resume for patient care manager

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Patient Care Manager resume examples for 2024

Patient care manager resume research summary. We analyzed 4,032 patient care manager resumes to determine which ones land the most jobs. Below you'll find example patient care manager resumes that can help you get an interview (and a job offer) from companies like Sunrise Senior Living Management and Sunrise Assisted Living. Here are the key facts about patient care manager resumes to help you get the job:

• The average patient care manager resume is 391 words long
• The average patient care manager resume is 0.9 pages long based on 450 words per page.
• Home health is the most common skill found on resume samples for patient care managers. It appears on 15.1% of patient care manager resumes.

After learning about how to write a professional resume for a patient care manager, make sure your resume checks all the boxes with our AI resume builder .

Patient Care Manager resume example

How to format your patient care manager resume:.

• Use the exact job title 'Patient Care Manager' on your resume to match the application.
• Focus your work experience on specific achievements that demonstrate your impact, rather than just listing responsibilities.
• Tailor your Patient Care Manager resume to fit on one page, as suggested by reviewers and hiring managers.
• Highlight skills like Revenue Cycle Management, Data Analytics, Information Governance, and Privacy and Security of health information on your Patient Care Manager resume.
• Incorporate soft skills such as writing, communication, organization, multi-tasking, and critical thinking on your Patient Care Manager resume.
• Include technical skills such as working with electronic health record systems, encoders, and release of information systems on your Patient Care Manager resume.
• According to Linda Galocy , Director and Assistant Dean, Clinical Associate Professor at Indiana University Northwest, 'The ability for a health information professional to understand an entire process, such as the revenue cycle...is a must' for Patient Care Managers.

Choose from 10+ customizable patient care manager resume templates

Choose from a variety of easy-to-use patient care manager resume templates and get expert advice from Zippia’s AI resume writer along the way. Using pre-approved templates, you can rest assured that the structure and format of your patient care manager resume is top notch. Choose a template with the colors, fonts & text sizes that are appropriate for your industry.

Patient Care Manager resume format and sections

1. add contact information to your patient care manager resume.

Patient Care Manager Resume Contact Information Example # 1

Hank Rutherford Hill

St. Arlen, Texas | 333-111-2222 | [email protected]

2. Add relevant education to your patient care manager resume

Your resume's education section should include:

• The name of your school
• The date you graduated ( Month, Year or Year are both appropriate)
• The name of your degree

If you graduated more than 15 years ago, you should consider dropping your graduation date to avoid age discrimination.

Optional subsections for your education section include:

• Academic awards (Dean's List, Latin honors, etc. )
• GPA (if you're a recent graduate and your GPA was 3.5+)
• Extra certifications
• Academic projects (thesis, dissertation, etc. )

Other tips to consider when writing your education section include:

• If you're a recent graduate, you might opt to place your education section above your experience section
• The more work experience you get, the shorter your education section should be
• List your education in reverse chronological order, with your most recent and high-ranking degrees first
• If you haven't graduated yet, you can include "Expected graduation date" to the entry for that school

Check More About Patient Care Manager Education

Patient Care Manager Resume Relevant Education Example # 1

Master's Degree In Social Work 2009 - 2010

Virginia Commonwealth University Richmond, VA

Patient Care Manager Resume Relevant Education Example # 2

Master's Degree In Psychology 2006 - 2007

Florida State University Tallahassee, FL

3. Next, create a patient care manager skills section on your resume

Your resume's skills section should include the most important keywords from the job description, as long as you actually have those skills. If you haven't started your job search yet, you can look over resumes to get an idea of what skills are the most important.

Here are some tips to keep in mind when writing your resume's skills section:

• Include 6-12 skills, in bullet point form
• List mostly hard skills ; soft skills are hard to test
• Emphasize the skills that are most important for the job

Hard skills are generally more important to hiring managers because they relate to on-the-job knowledge and specific experience with a certain technology or process.

Soft skills are also valuable, as they're highly transferable and make you a great person to work alongside, but they're impossible to prove on a resume.

Example of skills to include on an patient care manager resume

Community resources are a set of resources that are used in the day to day life of people which improves their lifestyle in some way. People, sites or houses, and population assistance can come under the services offered by community resources.

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Mental health is the state of wellbeing in which an individual can cope with the regular stresses and tensions of life, and can work productively without having any emotional or psychological breakdown. Mental health is essential for a person of any age and helps them make the right decisions in their life.

Phone calls are a wireless or wired connection made over a telephone or a mobile phone between two people. Two parties are involved in a phone call, the caller and the receiver. A caller dials the number of the one he wants to call, and the recipient hears a bell or a tune to which he picks up the call. The call establishes a connection between them through which they can communicate. The voice is converted into signals and is transmitted through wired or wireless technology.

Top Skills for a Patient Care Manager

• Home Health , 15.1%
• Patients , 11.7%
• Quality Care , 7.6%
• Social Work , 6.8%
• Other Skills , 58.8%

4. List your patient care manager experience

The most important part of any resume for a patient care manager is the experience section. Recruiters and hiring managers expect to see your experience listed in reverse chronological order, meaning that you should begin with your most recent experience and then work backwards.

Don't just list your job duties below each job entry. Instead, make sure most of your bullet points discuss impressive achievements from your past positions. Whenever you can, use numbers to contextualize your accomplishments for the hiring manager reading your resume.

It's okay if you can't include exact percentages or dollar figures. There's a big difference even between saying "Managed a team of patient care managers" and "Managed a team of 6 patient care managers over a 9-month project. "

Most importantly, make sure that the experience you include is relevant to the job you're applying for. Use the job description to ensure that each bullet point on your resume is appropriate and helpful.

• Educated patients and families on preoperative and postoperative teachings concerning surgical procedure and lifestyle changes.
• Monitored the baby's heart rate and mother's blood pressure.
• Interviewed, selected and managed candidates for the SICU Fellowship Program.
• Employed leadership abilities to serve as Code Blue/Code Heart team leader and Resource RN.
• Developed and implemented pilot educational program for heart failure patients.

5. Highlight patient care manager certifications on your resume

Specific patient care manager certifications can be a powerful tool to show employers you've developed the appropriate skills.

If you have any of these certifications, make sure to put them on your patient care manager resume:

• Certified Case Manager (ACM)
• Patient Care Technician
• Medication Aide Certification (MACE)
• Basic Life Support (BLS)
• Certified Clinical Medical Assistant (NHA)
• Certified Medical Administrative Assistant (CMAA)
• Certified Management Accountant (CMA)
• Certified Manager Certification (CM)
• Certified Managed Care Nurse (CMCN)
• Certified Medical Interpreter - Spanish (CMI)

6. Finally, add an patient care manager resume summary or objective statement

A resume summary statement consists of 1-3 sentences at the top of your patient care manager resume that quickly summarizes who you are and what you have to offer. The summary statement should include your job title, years of experience (if it's 3+), and an impressive accomplishment, if you have space for it.

Remember to emphasize skills and experiences that feature in the job description.

Common patient care manager resume skills

• Home Health
• Quality Care
• Social Work
• Community Resources
• Substance Abuse
• Resident Care
• Medication Administration
• Senior Care
• Customer Service
• Direct Patient Care
• Medication Management
• Mental Health
• Phone Calls
• Primary Care
• Medical Necessity
• Utilization Management
• Care Coordination
• Discharge Planning
• Medical Care
• Rehabilitation
• Good Judgment
• Care Management
• Crisis Intervention
• Social Services
• Utilization Review
• Community Services
• Patient Satisfaction
• Meaningful Relationships
• Community Agencies
• Vital Signs
• Patient Education
• Memory Care
• Physical Safety
• Individual Care
• Blood Pressure

Patient Care Manager Jobs

Links to help optimize your patient care manager resume.

• How To Write A Resume
• List Of Skills For Your Resume
• How To Write A Resume Summary Statement
• Action Words For Your Resume
• How To List References On Your Resume

Updated March 14, 2024

Editorial Staff

The Zippia Research Team has spent countless hours reviewing resumes, job postings, and government data to determine what goes into getting a job in each phase of life. Professional writers and data scientists comprise the Zippia Research Team.

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Patient Care Manager Related Jobs

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Patient Care Manager Resume Samples

Patient care managers work normally in the healthcare facilities and are accountable for patient care. The job duties that are typically seen on the Patient Care Manager Resume are – communicating with patients , handling business operations, developing and drafting customized care plans for patients , allocating budgets, evaluating staff performance, handling patient care assignments , facilitating multiple care aspects, arranging abeyances, recording patient care information and instituting various plans to improve patient care.

Some of the essential skills and qualifications expected from patient care managers include – health management expertise, excellent time management, and problem-solving skills, familiarity with latest related software, budgeting skills, and customer service orientation. A Well crafted resume normally highlights a degree in the field of Health management or health information.

• Resume Samples
• Patient Care Manager

Patient Care Manager Resume

Objective : Patient Care Manager with 3+ years of experience in Responding to customer complaints regarding patient care and assure all complaints are handled in accordance with company policies and procedures.

Skills : CNA Class Certificate And CPR/First Aide Trained.

Description :

• Provide personal care to residents which included, bathing, dressing, feeding, assisting with daily activities.
• Working in a team environment but also individually at times. CPR and First Aid training completed.
• Impacted many lives of the residents and co-workers. Showed what a difference can make in someone's life.
• Supported seven physicians in a Medical Home Project Contributed to the implementation of quality patient care through patient education.
• Provided diabetic teaching classes and coordinated therapeutic treatments together with the Primary Care Physicians to patients.
• Provided telephonic and face-face assessments and interventions to patients in the Medical Home Coordinated patients.
• Responsible for leading the stand-up meetings each morning Ensured adequate staffing for patient load and care Reviewed admission paperwork from the RNS.

Patient Care Manager/Representative Resume

Headline : Dedicated RN with over 20 years of experience within medical setting with 19 years specializing in hospice. Looking for a challenging position with a growing, financially stable organization.

Skills : Clinical research recruitment and management, patient advocacy.

• Supervision and clinical management of Homecare and Hospice Supervision of all clinical staff including RN's, LPN's.
• Maintain and assess quality assurance of all clinical documentation. Perform clinical record reviews quarterly for quality assurance.
• Responsible for the overall direction of clinical services Establish, implement and evaluate goals and objectives for hospice services.
• Respond to customer complaints regarding patient care and assure all complaints are handled in accordance with the company.
• Policies and procedures and, or legal compliance requirements Manage related expenditures in a fiscally responsible.
• provide oversight and leadership to medical/surgical nursing staff. Ensure Medicare compliance with all services and documentation.
• Responsible for evaluating, disciplining and managing staff during the weekend Performed charge duties.

Summary : A successful manager and leader. Strong background in planning, program development, counseling, budgeting, staffing, and training.

Skills : Microsoft office, Managerial, Auto cad, Customer Service.

• Patient care and supervision of staff on her shift. years as an educator and division chair.
• Initiated computerized test bank program, developed nursing related courses, managed a staff of faculty and administrative assistants.
• Researched, wrote and administered grants which were funded for in excess.
• Oversaw reaccreditations of program, including writing the self-study and working with faculty.
• Provides direct supervision, monthly schedules, and annual evaluations to Mental Health Technicians, Intake Workers. 
• Provides staff with on-going education according to evidenced-based psychiatric nursing practices Participates and organizes a community.
• Assisting residents during the night shift and with housekeeping, dressing, and breakfast during morning care.

