • Interview and evaluate assigned staff performance including annual performance reviews, performance improvement plans and disciplinary steps pursuant to Hospital’s Human Resource policies and procedures
  • Is cognizant of regulations and policies of all review organizations relating to billing of the services provided in the hospital setting, monitors and evaluates options and services to meet patient’s health needs
  • In conjunctions with the compliance department, ensures regulatory patient notification requirements are met and document within the patient’s medical record
  • Photocopying and faxing appropriate information to above facilities to help facilitate placement as requested by RN Care Managers and/or Social Workers
  • Analyzing department efficiency/goals and preparing action plans as needed
  • Performing admission and following through with all parties accordingly
  • Assists Care Manager/Care Coordination department in collecting data related to patient-care outcomes and auditing data for accuracy
  • Makes home care referrals, ensuring forms are completed correctly and compliantly
  • Explores availability and updating of community resources

Responsibilities For Manager of Care Management Resume

  • Inputs clinical information, and discharge planning details into the medical record
  • Develops the CHRUSTUS Health framework that is used to design care management programs and to enhance consistency in services provided and reporting
  • The position is responsible to create presentations for internal and external stakeholders explaining care management vision, strategies and processes
  • Develops new policies, procedures, job aids, and work flows that enhance operating efficiency of the care management programs or activities
  • Evaluates care management staff performance by providing monthly management level and role level report cards

Responsibilities For Care Management Assistant Resume

  • Assists with analysis of denied days, denial report preparation and trending of denial data and physician performance
  • Responsible for all incoming and outbound clinical requests, questions, concerns and complaints
  • Performs daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interrater Reliability)
  • Develops department budget and monitors monthly for variance reporting for assigned hospitals
  • Is a champion of EBM, and in particular of MCG which currently are the company’s primary review guidelines
  • North Carolina Licensed physician; Board Certified in ABMS/ABOMS specialty
  • Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member’s medical condition and the potential home care needs
  • Oversees and monitors each facility’s UM plan, ensuring compliance with CMS regulations
  • Provides leadership, direction and coordination of assignments for staff

Responsibilities For Senior Medical Director of Care Management Resume

  • Responsible for performance appraisals, corrective action for team members
  • Provides daily input to forecasting and planning activities relevant staffing and facility coverage due to identified utilization trends and membership fluctuations. Inpatient facilities include: Acute Care hospitals, Acute Inpatient Rehab, SNFs
  • Manages 4 - 7 direct reports (Managers- with 105 indirect reports, ICMs) including ongoing performance monitoring and completing annual MAP evaluations
  • Uses internal performance evaluation system to: establish, discuss and monitor direct report’s performance, create development plans and implement Corrective Action Plans as needed and as described in the performance management guidelines
  • Direct supervision of HBH Clinical Managers and oversight of these manager’s teams including personnel hiring, performance monitoring, disciplinary actions, performance reviews, etc
  • Routinely meet with currently collaborating PCP’s
  • This role as the potential to WFH after 6 - 12 months
  • Active Licensed physician; Board Certified in ABMS/ABOMS specialty

Responsibilities For Care Management Supervisor Resume

  • Responsible for compiling Care Management data and coordinating Care Management data reports as required by ABQ HP’s contracted partners and regulatory agencies
  • Define, Source, Interview, Hire , Onboard, and support Clinical staff
  • Holds a current license to practice as an RN, PT, OT or SLP
  • Three (3) years’ experience managing region or division level positions. Five-(5) years’ health care management in multi-facility, long-term care organizations
  • Knowledge of state and federal regulations, both clinical and financial, as it relates to the RAI process and reimbursement systems

Responsibilities For Supervisor, Care Management Resume

  • Proficient in the use of Microsoft office products, specifically excel and Lotus notes
  • Conduct review of current care management operations across CHOP, and make recommendations for areas of opportunity and alignment across roles
  • Collaborate with executive leadership to formalize the approach and a structure designed to improve health outcomes and patient care experience while reducing costs
  • Establish goals, objectives, and metrics of success
  • Create and maintain connections throughout the organization in support of care management activities
  • Oversee the program’s operational budget and financial management
  • Works with the health care team members to verify that both the medical record and the assessment instrument accurately reflect the patient’s status at the time of assessment, intensity of services provided and appropriate medical necessity for the services rendered to the patient

Responsibilities For Care Management Specialist Resume

  • Monitors services provided and selects appropriate diagnosis for coding. Verifies the coding of the patient diagnoses and monitors percentage of patients with regulatory-agency-determined appropriate rehabilitation or skilled nursing diagnoses
  • Coordinates schedule of patient/resident’s care planning conferences with the interdisciplinary team and invites family participation in the care planning process by issuing a written or verbal invitation to the conferences
  • Serves as case manager for all Medicare and Managed Care patients/residents admitted to Medicare unit. Provides clinical services in the incumbent’s respective discipline, i.e. Staff RN, PT, OT, and SLP
  • Ensures that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the market’s engagement and clinical targets for assigned population. Ensures on-going staff development through education and opportunities for professional development
  • COLLABORATION: Collaborates with patient's care team to compile information regarding the patient's needs. Reviews documentation to assist in the development and implementation of a comprehensive care plan/ intervention
  • PROFESSIONAL DEVELOPMENT: Participates actively in all program and practice staff meetings, case conferences and work groups, and professional development workgroup sessions

Responsibilities For Director, Care Management Operations Resume

  • Learn hospital ambulatory scheduling system, electronic medical record and new applications used for care coordination
  • Responsible for the development and execution of care management activities to drive compliance with health plan partners’ models of care
  • Have overall responsibility for ensuring that HealthEast’s care management, population management, and transitions of care management activities are effectively operated, resourced, led, and monitored
  • Lead and provide technical expertise for the design, development, acceptance, and implementation of HealthEast’s transfer protocols, ensuring that they properly identify candidates for care transition and coordinate closely with broader care management pathways
  • Actively monitor the safety, effectiveness, and efficiency of “hand-offs” in care across the continuum of inpatient and outpatient management of HealthEast’s patient population
  • Be primarily accountable for the quality, effectiveness, efficiency, coordination, and satisfaction related to HealthEast’s care management relationships with primary, community, and sub-acute care rendered to its patients
  • Collaborate with clinical and administrative leadership to develop meaningful analytics and metrics for care management and appropriate IS interoperability, which supports the system’s care management goals
  • Relevant clinical or health plan experience in UM or related field
  • LPN with MN license without restrictions or pending restrictions

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