Senior Case Manager Resume Sample

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Reba Medhurst
65245 Barrows Skyway,  Houston, TX
+1 (555) 182 4302

Work Experience


Senior Case Manager
02/2016 - PRESENT
Houston, TX
  • Executes against ICG’s delivery commitment related to the Global AML PMO workstreams (Governance and Oversight, Risk Assessment, Customer Due Diligence/Know Your Customer, AML Monitoring, Remote Deposit Capture, Independent Testing)
  • Planning and Implementation. Develops and implements action-oriented and time specific case management plans by determining and documenting specific objectives, goals, and actions designed to meet the client’s health and human service needs identified through the assessment process
  • Monitoring and Evaluation. Gathers information and documentation from all relevant sources regarding the case management plan’s activities and/or services to determine the plan’s effectiveness in reaching desired outcomes and goals. Modifies or changes the case management plan, as needed
  • A genuine desire to support and help our customers to realise their best life
  • A holistic approach to assisting customers with empathy, understanding and timeliness
  • Exceptional communication skills, with a proven background in sensitively managing tough conversations, demonstrating the ability to listen and put yourself in the customers position
  • Broad knowledge of specialty areas including medical, financial, legal, investigations, occupational and rehabilitation
  • Extensive experience in strategically assessing complex medical/ disability claims and advising on RTW strategies
  • Strong commercial acumen; always looking for win/win strategies balancing business outcomes with the customer experience
Basu Cadd-senior Case Manager
04/2010 - 12/2015
Dallas, TX
  • A robust decision making ability – applying a strategic and analytical lens to decisions
  • Collaborates with other members on the Patient Services Team for the purposes of updating patient status’ currently in Financial Case Management
  • Company research reports or by interacting with the RM’s for the same
  • Manage patient transition to Shire products. Work with nurses to provide injection/infusion training to patients
  • Trouble shoot and resolve ongoing reimbursement issues (step edits, insurance changes, PA’s, etc)
  • Answer patient and medical office inquiries and resolve customer problems
  • Attend patient meetings and represent Shire at industry conferences
Icg-kyc-senior Case Manager
09/2006 - 01/2010
Phoenix, AZ
  • Travel to sales meetings and medical offices as necessary
  • Providing Workers’ Compensation claims and return to work advice to all stakeholders and participate in claims reviews
  • Working in conjunction with treating health practitioners, providers and employers to drive injured workers’ return to work
  • Assesses patients’ needs and develops action plans that provide for the introduction and continuation of enzyme replacement therapy while coordinating the exchange of all patient-related information with internal and external customers
  • Demonstrates understanding of Genzyme’s business model, and their role in commercializing the business
  • Experience of lending and / or recoveries in residential and commercial loans essential
  • Conduct the performance appraisals process for junior staff and assess their developmental needs (Note – for Costa Rica and Mumbai, appraisals performed by Team Lead)

Education


Ottawa University - Wisconsin Campus
2000 - 2005
Bachelor's Degree in Finance

Professional Skills


  • Excellent verbal and written communication skills, analytical, and project management skills
  • Strong public speaking and presentations skills to effectively communicate to various levels of employees, including senior leadership
  • Strong comprehending as well as English writing skills, good analytical and research skill, detailed and meticulous
  • Demonstrate collaborative working within the Flex Team; sharing practice and skills, and promoting a team ethos
  • Excellent problem solving skills – ability to come up with solutions that meet our customers' needs, while aligning with company and regulatory guidelines
  • Acts as a resource for internal and external sources, utilizing excellent communication skills and responding in a timely and focused professional manner
  • Excellent written and verbal communication skills and aptitude in communicating with senior management. Fluency in Russian and English

How to write Senior Case Manager Resume

Senior Case Manager role is responsible for finance, regulatory, government, compliance, research, analysis, aml, metrics, leadership, english.
To write great resume for senior case manager job, your resume must include:

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

Contact Information For Senior Case Manager Resume

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

Work Experience in Your Senior Case Manager Resume

The section work experience is an essential part of your senior 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 senior 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 senior case manager position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Senior Case Manager resume experience can include:

  • Strong experience in claims management and working in an operations type of environment
  • Demonstrated ability to prioritize, multi-task and work within tight and changeable timeframe while still maintaining high-level of accuracy
  • Recent Clinical Nursing experience, case management, or insurance experience with a stong, successful track record
  • A proven track record with at least 5-7 years of relevant KYC/AML experience (i.e. Quality Assurance, Client Onboarding, Compliance, Audit and Regulatory)
  • Proven experience in QLD Workers’ Compensation,
  • Investigative experience in the public and/or private sector and/or experience as an HRBP