Patient Care Manager/Co-ordinator Resume

Summary : Outgoing Registered Dental Hygienist offering superb patient care and passion for dental hygiene. Motivated individual with exceptional organizational and prioritization abilities.

Skills : Home Health, Hemodialsis, Telemetry.

• Organizes and directs the care of a team of patients and clinicians, in accordance with the current Federal, State, and local standards.
• Schedulers to ensure appropriate utilization of resources and coordination of care.
• Facilitates communication of all disciplines, physicians, patients, and their caregivers.
• Coordinates orientation and ongoing education of team clinicians.
• Implementing appropriate orders/interventions for complicated wounds and ostomy patients.
• Ensure appropriate utilization of services, accuracy, and review for a patient-focused plan of care.
• Assigned team of clinicians including field education/shared visits, PIP processes, annual reviews, payroll, productivity oversight.

Patient Care Manager/Supervisor Resume

Headline : Medical Doctor with notable experience in the public health arena. An articulate and effective communicator, with a practical and empathetic approach to patient management.

Skills : Clinical Research Recruitment And Management, Patient Advocacy.

• Advanced Radiation Oncology Centers, the motivation is to provide patients with compassionate and quality oncological care.
• Utilized therapies include IMRT radiation therapy, Cone Beam CT, Calypso GPS, BAT Ultrasound, and a Rotating Gamma System.
• Partner with medical staff to effectively manage real-time patient protocol, with the purpose of fostering an effective multi-disciplinary approach to patient care.
• Facilitate weekly review sessions with medical staff, focused on case-by-case patient scenarios.
• Interacting with patient's families, scheduling of diagnostic/future appointments, directing patients to appropriate support resources.
• Serve as the first point of contact for any patient concerns/conflict resolution. Actively observe and document patient visits.
• Providing appropriate and accurate patient care, case mix weight, and appropriate utilization of delivery of patient care.

Patient Care Manager/Executive Resume

Headline : Driven and compassionate healthcare professional seeking a position within a competitive organization where vast experience and skills will be utilized in determining the psycho-social, biophysical.

Skills : Proactive Problem Solver, Demonstrated Analytical And Financial Skills.

• Collaborated to achieve futuristic, win-win decisions in the best interest of the community/interdependence of organizations/hospital care.
• Maintained quality, accreditation readiness/marketing/business management; budget, staff.
• Assessed current status/future needs of service in the rapidly growing county.
• Initiated proactive changes/construction plans to meet the increase in births for a period.
• Implementing a patient-first philosophy, restaurant-style meals, guesting policy for mothers/parents of NICU babies.
• Developed/initiated competency-based professional orientation/education programs consistent with national standards.
• Accountable for financial responsibility related to budget goals through utilization, documentation,

Patient Care Manager III Resume

Summary : Professional, energetic, and innovative RN offering over 10 years of experience in patient care and leadership. Specific expertise in situational awareness, critical thinking, physician.

Skills : Microsoft Office, EHR, LEAN.

• Provide education and professional development for a staff of Stabilized staff turnover and obtained employee engagement scores.
• Implemented the throughput process which decreased door to doctor time to an average of ranking fasted in the state of Minnesota.
• Increased and maintained operational productivity. Decreased labor costs while maintaining overtime of worked hours.
• Improved patient experience scores consistently ranking in the percentile.
• Experience in contract negotiations with board-certified emergency physicians, General Surgery, and county correctional services.
• Oversite of correctional service medical staff ensuring the delivery of quality medical, mental health and substance abuse care.
• Coordinated annual continuing education for correctional services medical staff to ensure competency and currency in the field.

Summary : The resourceful, determined, dedicated professional working with customers. Highly efficient results in a fast-paced, multi-tasking dynamic environment.

Skills : Patient Care, Patient Assessments, Nursing Process.

• Participates in the recruitment, interviewing, selection, and orientation of team members.
• Evaluates their performance relative to job goals/requirements; coaches staff and recommends in-service education programs.
• Manages the assignment of clinical associates. and ensures adherence to internal policies/standards.
• Ensures service quality and participates in care coordination to ensure proper communication between caregivers, patients.
• Discusses operational issues, updates staff on new/changed regulations and reviews records to ensure regulatorily.
• Oversight of clinical integrity of appropriate documentation, quality of care provided, visits utilization, appropriate contacts with physicians.
• Prepared and processed medical insurance claim forms for several insurance companies, verifying coverage.

Objective : Seasoned nursing professional with proven leadership capabilities offering more than 8 years of experience providing oversight, planning, and direction to multifaceted departments.

Skills : Customer Service, Technical Skills.

• Responsible for strategic planning, implementation, coordination, and evaluation of home health and hospice programs.
• Directed, coordinated and supervised the delivery of health care services to an average daily census.
• Provided clinical oversight and instruction to a staff of health care providers, supervisors, and administrators.
• Managed an operating budget with a budget variance of under in salaries and under in expenses for consecutive years.
• Management and process improvement efforts reduced staff turnover.
• Reformed the claims review process from retrospective to a progressive method resulting in a decreased percentage of billing errors.
• Established a clinical practice committee to design clinical care pathways and protocols using evidence-based practice.

Patient Care Manager/Analyst Resume

Objective : Exceptional Nursing professional with a proven history of excellent patient care, clinical compliance, financial stewardship, and program growth.

Skills : Communications, Take caring of patient.

• Define and communicate expectations regarding the quality provision of services and productivity to the interdisciplinary teams.
• Ensure staffing meets requirements of ratios per census.
• Completed and conducted annual performance evals in a timely manner and completed corrective action plans as necessary.
• Ensured maintenance of patient/client records, statistics, reports, and records for the purposes of evaluation and reporting.
• Ensuring all patient medical record documentation is present per policy and procedures and in compliance with local, state and federal laws.
• Managed an interdisciplinary team of clinical staff, including the management of the site medical director.
• Coordinated the admissions department, processed referrals, assigned staff and screened patients for Hospice eligibility.

Headline : Performing a wide range of tasks such as collaborating with various medical personnel to stay updated about patient information, supervising the patient care staff.

Skills : Ms-office,Customer Service.

• Establish, implement and evaluate goals and objectives for home health services that meet and promote Lighthouse Hospice standards.
• Supervise and evaluate qualified Hospice interdisciplinary team personnel.
• Provide daily direction to the team, including all scheduling, care planning, documentation, productivity.
• Manage all patient care expenditures, including but not limited to labor, pharmacy, DME, medical supplies.
• Assure regulatory compliance, including achieving and maintaining Hospice Medicare certification.
• Respond to customer complaints regarding patient care and assure all complaints are handled in accordance with Company policies.
• Manage related expenditures in a fiscally responsible manner in accordance with the Company's budget.

Objective : Highly qualified Patient Care Manager with experience in the industry. Enjoy creative problem solving and getting exposure on multiple projects, and excel in the collaborative environment.

Skills : Ms-office, Ms-excel, Communication Skills.

• Ensure organizational Quality measures are compiled and submitted monthly.
• Provide time off coverage for critical care cluster units. Provide weekend hospital-wide supervision.
• Interview hired and facilitates orientation for new employees. A member of the IRB, Patient Throughput and Stroke committee.
• Reports to the Senior Director of Critical care with direct reports.
• Promote the company's standards of quality and contribute to the total organization and philosophy Hire, train, orient, supervise.
• provide oversight and leadership to medical/surgical nursing staff.

Patient Care Manager/Director Resume

Summary : To use administrative skills and experience to maintain sound, productive business operations, while assisting staff in providing the highest level of service to patients, customers, clients.

Skills : Communication Skills, Customer Service.

• Supervise & manage three front office staff members, serving four offices. Maintain & update spreadsheets tracking hearing aid orders.
• Generate claims for private pay patients & Veterans. Train all new administrative staff, including traveling to other island offices.
• Keyholder delegated to make bank transactions in the company account. Responsible for the handling of insurance benefit checks.
• Provides direct supervision, monthly schedules, and annual evaluations to Mental Health Technicians, Intake Workers, Unit Clerks.
• Collaborated with the psychiatric unit team to provide appropriate services and care to patients with diverse psychiatric and behavioral diagnoses.
• Maintains and monitors units according to state regulatory requirements Prepares reports using computer-based technology for risk management

Patient Care Manager I Resume

Objective : To continue the expansion of medical knowledge and growth, both professionally and personally, in a supportive business environment.

Skills : Ms-office, Communication Skills.

• Responsible for team leadership, in a supervisory role, of Case Managers as well as Chaplains, Social Workers.
• Documentation review of all paperwork submitted prior to chart placement. Pharmacy reporting monthly to the program director and corporate office.
• Conducted IDG every other week for the team to maintain compliance with Medicare.
• Managed a team of five nurses, two social workers, three chaplains, ten HHAs, and a patient care secretary.
• Responsible for evaluating, disciplining and managing staff during the weekend Performed charge duties and patient care.
• Responsible for daily operations of one or more medical practices in Family Medicine, Internal Medicine, and Pediatrics.
• Promoted teamwork, preceptor to new employees and assisted the physician, as needed, with the outpatient clinic visit Administrative responsibilities.

Headline : Highly efficient healthcare professional combining more than 15 years of work in critical care with expertise in all areas of healthcare management, including budgeting, program planning.

Skills : Ms-office, Customer Service.

• Manage two separate Optical Departments, one with yearly sales.
• Manage the quality and competency of the staff. verifying coverage and obtaining approval for claims submitted.
• Prepared and processed medical insurance claim forms for several insurance companies
• Maintained files, received, routed, and processed incoming and outgoing mail.
• Personally consulted with customers/patients on selecting the best products to meet their eye care needs.
• Proper use and storage of chemicals in accordance with current company policies and MSDS guidelines.
• Helped oversee final phases of construction for the new stores, ensuring construction plans were in compliance with current Occupational Safety and Health.

Associate Patient care manager Resume

Summary : Dedicated registered nurse (RN) with specialty experience in the emergency department, case management, and hospice management. Strong assessment, intervention, and leadership skills.

Skills : Ms-office, Technical Skills.

• Coordinate field staff to care for terminally ill patients. Case managers, hospice aides, social work and chaplain, and volunteers.
• Hire and supervise the training of new employees. Accomplishments Implementation of new policies and procedures.
• Appropriately greeting and welcoming all guests who visit the medical facility as well as answer incoming phone calls.
• Provided much of the initial information that the patient would need in order to feel at home and answer questions that generally facilitate their arrival.
• Verified demographic and health plan information as well as collect payments and schedule upcoming appointments.
• Successfully took agency through Joint Commission Survey and assisted with CHAPS accreditation.
• Performing performance evaluations, onsite visits with staff, counseling and competency evaluations.

Lead Patient Care Manager Resume

Summary : An accomplished and results-oriented leader with 9 years of managerial experience in the healthcare industry seeking an executive-level position with an emphasis on administration.

