Diligent Care Manager focused on providing optimal support to members and team through personalized assistance and care required to manage diverse pediatric medical and behavioral conditions. Proficient in organization skills, time management, communication, managing multiple tasks, prioritizing, assisting with staff development/mentoring. Caring, organized and friendly with excellent interpersonal skills.
• Evaluates members for case management services and determines appropriate level of care coordination/ management services for member.
• Completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the members need for alternative services.
• Acts as a primary case manager for members identified as Complex as defined by Case Management Program Description.
• Develops and monitors members plan of care, to include progress toward meeting established goals and self-management activities.
• Interacts continuously with member, family, physician(s), and other providers utilizing clinical knowledge and expertise to determine medical history and current status. Assess the options for care including use of benefits and community resources to update the care plan.
• Assists with implementation of new and expanding healthcare case management initiatives.
• Assists in implementation of market specific strategies that improve on the quality and outcomes of member's care.
• Represents supervisors and management in meetings or on special assignments.
• Helps establish process improvements leading to best practice and assist in implementing change movement.
• Trains, mentors and provides guidance to new and current Field Service Coordinators regarding policy and procedure, systemic tools, workload and care plan development.
• Supervises and/or acts as a resource for non-clinical staff (i.e., Service Coordinators and Field Social Workers).
• Act as liaison and member advocate between the member/family, physician and facilities/agencies.
• Maintains accurate records of case management activities in the Enterprise Medical Management Automation (EMMA) System using clinical guidelines.
• Coordinates community resources, with emphasis on medical, behavioral, and social services. Applies case management standards, maintains HIPAA standards and confidentiality of protected health information and reports critical incidents and information regarding quality of care issues.
• Ensures compliance with all state and federal regulations as well as Corporate guidelines in day-to-day activities.
• Meets with clients in their homes, work-sites, physician's or hospital to provide management of services.
• Adapts to changes in policies, procedures, new techniques and additional responsibilities.
• Participates with other Case Managers and Medical Directors in regular or special meetings such as Clinical rounds.
• Perform other duties as assigned.
Provided coordination of services for chronically ill pediatric population. Daily tasks included telephonic assessments of members; assisting members/families and providers with submitting request for authorizations and receiving services; assisting member/families with locating services, providers, and community resources; advocating for members; coordinating Lakeland Cleft Team clinics, which included coordinating schedules with members and providers; communicating with members and providers to ensure Team recommendtions were completed; oversight of member's visit during clinic. Provided back up to Cardiac Clinic. Other duties, as assigned.
Certified Case Manager - 2018 to present
Resumes, and other information uploaded or provided by the user, are considered User Content governed by our Terms & Conditions. As such, it is not owned by us, and it is the user who retains ownership over such content.
Job Titles Held: