Telephonic Case Manager Resume Samples

Description :

1. Performed comprehensive telephonic assessments to identify patient/family needs and risks; continual re-assessment of patient status and needs with appropriate referrals and care coordination.
2. Identified high-risk areas and collaborated with resources and providers to meet patient needs, minimize risks, and promote optimal health in the most cost-effective manner.
3. Managed a caseload of 60-80 patients, an average of 10 calls/day.
4. Integrated evidence-based practices and preventive health guidelines.
5. Monitored care through Medicare ACO data collection and analysis to maximize clinical, quality, and fiscal outcomes for the targeted population.
6. Activated participant of a highly effective ACO team, contributing to the financial success of the entire organization.
7. Recognized by managers and peers as an expert in educating families in areas of the hospice discipline, including pain/symptom management, philosophy, etc.

Experience

2-5 Years

Level

Junior

Education

GED

Description :

1. Provided telephonic case management to the pediatric thru geriatric population.
2. Researched and coordinated services for members, offer holistic approaches and education to enhance effective self-care management.
3. Performed health needs assessment.
4. Interdisciplinary communication to collaborate for a member's health care needs.
5. Assisted in the management and improvement of high cost claims, in-network usage and readmission prevention.
6. Utilized computerized clinical record documentation, electronic health records and organization-wide documentation.
7. Participated in the improvement of customer service and effective engagement.

Experience

5-7 Years

Level

Executive

Education

GED

Description :

1. Reviewed and evaluated all medical correspondence obtained from providers.
2. Completed written correspondence completed after each visit or every 30 days according to account profile.
3. Coordinated Independent Medical Examinations, as well as provider appointments for the client.
4. Arranged transportation services and necessary and authorized.
5. Coordinated and monitored home health care as necessary.
6. Evaluated physical therapy facilities and physician qualifications Implements and utilizes community resources when applicable.
7. Analyzed documents and accurate record keeping.

Experience

2-5 Years

Level

Executive

Education

MS

Description :

1. Counseled and educated patients about chronic illnesses such as COPD, CHF, DM.
2. Self-directed with astute judgment skills.
3. Effective counseled in health maintenance and disease management.
4. Processed monthly reports for department performance.
5. Instructed patients and family members on proper discharge care.
6. Ensured HIPAA compliance.
7. Developed and implemented nursing care plans.

Experience

2-5 Years

Level

Executive

Education

BA

Description :

1. Experienced with documenting and maintains accurate records of telephone assessment, interventions, and disposition into the nurse advice software system.
2. Experienced with conducting follow-up telephone calls of all nurse advice encounters to assess the outcome of the initial nurse advice provided, and /or re-triage if the prior presenting symptoms continue or worsen.
3. Experienced with using nursing assessment skills, patients will be identified and referred to the appropriate disease management and medical case management programs Experience with participating in mentoring new nurses as needed.
4. Actively participated in internal quality and workflow enhancement projects, and other duties, as assigned.
5. Maintained Clinical Telephone nurse advice standards in accordance with established policies and procedures Experience with maintaining office standards in accordance with HIPAA and Clinical Telephonic Services.
6. Complied with required workplace safety standards.
7. Experienced with participating in the Clinical Telephonic Services Quality Improvement Program by attending regular staff meetings, in-services, and identifying and reporting issues to the appropriate management personnel for intervention and /or referring to the appropriate department(s) at the local state level.

Experience

2-5 Years

Level

Junior

Education

BSN

Description :

1. Performed a 3-4 point contact within 24 hours of receiving the file.
2. Pursued direct contact with the injured worker to complete the initial medical assessment telephonically, and maintained contact to reassess progress towards goals on monthly basis, or sooner as needed.
3. Discussed the injured worker file with the claims examiner to develop a patient-centric care plan.
4. Reached out to the provider within 24 hours of an appointment to obtain a treatment plan and work status.
5. Directed contact with the employer to update the work status, provide the next medical appointment date, and facilitate return to work as indicated.
6. Completed Utilization review to process treatment requests as per state and URAC standards.
7. Telephonically managed members with a terminal diagnosis, ensuring the quality of care and life for the member and family members.

Experience

2-5 Years

Level

Executive

Education

Associate Of Science In Nursing

Description :

1. Developed a plan of care with the member's goals and chronic conditions in mind.
2. Collaborated with the interdisciplinary team to assist with internal and external resources.
3. Utilized many computer programs and chart all communication within the electronic medical record.
4. Acted as the point person for my manager to assist coworkers when she is off.
5. Provided support and education on members' choices and disease processes.
6. Assisted in the prevention of hospitalizations by providing education to members and families regarding the use of hospice.
7. Experienced with various medical conditions including Parkinson's, Dementia, Diabetes, Cancer, Alzheimer's, and Paget's disease.

Experience

5-7 Years

Level

Executive

Education

Associate In Nursing

Description :

1. Scheduled follow-up appointments and making sure clients have what they need in order to promote excellent healthcare.
2. Prepared patients for surgery by inserting IVs and doing full assessments of preop patients, assisting anesthesiologists with blocks.
3. Recovered patients in PACU by assessing their physical status along with controlling their pain and overall wellbeing.
4. Assisted in scheduling patients for surgery by triaging patients and doing follow-up phone calls to patients after surgery.
5. Trained to assist as a circulating RN in the OR.
6. Ability to prioritize case activities, such as coordinating all claimant discharge plan from the hospital and either go home or go to rehab, coordinate care with attorney offices and medical facilities is the field-based case manager.
7. Sought out for expertise in promoting & managing customer and employee satisfaction.

Experience

5-7 Years

Level

Executive

Education

Bachelors Of Nursing

Description :

1. Worked remotely, supporting multiple national retail clients, and provided telephonic medical case management services for Workers Compensation cases using a collaborative approach to assess, plan and facilitate quality, cost-effective care for the injured employee, and ensure the ability to return to work and function at an optimal level.
2. Conducted initial intakes with employees to determine health status and gathered all pertinent information to collaboratively establish a care plan.
3. Interacted and collaborated with other individuals involved in the medical case management process including employer, medical care providers, and other stakeholders to coordinate care and facilitate return to work plans.
4. Maintained contact and communication with employees throughout the case management cycle to monitor and assess health status, identify any gaps or needs for services, and manage employee's return to work.
5. Provided claims adjusters with medical and cost management information as needed and participated in file review of cases.
6. Prepared and maintained accurate, detailed case management documentation of all contact and outcomes, following established guidelines and protocols.
7. Provided prospective, concurrent, and retrospective review services on assigned cases.

Experience

2-5 Years

Level

Executive

Education

BS

Description :

1. Provided proactive case management by anticipating and facilitating medical treatment for worker's compensation claims.
2. Developed well-defined and measurable action plans.
3. Ensured delivery of effective services by balancing cost, quality, and access to care.
4. Educated employers on the benefits of early return to work and coordinated safe return to work.
5. Customized services to meet the company's specific needs.
6. Built strong relationships between employers, employees, providers, insurance carriers, self-insured, and third party administrators.
7. Developed comprehensive life care plans and Medicare Set-aside Allocations for catastrophic claims.

Experience

5-7 Years

Level

Executive

Education

Masters In Business