director of case management resume example with 10+ years of experience

Jessica Claire
  • Montgomery Street, San Francisco, CA 94105 609 Johnson Ave., 49204, Tulsa, OK
  • Home: (555) 432-1000
  • Cell:
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 , 02/2010 to 11/2012
HcaOcala, FL,
  • 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, 09/2006 to 11/2009
HcaBradenton, FL,
  • 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 , 09/2003 to 11/2007
HcaPensacola, FL,
  • 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, 09/2001 to 11/2003
Allegiance Mobile HealthMico, TX,
  • 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
AS: Nursing, Expected in
Southwestern Adventist University - ,
BA: Business/Psychology, Expected in
Simpson College - ,
MHA: HealthCare, Expected in
CSU Global - Denver, Colorado

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

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Resume Overview

School Attended

  • Southwestern Adventist University
  • Simpson College
  • CSU Global

Job Titles Held:

  • Director of Case Management
  • Director of Case Management
  • Manager of Case Management
  • Clinical Case Manager


  • AS
  • BA
  • MHA

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