Care Manager Resume Samples

LS
L Spinka
Lester
Spinka
78476 Leuschke Causeway
Detroit
MI
+1 (555) 632 2791
78476 Leuschke Causeway
Detroit
MI
Phone
p
+1 (555) 632 2791

Experience

Experience

07/2016

present
Philadelphia, PA
Msw-care Manager
Philadelphia, PA
Msw-care Manager
07/2016

present
Philadelphia, PA
Msw-care Manager
07/2016

present

  • Basic knowledge of complex care management and care management principles
  • Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
  • Comply with performance and reporting standards as defined by Humana Corporation
  • Understand clinical program design, implementation, management, monitoring and reporting
  • Licensed in Social Work if residing in ID, MN, NM, NV, ND, SD, UT, WY, CT, MD, KY, MI, OK, LA, AL
  • Core business hours are 8-4:30 Monday – Friday with possibility of working Saturdays. 2 Late Start dates a month 10:30 – 7
  • Proactive telephonic outreach to eligible Humana members and engage participation in Humana At Home Complex Care Management program

06/2013

02/2016
San Francisco, CA
RN Care Manager
San Francisco, CA
RN Care Manager
06/2013

02/2016
San Francisco, CA
RN Care Manager
06/2013

02/2016

  • Current working knowledge of discharge planning, utilization management, case management, performance improvement, and managed care reimbursement
  • Assist in the development of network protocols and processes for care management of high risk and rising-risk patient population
  • Assists with the orientation of new Healthcare Management personnel and contributes to the ongoing networking of expertise with co-workers
  • Work with Clinical Manager to develop and streamline workflows and processes for current case criteria as well as future case criteria
  • Provide support to clinical teams and collaborate with business partners, health plans, hospitals, vendors, providers, family and support network
  • Establishes patient care management plans, interventions, treatment goals, and self-management goals
  • Organizes work and develops strategies for adapting to a constantly changing workload or when confronted with unseen situations

10/2009

01/2013
Dallas, TX
Care Manager
Dallas, TX
Care Manager
10/2009

01/2013
Dallas, TX
Care Manager
10/2009

01/2013

  • Builds, develops and maintains a positive and collaborative relationship with local providers by establishing a local presence
  • Develop working relationships with primary contractor (Axis Point Health), nurse care managers, discharge planners, and peers
  • Identification of all assigned Care Management Telephonic collaboration with providers and county agencies regarding members in Care Management
  • Assists the Supervisor and/or manager in special assignments (i.e. program and process improvements, recommendations for training, etc
  • Address member and provider issues telephonically. The majority of the Clinical Care Managers work is done telephonically
  • Partner with the licensed nursing staff to plan, develop, organize, provide and execute individualized restorative therapy programs
  • Works with the chair of the department and the Director of Care Management to develop standards and education around medical necessity

Education

Education

Bachelor’s Degree in Nursing Preferred
Bachelor’s Degree in Nursing Preferred
Northern Illinois University
Bachelor’s Degree in Nursing Preferred

Skills

Skills

  • Knowledgeable of Community Resources and Alternate Care facilities
  • Intermediate Ability to work independently Ability to work independently, handle multiple assignments and prioritize workload
  • Intermediate Ability to create, review and interpret treatment plans Ability to create, review and interpret treatment plans
  • Ability to troubleshoot or explain basic hardware and software errors and work with a Technician by remotely to perform step-by-step repairs
  • Excellent Interpersonal skills and ability to work effectively and independently
  • Able to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines
  • Detail oriented with strong organizational, planning, and problem solving skills
  • Strong medical skills and knowledge
  • Strong admissions knowledge
  • Strong organizational skills and the ability to prioritize and follow through on multiple projects in a timely manner