Care Manager Resume Sample

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Jayde Lemke
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Work Experience


Care Manager
02/2016 - PRESENT
San Francisco, CA
  • Coordinates development of care plan for members by meeting with members, caregivers, healthcare providers, and appropriate individuals to integrate services required to effectively meet the member’s needs
  • Advocates for the members’ needs, addresses concerns and resolves
  • Customer Focus: Connects meaningfully with customers to build emotional engagement and customer advocacy. Develops and applies deep customer knowledge and intimacy to develop and deliver products, services, and interactions that provide value beyond expectations
  • Executes for Results: Effectively leverages resources to create exceptional outcomes. Determines the best course of action when facing ambiguity. Anticipates and constructively resolves barriers and constraints
  • In conjunction with the PCP, member, member’s family, and other pertinent members of the Interdisciplinary Care Team (IDT), CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services. Assesses short-term and long-term needs and establishes case management objectives
  • In conjunction with the PCP, member, member’s family, and other pertinent members of the Interdisciplinary Care Team (IDT), CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services. Assesses short-term and long-term needs and establishes care management objectives
  • Participates in House of Mercy’s Performance Quality Improvement Program as an active member
RN Care Manager
05/2012 - 12/2015
Philadelphia, PA
  • Escalates utilization and system problems which have not been resolved at the local level to the next level immediately
  • Monitors the progression of the plan of care and facilitates discussions with the multidisciplinary teams
  • Educates other healthcare team members on utilization and cost containment initiatives
  • Collaborates with and provides information to patients, families, physicians, and staff regarding the provisions of care
  • Incorporates and counsels on the correct and consistent application, interpretation, and utilization of member health care benefits (including transition of care)
  • Discharge Planning: Ensures continuity of care through communication in rounds and written documentation, level of care
  • Uses, protects, and discloses 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 Davita, Inc.’s commitment to our mission and values
Integrated Care Manager
02/2006 - 11/2011
Detroit, MI
  • Valid Driver’s license
  • Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Participates in clinic’s Quality Management Program, High Risk Program, Group Visits, and other programs as requested
  • 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
  • This is an office position at 1 East Washington Street, Phoenix, AZ
  • 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
  • Ensures continuity of care for newly enrolled members

Education


University of Southern Nevada
2001 - 2005
Bachelor's Degree in Nursing

Professional Skills


  • Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer’s disease and other disease-related dementias) in an ethnically diverse, dual-eligible aging population
  • Excellent interpersonal skills, including a friendly manner, an open demeanor, and good listening skills
  • Strong computer and organizational skills including Microsoft office
  • Strong time management/organizational skills, independent thinking, ability to work in a team environment
  • Strong medicals skills and knowledge
  • Strong organizational, communication, writing, and customer service skills
  • Strong interpersonal skills to coordinate with many NOKIA organizations to gather data and drive results

How to write Care Manager Resume

Care Manager role is responsible for interpersonal, computer, clinical, health, patient, medical, assessment, customer, organizational, microsoft.
To write great resume for care manager job, your resume must include:

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

Contact Information For Care Manager Resume

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

Work Experience in Your Care Manager Resume

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

  • Provides point of need support and coaching to Care Managers and other clinical team members in the course of normal operations. Builds clinical team members expertise through direct feedback and real-time coaching. Is available to provide clinical, procedural or interpretational assistance
  • Excellent decision-making and follow-up skills
  • Strong active listening and interpersonal communication skills
  • Strong computer skills including /Excel/Powerpoint required
  • Solid writing and verbal communication skills
  • Good verbal and people skills

Education on a Care Manager Resume

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

When listing skills on your care 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 care manager skills:

  • Uses excellent communication skills with customers, using effective customer service strategies, and responding to customer questions and problems
  • Demonstrated work experience to influence, negotiate and effectively manage patient care and health care outcomes
  • Demonstrate excellent oral, written and interpersonal skills
  • Demonstrate excellent interpersonal skills and develop rapport with physicians, patients and their families
  • Multitask, prioritize and effectively adapt to a fast paced changing environment Sedentary work involving periods of sitting, talking, listening
  • Excellent Problem-Solving Skills: The ability to think critically and clearly about challenging situations and the ability to find solutions

