Case Management Specialist Resume Samples

JO
J Ondricka
Jimmy
Ondricka
1272 Durgan Pine
Philadelphia
PA
+1 (555) 259 5192
1272 Durgan Pine
Philadelphia
PA
Phone
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+1 (555) 259 5192

Experience

Experience

04/2016

present
Philadelphia, PA
Senior Case Management Specialist
Philadelphia, PA
Senior Case Management Specialist
04/2016

present
Philadelphia, PA
Senior Case Management Specialist
04/2016

present

  • Is proficient in the use of Sales Logix and in producing data specific reports upon request
  • Raises own performance expectations and goals to support entrepreneurial approach to the business
  • Attends patient meetings, site visits, conferences and trade shows to educate individuals regarding case management services. Represent Genzyme in all venues in a professional manner
  • Establishes and maintains professional and effective relationships with all internal and external customers including but not limited to care coordination colleagues, medical, sales, corporate accounts, Patient Advocacy, insurance company case managers, specialty pharmacies, home health agencies, infusion site staff and office coordinators
  • Consistently monitors systems and processes and recognizes when it is time to try new approaches
  • Effectively shares reimbursement and other knowledge with patient care team members through orientation training, case studies, consultation for complex cases and special projects as requested
  • Assists in obtaining insurance approval for enzyme replacement therapy, and proactively plans for maintenance of coverage by working with the patients and their family, healthcare providers, insurance companies, specialty pharmacies, and Genzyme Colleagues

07/2011

10/2015
New York, NY
Msw-case Management Specialist
New York, NY
Msw-case Management Specialist
07/2011

10/2015
New York, NY
Msw-case Management Specialist
07/2011

10/2015

  • Proficiency in all Microsoft Office applications, including Word and Excel
  • Familiarity with medical terminology and/or ICD-9 codes
  • Proficiency in all Microsoft Office applications, including Word, Excel and Outlook
  • Independently makes decisions based on information provided by the employee and the health care provider and supporting documentation
  • Advising and counseling people managers about the leave of absence policies and legal implications
  • Coordinate with the HR Service Center to provide direction and validate an employee’s payroll and benefits while they are on leave (15%)
  • Work closely with internal contacts, HR business partners, legal contacts, other members of the Employee Relations team, and third party vendors (10%)

03/2007

01/2011
New York, NY
Case Management Specialist
New York, NY
Case Management Specialist
03/2007

01/2011
New York, NY
Case Management Specialist
03/2007

01/2011

  • Maintain strict employee confidentiality
  • Responsible for development and standardization of Sponsor and Child Abuse and Neglect Checks on potential sponsors for unaccompanied children who may be in immigration proceedings
  • Interface with the respective Federal and State-level Criminal History and/or Child Protective Service agencies throughout the U.S
  • Conduct necessary research on policies and procedures regarding state Child Protective Service Checks – Child Abuse and Neglect Checks
  • Respond to email requests in a timely manner
  • Evaluate various database searches for potential sponsor information
  • Produce graphical and written reports on findings and statistics

Education

Education

Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
Tulane University
Bachelor’s Degree in Nursing

Skills

Skills

  • Make outbound phone calls to providers to verify admission, obtain clinical information and discharge information
  • Document all calls and attach clinical information received
  • Create and send out written correspondence—including denial letters- to providers and members
  • Manage databases and caseloads using Microsoft Excel, Word and other programs
  • Assist the Utilization Management team with various clerical and administrative tasks as necessary
  • Participate in special projects as assigned by the Case Management Frontline Leader or Clinical Operations Manager
  • 6 Months Limited Term
  • Knowledge of workers’ compensation laws and regulations
  • Excellent oral and written communication, including presentation skills
  • PC literate, including Microsoft Office products