Education on a Senior Case Manager Resume

Make sure to make education a priority on your senior 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 senior 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 Senior Case Manager Resume

When listing skills on your senior 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 senior case manager skills:

  • Fantastic customer service skills to all injured workers, employers and providers and be able to effectively resolve conflict
  • At least three years of prior clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
  • Excellent computer skills working with Word, Outlook and Excel
  • At least three years of prior clinical experience as a nurse preferably in an acute care, skilled or rehabilitation clinical setting
  • Excellent analytical skills; ability to analyze and interpret regulatory documents and understand implications to company
  • Strong influence and persuasion skills with leadership

List of Typical Experience For a Senior Case Manager Resume

1

Experience For Basu Cadd-senior Case Manager Resume

  • Demonstrable and articulable knowledge of federal disability programs; excellent time management skills
  • Prior experience in a work at home and telephonic role
  • Leadership skills, ability to manage and direct staff
  • Directly monitors case management staff to ensure proper and effective job performance
  • Claim review meetings – Prepare up to date summary reports of claims for client which displays effective management
  • Identifying privacy issues when forwarding material relating to claims and conciliation to ACCS
  • Actioning conciliation outcomes including processing weekly comp & medical expenses in strict timeframes
  • Creating and maintaining files and computer records
  • Updating worker/employer/worker’s representative/ACCS on progress of processing conciliation outcome
2

Experience For Senior Case Manager Inpatient Services Resume

  • Requesting Centrelink clearances/updating recoveries
  • Being a point of contact for Accident Compensation Conciliation Service (ACCS) inquiries
  • Maintaining databases and registers specific to the Dispute Resolution Team
  • Contacting external stakeholders as required
  • Independently manage the regulatory process, collaborating and utilizing manager and director and other leaders as necessary
  • Monitor their pipeline of work daily (e.g. coming due) and ensure actioned as per agreed timelines Ensure data quality in the BSU/FCB tool with periodic checks
  • Background working in case management
3

Experience For Icg-kyc-senior Case Manager Resume

  • Assists other department heads and members of the administrative staff relating to correctional programs issues
  • Serves as resource when addressing inmate program issues
  • Efficiently manage a case load from assigned external firms, providing boutique level service at all times
  • Receive and review incoming new insurance applications for completeness
  • Request and review all underwriting requirements
  • Maintain and update the Resonant new business system with the current status of each case and any outstanding requirements
  • Manage Team of KYC analyst supporting 4 countries in accordance with globally consistent KYC BSU standards
  • Attend patient meetings, conferences to educate patients, providers or payors regarding disease/product information and case management services
  • Serve as expert witness, including preparation of testimony, discovery, and work papers
4

Experience For Senior Case Manager for Student Life Resume

  • Manage claims on an ongoing basis to finalisation, undertake reviewable decisions in accordance with time frames
  • Proactively identifies/resolves issues impeding diagnostic, treatment progress and discharge
  • Completes Utilization Management and Quality Screening for assigned patients
  • Develop coverage/succession plan for out of office/ holidays and vacation scenarios (Note – For CR this is performed by Team Lead)
  • Develop coverage/succession plan for out of office/holidays and vacation scenarios (Note – For CR this is performed by Team Lead)
  • Provide assessments of physical, psycho-social and transition needs in settings not limited to the PCP office, hospital, or member’s home
  • Develops, implements, coordinates, reviews and updates case management and service plans for ISAP participants in conformance with state and federal regulations and program requirements. Meets with participants face-to-face regularly as required by contractual obligations
  • Responsible for the execution/completion of KYC Records assigned to the pod and quality control of the completed KYC Records
  • Meet Case Managers on daily basis to discuss WIP KYC Records and to provide feedback based to them based on KYC Records checked
5

Experience For MYS Ctsm Kl-senior Case Manager Resume

  • Proactively identifies and resolves any other execution risks and issues, escalating Issues to RM Supervisor, Compliance, Operations Head etc. to ensure KYC Records progress
  • Conduct side by side training on a monthly basis to ensure Case Managers are having full comprehension of the policies and procedures
  • Review/implement feedback from Compliance and BSG (as applicable) to ensure continuous improvements
  • Conduct In process reviews of KYC Records ( All client types)
  • Act as primary point of contact for assigned region
  • Engage with stakeholders/Senior management and ensure timely feedback loop
  • Reviews and approves program participants' service plans to ensure compliance with state requirements and contractual obligations
  • Conducts home visits to verify ISAP participants' places of residence in compliance with contractual obligations
6