List of Typical Experience For a Care Manager Resume

1

Experience For RN Care Manager Resume

  • Skills and experience in establishing and maintaining effective working relationships with physicians, patients, staff, teammates and the public
  • Strong problem solving, organizational and crisis management skills
  • Demonstrated fast and accurate typing and data entry skills
  • Function independently and as a team member.- Good organization, time management and communication skills
  • Assessment skills and ability to implement evidence based interventions and protocols for chronic conditions
  • Demonstrate effective teaching techniques applying adult learning principles
  • Clinical nursing experience in an acute care setting and 3+ years of case management experience in a managed care setting
  • Demonstrates excellent written, verbal, and motivational interviewing techniques. Builds positive relationships with the patient/family and care team
2

Experience For Clinical Care Manager Resume

  • Critical thinking skills and knowledge of patient self -management tools and techniques
  • Think critically and use problem-solving skills to ensure member care plans are followed
  • Think critically and use problem solving skills to assure the member's plan of care is addressed and followed
  • Demonstrate insight into human behavior and to communicate and interact with individuals at varying levels of skill and education preparation
  • Demonstrated utilization review/discharge planning experience
  • Computer skills (email, word processing, and spreadsheets)
  • Previous experience in case management, care coordination, or discharge planning role. 1 year experience in management position, (charge nurse acceptable)
  • Experience assessing and referring individuals seeking care for variety of mental health issues including substance abuse concerns
3

Experience For Integrated Care Manager Resume

  • Organizes and prioritizes daily work by screening, assessing and risk stratifying patient needs in area(s) of responsibility
  • Assesses and coordinates Hospitalization / Skilled Services CHHA /Nursing Home Communication and Planning
  • Knowledge and experience working with Banner or Maxient or Accessible Learning
  • Experience working with a broad range of hospital staff including MDs, pharmacists, nurses, Care Managers, and senior executives
  • (Depending on the product line/role) One of the following educational and work experience requirements
  • Extensive work experience in case management, working with a team of providers including psychiatrists and therapists
4

Experience For Senior Care Manager Resume

  • Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care; Required
  • Experience in extended care planning highly desirable (discharge planning to Rehab, SNF, home care, hospice)
  • Clinical practice experience, e.g., hospital setting, alternative care setting such as home health required
  • Clinical practice experience (hospital setting or community based setting) required
  • Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
  • Experience working in a hospital setting
  • Experience completing audits and assisting with process improvements
  • One to three years of experience working with individuals and families.Â
  • Coordinates transitional care management (acute to home, home to skilled nursing facility SNF/custodial, home to hospital and acute to SNF/custodial
5

Experience For Transition Care Manager Resume

  • Conducts managed long-term care quality measure planning and implements evidence based clinical pathways
  • Provider-relations experience within a behavioral setting would be seen as very valuable
  • Perform daily clinical review utilizing InterQual criteria as a guide to validate whether resident meets admission or continued stay criteria
  • Acute inpatient case management / discharge planning experience
  • Demonstrates working knowledge of common diagnosis related to select population
  • Experience in Inpatient Care Management setting
6

Experience For Lead Care Manager Resume

  • OR Masters of Social Work and experience in hospital discharge planning
  • Experience with case management, student conduct, or working with students with disabilities
  • Clinical practice experience, e.g., hospital setting, crisis line, outpatient treatment, residential facility; Required
  • Experience in the coordination of care process using community resources
  • Demonstrated ability to educate and coordinate resources on an ongoing basis
7

Experience For Emergent Care Manager Resume

  • Experience working with people with disabilities and vulnerable populations who have chronic or complex conditions in a managed care environment
  • Experience in hospital discharge planning
  • Current MD and DC RN license in good standing
  • Experienced with ER/Critical Care in an acute care setting
  • Two (2) years of combined current clinical experience in public health, community health, or in an acute care hospital setting
8

Experience For Body Care Manager Resume

  • Experience in direct education and/or coaching individuals for disease prevention, health promotion and behavior change
  • Three to five (3 - 5) years clinical experience or in an acute care setting
  • Valid Unrestricted license as a LPC, LCSW, LMFT or other master’s level behavioral health professional, including LMSW
  • At least one (1) year management experience in a dementia care environment and working with memory impaired seniors
  • Clinical maternal-child health nursing experience
  • Experience providing mental health consultation, referrals, and preauthorizations and knowledge of Medicaid applications and eligibility requirements
  • Experience working with electronic records is required
  • 3+ years' experience in a social work setting
  • Experience with psychiatric, substance use disorder, or behavioral health setting required
9

