Clinical Care Coordinator Resume Samples

Description :

1. Responsible for same-store growth within your market, as well as working as a team to help other team members accomplish this goal.
   
2. Maintained ongoing communication with case managers, discharge planners, and physician office staff; conducting frequent presentations, both formally and informally, in order to build a strong network of referrals.
3. Attended hospital case manager/discharge planner meetings/case conferences to discuss the agency's patients and also to provide education related to any changes in-home health care guidelines Compiled information needed to establish definitive patient home care plans, including assessment of the appropriateness of requested services.
4. Communicated information regarding the patient to the clinical supervisor and/or primary care nurse; making agency administrative staff aware of additional patient needs and arranging for medical supplies as necessary.
5. Documented all supporting records in accordance with regulations of applicable regulatory agencies Consistently met established sales call objectives and completing all required account data, call logs, and Quarterly Sales Plan forms as directed by the Sales Manager.
6. Actively participated in the agency's business growth meetings, strategic planning meetings, company in-services, and required activities as determined by the Sales Manager.
7. Assisted the Sales Manager and Sales Trainer in the orientation and mentoring of other staff related to business growth.

Experience

7-10 Years

Level

Management

Education

Health Care Management

Description :

1. Made home visits and conducted an assessment for health care needs, service delivery, and provided comprehensive care coordination that reduced barriers to full community integration, optimal health, and choices for independence.
2. Developed, reviewed, and revised Plan of Care and Case Management Goals according to the client's acuity level (LOC).
3. Telephonically contacted service recipients monthly and completed health status updates and followed through with service needs.
4. Maintained continuous contacts and communication with other service providers such as Doctors, Nursing Care Agencies, Pharmacies, Medical Equipment suppliers, Personal Care Aides (PCAs), and other Resource Coordinating agencies.
5. Conducted quarterly Cost Utilization Data reviews (CUD) to ensure that the service and equipment used are cost-effective and within program guidelines.
6. Conducted Private Duty Nursing (PDN) assessments and recommended increase or decrease in Private Duty Nursing (PDN) hours to the Dept.
7. Conduct daily reviews with inpatient psychiatric units in Lake and Cook County Supervised care coordinators Facilitated weekly staffings with attending psychiatrist about care management Completed intakes for new members.
   

Experience

7-10 Years

Level

Consultant

Education

Social Work

Description :

1. Represents the best interest of the patients, pateint advocate.
2. Coordinates and manages nursing tasks and interventions among team members based on the needs of the patient.
3. Ensures effective communication and flow of information to all appropriate care providers.
4. Anticipates and evaluates clients' risks to prevent errors in care delivery-work with quality improvement teams in implementing a process to maintain and promote patient safety.
5. Delivers care in a timely, safe, cost-effective manner utilizing clinical and theoretical nursing concepts, hospital protocols and policies and evidence-based practice.
6. Oversees the management of patient care through assessment of the assigned patient population daily to achieve optimal patient outcomes.
7. Educates and informs patients and family members regarding available care options, advance directives and supports their rights and decisions about care and treatment.

Experience

10+ Years

Level

Senior

Education

BSN

Description :

1. Serves as facility authority and case manager for pediatric patients with asthma and RAD directing the integration of care within BAMC and/or with other community agencies.
2. Develops case management patient care plans; conducts case management discussions with a variety of stakeholders; and evaluates appropriateness, quality, and/or cost effectiveness of care.
3. Coordinates and monitors the administration of medication by protocol and documents effectiveness.
4. Responsible for developing patient education programs to teach inpatients/family members self-management techniques for the successful daily management of asthma and RAD.
5. Ensures the care provided in the Pediatric Disease Management Clinic is in compliance with all regulatory agencies and NHLBI guidelines.
6. Performs healthcare systems delivery analysis and provides recommendations to healthcare providers and/or case managers regarding diagnosis and clinical events to facilitate efficient, effective, and high quality patient care.
7. Serves as a member of the Clinical Practice Guidelines working group on Asthma.

Experience

7-10 Years

Level

Management

Education

Health Care Administration

Description :

1. Perform functional assessments of members using clinical skills and appropriate measurement tools.
2. Provide outcomes targets to appropriate audience.
3. Utilizes naviHealth proprietary technology for consideration of the level of care.
4. Maintains UM/CM tool Collaborate effectively with the member's health care team to establish an optimal, transition plan to the most appropriate PAC setting.
5. Assist the member in meeting short and long-term goals with regards to their overall well-being.
   
6. Consult with Medical Directors and/or management to resolve any barriers in the patient's movement along the continuum of care.
7. Assess and monitor patient's appropriateness for care setting (as indicated) according to LiveSafe and InterQual criteria for approvals and refer to licensed physicians for the next level of care determinations that do not meet criteria to be approved.