• Supervision and Mentorship Directly supervised staff members, including Registered Nurses, Patient Service Assistants, Inventory Specialists.
• Transitioned staff nurses to the Temporary Supervisor role to develop leadership skills of staff.
• Mentored and empowered frontline staff by guiding through problem-solving and implementation strategies.
• Financial Management Performed budget planning and implementation, and position control.
• Strategically hired to maintain safe and quality care. Utilized an on-call system to decrease operating costs.
• Established and implemented the Nurse Extern Program in a critical care setting to decrease the turnover rate.
• Management Performed scheduling, performance auditing, and performance evaluations for all nursing and ancillary staff members.

Objective : Intensive experience in diverse hospital and human services environments in a range from medical/surgical, neurology, geriatrics, Emergency Room and Psychiatric locked and unlocked units.

• Responsible for the overall direction of clinical service. and contribute to the total organization philosophy.
• Establish, implement and evaluate goals and objectives for hospice services that meet and promote standards of quality,
• Hire, train, orient, supervise and evaluate qualified hospice interdisciplinary team personnel.
• Provide daily direction to the team, including scheduling, care planning documentation productivity and all other patient care operations.
• Manage all patient care expenditures including but not limited to labor, pharmacy, DME, medical supplies and patient care mileage.
• Assure regulatory compliance including achieving and maintaining Hospice Medicare certification.
• Respond to customer complaints regarding patient care and assure all complaints are handled in accordance with company policies.

Asst. Patient Care Manager Resume

Objective : Seeking an RN position where work with a progressive healthcare team to promote healthy lifestyles while expanding knowledge and advancing career goals.

Skills : Ms-excel, Communication Skills.

• Develop policies, procedures and guidelines to fulfill program objectives.
• Oversee scheduling and on-going educational programs for all professional and paraprofessional staff providing direct patient services.
• Collaborate and support the Quality Assurance department on various aspects of compliance.
• Oversee the maintenance of medical records, assuring accuracy, completeness, and compliance with licensing regulations.
• Participate in recruitment, hiring, and career development of interdisciplinary team personnel.
• Plan and implement staff education program for all team members Share in providing or arranging the provision of care to patients.
• Assume responsibility for various administrative duties in the absence of the Administrator.

Patient Care Manager II Resume

Objective : Proficient in communicating and collaborating with patients, families, physicians, and other health care professionals and has provided exceptional patient care.

Skills : Communication Skills, Technical Skills.

• Ran the day to day operations of home hospice for an interdisciplinary team and caseload of patients.
• Participated in interviewing, hiring, training, orientation, and education while overseeing competencies and evaluations.
• Provided guidance and counseling to personnel while maintaining agency standards as well as compliance with Medicare.
• Provided consultation and education to patients, families, community members, physicians, and administrative staff.
• Ensured all core disciplines were available while maintaining staffing and on-call schedules.
• Monitored over time, productivity and use of PRN staff. Participated in QAPI and PIP quarterly and on-going.
• Responsible for the following audits: new admissions, Face to Face, tracers consisting of admission, discharge, nursing.

Table of Contents

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Patient Care Manager Resume Examples and Templates

This page provides you with Patient Care Manager resume samples to use to create your own resume with our easy-to-use resume builder . Below you'll find our how-to section that will guide you through each section of a Patient Care Manager resume.

What do Hiring Managers look for in a Patient Care Manager Resume

• Clinical Expertise: Proficiency in healthcare and clinical practices to ensure quality patient care and support the healthcare team.
• Leadership Skills: Strong leadership abilities to manage and guide healthcare staff, including nurses and support personnel.
• Patient Advocacy: Commitment to advocating for patients' rights, needs, and ensuring their well-being.
• Communication and Interpersonal Skills: Effective communication, both verbal and written, to interact with patients, families, and healthcare professionals.
• Administrative Skills: Organizational and administrative abilities to oversee patient care operations, including scheduling, resource allocation, and compliance with healthcare regulations.

How to Write a Patient Care Manager Resume?

To write a professional Patient Care Manager resume, follow these steps:

• Select the right Patient Care Manager resume template.
• Write a professional summary at the top explaining your Patient Care Manager’s experience and achievements.
• Follow the STAR method while writing your Patient Care Manager resume’s work experience. Show what you were responsible for and what you achieved as a Patient Care Manager.
• List your top Patient Care Manager skills in a separate skills section.

How to Write Your Patient Care Manager Resume Header?

Write the perfect Patient Care Manager resume header by:

• Adding your full name at the top of the header.
• Add a photo to your resume if you are applying for jobs outside of the US. For applying to jobs within the US, avoid adding photo to your resume header.
• Add your current Patient Care Management position to the header to show relevance.
• Add your current city, your phone number and a professional email address.
• Finally, add a link to your portfolio to the Patient Care Manager resume header. If there’s no portfolio link to add, consider adding a link to your LinkedIn profile instead.
• Bad Patient Care Manager Resume Example - Header Section

Joey 7600 W. Bay Meadows Avenue Rochester, NY 14606 Marital Status: Married, email: [email protected]

• Good Patient Care Manager Resume Example - Header Section

Joey Campos, Rochester, NY, Phone number: +1-555-555-5555, Link: linkedin/in/johndoe

Make sure to add a professional looking email address while writing your resume header. Let’s assume your name is John Doe - here is a formula you can use to create email addresses:

• [email protected] - [email protected]
• [email protected] - [email protected]
• [email protected] - [email protected]
• [email protected] - [email protected]
• [email protected] - [email protected]
• [email protected] - [email protected]

For a Patient Care Manager email, we recommend you either go with a custom domain name ( [email protected] ) or select a very reputed email provider (Gmail or Outlook).

How to Write a Professional Patient Care Manager Resume Summary?

Use this template to write the best Patient Care Manager resume summary: Patient Care Manager with [number of years] experience of [top 2-3 skills]. Achieved [top achievement]. Expert at [X], [Y] and [Z].

How to Write a Patient Care Manager Resume Experience Section?

Here’s how you can write a job winning Patient Care Manager resume experience section:

• Write your Patient Care Manager work experience in a reverse chronological order.
• Use bullets instead of paragraphs to explain your Patient Care Manager work experience.
• While describing your work experience focus on highlighting what you did and the impact you made (you can use numbers to describe your success as a Patient Care Manager).
• Use action verbs in your bullet points.

Patient Care Manager Resume Example

Patient Care Manager

• Provided healthcare services to patients and managed the healthcare facility.
• Matched patient needs with appropriate services and communicated with providers to determine the best course of action.
• Offered a range of services, including platelet-rich therapy and cellular therapy for treating orthopedic injuries, arthritis, and other degenerative conditions.
• Maintained and updated patient records, ensuring the accuracy and completeness of health information.

Top Patient Care Manager Resume Skills for 2023

• Patient Care Planning
• Clinical Leadership
• Healthcare Regulations
• Patient Assessment
• Care Coordination
• Staff Management and Supervision
• Patient Safety Protocols
• Patient Education
• Medical Records Management
• Treatment Plan Development
• Healthcare Compliance
• Medication Management
• Infection Control
• Quality Assurance
• Performance Metrics Tracking
• Patient Feedback Analysis
• Interdisciplinary Team Collaboration
• Healthcare Policies and Procedures
• Nursing Care Plans
• Emergency Response Planning
• Patient Advocacy
• Patient Rights and Privacy
• Healthcare Technology Tools (e.g., EMR)
• Telemedicine Coordination
• Patient Discharge Planning
• Patient Support Services
• Palliative Care Management
• Home Health Care Coordination
• Healthcare Accreditation Standards
• Staff Training and Development
• Patient Communication
• Healthcare Billing and Coding
• Budgeting and Resource Allocation
• Care Plan Modification
• Patient Progress Monitoring
• Healthcare Analytics
• Patient-Centered Care
• Health Assessment Skills
• Healthcare Continuum of Care
• Case Management
• Healthcare Data Security
• Patient Family Engagement
• End-of-Life Care Planning
• Pain Management
• Risk Assessment and Management
• Healthcare Ethics
• Healthcare Decision Support
• Regulatory Reporting
• Continuous Quality Improvement

How Long Should my Patient Care Manager Resume be?

Your Patient Care Manager resume length should be less than one or two pages maximum. Unless you have more than 25 years of experience, any resume that’s more than two pages would appear to be too long and risk getting rejected.

On an average, for Patient Care Manager, we see most resumes have a length of 2. And, that’s why we advise you to keep the resume length appropriate to not get rejected.

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• • Devised a comprehensive plan of care for 150+ members, focusing on improving health outcomes while ensuring cost-effectiveness, leading to a 20% betterment in resource utilization.
• • Directed interdisciplinary care teams, optimizing coordination and service delivery that heightened member satisfaction by 25%.
• • Negotiated with medical and non-medical service providers to improve the socio-economic support for members, achieving a 15% increase in successful community resource linkages.
• • Pioneered a provider education initiative that improved compliance with care guidelines and boosted provider participation by 30%.
• • Implemented an innovative risk management protocol that identified and mitigated potential issues, reducing member complaints by 40%.
• • Automated the entry and maintenance of clinical data in medical systems, enhancing data accuracy and reducing processing time by 50%.
• • Effectively managed a diverse caseload of 100 members, improving care plan adherence by tailoring interventions to individual member needs resulting in a 10% decrease in hospital readmissions.
• • Coordinated with PCPs and specialists to ensure a seamless continuum of care, curtailing the average duration of treatment from initiation to conclusion by 15%.
• • Conducted 300+ member assessments annually, identifying critical health issues and expediting care, which enhanced member recovery rate.
• • Led member access initiatives to community-based services, growing the number of assisted members by 20% year over year.
• • Participated in care management rounds and contributed to committee decision-making, impacting the overall strategy for patient care services.
• • Provided direct nursing care to patients, achieving a patient satisfaction score of 95% through empathetic and effective communication.
• • Collaborated on the development of treatment plans for 500+ patients, significantly reducing recovery time by an average of 10 days.
• • Educated patients and families about health management, leading to a 15% increase in compliance with post-discharge guidelines.
• • Managed timely documentation of patient interactions and interventions in electronic health records with 100% accuracy.

5 Care Manager Resume Examples & Guide for 2024

As a care manager, your resume must highlight your experience with interdisciplinary teams. Show examples of how you've led or collaborated effectively in diverse healthcare settings. Ensure your resume reflects your expertise in care planning and patient advocacy. It's crucial that your documented successes demonstrate your commitment to improving patient outcomes.

All resume examples in this guide

Traditional

Resume Guide

Resume Format Tips

Resume Experience

Skills on Resume

Education & Certifications

Resume Summary Tips

Additional Resume Sections

Key Takeaways

As a care manager, articulating the vast spectrum of your responsibilities and skills in a concise resume can be quite challenging. Our guide provides expert tips on streamlining your experience and qualifications, ensuring your resume effectively showcases your leadership in health and social care management.

• Apply best practices from professional resumes to spotlight your application;
• Quantify your professional experience with achievements, career highlights, projects, and more;
• Write an eye-catching care manager resume top one-third with your header, summary/objective, and skills section;
• Fill in the gaps of your experience with extracurricular, education, and more vital resume sections.