Experience For Technical Care Manager Resume

  • Acute care or community nursing experience required
  • Three (3) years of clinical experience in an HMO, medical group, affiliated model, hospital or medical office/clinic setting required
  • If driving required, Valid California Driver’s License and automobile insurance for employee-owned vehicles
  • At least two years’ experience in community or managed behavioral health care setting
  • Has at least two years of recent nursing experience within the last 5 years in ambulatory care
  • Acute care nursing experience
10

Experience For Clinical Care Manager Clinical Care Manager Resume

  • Nursing experience in an emergency department and/or case
  • Nursing experience in an emergency department and/or case management, care coordination or transition of care
  • Ambulatory experience working in a health center or physician’s office
  • Post-acute Experience working in settings such as LTAC, IRF, SNF and/or homecare
  • Care planning experience
  • Knowledge and experience teaching self-management

List of Typical Skills For a Care Manager Resume

1

Skills For RN Care Manager Resume

  • Excellent organizational skills High level of oral and written communication skills
  • Demonstrated professional writing and electronic documentation along with clear and concise telephonic assessment skills
  • Experience meeting strict deadlines and established cycle times through effective prioritization and follow-up
  • Strong problem - solving, organizational and crisis management skills
  • Clinical nursing experience in a clinical, acute care, or community setting and 1+ years of case management experience in a managed care setting
  • Demonstrate effective teaching techniques, applying adult learning principles
  • Demonstrated autonomy in decision-making using sound judgment based upon factual information, clinical experience, and nursing process
  • Nursing experience; 1+ year of experience in a Hospital setting
  • Nursing experience; 2+ years of experience working with the Underserved and/or Substance Abuse population
2

Skills For Clinical Care Manager Resume

  • Prior experience conducting individual Patient Education and Counseling Sessions
  • Superior rating or higher on annual performance evaluation for consideration and Solid/Strong rating to maintain position
  • Proven working experience as a behavioral health case manager or case manager in an integrated health care setting
  • Bilingual Spanish/English speaking skills are highly desired
  • Computer skills including excel, word, and PowerPoint [cha101716]
3

Skills For Integrated Care Manager Resume

  • Strong utilization and discharge planning experience,
  • Management experience in a licensed early childhood setting with proven ability to organize and direct early childhood educational activities
  • Knowledgeable in CQI principles. Critical thinking skills and ability to analyze complex data sets required
  • Provide empathetic and courteous service while working effectively with co-workers face - to - face or remotely in dynamic and emergent situations
  • Previously demonstrated ability to foster strong collaboration with co-workers, peers, physicians, nursing, and ancillary departmental support staff
  • Basic computer skills including Microsoft Word, Windows, and Excel
  • Basic computer skills required, including Word and Excel
  • Function effectively in a fluid, dynamic, and rapidly changing environment
4

Skills For Senior Care Manager Resume

  • Care management experience, with preference for experience supervising staff
  • ED experience/clinical background and experience with care management
  • Prior business and clinical experience
  • Work effectively to address challenges as part of an interdisciplinary team
  • Superior rating or higher on annual performance evaluation for consideration (if internal to UPMC) and Solid/Strong rating to maintain position
  • Collaborate and communicate effectively with executives and senior leadership
  • Prior Care Management experience in a healthcare and/or Managed Care setting
  • Prior CHHA and UAS experience
5

Skills For Transition Care Manager Resume

  • Engagement and outreach skills
  • Prior experience in a certified home health agency
  • Clinical Acute Care experience; 1+ year of Care / Case Management experience
  • Bilingual skills - Spanish and/or Chinese
  • Prior utilization management, case management, compliance, or payer experience also required
  • Effectively present information and respond to questions from groups of managers, patients, physicians, and payors
  • Competent Computer navigation skills
  • Superior clinical decision making skills
6

Skills For Lead Care Manager Resume

  • Experience assessing and developing service plans for families with aging family members
  • Previous experience working with an insurance company performing inpatient admissions
  • Current experience in Utilization Management, including: Pre-authorization; Utilization / Concurrent Review; and, Discharge Planning
  • Experience working in a medical surgical setting
  • At least one year years of experience in clinical setting demonstrating
  • Greater than 5 years related experience and/or training in long term care/assisted living required
  • Nursing experience in Long-Term Care/Acute Care setting required
  • Demonstrated competency working with health care setting computer systems
7