Experience For MYS Ctsm Kl-cadd Bsu-senior Case Manager Resume

  • Serves as the point of contact for DHS in the Program Manager's absence
  • Under direction of the manager, oversees the case/disease management staff and all activities, monitoring and adapting schedules to meet department goals and objectives
  • Acts as a preceptor for new employees. Ensures that new employees follow appropriate case/disease management processes and policies and works to develop appropriate skill levels in all associates
  • Provides feedback to the manager regarding probationary, interim and annual staff reviews and status of corrective action plans when indicated
  • Under the direction of the manager, oversees case/disease management process, identifying process issues to the manager
  • Assists manager in identification/re-education of quality issues regarding the inbound queue process
  • Performs audits and monitors staff performance as indicated. Evaluates and identifies strengths and opportunities for staff improvement based on audit results
7

Experience For Senior Case Manager Complaints Resume

  • Maintains accurate attendance records and notifies manager of individuals with variation from the standard company policy. Authorizes staff time off
  • Functions as a subject matter expert in the development and evaluation of policies and procedures
  • Monitors, delegates, and empowers staff to support team spirit and staff commitment
  • Assists with cases as indicated
  • Attends meetings as delegated by manager and works on special projects
8

Experience For Senior Case Manager Resume

  • Current, active, and unrestricted PA RN licensure
  • Accept and respond appropriately to change
  • Technical proficiency; ability to troubleshoot technical issues
  • Lead a team of Case Managers
  • Manage relationships with Coverage teams and Compliance for Ukraine
  • Assist relationship and coverage teams globally in completion of the KYC records
  • Meet agreed targets for KYC records review and completion within agreed Service Level Agreement timeframes
9

Experience For Basu Cadd-senior Case Manager Resume

  • Assist with departmental quality reviews as appropriate (MCA etc.)
  • Take responsibility for the weekly updates and MIS reports for the BSU unit
  • Ensure the implementation, execution of and follow-up control over the subordinated to him/her unit activity on internal control procedures and policies of the Bank and on the implemented internal controls
  • Manage a caseload of the more complex/higher risk cases based on evidence-informed assessment(s), including Risk of Serious Recidivism (RSR) score
  • Proactively take responsibility for developing and maintaining relationships and networks, including but not limited to Multi-Agency Risk Assessment Conferences (MARAC) and Domestic Violence (DV) multi-agency relationships, to ensure appropriate support and engagement with service users
  • Actively manage risk and take responsibility for recognising when risk escalation is required and take the necessary action
  • Providing administrative co-ordination to the Dispute Resolution Team in order to facilitate the proper application of proceedings and directions to conciliation applications
  • Co-ordinating the administrative function within the Team, including registration of applications, setting of reviews and conferences, following up compliance activities as required
  • Serves as expert to line staff in correctional programs policies and procedures
10

Experience For Senior Case Manager Inpatient Services Resume

  • Provides guidance and promotes an atmosphere conducive to personal and professional achievement, progress and advancement among classification staff
  • Advises and assists in the development and implementation of policies and procedures pertaining to all phases of the custody, administration, classification and program status of inmates
  • Develops, coordinates and implements training for case management personnel
  • Reviews and evaluates case management department policies and procedures to ensure they are pertinent, applicable and effective and that they comply with GEO, institution, ACA and client agency requirements, guidelines and standards
  • Serves as liaison with U.S. Probation, U.S. Parole Commission, Pretrial Services, and Federal courts

List of Typical Skills For a Senior Case Manager Resume

1

Skills For Basu Cadd-senior Case Manager Resume

  • Serves as informal mentor to new case managers/service coordinators, answering questions, offering opportunities to shadow and observe, and explaining basic information about sites programming
  • Clinical nursing experience as a Registered Nurse, preferably Home Health, acute care, skilled, or rehab clinical setting
  • Experience in regulatory/policy, analytics, project management, case management, financial, and/or corporate communications experience
  • Relevant experience working on Life Claims Assessing, Superannuation and Super Trustee
  • Previous experience managing large corporate clients
  • 2 – 3 years’ experience in banking or finance
2

