A Care Management Associate typically works in the healthcare setting, assisting the Care Manager in executing and coordinating discharge plans for patients, and to help in providing the needed resources and referrals. While duties vary from setting to setting, the following are certain core duties that are listed on the Care Management Associate Resume – hiring and training of new hires, assisting with the transition of new business; making outreach calls; providing accurate case documentation of all services; identifying triggers; pulling on inpatient admission list; and providing alternative payment information and other details to patients.
The nature of the job demands the following skills and abilities – strong understanding of healthcare; the ability to lead major initiatives across organizations; excellent communication skills; knowledge of third-party billing; familiarity with medical and billing terminologies; and knowledge of CPT and ICD-9 coding. A Medical administration degree is a mandatory requirement.
Objective : To obtain a Care Management Associate position that will allow growth and welcomes initiative, dedication and experience. A team-player with the ability to work under high pressure, while managing, motivating and offering innovative techniques within a team dynamic.
Skills : Microsoft Office, Interpersonal Skills, Multitasking.
Description :
Implanted and created of work process for distribution of Important Medicare Message (IMM) prior to discharge.
Worked effectively as a team member and independently.
Demonstrated multitasking skills by managing high volumes of patient discharge that need an IMM letter on nine different units throughout the hospital with a positive, professional, and friendly manner.
Effectively communicated to patients, Power of Attorney, Legal Guardian, and Representative the IMM letter, answering questions, before obtaining a signature on E-Signature application.
Demonstrated a high level of caution while working on units to protect patient health information (HIPAA) by asking for two forms of patient identification to refer patients.
Exhibited use of Work Queue, Work Report List, Teletracking Patient Portal, EPIC, Motion Tablet, Allscripts, E-Signature, Pager, Fax-Copier-Scanner-Printer, multiline phone system, Microsoft Outlook, Excel, etc.
Maintained current work policies and Medicare policies by attending Webinars, meetings, and educational presentations.
Experience
2-5 Years
Level
Junior
Education
GED
Care Management Associate Resume
Objective : Highly qualified Care Management Associate with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and I would excel in the collaborative environment on which your company prides itself.
Skills : Microsoft Office, Presentation Skills, Management Skills.
Description :
Responsible for initial review and triage of Care Team tasks.
Identified principal reason for admission, facility, and member product to correctly apply intervention assessment tools.
Screened patients using targeted intervention business rules and processes to identify needed medical services.
Monitored non-targeted cases for entry of appropriate discharge date and disposition.
Identified and referred to outlier cases (e.g., Length of Stay) to clinical staff.
Identified triggers for referral into Aetna's Case Management, Disease Management, Mixed Services, and other Specialty Programs.
Utilized complex Aetna systems to build, research, and enter member information, as needed.
Experience
2-5 Years
Level
Executive
Education
Bachelor Degree
Care Management Associate Resume
Objective : A highly motivated self-starter with exceptional interpersonal skills and over ten years' experience in the Health Care Industry. Talent for identifying customer needs and presenting appropriate company product and service offerings. Demonstrated ability to gain customer trust and provide exceptional follow-up, leading to increased repeat and referral business.
Skills : Multitasking, Detail-Oriented, Time Management Skills.
Description :
Assisted providers with verifying and opening cases for precertification/pre-authorization requests for inpatient hospitalization and outpatient services, as well as, reviewing retro cases for proper claim payments.
Initiated and approved pre-certification for inpatient stays and outpatient procedures that do not require medical review for a designated account.
Maintained and completed weekly Crystal reports using excel spreadsheets.
Precepted, trained and mentored new and current employees.
Maintained accurate and completed documentation of required information that meets risk management, regulatory, and accreditation requirements.
Reviewed medical records to obtain pertinent information needed for inpatient/ outpatient cases requiring Retro Review.
Maintained accurate and completed documentation of required information that meets risk management, regulatory, and accreditation requirements.
Experience
2-5 Years
Level
Executive
Education
G.E.D
Care Management Associate Resume
Objective : As a Care Management Associate, responsible for Engaging members and caregivers in a collaborative relationship, empowering them to manage their physical, psychosocial, and environmental health to improve and maintain lifelong well being.
Skills : Proficient in Microsoft Word, and PowerPoint, Video and Film Editing.
Description :
Coordinated, scheduled, and recommended systematic based care, with guidance and direction from credentialed health care professionals by establishing best care referrals according to financial and eligibility data elements.
Determined eligibility and carries out screening responsibilities by incorporating policies, processes, and supportive documentation to ensure accurate enrollment into health care plans.
Served as a primary communication conduit between health care providers and plan administrators.
Ensured that regulatory, risk management, and governmental oversight policies are adhered and met throughout the assessment process.
Provided nursing staff with inpatient bed day management utilizing MS Excel generated log.
Utilized the Health Line system to assess status of inpatient utilization cases.
Maintained constant communication with hospital utilization review, admissions, and medical records departments to ensure accuracy and updated information distribution.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Care Management Associate Resume
Objective : Seeking a Care Management Associate position, responsible for Screening members according to MetroPlus Health Plan policies and procedures, assisting members to identify appropriate support activities and services to maximize health and wellness.
Skills : MS Office, Customer Service, Coordinating Skills.
Description :
Supported comprehensive coordination of medical services including Care Team intake.
Screened and supported the implementation of care plans to promote effective utilization of healthcare services.
Promoted and supported the quality and effectiveness of Healthcare Services.
Answered incoming calls from providers or members to pre-certify or register for surgical procedures.
Coordinated care with appropriate nurses, verify eligibility and provide excellent customer service.
Assisted Prior authorization Manager with Shift care state reporting.
Assisted the Utilization Management team with member readmission and provider notification process.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Care Management Associate Resume
Headline : Care Management Associate with 6 years of experience in Advocating for members by assisting them to address challenges, and make informed choices regarding the use of social and other community supports, and also Developing collaborative relationships with clinical providers and facility staff.
Skills : Microsoft Office, Developing Skills, Supervising SKills.
Description :
Supported comprehensive coordination of medical services including the Care Team.
Promoted and supported quality effectiveness of healthcare services.
Delivered extraordinary customer care by responding to customer questions and concerns in a polite, courteous and professional manner.
Ability to review and navigate multiple screens in order to efficiently resolve customer needs.
Codeveloped, 60page training that enabled faster rampup for newly hired support staff.
Developed innovative PowerPoint presentation used by the supervisors for team training modules.
Contacted members recently discharged from in-patient to coordinate care and resources.
Experience
5-7 Years
Level
Executive
Education
Bachelor Degree
Care Management Associate Resume
Objective : Seeking a Care Management Associate position, responsible for Promoting communication, both internally and externally to enhance the effectiveness of clinical and non-clinical services and overall case management services, and also Assisting members in understanding the mechanics and management of health care social support networks.
Skills : Microsoft Word, Proprietary Documentation Systems, Developing Skills.
Description :
Scheduled appointments for follow up calls from the Case Managers.
Updated cases and documented as needed.
Performed research pertinent to the establishment, maintenance, and closure of open cases.
Protected the confidentiality of member information and adheres to company policies.
Conducted essential base information research on information that was required to process claims.
Oversaw Aetna International Department Mailbox and distribute correspondence and Internal/External requests to the appropriate person for handling.
Reviewed and maintained Pulse Aim Report to ensure high dollar accounts associated with trigger diagnosis are reviewed for Case Management.
Experience
2-5 Years
Level
Executive
Education
High School Diploma
Care Management Associate Resume
Objective : Highly motivated and accomplished Care Management Associate with a proven track record in customer service and administrative skills. Adeptly handles multiple special projects as assigned while maintaining daily workload and working independently. Looking to acquire a position that uses my customer service and insurance background in the medical community.
Skills : Communication SKills, Database Management, Competitive Intelligence.
Description :
Checked case files for Aetna members' assessment dates, updating members' information in QNXT, Dynamo, and UAS.
Assisted Assessment RN's with scheduling appointments to perform environmental assessments on members for personal care needs.
Generated authorizations in QNXT for member services in both MLTC and FIDA.
Used Dynamo and QNXT for members in the community, in the hospital, and the nursing facility to see if authorizations were put in for services.
Checked to make sure vendors and facilities are participating via QNXT.
Supported the Development and Implementation of Care Plans.
Assisted with scheduling Congestive Heart Failure patients with appointments to follow-up with their Primary Care Providers.
Experience
2-5 Years
Level
Junior
Education
BS
Care Management Associate Resume
Objective : Care Management Associate with 2 years of experience in Maintaining accurate and completing documentation of required information in compliance with risk management, regulatory accreditation requirements.
Skills : Ms. Word, Analyzing Skills, Management Skills, Multitasking.
Description :
Provided customer service for Aetna Healthcare products.
Screened members to identify needed medical services, make appropriate referrals to medical services staff, and coordinate the required services in accordance with the benefit plan.
Identified triggers for referral into Aetna's Case Management, Disease Management, and other Specialty Programs.
Successfully utilized all Microsoft Windows programs including Word, Excel, PowerPoint, Access, and Outlook.
Coordinated and arranged for health care service delivery under the direction of a nurse or medical director in the most appropriate setting at the most appropriate expense by identifying opportunities for the patient to utilize participating providers and services.
Promoted communication, both internally and externally to enhance the effectiveness of medical management services.
Identified triggers for referral into aetnas case management, disease management, mixed services, and other specialty programs.
Experience
2-5 Years
Level
Executive
Education
Diploma
Care Management Associate Resume
Objective : As a Care Management Associate, responsible for Complying with all orientation requirements, annual and other mandatory training, organizational and departmental policies and procedures, and actively participate in the evaluation process, and also maintaining professional competencies as a Care Manager Associate.
Skills : Data Entry, Typing, Customer Service, Phone Work.
Description :
Screened Rumba mainframe and documented for accuracy and completeness regarding Medicaid guidelines.
Developed an enhanced procedure to handle difficult Medicaid/Medicare letters while staying in compliance.
Performed numerous outbound calls for clinical information and enrollment purposes.
Successfully mentored and supervised five Care Managers as a Unit which resulted in consistent production of record numbers in terms of client satisfaction ratings.
Performed non-medical research pertinent to the establishment, maintenance, and closure of open cases.
Provided support services to team members by answering telephone calls, taking messages, researching information, and assisting in solving problems.
Screened and supported the implementation of care plans to promote effective utilization of health care services.
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