Livecareer-Resume
Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary
Highly motivated Sales Associate with extensive customer service and sales experience. Outgoing sales professional with track record of driving increased sales, improving buying experience and elevating company profile with target market.
Skills
  • Database Management
  • Employee performance evaluations
  • Staff Management
  • Staff supervision
Work History
Associate Manager Clinical Support, 09/2018 - Current
Beacon Health Options/Anthem/Empower HCS City, STATE,
  • Provides supervision and administrative oversight to a team of 18-25 Care Coordinators.
  • Conducts weekly or biweekly check ins with each team member based on performance, weekly all team meetings via zoom, and monthly in person all team meetings.
  • Ensures assigned staff complete all of the requirements of the program as outlined by Arkansas Medicaid, including face to face visits, monthly contact via phone, Personal Centered Service Plans, timely completion of work product, documentation standards are followed, and general adherence to all relevant policies and procedures to meet Quality Metrics for the Care Coordination Program.
  • Manages caseload assignments, problem solves with staff as needed, and provides oversight to the day to day operations of assigned care coordination team.
  • Participates in strategic, systems, and organizational planning of the department and the company as a whole.
  • Serves as a liaison between Clinical Department and other organization departments to remediate problems and identify efficiencies.
  • Coordinates with Supervisor Team and Clinical Directors to ensure processes and procedures are followed consistently, and program operations run seamlessly.
  • Assists team in resolving member issues including pharmacy and prescription, member complaints and grievances, claims, provider issues, and Medicaid eligibility.
  • Monitors difficult cases with specialty populations and provides clinical insight to ensure members are receiving appropriate resources and services.
  • Coordinates and conducts weekly multidisciplinary staffing for difficult cases and residential treatment discharge planning. Attends interdisciplinary staffing and discharge planning meetings for complex cases.
  • Assists team with outreach to providers to coordinate member services.
Utilization Manager/Care Manager/Care Coordinator, 05/2012 - 09/2018
Beacon Health Options/Value Options City, STATE,
  • Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care using established criteria, guidelines and policies. This includes referring cases that do not meet medical necessity criteria to a peer advisor when unable to render a certification decision.
  • Responsible for building positive professional rapport with providers and communicating in a clear and timely manner.
  • Utilizes rounds and case consultations with Clinical Supervisor, Peer Advisor for cases outside criteria or not progressing.
  • Refers cases to Peer Advisors that do not meet criteria for decision of medical nessesity.
  • Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity of patient care.
  • Maintains confidentiality, ethical and professional standards, adhering to ValueOptions Clinical Policy and Procedures and Benefit Plan requirements.
  • Maintains departmental productivity and performance standards.
Unit Nurse/Utilization Review Registered Nurse, 05/2002 - 05/2011
United Methodist Children's Home City, STATE,
  • Performed prior authorization review of services requiring notification.
  • Maintained all utilization review documentation using company owned database/EMR.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Observed and documented patient factors such as diets, physical activity levels and behaviors to understand conditions and effectively modify treatment plans.
  • Delivered high level of quality care to diverse populations while overseeing patient admission and triaging based on acuity and appropriate department admission.
  • Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
  • Evaluated patient histories, complaints and current symptoms.
  • Communicated with healthcare team members to plan, implement and enhance treatment strategies.
  • Investigated and resolved issues affecting hospital operations and patient care, including power or system outages, patient or family grievances, security issues and employee issues.
  • Accurately documented all elements of nursing assessment, including treatment, medications, discharge instructions and follow-up care.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
Education
No Degree: Practical Nursing, Expected in
-
Pulaski Technical College - North Little Rock, AR
GPA:
Associate of Applied Science: Nursing, Expected in 12/2011
-
University of Arkansas Community College-Batesville - Batesville, AR
GPA:
Bachelor of Science: Mathematics, Expected in 08/1990
-
University of Arkansas At Monticello - Monticello, AR
GPA:

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Resume Overview

School Attended

  • Pulaski Technical College
  • University of Arkansas Community College-Batesville
  • University of Arkansas At Monticello

Job Titles Held:

  • Associate Manager Clinical Support
  • Utilization Manager/Care Manager/Care Coordinator
  • Unit Nurse/Utilization Review Registered Nurse

Degrees

  • No Degree
  • Associate of Applied Science
  • Bachelor of Science

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