Skills For Senior Case Manager Inpatient Services Resume

  • Experience working with the geriatric population
  • Experience with using an Electronic Medical Record
  • Strong communication and problem solving ability
  • Determine specific short and long-term goals, objectives, and interventions with accompanying timeframes based upon evidence-based medicine guidelines
  • Previous experience in care management, discharge planning and/or home health or rehab
  • Previous experience in case management, discharge planning and/or home health or rehab
  • Good Command written and spoken of Mandarin language would be an advantage
  • Effective time management and an organised pro-active approach to their work
  • Previous experience in Workers Compensation Case Management
3

Skills For Icg-kyc-senior Case Manager Resume

  • Experience in post - acute care, such as long term care
  • Education (or equivalent years of experience)
  • Strong customer service ethic and ability to execute client focused outcome
  • Working with the business to agree the approach, providing written recommendations to senior management and client committees
  • Working in conjunction with medical professionals, providers and employers to return injured workers to work
  • Assists the manager in identifying training needs and assists in departmental training
  • Complete required documentation, including but not limited to: Assessments (initial and on-going), Care Plan (initial and on-going), program referrals, etc
  • Conduct root cause analysis by identifying & analyzing areas of common defect/issues/themes
  • Work with BSU Head on goal setting, performance management planning/implementation and one to ones
4

Skills For Senior Case Manager for Student Life Resume

  • Take a leading position with issues resolving
  • Provide practice oversight and guidance to Case Managers as required (informal coaching and mentoring)
  • Willingness to continue to learn and push themselves in everything they do
  • Flexible work hours including the opportunity for a Productivity Day each month
  • Work in a rapidly changing environment with tight deadlines
  • Thorough understanding of Life Insurance products
  • Mentor and coach Case Managers on an on-going basis
  • Maintain ongoing contact with client
  • Maintains detailed records of all activities, both pending and completed
5

Skills For MYS Ctsm Kl-senior Case Manager Resume

  • Review, post-discharge calls and discharge planning
  • Tertiary qualification related to banking, financial services or legal required
  • Work with Medicare members to assess care needs immediately post discharge from clinical setting
  • Serves on team and/or division committees
  • PC Literate – Microsoft Office, Acction and Novus
6

Skills For MYS Ctsm Kl-cadd Bsu-senior Case Manager Resume

  • Experience working with programs funded with HUD’s Community Development Block Grant program and/or FEMA disaster recovery funds (FEMA Public Assistance or FEMA Hazard Mitigation Grant programs)
  • Proven experience in NSW Workers’ Compensation,
  • Demonstrated Workers Compensation experience
  • Personal touches like weekly fruit bowls and birthday celebrations
  • Fluency in another Asian language such as Japanese, Korea or Mandarin is desirable, but not required
  • Computer Skills: Advanced level proficiency with word processing (Word), spreadsheets (Excel), presentation programs (PowerPoint) and databases (SharePoint and Relativity). High level of competency in navigating the Internet
  • Mathematical Skills: Ability to calculate figures and amounts such as regular rates of pay, overtime, proportions, percentages, discounts, commissions, etc
  • Current unrestricted Registered Nurse license in the state of New York
  • Extremely detailed and customer service oriented
7

Skills For Senior Case Manager Complaints Resume

  • Assists in the collection and reporting of financial indicators including case mix, LOS, cost per case, excess days, resource utilization, readmission rates, denials and appeals
  • Uses data to drive decisions and plan/implement performance improvement strategies related to case management for assigned patients, including fiscal, clinical and patient satisfaction data
  • Documents key clinical path variances and outcomes which relate to areas of direct responsibility (e.g., discharge planning)
  • Provide direction, coaching and oversite for staff assigned to SSI service track activities
  • Maintain a high standard of work, submitting complete federal disability applications with documentation to successfully secure benefits for the client
  • Determine if clients has a pending SSI application
  • Collects, analyzes and addresses variances from the plan of care/care path with physician and/or other members of the healthcare team
  • Collects delay and other data for specific performance and/or outcome indicators as determined by Director of Case Management
8

Skills For Senior Case Manager Resume

  • Initiates and leads the development, implementation, evaluation and revision of clinical pathways and other Case management tools as a member of the clinical resource/team
  • Assists in compilation of physician profile data regarding LOS, resource utilization, denied days, costs, case mix index, patient satisfaction and quality indicators (e.g., readmission rates, unplanned return to OR, etc.)
  • Claims Management / Workers Compensation experience
  • Responsible for processing a small KYC Record population, preferably complex cases that need higher level of experience/attention to detail
  • Extensive years experience in banking or finance
  • Experience in banking or finance
  • Three (3) years of experience in hospital-based nursing or social work required
  • Home Health and OASIS experience
  • 5 total years of relevant experience
9