We've selected, especially for you, some of our most relevant care manager resume guides. Getting you from thinking about your next career move to landing your dream job.

• Clinical Director Resume Example
• Hemodialysis Nurse Resume Example
• Certified Nurse Aide Resume Example
• ICU Nurse Resume Example
• Pediatric Dentist Resume Example
• Massage Therapist Resume Example
• Nursing Student Resume Example
• Nursery Worker Resume Example
• Therapist Resume Example
• Staff Pharmacist Resume Example

Enhancing your care manager resume: format and layout tips

Four popular formatting rules (and an additional tip) are here to optimize your care manager resume:

• Listing experience in reverse chronological order - start with your most recent job experiences. This layout helps recruiters see your career progression and emphasizes your most relevant roles.
• Including contact details in the header - make sure your contact information is easily accessible at the top of your resume. In the header, you might also include a professional photo.
• Aligning your expertise with the job requirements - this involves adding essential sections such as experience, skills, and education that match the job you're applying for.
• Curating your expertise on a single page - if your experience spans over a decade, a two-page resume is also acceptable.

Bonus tip: Ensure your care manager resume is in PDF format when submitting. This format maintains the integrity of images, icons, and layout, making your resume easier to share.

Finally, concerning your resume format and the Applicant Tracker System (ATS):

• Use simple yet modern fonts like Rubik, Lato, Montserrat, etc.
• All serif and sans-serif fonts are friendly to ATS systems. Avoid script fonts that look like handwriting, however.
• Fonts such as Ariel and Times New Roman are suitable, though commonly used.
• Both single and double-column resumes can perform well with the ATS.

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If you happen to have plenty of certificates, select the ones that are most applicable and sought-after across the industry. Organize them by relevance to the role you're applying for.

Ensure your care manager resume stands out with these mandatory sections:

• Header - the section recruiters look to find your contact details, portfolio, and potentially, your current role
• Summary or objective - where your achievements could meet your career goals
• Experience - showcasing you have the technical (and personal) know-how for the role
• Skills - further highlighting capabilities that matter most to the care manager advert and your application
• Certifications/Education - staying up-to-date with industry trends

What recruiters want to see on your resume:

• Demonstrated experience in care coordination and case management, specifically in the relevant healthcare sector.
• Knowledge of healthcare systems, including electronic health records (EHRs), insurance, and regulatory requirements.
• Strong leadership skills and experience in managing a multidisciplinary team to provide patient-centered care.
• Excellent communication and interpersonal skills to interact with patients, families, and healthcare professionals.
• Expertise in developing care plans, conducting assessments, and implementing interventions to improve patient outcomes.

Guide to your most impressive care manager resume experience section

When it comes to your resume experience , stick to these simple, yet effective five steps:

• Show how your experience is relevant by including your responsibility, skill used, and outcome/-s;
• Use individual bullets to answer how your experience aligns with the job requirements;
• Think of a way to demonstrate the tangible results of your success with stats, numbers, and/or percentages ;
• Always tailor the experience section to the care manager role you're applying for - this may sometimes include taking out irrelevant experience items;
• Highlight your best (and most relevant) achievements towards the top of each experience bullet.

You're not alone if you're struggling with curating your experience section. That's why we've prepared some professional, real-life care manager resume samples to show how to best write your experience section (and more).

• Spearheaded a client-centered care coordination system at Sunrise Senior Living, enhancing the quality of personalized care for over 100 residents.
• Implemented a new electronic health records system, improving care plan accuracy and compliance by 25% within the first six months.
• Led a cross-functional team to develop and launch an innovative fall prevention program, decreasing fall-related incidences by 40% within a year.
• Orchestrated a community outreach initiative for Aetna, connecting services with over 200 low-income families, resulting in a 15% increase in enrolled members.
• Championed a care management process overhaul, which enhanced patient satisfaction scores by 20% through more efficient service coordination.
• Collaborated with healthcare providers to optimize care delivery, reducing hospital readmissions for chronic conditions by 18%.
• Managed a team of 15 care coordinators at UnitedHealth Group, achieving top 10% in national performance metrics for patient care management.
• Developed and executed a strategic plan for patient engagement, increasing preventive service utilization by 30%.
• Pioneered a telehealth program that expanded access to care for rural patients by 50%, reducing travel time and costs.
• Facilitated interdisciplinary team meetings at Kindred Healthcare to ensure comprehensive care plans, elevating team performance metrics by 22%.
• Streamlined case management protocols, cutting down on redundant processes and saving 15% in administrative costs annually.
• Initiated a quality improvement project that addressed medication errors, reducing their occurrence by 35% over two years.
• Oversaw care planning and resource allocation at Cigna for a portfolio of 300+ clients, consistently maintaining above 90% client satisfaction ratings.
• Drove the adoption of a standardized risk assessment tool which helped personalize care interventions, leading to a 10% improvement in patient outcomes.
• Mentored junior care managers, fostering professional development and helping the team exceed annual care quality targets by 15%.
• Revamped patient intake processes at Molina Healthcare, optimizing the workflow and reducing patient wait times by an average of 20 minutes.
• Established a patient advocacy program that enhanced patient-clinician communication and increased patient retention rates by 12%.
• Led a cost-containment task force that identified inefficiencies, saving the organization approximately $200,000 annually in unnecessary spend.
• Developed a caregiver support program at Anthem Blue Cross that improved employee productivity and satisfaction by relieving caregiver stress.
• Leveraged data analytics to identify care gaps and successfully implement targeted interventions, improving compliance with chronic disease management protocols by 25%.
• Established a cross-sector partnership to support community health initiatives that increased access to preventative care by 20% in underserved areas.
• Converted underperforming care management department at Health Net into a high-functioning unit, achieving a 90% improvement in meeting regulatory care management standards.
• Collaborated with IT to design a care tracking system that streamlined the care coordination process and boosted productivity by 30%.
• Created a staff training program that increased the care management team's expertise in complex case handling by 20%, directly enhancing patient care quality.
• Improved care coordination for special needs patients at Kaiser Permanente by implementing an integrated care model that decreased ER visits by 25%.
• Developed a metrics-driven approach to monitor care effectiveness, resulting in a 15% improvement in adherence to care plans.
• Facilitated bi-weekly workshops to educate care teams on best practices, significantly improving interdepartmental communication and collaboration.
• Pioneered a data-driven care coordination initiative at Humana that aligned patient care goals with measurable outcomes, raising care effectiveness by 18%.
• Streamlined patient discharge procedures which shortened average hospital stays by 1.2 days and increased patient satisfaction by improving home care transition.
• Recruited and trained a multifunctional care team that outperformed organizational standards by delivering patient-centered care that exceeds best practice benchmarks.

Quantifying impact on your resume

• Include the number of care plans developed to showcase strategic planning abilities.
• List the percentage of client satisfaction improvement to demonstrate effectiveness in client care.
• Specify the dollar amount of budget managed to highlight fiscal responsibility and financial management skills.
• State the number of staff members supervised to communicate leadership and team management experience.
• Mention the rate of compliance with regulatory standards to show understanding of and adherence to industry regulations.
• Quantify the reduction in incident or accident rates to prove commitment to client safety and risk management.
• Report the number of training sessions conducted to emphasize a commitment to staff development and education.
• Detail the increase in efficiency or service delivery times to illustrate process improvement initiatives.

Action verbs for your care manager resume

Writing your care manager experience section without any real-world experience

Professionals, lacking experience, here's how to kick-start your care manager career:

• Substitute experience with relevant knowledge and skills, vital for the care manager role
• Highlight any relevant certifications and education - to showcase that you have the relevant technical training for the job
• Definitely include a professional portfolio of your work so far that could include university projects or ones you've done in your free time
• Have a big focus on your transferable skills to answer what further value you'd bring about as a candidate for the care manager job
• Include an objective to highlight how you see your professional growth, as part of the company

Recommended reads:

• How to List a Major & Minor on Your Resume (with Examples)
• Should You Include Eagle Scout On Your Resume?

If you happen to have some basic certificates, don't invest too much of your care manager resume real estate in them. Instead, list them within the skills section or as part of your relevant experience. This way you'd ensure you meet all job requirements while dedicating your certificates to only the most in-demand certification across the industry.

Bringing your care manager hard skills and soft skills to the forefront of recruiters' attention

Hard skills are used to define the technological (and software) capacities you have in the industry. Technical skills are easily defined via your certification and expertise.

Soft skills have more to do with your at-work personality and how you prosper within new environments. People skills can be obtained thanks to your whole life experience and are thus a bit more difficult to define.

Why do recruiters care about both types of skills?

Hard skills have more to do with job alignment and the time your new potential employers would have to invest in training you.

Soft skills hint at how well you'd adapt to your new environment, company culture, and task organization.

Fine-tune your resume to reflect on your skills capacities and talents:

• Avoid listing basic requirements (e.g. "Excel"), instead substitute with the specifics of the technology (e.g. "Excel Macros").
• Feature your workplace values and ethics as soft skills to hint at what matters most to you in a new environment.
• Build a separate skills section for your language capabilities, only if it makes sense to the role you're applying for.
• The best way to balance care manager hard and soft skills is by building a strengths or achievements section, where you define your outcomes via both types of skills.

There are plenty of skills that could make the cut on your resume.

That's why we've compiled for you some of the most wanted skills by recruiters, so make sure to include the technologies and soft skills that make the most sense to you (and the company you're applying for):

Top skills for your care manager resume:

Case Management

Patient Advocacy

Medical Knowledge

Care Planning

Regulatory Compliance

Documentation Proficiency

Healthcare Software Proficiency

Budgeting and Financial Management

Risk Management

Resource Allocation

Problem-Solving

Communication

Adaptability

Interpersonal Skills

Organization

Time Management

Critical Thinking

List your educational qualifications and certifications in reverse chronological order.

Care Manager-specific certifications and education for your resume

Place emphasis on your resume education section . It can suggest a plethora of skills and experiences that are apt for the role.

• Feature only higher-level qualifications, with details about the institution and tenure.
• If your degree is in progress, state your projected graduation date.
• Think about excluding degrees that don't fit the job's context.
• Elaborate on your education if it accentuates your accomplishments in a research-driven setting.

On the other hand, showcasing your unique and applicable industry know-how can be a literal walk in the park, even if you don't have a lot of work experience.

Include your accreditation in the certification and education sections as so:

• Important industry certificates should be listed towards the top of your resume in a separate section
• If your accreditation is really noteworthy, you could include it in the top one-third of your resume following your name or in the header, summary, or objective
• Potentially include details about your certificates or degrees (within the description) to show further alignment to the role with the skills you've attained
• The more recent your professional certificate is, the more prominence it should have within your certification sections. This shows recruiters you have recent knowledge and expertise

At the end of the day, both the education and certification sections hint at the initial and continuous progress you've made in the field.

And, honestly - that's important for any company.

