Director Of Case Management Resume Example Sky Ridge Medical Center

DIRECTOR OF CASE MANAGEMENT

Executive Profile

Experienced Case Manager aware of all aspects of Case Management and Transitions of Care. Creates strategic alliances both internally and externally for the benefit of the patient. Able to develop programs and through the continuous assessment of data and process improvement put in place initiatives that benefit the patient while improving organizational compliance and fiscal responsiblility

Skill Highlights

Project management
Leadership/communication skills
Business operations organization
Human resources
Budgeting expertise
Client account management
Negotiations expert

Self-motivated
Customer-oriented
Team leadership
Community outreach
Communication skills
Government payer compliance expert
Analytical skills
Computer skills

Core Accomplishments

Excellent presentation skills to multidisciplinary groups including Quality and Management Teams Presented Case Management efforts at Core Measure Meetings and HCAPS. Presented Case Management to all new hospital orientations. Started multidisciplinary core measure and readmit team
Extracted data and presented to Utilization Committee on a quarterly basis
Team building and cohesiveness as a core value
Decreased LOS and increased CMI while aligning CM with CDI

Professional Experience

Director of Case Management
March 2010 to December 2012Sky Ridge Medical Center － Lone Tree, Colorado

Worked to stabilize staffing for 20 FTE, social workers and Clinical Documentation Specialists. Decreased length stay while increasing throughput. Worked to increase presence and profile of case management by initiating interdisciplinary rounding. Decreased denials due to efficient patient movement. Developed communication portal for physicians and case managers to communicate regarding patients readiness and/or barriers to discharge. Developed readmission plan by placing Case Managers in the Emergency Department, increased floor case managers knowledge of assessment and readiness of discharge, external support in transitions of care
Ensured compliance in all Government regulations
Developed new policies for Mental Health and revised old policies to reflect changes in regulation and practice
Trainer for implementation of HPF (electronic medical record)
Led project for Accretive (External Physician Advisor)
Developed first working HCA "proof of concept" to develop centralized (off site) UR for commercial payers
Led team in development of patient comfort measures, palliative care and concern for patient/families
Developed "no one dies alone" initiative
Worked closely with the throughput team to efficiently discharge patients and bed patients to the floor without delays in service .Developed risk of readmission risk standards and processes; worked with Colorado Hospital Association in training/implementation and best practices for Case Management team in transitions of care, worked to develop community partners to assist patients in safe and appropriate next level of care

Director of Case Management
October 2006 to December 2009Shasta Regional Medical Center － Redding, California

Reported long stay and barriers to discharge daily to CMO
Managed staff of 15 FTE (Social Work/RN Case Managers/Discharge Planners and Clinical Documentation Specialists)
Trained all staff in InterQual and became corporate trainer for Prime Healthcare hospital system. Traveled to 13 hospitals in California to share and learn best practices
Managed high Medicare population with an eye to GMLOS, working closely with Clinical Documentation Specialists. Worked closely with community providers, and introduced our staff and our processes at an annual community luncheon

Manager of Case Management
October 2003 to December 2007Hospital Partners of America － Redding, California

Responsible for training and orientation of new staff
Responsible for scheduling of team
Assisted Case Management Director with day to day functions while managing a caseload

Clinical Case Manager
October 2001 to December 2003Redding Medical Center － Redding, California

Trained in all functions of Case Management
Worked to ensure patient safe discharge/transition to the next level of care
Worked with Interdisciplinary team to efficiently facilitate highest quality care at the lowest possible cost
Worked with patients to choose appropriate care while conserving their benefits, when appropriate

Education

AS : NursingSouthwestern Adventist University

BA : Business/PsychologySimpson College

MHA : HealthCareCSU Global － Denver, Colorado, USA

In Progess

Professional Affiliations

Professional in Health Care Quality Association Case Management Society of America Acute Case Management Association California Hospital Association California Association of Clinical Nurse Leaders Southern California Nurse Executives Colorado Hospital Association Licenses held in Texas, California, Oklahoma, and Colorado

Resume Overview

Companies Worked For:

Sky Ridge Medical Center
Shasta Regional Medical Center
Hospital Partners of America
Redding Medical Center

School Attended

Southwestern Adventist University
Simpson College
CSU Global

Job Titles Held:

Director of Case Management
Manager of Case Management
Clinical Case Manager

Degrees

AS : Nursing
BA : Business/Psychology
MHA : HealthCare

Director of Case Management Resume Example

Resume Score: 80%

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