Skills For Basu Cadd-senior Case Manager Resume

  • Extensive years people management experience
  • Acts as preceptor/mentor to new hires. Assists in developing orientation schedule and helps identify individual needs for learning
  • Provide services to clients with more complex Federal Disability applications
  • Ensure all clients are served timely and professionally
  • Implement strategies that improved award rates for our client
  • Review for reasonable accommodations , document need and ensure accommodations are provided
  • Explain role of AR, give client option of designating and if agreeable complete appropriate forms with client. If AR already exist, confirm and take appropriate action
10

Skills For Senior Case Manager Inpatient Services Resume

  • Assist client in accessing treatment and complying with clinical evaluations
  • Responsible for checking all KYC Records within team, and capturing rejection reasons per KYC Record checked
  • Assist client in securing relevant documentation
  • The capability to work autonomously, and as part of a high-functioning team
  • Serves as the point of contact for DHS in the Program Manager’s absence
  • Motivated and energetic individuals who are keen to challenge themselves!
  • Point of escalation for the Makers
  • Communicate and coordinate with senior management of ICG APAC from coverage, compliance, implementations, risk, and operations in various products
  • Develop coverage/succession plan for out of office/ holidays and vacation scenarios (Note – For CR this is performed by Team Lead) Operational

List of Typical Responsibilities For a Senior Case Manager Resume

1

Responsibilities For Basu Cadd-senior Case Manager Resume

  • Maintain strong knowledge of state and regulatory guidelines including Replacements, NY Regulation 60, and 1035 Exchange processing
  • Completing standard letters
  • Take initiative to proactively push cases through the underwriting process and reducing cycle time from application to issue and delivery
  • Answer incoming calls on ACD line for life insurance status and inquiries
  • Registration and determination of new and ongoing workers compensation claims
  • Arrange archiving of closed claims
  • Monitors the victim/witness notification, inmate financial responsibility, and inmate performance pay programs to ensure policy compliance
  • Respond quickly and accurately to all interested parties (agents, wholesalers, management, etc.) by phone, email or mail - regarding inquiries on pending case statuses
2

Responsibilities For Senior Case Manager Inpatient Services Resume

  • Conduct regular follow-up on cases via phone primarily and email and/or fax secondarily, on all outstanding requirements with insurance business partners and clients
  • Act as project lead for Global KYC BSU projects / quality initiatives as required
  • Facilitate the coordination of health care provider and payor resources to ensure access to chronic complement inhibition therapy for patients with PNH, aHUS, HPP & LAL D
  • Develop and implement plans of action to overcome barriers to disease knowledge or access for patient’s choice of Alexion FDA approved therapies
  • Maintain records, complete reports and communicate case status and direction as per OneSource CM Program design and in compliance with company policies
  • Identify resources for patient assistance
  • Work in tandem with 3rd party vendors in compliance with company policy to support patient needs
  • Assigned the cases of moderate complexity
3

Responsibilities For Icg-kyc-senior Case Manager Resume

  • Develop relationships to collaborate externally with stakeholders to further the company’s objectives
  • Review and assist subject matter experts with development of testimony, work papers and discovery responses, settlement documents and communications materials; anticipate and understand the impact and proactively address issues
  • Evaluate and develop recommendations on cost recovery, ratemaking, customer programs and tariffs; continually look for and recommends process improvements
  • Ensure all compliance items are identified, tracked, monitored and implemented
  • Claims Administration – Ensure compliance with provisions of the Safety Rehabilitation and Compensation Act and Regulatory requirements
  • Provider Payments - ensure swift authorisation and payment of accounts for service providers; Record payments on Claims Management System
  • Claims management -manage and review a portfolio of claims
  • Approve claims in accordance with delegated limits and legislation
  • Oversight of the determination of Normal Weekly Earnings (NWE) in accordance with The Safety Rehabilitation and Compensation Act 1988; Ensure payments are authorised and processed within strict timeframes
4