Below, discover some of the most recent and popular Care Manager certificates to make your resume even more prominent in the applicant pool:

The top 5 certifications for your care manager resume:

• Certified Care Manager (CCM) - National Academy of Certified Care Managers (NACCM)
• Certified Case Manager (CCM) - Commission for Case Manager Certification (CCMC)
• Care Manager Certified (CMC) - National Association of Social Workers (NASW)
• Aging Life Care Professional (ALCP) - Aging Life Care Association (ALCA)
• Certified Disability Management Specialist (CDMS) - Commission on Disability Management Specialist Certification (CDMSC)

Highlight any significant extracurricular activities that demonstrate valuable skills or leadership.

• How to List Continuing Education on Your Resume

Practical guide to your care manager resume summary or objective

First off, should you include a summary or objective on your care manager resume?

We definitely recommend you choose the:

• Resume summary to match job requirements with most noteworthy accomplishments.
• Resume objective as a snapshot of career dreams

Both the resume summary and objective should set expectations for recruiters as to what your career highlights are.

These introductory paragraphs (that are no more than five sentences long) should help you answer why you're the best candidate for the job.

Industry-wide best practices pinpoint that the care manager resume summaries and objectives follow the structures of these samples:

Resume summaries for a care manager job

• With over 7 years of dedicated experience in geriatric care management, a proven record in developing tailored care plans that resulted in a 30% improvement in patient satisfaction, and a comprehensive skill set in case management and interdisciplinary coordination, seeking to leverage my expertise to ensure high-quality, client-focused care.
• Accomplished registered nurse with 10 years of experience in a fast-paced hospital setting pivoting to care management, bringing a strong background in patient advocacy, discharge planning, and chronic disease management, eager to apply a patient-centered approach to improve health outcomes within the community.
• Eager to transfer a decade of experience as a social worker specializing in family services into a care management career, equipped with skills in crisis intervention, community resource navigation, and empathetic communication, aiming to contribute to the enhancement of patient care delivery and support services.
• Former senior project manager in the tech industry with 15 years of experience leading cross-functional teams, now seeking to apply transferable skills in problem-solving, strategic planning, and process optimization to the dynamic field of care management, with a focus on developing innovative solutions for patient care challenges.
• As a recent graduate with a Master's in Health Administration and an intern experience at a leading healthcare facility, I am passionate about initiating my career in care management, where I can apply my knowledge in health policy, clinical workflows, and patient advocacy to make a tangible impact in improving care delivery.
• Armed with a Bachelors in Social Work and volunteer experience with elderly care programs, I am deeply driven to launch a career in care management, where I can utilize my understanding of social determinants of health and commitment to compassionate service to contribute to the wellbeing of patients and their families.

Showcasing your personality with these four care manager resume sections

Enhance your care manager expertise with additional resume sections that spotlight both your professional skills and personal traits. Choose options that not only present you in a professional light but also reveal why colleagues enjoy working with you:

• My time - a pie chart infographic detailing your daily personal and professional priorities, showcasing a blend of hard and soft skills;
• Hobbies and interests - share your engagement in sports, fandoms, or other interests, whether in your local community or during personal time;
• Quotes - what motivates and inspires you as a professional;
• Books - indicating your reading and comprehension skills, a definite plus for employers, particularly when your reading interests align with your professional field.

Key takeaways

• Invest in a concise care manager professional presentation with key resume sections (e.g. header, experience, summary) and a simple layout;
• Ensure that the details you decide to include in your resume are always relevant to the job, as you have limited space;
• Back up your achievements with the hard and soft skills they've helped you build;
• Your experience could help you either pinpoint your professional growth or focus on your niche expertise in the industry;
• Curate the most sought-after certifications across the industry for credibility and to prove your involvement in the field.

Looking to build your own Care Manager resume?

• Resume Examples

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Care Manager Resume Samples

The guide to resume tailoring.

Guide the recruiter to the conclusion that you are the best candidate for the care manager job. It’s actually very simple. Tailor your resume by picking relevant responsibilities from the examples below and then add your accomplishments. This way, you can position yourself in the best way to get hired.

Craft your perfect resume by picking job responsibilities written by professional recruiters

Pick from the thousands of curated job responsibilities used by the leading companies, tailor your resume & cover letter with wording that best fits for each job you apply.

Create a Resume in Minutes with Professional Resume Templates

• 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
• 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
• 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
• 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

15 Care Manager resume templates

Read our complete resume writing guides

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• 3+ years of clinical experience with a focus in managed care, including disease or case management
• MAPD experience
• Able to understand and apply coverage guidelines and benefit limitations
• Familiar with clinical needs and disease processes for chronic physical and behavioral illnesses (depression, challenging behaviors, Alzheimer’s disease and other disease-related dementias) in an ethnically diverse, dual-eligible aging population
• Comfortable with conducting home visits and commuting within the service area
• Basic computer skills and demonstrates a willingness to learn more advanced skills
• CCM or CCP certification
• MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME)
• Bi/multilingual ability

Orthopedic Care Manager Resume Examples & Samples

• Minimum of 3 years of clinical work in orthopedics, physical rehab or case management
• Experience in an outpatient or inpatient setting

Emergency Department Care Manager Resume Examples & Samples

• 2+ years of experience
• ED clinical background and experience
• Available weekends
• Great clinical skills
• Knowledgeable of assessments
• Strong Med/Surg background $
• Experience in care management
• Interqual/Milliman

Transition Care Manager Resume Examples & Samples

• MSN and/or DNP
• NJ Nurse Practitioner (NP) or Advanced Nurse Practitioner Nurse (ANP) license
• Experience as an Advanced Nurse Practitioner (ANP) with ICU and/or ER experience
• Previous Counseling / Advising experience

RN Care Manager Resume Examples & Samples

• New York Registered Nurse License
• Strong clinical and assessment skills
• Self-motivation, organization and flexibility
• Commitment to improve care in underserved populations
• Collaborative work style
• High level of accountability
• Home care, long term care, care management experience

Assistant Patient Care Manager Mixed Medicine Unit Evenings Resume Examples & Samples

• Charge and leadership experience
• Med-Surg clinical background
• 3-5 years of experience

Integrated Care Manager Resume Examples & Samples

• 5+ years of Hospital or Managed Care
• Knowledge of the case management and utilization review process $
• LTHHC experience
• Registered Nurse licensure in New York State
• A minimum of two (2) to three (3) years of clinical experience in a certified Home health agency (CHHA), Lombardi program and/or MLTC
• Excellent communication, written and analytical skills
• Basic knowledge of computer systems $
• Bachelor's Degree (BSN)

Senior Care Manager Resume Examples & Samples

• Serves as a point of contact for internal and external clients including: screening phone calls, ensuring client messages are communicated to the appropriate client service staff, and following up with clients, when appropriate
• Provides general administrative support to partners, including but not limited to
• High School Diploma/GED required; College coursework/degree preferred
• A minimum of 2 years of experience in an administrative role is required
• Experience in a professional services firm preferred
• Capability to work in a fast paced environment and under pressure
• Advanced skills with Microsoft Office, specifically Outlook & Excel
• Experience in accounting procedures preferred
• Flexibility with overtime to meet deadlines
• Strong organizational skills

Point of Care Manager Resume Examples & Samples

• Bachelor's Degree in Medical Technology
• NYS Medical Technologist license
• Familiar with either CAP or NYS Point of Care (POC) requirements
• Experience as a Chemistry Supervisor, Hematology Supervisor, Coagulation Supervisor, or CORE lab supervisor
• Able to multi-task and enjoy working in a fast-paced, team environment
• Point Of Care (POC) experience
• 2+ years of Clinical background and experience
• Strong Medical/Surgical background
• Knowledgeable with assessments, and work in a fast-paced environment
• Highly organized $
• Care Management experience
• PRI certified and have Utilization and/or Concurrent Review experience with an acute care facility
• Psych experience

Clinical Care Manager Resume Examples & Samples

• Develop/manage the patient care transition process which includes coordinating, facilitating and assisting patients throughout the episode of care
• Serve as clinical resource with expertise in musculoskeletal patient care management and serve as liaison regarding services for this patient population
• Oversee the process for clinical pathway development, staff training, and data collection and reporting
• Act as a positive role model as a nursing leader
• 3+ years of related experience as a medical/surgical nurse
• 2 years of UM or case management experience
• Strong ability to develop, guide, motivate, nurture, and coach others

Utilization Managment Care Manager Resume Examples & Samples

• Dealing with Medicaid/Medicare members, perform pre-admission, concurrent and retrospective reviews to evaluate appropriateness of admission, need for continued stay, length of stay, utilization of resources, patient outcomes, and usage of other services post-encounter
• Document all interventions and telephone encounters with providers, members, and vendors in the appropriate system in accordance with established documentation standards to insure integrity of member services
• Identify opportunities and facilitate member transfers to: a) hospital of enrollment/other appropriate in-network hospital when hospitalization occurs out-of-network; or b) hospital of enrollment when hospitalization occurs at another network hospital
• 5+ years relevant UM or Case Management experience
• RN, LPN, AAS
• Supervisory experience/skills
• LMSW, LCSW, Mental Health Counselor, or RN license
• Experience with mental health and substance abuse
• Psych, Discharge Planning, Chemical Dependency, CCM, Case Management, Behavioral, Ambulatory
• 5+ years RN experience
• 2+ years experience in women's health
• Care management experience in prenatal service/obstetrical care management
• IVF experience or IVF case management experience
• Proficiency in Utilization Review, OB/GYN, IVF/Infertility, and Case Management
• 3+ years of experience in an Outpatient, Orthopedic, or Acute Care setting
• NYS Physical Therapist (PT) license
• Previous Managed Care and Pain Management experience
• Pediatric background

Hospital Care Manager Resume Examples & Samples

• 2+ years of Medical-Surgical experience
• Hospital Case Management experience
• Utilization and/or Concurrent Review experience
• Knowledge of Discharge Planning
• Broad Clinical background
• Advocates for the members’ needs, addresses concerns and resolves
• Facilitates the completion of Medicaid and other benefits programs eligibility application process for members and monitors the process
• Attends a minimum of one networking event each month to promote AEC services within the community
• Bachelor’s Degree in Social Work, Sociology, Psychology, Gerontology or a related field
• Two or more years of case management experience
• Valid Driver’s License and current auto insurance

Msw-care Manager Resume Examples & Samples

• Complete needs surveys regarding psychological, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care
• Coordinate community care and services as deemed appropriate
• Work collaboratively with other members of the Humana At Home Interdisciplinary team-to include: Humana At Home Care Managers, Field Care Managers, and Community Health Educators
• Master’s degree in Social Work (MSW)
• Licensed in your residential state
• Minimum 3 years of care/case management experience with adults
• Knowledge of community health, community resources, and social service agencies
• Ability to interact effectively with multi-disciplinary team members
• Self-starter who is able to multi-task and prioritize
• Must have a separate room with a locked door that can be used as a home office to ensure you and our members have absolute and continuous privacy while you work
• Must have accessibility to high speed DSL or Cable modem internet for your home office (Satellite internet service is NOT allowed for this role); and recommended speed for optimal performance form Humana systems is 10M X 1M
• Ability to work a full-time (40 hours minimum) flexible work schedule
• Previous work with vulnerable adults or geriatric population
• Central and Mountain times zones a plus
• Licensed in your residential state (ND, SD, NV, UT, LA, AL, OK)
• Ability to work a full-time (40 hours minimum) Monday - Friday
• Central and mountain time zones would be a plus

