care management operations manager resume example with 12+ years of experience

Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000,
Professional Summary

Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Highly skilled in streamlining operations and improving throughput through continuous process improvement and cross-functional collaboration. Solid clinical, utilization review, and case management experience within the inpatient environment. Able to operate in high-pressure situations while recommending the best resources and courses of action to benefit patient needs and return each to optimal quality of life.

  • Highly organized with well-regarded administrative and supervisory strengths
  • Fully committed to adhering to facility policies and procedures to improve patient outcomes
  • Excellent critical thinking with problem solving skills
  • Utilization review
  • Palliative care awareness
  • Staff education and training
  • Comprehensive assessment and cost-effective discharge planning
  • Expert knowledge of Medicare/Managed Care guidelines including post-acute resources
  • Patient advocate
Work History
02/2021 to Current Care Management Operations Manager Signify Health | Belleville, IL,
  • Supports the daily operations of the Care Management departments (both Inpatient and Emergency Department settings) to include 26 direct reports.
  • Ensures documentation compliance of the Care Management department (Discharge Planning Evaluation, IMM, MOON, Patient Choice, etc.).
  • Assures staff documentation is completed per guidelines as evidenced by appropriate monitoring techniques, coaches staff as needed.
  • Assures effective discharge planning to meet patient needs, meet regulatory requirements and achieve organization objectives related to readmission reduction and pace of care delays.
  • Participates, as needed, in hospital/medical staff meetings to review patients meeting criteria related to high dollar/extended length of stay and/or difficult placement; maintains meeting minutes as appropriate.
  • Assists in the development and oversees the implementation of Care Management policies, procedures, and standards.
  • Plans, organizes and delegates activities as required for safe, efficient and effective operations of the unit/area including active participation with other hospital and leadership staff to accomplish this purpose.
  • Monitors and meets productivity standards and staffing needs.
  • Responsible for personnel functions including staffing, performance reviews and corrective action.
  • Hires and retains individuals with appropriate skills and works to develop staff to their highest.
08/2018 to 02/2021 Lead Care Manager Sunrise Senior Living | Westfield, NJ,
  • Oversee and optimize work of over 15 employees performing high-quality case management work.
  • Complete daily staffing and adjust job assignments and schedules to keep pace with hospital census, factoring in processes, employee knowledge and patient needs.
  • Apply strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand.
  • Partner with physicians, social workers, activity therapists, nutritionists and fellow case managers to develop and implement individualized care plans and document all patient interactions and interventions in electronic charting systems.
  • Address disruptions in patient care, including delays in discharge, postponed procedures and discharge equipment unavailability.
  • Attend multi-disciplinary rounds to coordinate patient care, determine care priorities, establish daily goals, and plan for potential transfers or discharges.
  • Attend weekly PRC meetings to improve HCAHPS scores, readmission rates, patient safety and length of stay management.
  • Work directly with managed care insurance companies to ensure safe and appropriate discharge planning.
01/2017 to 08/2018 Transition Care Registered Nurse Hca | Plantation, FL,
  • Prevented health complications and readmissions in a specific patient population by providing them with comprehensive discharge planning and outpatient follow-up.
  • Conducted a comprehensive assessment of the patient's health status, health behaviors, level of social support, and goals.
  • Developed an individualized plan of care consistent with evidence-based guidelines, in collaboration with the patient and his/her doctors.
  • Focused on patients' self-identified goals and help them develop self-management skills.
  • Collaborated with nurses, physicians, patients, families, and case management to coordinate and arrange care in the post-acute care setting.
  • Assisted patients with appropriate doctors' appointments prior to discharge.
  • Provided close follow-up in the home setting including post-discharge telephone outreach and visits to the patient's home.
  • Extensively educated patients and their families on the specific disease process, medications, and discharge instructions from admission through transition.
11/2009 to 01/2017 Cardiac PCU Registered Nurse AdventHealth | City, STATE,
  • Provided care to patients requiring telemetry monitoring for various cardiovascular disorders, including cardiac arrhythmias, Acute Coronary Syndrome, hypertension and heart failure, as well as patients recovering from cardiac catheterizations through interpretation of advanced ECG recordings, management of cardiac drips, chest tubes, and pacemakers.
  • Trained in the prompt detection of emergency conditions, and prevention of complications associated with cardiovascular disorders and interventional procedures.
  • Coordinated nursing care using a collaborative, multidisciplinary approach of the healthcare team such as physicians, surgeons, respiratory therapists, physical therapists, social workers, case management, and pastoral care among others, to ensure the optimal care of each patient.
  • Educated patients and families on life-style modifications, medications, procedures, and other pertinent information to minimize negative physical and psychological effects of disease processes.
  • Mentored newly licensed nurses and helped them achieve independent, autonomous success through leadership and tailored learning.
  • Assumed the role of relief charge nurse. Helped to maintain the safety and care of the patient and families on the unit, as well as, identified and evaluated problems, managed patient census, and allocated staff assignments.
Expected in 08/2015 to to Bachelor of Science | Nursing Adventist University of Health Sciences, 671 Winyah Drive Orlando, FL GPA:
  • Graduated Magna Cum Laude
Expected in 12/2010 to to Associate of Arts | Valencia College, Orlando, FL GPA:
Expected in 08/2009 to to Associate of Science | Nursing Valencia College, Orlando, FL GPA:

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Resume Overview

School Attended

  • Adventist University of Health Sciences
  • Valencia College
  • Valencia College

Job Titles Held:

  • Care Management Operations Manager
  • Lead Care Manager
  • Transition Care Registered Nurse
  • Cardiac PCU Registered Nurse


  • Bachelor of Science
  • Associate of Arts
  • Associate of Science

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