Responsibilities For Senior Case Manager for Student Life Resume

  • Perform outbound calls to high-risk members within 72 hours of discharge from acute and skilled care facilities, per program workflow to perform interventions to close clinical gaps
  • Identify, organize, and integrate the appropriate acute, rehabilitative, sub-acute, homecare, alternative, and community resources needed to accomplish the identified goals in the care plan
  • Collect sufficient data from all relevant resources to determine the effectiveness of the care plan
  • Make repeated assessments of the care plans effectiveness at appropriate intervals and make plan modifications, as necessary, to achieve patient goals and improve outcomes
  • Current driver’s license with own dependable vehicle
  • Designing control frameworks for each client that is designated as "Sensitive", which includes creatively tailoring control options to the particular risks identified, ensuring that these are applied, and monitoring the client's activity on an ongoing basis to ensure that the financial crime risk remains within tolerance
  • Active unrestricted RN license in the state of Florida, and the ability to be licensed in multiple states without restrictions
  • Active RN license in the state associate lives
5

Responsibilities For MYS Ctsm Kl-senior Case Manager Resume

  • Work independently in a virtual/home office environment, under general instructions and with a team
  • Fortnightly payroll authorisations
  • Bi-lingual - Spanish/English
  • Travel requirements 25-30%
  • Reports to:Mgr, Case Mgmt
6

Responsibilities For MYS Ctsm Kl-cadd Bsu-senior Case Manager Resume

  • ACAMS, Any other prominent certification in AML/KYC
  • 18 Months as a Case Manager within this team
  • Certified forensic investigator, required
  • Oversees the management of specific patient populations across the continuum focusing on high-risk, high-cost patients. Serves as a resource to the multidisciplinary team for the management of complex patients
  • Works with physician leadership and the multidisciplinary team for defined patient populations to develop clinical pathways, continuum care management programs, measurement and feedback of performance indicators for cost, quality and service and patient satisfaction
  • Serves as the primary information resource for case management staff, payors, physicians, other healthcare team members and customers (skill areas include: regulatory requirements, pathway development/implementation, ethics/healthcare law, clinical skill, etc.)
  • Facilitates learning experiences of healthcare team members, conducts in-services, and/or serves as a resource for pathways. Participates in teaching CM Modules
7

Responsibilities For Senior Case Manager Complaints Resume

  • Assumes delegated activities from the Director as needed
  • Works collaboratively and maintains active communication with physicians, nursing and other members of the multi-disciplinary care team to effect timely, appropriate patient management
  • Applies approved clinical appropriateness criteria to monitor appropriateness of admissions and continued stays, and documents findings based on Department standards
  • Communicates with Resource Center to facilitate covered day reimbursement certification for assigned patients. Discusses payor criteria and issues on a case-by-case basis with clinical staff and follows up to resolve problems with payors as needed
  • Ensures that all elements critical to the plan of care have been communicated to the patient/family and members of the healthcare team and are documented as necessary to assure continuity of care
  • Meets directly with patient/family to assess needs and develop an individualized continuing care plan in collaboration with physician
8

Responsibilities For Senior Case Manager Resume

  • Collaborates and communicates with multidisciplinary team in all phases of discharge planning process, including initial patient assessment, planning, implementation, interdisciplinary collaboration, teaching and ongoing evaluation
  • Ensures/maintains plan consensus from patient/family, physician and payor
  • Refers appropriate cases for social work intervention based on Department criteria
  • Collaborates/communicates with external case managers. Initiates and facilitates referrals through the Resource Center for home health care, hospice, medical equipment and supplies
  • Obtain all required consents
  • Maintains knowledge of current community resources
9

Responsibilities For Basu Cadd-senior Case Manager Resume

  • Produces status regular status reports as requested
  • Maintains periods set by project management tasks are completed in accordance with project expectations
  • Ensures consistent application of all confidentiality laws and regulations pertinent to the foster care and federal disability programs
  • Submits SSI files and documentation in accordance with deadlines and goals established by management staff and the Social Security Administration
  • Use computer software such as Microsoft Word and Excel and Outlook
  • Work with community groups and the public
  • Work with Medicare members to assess care needs through assessment(s), develop short-term case management care plans goals and refer to specific disease management programs and other health improvement related programs
  • Collaborate with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines and clinical review criteria
  • Review and summarize proposed decisions and other regulatory filings; considering the impact of a case developments on the company overall, provide insight into implications and make recommendations of possible courses of action relating to case comments and/or proposed decisions; and recommend changes in case strategy resulting from anticipated or unanticipated decisions, developments, comments

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