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Continuum of Care Manager, Northeast/Mid-Atlantic Regions Resume Example

Resume Score: 85%

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CONTINUUM OF CARE MANAGER, NORTHEAST/MID-ATLANTIC REGIONS
Summary
As a Sr. Manager of Case Management (CM) at Alexion for approximately 4.5 years, I have managed a team of case managers focusing on disease education to patients and families as well as gaining access to treatment for patients with PNH and aHUS. Primary goals include identification of opportunities and strategies to assist patients in understanding their illness; ongoing treatment expectations and supporting services, is a focus of our roles and I have worked with my team and the CM team in general to identify best practices and approaches for difficult situations. Some of those situations include but are not limited to, financial access for treatment; transportation to treatment sites (including travel arrangements when outside of normal treatment site); disease and treatment education to patients/patient representatives, family and Heath Care providers.
In addition, I play a critical role with the management team to achieve company goals including patient satisfaction and retention of patients on therapy. I strive to access all available resources to resolve identified problems and forecast opportunities to impact change and/or outcomes that impact the department and company positively. I have had success in developing process documents to assist case managers when best practice approaches have been identified. I have been involved in many projects and work groups to help achieve efficient processes for our team and identify opportunities to achieve company and department goals.
​
Other accomplishments include:
  • Developed job description for Case Manager Coordinator (CMC) role Developed and implemented the working process guide for the new CMC role
  • Mentored the first CMC in the CM Department to strengthen the functionality of the role to best assist the case managers
  • Outcome: CM department has increased staff in this role by 4 for a total of 5 CMCs
  • Worked cross-functionally with RSM to enhance the STAR Team communication with enhanced Partnership Calls
  • Outcome: New process implemented by STAR Team with more active participation by all team members and accountability of plans of action for each role
  • Identified the need for aggressive outreach to facilities on emergent admissions of patients and worked with RSM to enhance communication within STAR team about best options to obtain consents on all patients
  • Outcome: South and Southeast regions were identified as highest rate of consented patients during 2014
Highlights
  • Excellent interdisciplinary communication
  • Process/policy development
  • Ability to project impact of new/changed process on all affected parties
  • Positive approach in all situations
  • Regional Sales Manager/COR managers collaborative efforts with implimentation of processes that affect sales, COR and case management teams
  • Development of process guides as needs identified
  • Team collaboration on difficult cases for best outcomes for patients
  • Manage with positive approach to enhance  individual strengths and develop individual weaknesses
Accomplishments
  • AWARDS: In July 2005, I was nominated for and received the Aetna Way Excellence Silver Award for outstanding performance and demonstration of Leadership

Experience
Continuum of Care Manager, Northeast/Mid-Atlantic Regions
September 1997 to October 2010
Company Name - City, State
Manager for the Pennsylvania market: In 2005, I became the Continuum of Care Manager (COC) in the Northeast Region; acting as a liaison between National Patient Management and regional Patient Management. My span of direction included staff based out of what is now the Hartford office as well as staff in Blue Bell, PA office.  In 2009, Aetna piloted ‘Work From Home' as the number of employees expanded. My team became full time WFH by the May of 2010 and included all job levels. Communication to keep staff informed and bonded as a team was an important focus of my role as manager; all of which was necessary to achieve annual company goals.
In May of 2007, I took on the role of a Care Team Manager in addition to my COC role on a temporary basis and officially combined my management of the care teams and the COC role in January of 2008. I was successful in the management of both areas until June of 2009, when I relinquished my COC role to take on the Care Team manager as my focus.   I was successful in the implementation of our new Case Management program that began in 2005 and fully implemented in the NER in March of 2006 and again in 2008, when we underwent a system change and change in the CM program again.
My role as COC involved interactions with Supervisors to keep them up to date with current program information and communication with the case managers; advising of any changes or issues that are identified and how to follow up appropriately. This COC role also involved preparation of cases for external audits by plan sponsors; NCQA review and the follow up action plans if needed.   I have reviewed reporting data to determine if we as a region were on target for CM (Case Management) enrollment and worked to achieve that target. As a Manager, I have had the lead role in many projects, all related to achieving better outcomes for members and Aetna as a business. Writing of workflows and processes are a forte of mine since I had performed all of the roles that are involved in the workflows and try to anticipate the needs of each role.  
In the Market Management role, I participate on many workgroups and committees and actively participate in all Management meetings involving staffing issues, workload and achieving goals for the region. I also worked directly with the patient management director and our team of Medical Directors to identify best practice in achieving good communication between staff, management, and the team of physicians.
I strive to build sound, professional relationships with our providers and met with facilities in person as needed. As programs and processes changed within the company, I met with facilities to review the processes and develop a workflow that worked for both  CM staff and the staff of the facilities.  
My previous Aetna experience includes a supervisory role; Clinical Trainer for the Northeast Region (program and system training) and Concurrent review nurse - initially being a team leader on my team and managing our Aetna Student Health program.
Field Visiting Nurse
November 1989 to September 1997
Company Name - City, StateMy VNA experience as a primary care nurse included developing and carrying out care plans initiated by the physician. This planning required good communication skills among all parties including myself, the physician, patient, physical therapist, occupational therapist, social worker, as well as community resources, to attain the optimal outcome for the patient.
Education
RN Diploma : nursing, 1976Hartford Hospital School of Nursing - City, State, USAHartford Hospital School of Nursing, Diploma School Graduate
High School Diploma : College, 1973Sacred Heart High School - City, State, USSacred Heart High School -Waterbury, CT
Certifications
October 2007- CCM certification received (Certified Case Manager)/Recertified 2012
Skills

Management skills: in addition to management of daily activity I have put in place succession plans for 2 previous roles (Supervisor & Regional manager) and both plans were implimented and remain in place currently (2015)

Developing and mentoring skill: ability to identify strengths and weaknesses of staff and assit in building on strengths and overcoming weaknesses
Communication: excellent verbal and written skills at all levels of the organization
Problem Solving:ability to forecast barriers and propose actions to address barriers
Process/Policy development: as needed by Department
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Resume Overview

School Attended

  • Hartford Hospital School of Nursing
  • Sacred Heart High School

Job Titles Held:

  • Continuum of Care Manager, Northeast/Mid-Atlantic Regions
  • Field Visiting Nurse

Degrees

  • RN Diploma : nursing , 1976
    High School Diploma : College , 1973

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