Experience

2-5 Years

Level

Junior

Education

Masters Of Science

Description :

1. Applies utilization management criteria in determining the appropriateness of a requested level of care that considers the severity of illness and intensity of service.
2. Coordinates with physicians on causes requiring a higher level of care for initial or stay reviews.
3. Collects and reviews clinical information for concurrent and retrospective reviews for the purpose of extending the length of stays for all levels of care.
4. Reviews and makes recommendations as needed on initial and subsequent stay reviews.
5. Promoting decreased lengths of stay and assuring the appropriate level of care recommendations.
6. Present educational lectures, and do Blood Pressure and screening for these.
   
7. Coordinate care with physicians and follow plans of care set out by the physician.

Experience

2-5 Years

Level

Junior

Education

Psychology

Description :

1. Ensures facility's compliance with Medicare regulations, Managed Care/Insurance contracts and company guidelines, policies and procedures.
2. Advocates on behalf of the patient and Facility for needed patient resources and services within the reimbursement continuum.
3. Provides education (including orientation of new employees) to other health care providers, the facility's care team and the patient/family on Medicare, Managed Medi-Cal /Medicaid or Managed Care/Insurance.
4. Conducts weekly care management meetings to review and update plan of care and ensure contractual compliance for patients.
5. Collaborates with Business Office to ensure Medicare Part A services are appropriately billed and meet Medicare documentation guidelines.
6. Oversees the resource utilization of services covered under consolidated billing as well as ancillary costs.
7. Directs the completion of claims requests and appeals for denied Medicare, Managed Medical/Medicaid and Managed Care/Insurance claims.

Experience

7-10 Years

Level

Executive

Education

BS

Description :

1. Conducted referrals and managed data to ensure patient and provider continuity of services.
2. Provided guidance and handle complicated inquiries related to case initiation to internal and external customers.
3. Investigated and resolve complaints regarding claims issues or case initiation.
4. Educated providers in the certification process and helped reconcile inconsistencies and procedural difficulties.
5. Initiated cases by taking data over the phone from providers and contracted companies.
6. Helped to resolve issues and complaints from providers needing care management services related to: referrals for treatment, authorizations for services and verification of eligibility information.
7. Oversee the administration of discharges, aftercare follow-up, and administrative waivers.
8. Evaluated clinical appropriateness of treatment using professional knowledge within Ageless Home Care clinical guidelines.

Experience

7-10 Years

Level

Consultant

Education

Master Of Management

Description :

1. Determined and assessed clients' needs to determine the appropriate services to fulfill the therapeutic requirements of the family and client.
2. Advocated for the clients and their families within the agency and outside agencies, such as Magellan, to ensure that proper services were being provided and that all team members were provided appropriate information to provide services.
3. Arranged and facilitated meetings with clients, families, and clinicians to promote accurate and proper testing and evaluations.
4. Communicated with staff regularly to maintain an optimal level of service and cohesion.
5. Developed organizational documents and methods to allow all team members to maintain an up to date treatment protocol.
6. Trained new employees for their roles as therapeutic staff support personnel.
7. Recruited new employees, reviewed resumes, and conducted interviews with new candidates.

Experience

5-7 Years

Level

Executive

Education

BA In Psychology

Description :

1. Assessed Medicaid client's needs and coordination of services.
2. Developed and maintained a plan of care in consultation with primary care and specialty providers, the enrollee, caregivers or guardians, and family members.
3. Assist clients in mitigating issues and removing barriers to care.
4. Assist with coordination of clinical tests, images, and specialty consults as deemed appropriate by Healthcare providers and Medicaid benefits.
5. Assessed for efficacy and drug interaction/side effects.
6. Conducted medication education sessions, assuring client compliance and adherence to prescribed therapies.
7. Develop communication and referral mechanisms to assure seamless communication between Medicaid, the healthcare provider, and the Care Coordination Team.

Experience

7-10 Years

Level

Consultant

Education

Associate In Nursing

Description :

1. Management of day to day care of residents and managing changes in conditions.
2. Supervision of team on delivery of care and medication administration.
3. Communication with physicians regarding changes in condition, medication management and management of resident plan of care.
4. Development, review, verification of all resident's plan of care, and updating as resident condition changes.
5. Assessment of residents to manage ongoing care.
6. Participation in quality control team to improve quality measures that affect resident care.
7. Responsible for assuring policies and procedures are adhered to by team members and provide coaching or disciplinary action to assure adherence by all team members.
8. Skills Used Communication between all levels of staff members.

Experience

5-7 Years

Level

Executive

Education

Associates Of Science

Description :

1. Supervised 16 bed-detoxification unit contributing education, conflict resolution skills, and experience.
2. Enforce state regulations of the Department of Mental Health, Mental Retardation, and Substance Abuse.
3. Manage staff training, schedules, and coordination of care for clients.
4. Utilize the nursing process for client assessment, TB testing, EKGs, and urine drug screens.
   
5. Triage clients for medical clinic: immunizations, venipunctures, finger sticks, review lab results.
6. Coordinated referrals, follow-ups within the community and respond appropriately.
7. Responsible for monitoring of patients, medication administration, and providing client education.

Experience

5-7 Years

Level

Executive

Education

A.A.S In Nursing