Home Visit Field Care Manager Resume Examples & Samples

• 3 years of experience in home case/care management
• MUST LIVE within 10-15 MILES of Hampton, VA
• Registered Nurse with a valid nursing

RN Field Care Manager Resume Examples & Samples

• Valid Registered Nurse (RN) with no disciplinary action in the stateof TEXAS
• One year of field based eldercare with Home Care and/or caremanagement environment
• This role is considered to patient and is a part of Humana At Home Tuberculosis(TB) screening program. If selected for this role you will be required to bescreened for TB
• Valid driver’s license in the state if Texas, care insurance andaccess to a vehicle
• Proficient in Microsoft applications such as Outlook, Word, Excel andPower Point
• PRI certification
• Utilization and/or Concurrent Review experience within an Acute Care facility
• Knowledge with assessments and discharge planning
• Computer savvy
• Excellent communication skills (written and verbal)(
• Working knowledge of Interqual / Milliman
• Facilitate efficient care coordination and plan for patients' needs
• Evaluate patient medical necessity according to clinical criteria
• Communicate with payers
• At least 1 year of hospital experience as a Nurse Case Manager
• Graduate of an accredited 4 year nursing program
• Current RN license to practice professional nursing with no restrictions
• 3+ years of clinical experience with focus in managed care, including disease or case management
• Ability to apply Milliman Care Guidelines and other applicable, evidenced-based clinical guidelines
• Understands and is able to apply principles of Care Management and Person Centered Service Planning
• Home Care, Long-Term Care, MLTC experience, including appropriate support services in the community and accessing and using durable medical equipment (DME)
• Bilingual in English and a second language
• NYS RN License
• MLTC Home Care experience
• MS Office proficiency
• Uniform Assessment System (UAS) trained
• Bilingual in French/Creole
• 2+ years of previous Home Care experience
• Management experience with Registered Nurses (RNs)
• UAS experience
• Bilingual (English and Spanish / Russian)
• Managed Long Term Care (MLTC) experience
• 2+ years of current Clinical Nursing and/or Social Work experience
• MSW and/or BSN
• Previous experience with Home Care and Case Management
• Knowledge of Medicare and Medicaid programs an advantage
• Knowledge of Chronic Disease Management
• Experience in performing clinical assessment
• Solid clinical assessments skills
• Microsoft Office/Suite proficient (Outlook, Word, Excel, etc.)
• Experience with Home Care, Case Management
• Medicare / Medicaid Managed Care experience
• Experience working with a Geriatric population or equivalent experience
• 3+ years of Clinical experience working in Orthopedic, Physical Rehabilitation, or Case Management
• Bachelor's Degree in Physical Therapy (PT)
• Previous experience in an Outpatient or Inpatient setting
• Visits members in assisted living facilities as assigned by supervisor to assist the care manager in member satisfaction and ensure they are receiving the approved services
• Documents all interventions, interactions and observations in the members file
• Assists Care Manager by making and documenting monthly update calls to home members
• Provides administrative assistance in the coordination of services with network providers and informal services to ensure requested services are provided in a timely manner
• Assists as needed in member Medicaid application process and resolution of pending issues to ensure efficient and timely Medicaid eligibility
• Tracks Medicaid appointments and follows up to ensure members do not lose eligibility
• Enters member care plan update/action data into database system (Q)
• Provides coverage for on duty responsibilities on the branch and covers front desk as needed
• Shadows care managers on quarterly, annual, semi-annual and orientation visits as assigned by supervisor
• Participates in care management training programs
• Bachelors Degree in Social Work, Sociology, Psychology, Gerontology or a related field
• Three months to one year case management experience
• Valid Drivers License and current auto insurance
• Complete needs surveys regarding psychosocial, emotional and environmental resources, for the purpose of providing appropriate, timely interventions to ensure provision of optimal care
• If applying to work with members in the following states OK, NV, NM, SD, ND, UT, MN, WY, ID applicant must possess an active unrestricted license to practice social work
• Central, Mountain and Pacific Time Zones
• Coordinate, negotiate, procure, and manage the care of patients by incorporating a focus on care coordination across the acute care continuum
• Review and evaluate patient's medical records to determine the appropriateness and medical necessity for admission and continued hospitalization
• Evaluate appropriate clinical resource utilization
• Assess the patients for transitioning to the next appropriate level of care
• Collaborate with the healthcare team to ensure the achievement of quality outcomes for patients/families
• 1+ years ED experience and understanding of admissions criteria
• 3+ years of experience in Care / Case Management, Disease Management and/or Population Management, Utilization Review, Quality Assurance, Discharge Planning, or other Cost Management program
• NYS Licensed Medical or Clinical Social Worker (LMSW or LCSW) with current license in the state of practice
• Previous experience with CPT and ICD-9 coding
• 3+ years of Clinical experience with a strong Medical / Surgical background
• Previous experience in a Managed Care setting
• New York State Physical Therapy License
• 3+ years of clinical experience in orthopedics, physical rehab or case management
• Prior experience in either an inpatient or outpatient setting
• Compassionate and detail-oriented
• Exceptional interpersonal and organizational skills
• Polished and professional phone demeanor
• Minimal Bachelor’s degree in Social Work
• Progressive experience working in a medical or related field
• Current valid social worker license
• Ability to be licensed as a social worker in multiple states without restrictions
• Master’s degree in Social Work or related field
• Bilingual (English/Spanish); speaking, reading, writing, interpreting and explaining documents in Spanish
• New York State Registered Nurse license
• Adult Psych home care experience
• 2+ years of Emergency Department experience
• Ability to handle high volume of patients
• PRI-certified
• 3+ years of Clinical work experience in Orthopedics, Physical Rehabilitation or Case Management
• Experience in an Outpatient and/or Inpatient setting
• Previous Pain Management experience
• Registered Nurse with an ASN or BSN
• Broad spectrum of clinical background
• 2+ years of Medical-Surgical clinical experience
• Ability to multitask
• Experience with assessments
• PRI certified or willing to get certification
• Active New York State Registered Nurse license
• Bachelor’s Degree in Nursing, Social Work or other behavioral health professional license
• 3 years’ health care or managed care experience
• Demonstrated knowledge in Case Management $
• 2 years’ ADHC experience
• 2 years’ management experience in AADHP care management at an integrated delivery system, hospital system or community-based organization
• Knowledge of Article 49-Utilization Review Process
• Prefer CST, PST & GMT and AL, LA or NM
• Must be a Licensed Social Worker if you reside in ID, MN, NM,NV,ND, SD, UT, WY, CT, MD, KY, MI, OK, LA, AL
• Your schedule will be set anywhere between 8:00 AM - 8:00 PM in order to meet our members needs
• Option to work flex schedule with emphasis on late starts
• Prefer CST, PST & GMT and OK or WY
• Your schedule will be set anywhere between 8am-8pm in order to accomodate members needs
• 3 years of experience managing Registered Nurses
• Case management of assessment experience
• Prior UAS experience
• Prior Managed Long-Term Care experience
• 2+ years of experience as a case manager
• PRI Certified
• Higher education
• Minimum of two years experiences as a medical assistant or certified nurse assistant, or health related field, and/or degrees in psychology, health education, or social work
• Intermediate to advanced computer skills and experience with Microsoft Word and Excel
• Social Work experience a plus
• 3+ years of Case Management and/or Home Care experience
• Uniform Assessment System (UAS) experience
• Previous experience working within a Managed Long-Term Care setting
• Bilingual (English and Spanish or Russian)
• Bachelor's Degree in social work, nursing, social science, and/or psychology
• AA/AS in health or human services field with 3 years' of relevant work experience or Bachelor's Degree in a non-related field with 5 years' of post-bachelor's relevant work experience
• Experience working with one of the following communities: chronic disease including HIV/AIDS; substance user; mentally ill; LGBTQ
• Consistent team player capable of effectively operating within organizational structure
• Ability to use Microsoft Word and Excel
• Bilingual in English and Bengali or Hindi
• Associate's Degree in Nursing from an accredited program
• Bilingual, English and Spanish
• Experience with Utilization Management guidelines for Medicare and Medicaid
• Experience managing large case loads
• Ability to troubleshoot or explain basic hardware and software errors and work with a Technician remotely to perform step-by-step repairs
• Accurate typing skills
• Ability to pass Uniform Assessment System (UAS) training
• CCM or ANCC Case Management certification
• Fluency in speaking Mandarin/Cantonese
• 3 years of US-based work experience as a licensed Registered Nurse
• Experience working with the frail adult or elderly population
• Knowledge of current community health practices for the frail adult population and cognitive impaired seniors
• Knowledge of InterQual
• Thorough knowledge of current community health practices for the frail adult population and cognitively impaired seniors
• Care management knowledge
• Experience managing member information in a shared network environment using paperless database modules and archival systems
• Experience with multiple Medicaid managed care plan products
• 3+ years of relevant work experience
• Associate's Degree in Social Work, Nursing, Social Science, or Psychology
• Experience working with one of the following communities: chronic disease including HIV/AIDS; substance abuse; mentally ill; and LGBT
• Bilingual in English and Spanish, Bengali, or Chinese
• Proficient in Microsoft Work and Excel
• 5+ years of relevant work experience
• Bachelor's Degree in a non-related field
• Active and unrestricted New York State Registered Nurse license
• 2+ years of case management experience with the geriatric population
• Experience providing care in the home setting
• Experience working within a managed care environment
• Comfortable working with children and adolescents
• 1+ year of experience working in a hospital or outpatient setting providing care to children/adolescents and their families
• Familiarity with foster care
• Experience coaching/educating children/adolescents and families on health-related topics and managing follow-up/coordination with multiple providers/stakeholders
• Able to manage time effectively
• Knowledge of Microsoft Excel
• Comfortable using an electronic health record
• Accountable to the owners of the business
• Achievement of targets and delivery within budgets
• Management of staff and responsibility for their workload
• To ensure successful operation of quality control systems
• Implementation of complaints procedure
• To participate in the growth and development of the business, locally and regionally through various marketing exercises
• To be able to develop and maintain the quality control system
• To have a strong knowledge of the requirements of the Care Standards regulations
• To be able to create and maintain administrative systems
• To be able to recruit, select and effectively supervise a dispersed workforce
• To be able to establish and maintain effective working relationships
• Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions
• Identifies potential candidates for individual case management services and executes the screening and case management process
• Implements, coordinates and monitors efficient care for targeted patients using a variety of health care delivery systems as appropriate. The delivery systems can include acute, long-term acute care, subacute, skilled nursing and rehabilitation settings, as well as, surgery centers, home health agencies and other settings
• Works closely with patients at the time of enrollment to identify those who are currently high cost/high utilizers or at-risk for high/cost utilization
• Assesses the new patient’s situation, provides information about health care options, serves as guide and advisor to the patient and his/her family, and establishes and molds a long-term relationship with the primary care physician and the patient
• Works with the primary care physician to establish protocols for routine and preventive care for the patient which reflect accepted standards of care
• Researches and selects care options as appropriate. May make recommendations of alternative medical care and alternative non-medical services for approval and authorization by the primary care physician
• Supports utilization management decisions with nationally recognized medical management criteria
• Refers all cases that do not meet applicable criteria or have potential quality of care issues to the Physician Advisor
• Maintains a comprehensive, computerized medical and social history for assigned patients. Information will be used for such activities as patient assessment, care planning, patient/care evaluation, case tracking and risk predictions, as well as, cost analysis
• As a member of the care delivery team, works to facilitate patient compliance and ensure continuity of care per the team’s “care plan” throughout the patient’s tenure in the Program
• Regularly assesses and evaluates the effectiveness and quality of services. (i.e., home health care agencies) and treatments provided to patients by analyzing outcomes (clinical, functional, and financial) and reports (utilization, cost, etc.)