Skills For Emergent Care Manager Resume

  • Assess and coordinate hospitalization/skilled services/nursing home - communication and planning
  • Experience as a NY licensed RN or LMSW working in a home care environment or in an acute or sub- acute or long term care setting or managed long term care
  • Clinical nursing or case management experience in a clinical, acute care, managed care or community setting
  • Clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
  • Experience working with high risk Adult, Pediatric and/or Maternity populations with co-occurring medical conditions
  • Acute care, case management, UR, or discharge planning experience
  • Clinical work in orthopedics, physical rehabilitation or case management experience in an outpatient or inpatient setting
  • Clinical experience within a Certified Home Health Agency (CHHA) and/or a Managed Long-term Care setting
  • Previous experience in a Home Health, Physician's Office, and/or Public Health setting
8

Skills For Body Care Manager Resume

  • Previous experience with Discharge Planning; Case Management, and Health Insurance
  • Clinical experience in an acute care setting
  • Utilization Management / Utilization Review experience in Managed Care or Hospital setting
  • Previous experience working with the Geriatric, Homeless, Addiction and/or Foster Case population
  • Acute care nursing experience
9

Skills For Technical Care Manager Resume

  • Background in understanding file reviews for prior authorization (surgical procedures, home health, laboratory, wound care etc.)
  • Clinical experience in a Behavioral Health and/or Managed Care setting
  • UM/UR experience in managed care or hospital setting
  • Relevant expertise and experience in serving children and families in Child Welfare, Developmental Disabilities, Mental Health, Healthcare and/or other systems
  • Clinical experience in a Behavioral Health / Managed Care setting
10

Skills For Clinical Care Manager Clinical Care Manager Resume

  • Utilization review/management experience and discharge planning out of acute care or home care environment
  • Good working knowledge of CARES
  • Experience working in home care
  • Experience developing process and policy documents
  • Experience in a Community Health, Home Care, and/or Managed Care setting
  • Experience with managing complex and unique caseloads for persons with both physical and behavioral health needs

List of Typical Responsibilities For a Care Manager Resume

1

Responsibilities For RN Care Manager Resume

  • Assesses the new patient’s situation, provides information about health care options, serves as guide and advisor to the patient and his/her family, and establishes and molds a long-term relationship with the primary care physician and the patient
  • As a member of the care delivery team, works to facilitate patient compliance and ensure continuity of care per the team’s “care plan” throughout the patient’s tenure in the Program
  • Demonstrates the ability to effectively communicate and collaborate with care team members
  • Demonstrated skills in conflict management and resolution
  • Utilize best practices and accrued skills to assist caregivers to navigate crisis, family issues, and other challenges
  • Analyzing predicted and actual outcomes and cost-effectiveness of a member’s interventions/ services based on best practices
  • Demonstrates ability to engage in complex clinical decision making and multi-tasking
2

Responsibilities For Clinical Care Manager Resume

  • Knowledge of Microsoft Office and demonstrated proficiency in managing software such as Eclipsys Sunrise Manager, Canopy, and ECIN
  • Maintains effective working relationships with professionals and support personnel within the medical center and the community
  • Provides input (data, analysis or opinion) to the evaluation of the Program’s overall effectiveness
  • Actively engages with providers to promote quality and effective use of resources across the continuum of care
  • Demonstrates knowledge of the program, program criteria and referral process to program
  • Demonstrates knowledge of PCMH requirements and standards
  • Demonstrates ability to appropriately document data discretely in the EMR and serves as a resource for clinical office staff
  • Actively engages with providers to promote quality and effective use or resources across the continuum of care
  • Registered Nurse with at least 3 years of clinical experience
3

Responsibilities For Integrated Care Manager Resume

  • Two year's behavioral health work experience
  • Identify and prioritize the individual’s care management needs and goals in collaboration with the member and caregivers
  • Maximize the client’s health, wellness, safety, adaptation, and self-care through effective care coordination and case management
  • MN State Licensure Registered Nurse w/behavioral health experience
  • Performs concurrent reviews for inpatient and/or outpatient care and other levels of care as allowed by scope of practice and experience
  • Developing, streamlining, monitoring and adjusting members‘ Care Management Plans based on progress and outcomes to include
  • Designing Plan of Care for the new member to maintain health, independence and safety
  • Providing Monthly reports to customer on contracted deliverables to ensure customer satisfaction & loyalty
  • Providing clinical teams with the proper tools so members can self-manage care in order to safely live, work and integrate into the community
4