• Provides individual client focused reports accentuating case management activity and outcome
• Establishes a network of community resources (i.e., hospital discharge planners, AIDS counselors) necessary for providing appropriate care to patients
• Serves as a program advocate by conducting training sessions, offering presentations, visiting providers, etc
• Negotiates rates with vendors according to company policies and procedures
• Facilitates the flow of claims through the Healthcare Management Department
• Provides input (data, analysis or opinion) to the evaluation of the Program’s overall effectiveness
• Make recommendations for system development from a user’s perspective
• Participates in Quality Management initiatives
• Complies with Healthcare Management policies and procedures and conforms to American Accreditation Healthcare Commission/ Utilization Review Accreditation Commission standards while performing the job function
• Reviews and signs CoreSource Confidentiality Attestation at the time of employment and at each annual performance review
• Maintains active state nursing license and continuing education requirements and submits original copies of each to be photocopied for the employee file
• Other duties as assigned by a Healthcare Management Supervisor or Director of Healthcare Management
• 5+ years of Clinical experience
• Experience working with the Mental Health and/or Psychiatric population
• Utilization Review or Discharge Planning background
• Active New York State Registered Professional Nurse license
• 1 year of care management experience
• 2-3 years of total nursing experience
• Experience working in any of the following areas: Geriatrics, Discharge Planning, Case Management, Assessment, Acute, Sub-Acute, Long-Term Care (LTC), Health insurance, Home care environment, Homeless population, Addiction, Foster care
• Experience managing large caseloads
• Proficiency in navigating the Internet and multi-tasking with multiple electronic documentation systems simultaneously (toggling)
• Intermediate skills with a Corporate email system including using and sharing calendar rights, MS Word, MS Excel and electronic patient health information (PHI) database usage (medical records database)
• Experience working with a frail adult or elderly population
• Care management knowledge, including the concepts and philosophy and relevant standards of patient care
• Experience with multiple Medicaid managed care plan products such as, Family Health Plus (FHP), Eastern Benefits System (EBS), Federal Employee Program (FEP)
• Education: Bachelors Degree in Nursing
• Experience: Three years of Clinical Nursing Experience
• License: RN License in the state of Michigan
• Skills & Abilities: Knowledge of chronic disease, evidence-based guidelines, prevention, wellness, health risk assessment, and patient education. Excellent assessment and triage skills Ability to manage complex clinical issues utilizing assessment skills and protocols Ability to affect change, work as a productive and effective team member, to be flexible, and adapt to needs/priorities Demonstrates customer focused interpersonal skills to interact in an effective manner with practitioners, the interdisciplinary health care team, community agencies, patients, and families with diverse opinions, values, and religious and cultural ideals. Demonstrates strong leadership qualities including communication skills, organizational skills, problem solving and decision-making skills
• Previous Managed Long-term Care (MLTC) and Uniformed Assessment Systems (UAS) experience
• 1+ year of Healthcare experience
• Bilingual (English and Spanish or Mandarin / Cantonese)
• Review clinical documentation to determine initial and ongoing eligibility for long term care benefits
• Appropriately set follow up dates for ongoing benefit eligibility as prescribed by current protocols
• Ongoing monitoring of claims for high risk activity
• Professional clinician with a minimum of bachelor degree in nursing
• Current R.N. licensure without restrictions in state of practice
• 3+ years experience working with geriatric and chronic illness
• Work within the Long Term Care industry desirable
• Geriatric and health care system knowledge
• Demonstrated ability and experience in performing comprehensive ADL/Cognitive assessments and care plan development
• Awareness of global demographic trends and impact upon LTC population
• Ability to work within multi-disciplined teams
• Adaptability in a fast paced corporate environment
• Responsible for Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations
• Interacts continuously with member, family, physician(s), IDT members, and other providers, utilizing clinical knowledge and expertise to determine medical history and current status. Assesses the options for care, including use of benefits and community resources, in order to update the Person Centered Service Care Plan
• Maintains accurate records of care management activities in the EMMA system, using clinical guidelines
• Required A Bachelor's Degree in Nursing or related field may be required in certain states based on specific contracts
• Required Intermediate Microsoft Excel Intermediate knowledge and skills of MS Office including Excel, Word and Outlook Express
• Deliver training presentations to assigned client and may deliver clinical sessions based on client need
• Provides telephonic assessment and referral and/or short-term problem resolution and referral for members or their family members who contact us for assistance
• Assesses members for risk issues and creates safety plans when appropriate
• Consults with supervisors, managers and/or human resource professionals who contact us for guidance regarding increasing the likelihood of members using our services
• Provide back to work conference at client company for employee returning to work and an absence due to treatment
• Provide consultation to assigned client for optimal EAP participation and utilization
• Make recommendations toward goal of reaching diverse populations of employees at client organization
• Review training materials and make recommendations for high quality trainings
• Represent EAP at outreach opportunities
• Build relationships with various stakeholders (union, if applicable, wellness champions, HR, etc.)
• Submit data when requested so that results can be tracked and compiled into reports for client
• Participate in EAP Update Meetings with client and account management upon request
• May conduct Critical Incident Stress Debriefings or serve on committees upon client request
• 5 years of experience providing direct clinical services
• Ability to understand uniqueness of on-site role and working on team
• Presentation skills and a proven track record conducting on a variety of EAP-related topics
• Knowledge of care management and resource/utilization management
• Ability to monitor, assess and record patient progress against a plan of care
• 2+ years of related experience
• Active New Jersey State Registered Nurse or Practical Nurse license
• 5 years of clinical experience
• Experience with EMR systems such as centricity and/or IDX
• Working knowledge of Medicaid/Medicare
• Experience with population management and value-based services
• Education: Graduate from an Accredited School of Nursing. Bachelor’s degree in Nursing preferred
• 2+ years of clinical nursing experience in an acute care setting and 1+ years of case management experience in a managed care setting
• Licenses/Certifications: Current state’s RN license
• Graduate from an Accredited School of Nursing – minimum of Associate’s degree in Nursing is mandatory, Bachelor’s degree in Nursing preferred
• Current Louisiana RN license is required
• 2+ years of current clinical nursing experience in an acute care setting
• OB/ NICU (neonatal intensive-care) and labor/delivery experience REQUIRED
• Experience with discharge planning, concurrent review & Interqual
• Case Management experience BSN preferred
• Knowledge about discharge planning, concurrent review, and computer skills (Excel)
• Experience working with Managed Care (Medicaid/Medicare)
• Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options
• Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
• Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio economic needs of clients
• Provide patient and provider education
• Facilitate member access to community based services
• Monitor referrals made to community based organizations, medical care and other services to support the members’ overall care management plan
• Actively participate in integrated team care management rounds
• Identify related risk management quality concerns and report these scenarios to the appropriate resources
• Case load will reflect heavier weighting of complex cases than Care Manager I, commensurate with experience
• Enter and maintain assessments, authorizations, and pertinent clinical information into various medical management systems
• Direct care to participating network providers
• Perform duties independently, demonstrating advanced understanding of complex care management principles
• Licenses/Certifications: WA State RN License
• 1+ years of Case Management experience
• Pre-Admission Counseling
• Contacts patients with upcoming hospital admissions and discusses expectations
• Assesses patient's condition to understand illness or injury and evaluate ability to follow treatment plan
• Advises patients of probable length of stay and helps anticipate and arrange for services at discharge
• Admission Care
• Works with physicians and hospitals to enforce treatment plans and orders
• Ensures patient receives specialty care and tests as ordered
• Contacts medical team members to discuss patient's course of progress and needs
• Arranges for and coordinates health care team services, avoiding duplication and conserving benefit dollars
• Evaluates need for and authorizes equipment, supplies, services
• Identifies problems and instructs patient and family in proper care and refers patient back to physician or other health care team members
• Identifies plateaus, improvements, regressions and depressions, and counsels accordingly
• Coordination of Care
• Conducts hospital visits
• Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information
• Authorizes recommended modalities of treatment. Investigates and suggests alternatives
• Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers
• Facilitates beneficiary transfers among regions and collaborates with military liaison to minimize disruption care or services
• Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs
• Coordination of Financial Services
• Assesses patient's benefit plan coverage and limitations
• Negotiates rates for provider services by contacting multiple providers and comparing specialty item costs, researching and identifying required equipment, and pursuing contracts
• Suggests medical alternatives that accomplish treatment plan goals
• Post Discharge Follow-up
• Contacts patients within 48 hours of discharge to ensure sufficient support for full recovery
• Ensures proper receipt of equipment, home health and other services
• State Driver's License
• Telephonic**
• In conjunction with the PCP, member, member’s family, and other pertinent members of the Interdisciplinary Care Team (IDT), CM completes a comprehensive assessment and develops a Person Centered Service Care Plan utilizing clinical expertise to evaluate the member’s need for alternative services. Assesses short-term and long-term needs and establishes care management objectives
• Functions as a mentor for newly hired Care Managers
• May serve as a representative on interdisciplinary clinical care teams and cross functional workgroups
• Required 5+ years of experience in A clinical acute care position(s), preferably in home health, physician’s office, or public health
• Required 3+ years of experience in Current care/case management
• Intermediate Ability to analyze and interpret financial data in order to coordinate the preparation of financial records
• Intermediate Demonstrated written communication skills
• Advanced Knowledge of healthcare delivery
• Required Certified Case Manager (CCM)
• Graduate from an Accredited School of Nursing
• Bachelor’s degree in Nursing preferred
• Current state’s RN license
• Other Details: Competitive Compensation Package with Benefits, PTO, 401k, W-2 only, no 1099s or Corp to Corp
• Review services with interested practices and assist in enrolling them in the CCM program
• Educate provider offices on CMS CCM reimbursement schedule under CPT code 99490
• Provide all services necessary in order to execute an electronic care plan
• Determine an individual’s health and educational needs as a result of inbound and outbound phone calls, and review of medical records with patients
• Maintain communication with patients to measure no less than 20 minutes per month
• Collaborate with the patient's provider to facilitate appropriate physical, behavioral and social services
• Review care plans and make changes as necessary
• Provide patients with information regarding medical questions/concerns
• Ability to work collegially with staff members from multiple offices
• Ability to manage multiple patients simultaneously
• Ability to build and maintain relationships with patients, families and client providers
• Examples of CM activities may include educating newly diagnosed patients about the disease and treatments; managing therapies; and drug administration and side effects
• The following types of professionals will be eligible to serve as an Altarum Care Manager: Registered Nurse, Licensed Practical Nurse, Licensed Social Worker (Bachelors or Masters), Certified Medical Assistant, Certified Community Health Worker
• Minimum of 3 years’ of experience as a Care Manager or Case Manager
• Ability to provide transportation to client provider practices (mileage reimbursement available)
• Medicare/Medicaid experience
• Experience with multiple EHR/EMR systems
• Clinical or Care Management experience, Certified Care Manager preferred
• A background in geriatric care, family medicine and/or long-term care (home health, hospice, public health, assisted living)