Responsibilities For Senior Care Manager Resume

  • Monitoring and reporting of critical clinical events (CCE) in support of the CQI program
  • Designing Plan of Care for the new member to maintain health, independence, and safety
  • Developing, implementing, and evaluating individualized patient care plans
  • Advocating for a patient's welfare
  • Serving as a liaison between patients, their families, and healthcare providers
  • Reducing hospital admissions and unnecessary emergency department and crisis service use
  • Ensuring members are scheduled for prevention, EPSTD, disease management and health promotion activities, consistent with need
5

Responsibilities For Transition Care Manager Resume

  • Keeps abreast of professional developments in the field by reading, attending conferences and training sessions
  • Client case management including conducting in-home nursing assessments and development of care plan
  • Provides ongoing monitoring of patient involvement, participation and compliance with treatment plan, updating Care Plan as needed
  • Seen as a leader in the interdisciplinary team in determining goals of care and discharge as well as identifying and addressing barriers to care progression
  • Audits and evaluates the daily activates of Care management staff including utilization review, discharge planning, documentation, and interdisciplinary rounds
6

Responsibilities For Lead Care Manager Resume

  • Provides care management services in the community, including on-site and telephonic reassessments according to protocol
  • Assist patient in scheduling and obtaining transportation to medical and specialty appointments
  • Performs brief supportive therapy with individuals awaiting an appointment at treating provider
  • Provides education to other departments/floors regarding case management services and support, discharge planning and plan of care
  • Manages length of stay by proactively identifying and mitigating issues and barriers to care and a successful discharge plan; monitor GMLOS, daily LOS
7

Responsibilities For Emergent Care Manager Resume

  • Facilitates resolution of issues surrounding patient care in a compassionate manner, utilizing escalated team meetings as appropriate
  • Act as resource to the staff for regulatory issues regarding discharge-planning and psychosocial processes
  • Document care management activities according to Beacon Standard Operating Procedures
  • Documents case management activities in approved platforms according to Beacon standard operating procedures
  • Document care management activities in FlexCare and /or Health Plan Electronic Health Record according to Beacon Standard Operating Procedures
8

Responsibilities For Body Care Manager Resume

  • Strategies, such as health coaching and wellness, to facilitate behavior change to address underlying health needs and member self-management
  • Capable of learning and utilizing PC software to collect and analyze data and prepare and aggregate reports
  • Engages high-risk patients (and their caregivers) in understanding and setting self-management plans in a culturally and linguistically appropriate manner
  • Documents all team, physician, and patient/family communication and concerns pertaining to coordinating of care and services
  • Responsible for InterQual screening on every patient admitted to the hospital, including initial, continued stay and completion of discharge screens
  • Performs quality clinical reviews while educating and making appropriate interventions to advance the care of the member in treatment
9

Responsibilities For Technical Care Manager Resume

  • Researches, evaluates and recommends resources to meet medical and non-medical needs of patients and families while working with the Social Workers
  • Provide oversight to and assist with training of other case management staff CB
  • Oversees the patients’ plan of care while the patient is receiving care
  • Ensures that treatment plans are appropriate and coordinates treatment planning with the patient’s payor(s)
  • Provides patient teaching to patients and families as defined by need
  • Serves as a resource to Care Manager I’s regarding care management and care coordination
  • Engage with the most complex members of the health plan with the goal of improving health care outcomes and appropriate and timely utilization of services
  • Participates in customer service assessment activities, including telephone and medical record audits
  • Monitors hospital and SNF admissions according to post hospital program and provides education and/or interventions as necessary to reduce frequency
10

Responsibilities For Clinical Care Manager Clinical Care Manager Resume

  • Performs screening and case review of potential transition of care and chronic care management cases for assigned patient population
  • Refers cases formally to the peer advisor when unable to render a certification decision using Beacon Health Options’ clinical criteria and guidelines
  • Integrates National standards for case management scope of services including
  • Coordinate on-going outreach to students who would benefit from regular outreach throughout an academic year
  • Provide support to and consultation about distressed and distressing students
  • Maintain records in computer databases such as Maxient, Accessible Learning, and Banner, as appropriate

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