• A background and ability to work with populations with special needs
• Competence and experience with electronic charting
• Self-directed with the ability to work independently and in groups
• Exceptional time management skills, with a high level of individual initiative
• Can be depended upon to effectively plan and organize multiple assignments to ensure workload’s completion, yet flexible enough to handle changing schedules
• Proactive telephonic outreach to eligible Humana members and engage participation in Humana At Home care management programs
• Works Collaboratively with other members of the Humana Cares Interdisciplinary team-to include; Humana Cares Managers-Social Services, Field Care Managers and Community Health Educators
• Additional responsibilities as deemed appropriate by Humana Cares leadership
• Licenses/Certifications: Active Current state’s RN License without restrictions
• 2+ years of clinical nursing experience in a clinical, acute care (med/surg, pediatrics, ICU, ER, Telemetry, LTACH) or community setting
• 1+ years of Case Management experience in a managed care setting (CM in a hospital or with a HH Agency)
• Works with physicians and hospitals to enforce treatment plans and orders.　
• Ensures patient receives specialty care and tests as ordered.　
• Contacts medical team members to discuss patient’s course of progress and needs.　
• Arranges for and coordinates health care team services. 　
• Evaluates need for and authorizes equipment, supplies, and services.　
• Identifies problems and instructs patient and family in proper care and refers patient back to physician or other health care team members.　
• Identifies plateaus, improvements, regressions and depressions, and counsels accordingly.　
• Maybe require to perform on site review　
• Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information.　
• Authorizes recommended modalities of treatment. Investigates and suggests alternatives.　
• Documents case summary in Transitional Care Plan and shares appropriately with beneficiaries and providers.　
• Facilitates beneficiary transfers among regions and collaborates with hospital care teams. 　
• Coordinates basic benefit. Identifies and submits modifications, requests for exceptions or special programs.　
• Assesses patient’s benefit plan coverage and limitations.　
• Suggests medical alternatives that accomplish treatment plan goals.　
• Ensures proper receipt of equipment, home health and other services.　
• Assesses compliance with medications and follow-up appointments.　
• Assists patient in coordinating transportation and other basic needs, and in navigating the health care system.　
• Must have and maintain current, valid and unrestricted RN License that meets licensure requirement for the state in which you practice
• Extensive care coordination experience
• Experience providing service coordination and information, linkages, and referrals for community-based services
• Proven self-management abilities
• 2+ years of experience in a Clinical Acute Care position; 1+ year of experience in Care / Case Management
• Microsoft Office/Suite proficient (Excel. Word and Outlook)
• Previous experience in Home Health, Physician's office or Public Health setting
• Clinical Social Worker license
• Discharge planning experience, ideally in home or long-term care
• Geriatrics and home care experience
• Provides on-going program planning and management, develops region-wide protocols, and promotes standards of care for clients with, or at-risk, for genetic/ congenital conditions
• Develops and implements a plan of care for complex, high risk patients
• Initiates and participates in collaborative research projects, written articles, and professional presentations
• Identifies and promotes improved innovative clinical practice based on new knowledge and research in field of specialization, using a broad scope of nursing expertise
• Maintain up-to-date knowledge of current activities in genetics and recommends/ implements enhanced clinical practice standards for the department and the region
• Minimum two (2) years of previous acute nursing experience required
• Prior clinical nurse specialist/administrative/teaching experience preferred
• Previous computer experience preferred
• 2+ years of experience within a Managed Long Term Care setting
• Uniform Assessment System (UAS) background
• Bilingual (English and Chinese or Russian)
• Responsible for the maintenance, filing, archiving and monitoring of all paper records/storage areas (including all satellites)
• Insures that all documentation related to substance abuse and mental health treatment/programming has been completed, submitted, etc. in a timely and qualitative manner. This includes verifying client eligibility and program admission, completion and submission of program reports, insuring that all in-house documentation is in compliance with program requirements, etc
• Regularly monitors, reviews, audits program records to insure compliance with all regulatory (e.g., ISMART), accreditation (COA), and program specific expectations (e.g., House of Mercy protocols, HUD) in a timely and qualitative manner
• Participates in House of Mercy’s Performance Quality Improvement Program as an active member
• Provides ongoing monitoring/audits to insure compliance with time sensitive expectations related to: Physical Exams/TB testing; consents/releases of information; ISMART reports; Permanent Housing documentation; and, Outpatient/Continuing Care chart requirements
• Responds in a timely and qualitative manner to all requests for client related information insuring that all confidentiality and protected client/patient expectations are adhered to. Insures that all appropriate informational release situations are invoiced at the allowable fee. Keeps the information release billing guide updated and current with industry/regulatory standards
• On an ongoing basis, keeps House of Mercy Management Team informed on overall facility compliance with regulatory/accreditation standards and expectations
• On a timely basis, monitors and insures compliance of all discharged charts prior to archiving them
• Monitors and insures compliance of all House of Mercy provider documentation prior to their scheduled departure from the organization
• Participates in assigned public relations and media efforts to promote House of Mercy; attends community and informational meetings to keep House of Mercy current and to network with other agencies; attends training on relevant topics to stay current in meeting requirements of licensing and other regulations, and to obtain information to better serve clients
• Attends and participates in team meetings and training sessions as scheduled or appropriate
• Works on special projects as assigned. Participates on committees as appropriate and performs related duties as required
• Maintains an awareness of and adheres to mandatory child and dependent adult abuse reporting laws
• Maintains an awareness of and adheres to Federal confidentiality laws
• Maintains communications, on a professional level, with all co-workers, department staff, referral sources, vendors, donors, and residents
• Performs additional duties as assigned
• Bachelor’s degree in a human services related discipline from an accredited four-year program, required
• Valid Driver’s License required, must meet Mercy’s Motor Vehicle Safety Standards, must be at least 18 years of age and be eligible to drive per Iowa state law
• CADC certified with the State of Iowa or certified within nine (9) months of hire
• Ability to understand medical terminology and communicate effectively with healthcare professionals
• Educate patients and/or families about preventive care, medical issues, and use of prescribed medical treatments and/or medications
• Dedication, above all, to caring for patients suffering from complex chronic conditions
• Experience with geriatric or end of life care preferred
• Valid Driver’s license
• Ability to interface effectively with culturally diverse patients and communities, providers, management, and employees of the organizations
• Ability to exercise objectivity and good judgment relating to difficult and emotionally-charged situations
• Works closely with hospitals, clinics, health care facilities and agency clinical and administrative personnel to ensure patient care is seamless, efficient, effective and appropriate
• Interacts with customers, professionals, and the community to achieve continuity of care, coordination of services and to document plan of care
• Prepares and submits agency and employee activity statistical reports
• Makes evaluative/consultative visits in numerous settings, and provides supportive counseling and/or counseling referrals for client and family as needed
• Develops and maintains accurate case records of each referred customer/patient and documents fully and accurately
• Functions as liaison for patient/family in navigating the continuum of care. Serves as patient advocate
• 2+ years of Care and/or Case Management experience
• Experience working with the Geriatric population and patients dealing with Dementia
• Previous experience working with Disability and/or Rehabilitation Programs
• Public Health, Community-based or Home Care background
• Participates in defining, maintaining and interpreting care management standards of practice
• Assesses and educates patients and families on community agencies and resources
• Educates and reinforces the early identification of changes in patient condition and changes in care transition plans
• Assumes responsibility for own professional growth and is willing to share knowledge with coworkers and other health care providers
• A master’s degree in a clinical field that meets Washington State’s Mental Health Professional criteria and possess (or obtain within one (1) year of employment) Washington State mental health professional licensing is preferred
• At least two (2) years of clinical experience such as direct care, care coordination or case management in either public or private healthcare operations serving adults and/or youths
• Proficient in computer use/applications commonly used in this field/trade/position including Microsoft Office software
• Possess and maintain a valid driver’s license. Pass and maintain a clear background record as required by contractual requirements for healthcare organization under state and federal contracts
• Represents the Company in a professional manner, following all Company policies and procedures
• Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Responsible for quick and accurate triage response according to Company protocol
• Under direction and supervision of physician, administers prescribed medications and immunizations, provides emergency treatment and other patient services within the ambulatory setting
• Maintains clinical documentation within the medical records assuring compliance within all guidelines
• Conducts patient education and participates in health promotion activities
• Maintains equipment, adequate stock levels of consumables in all treatment and exam rooms
• Provides nursing care in the ambulatory setting to patients and families. Provides emergency treatment as required
• Participates in clinic’s Quality Management Program, High Risk Program, Group Visits, and other programs as requested
• Monitors inpatient, outpatient, and SNF patients and initiates patient care arrangements
• Assists with the education of the patient and/or family as directed by the physician
• Reports findings to Medical Management; Medical Director and Center Administrator
• Responsible for patient care management to assure appropriate care is provided; reinforces patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinates home health and DME requests and provides recommendations to the Center Medical Director
• Provides oversight in patient care evaluation, coordinates the collaboration of the Primary Care Provider and Consultants, and makes suggestions to improve plans to meet patient needs
• Assists with the monitoring of utilization management and makes recommendations regarding effectiveness of health care resources, trending and intervention
• Assists in the assessment of clinic operations and make recommendations as necessary
• Assures compliance with HCFA guidelines and covered service guidelines
• Assists with the contestation of Part A and Part B claims as needed
• Evaluates and recommends health delivery network changes with the site Medical Director and Center Manager
• Attends Case Management meetings. Assists the Center Medical Director with the management of high-risk patient populations and appropriate Case Management plans
• Performs case management, but spends the majority of time performing triage functions
• Ability to obtain CPR certification within 60 days of employment
• LPNs must have the ability to obtain IV Certification within 90 days of employment
• Five years of acute care clinical experience preferred
• Must be computer literate
• Ability to interact and communicate effectively with patients and all levels of personnel in a professional, courteous and effective manner using excellent customer service skills
• Strong working knowledge of triage nursing principles, theories and practices/
• Ability to take vital signs, perform approved clinical tasks including but not limited to: evaluate patient needs, emergency triage, administer prescribed medications, assist physician with examinations and treatments, prepare and apply dressings and perform wound care; instruct patient in health measures and self-care; change Foley catheters, and flush ports (or be willing to learn)
• Ability to record findings and observations
• Knowledge of medical equipment and maintenance
• Ability to provide on-site emergency treatment
• Ability to multi- task in a high paced environment with good organizational skills
• Ability to read, speak, write, and understand the English language fluently
• Provides concurrent medical management as needed to ensure medical necessity and compliance with applicable medical policy and health plan benefits
• Develops alternate plans and assist patients and Providers to navigate the healthcare system optimizing benefits. Refer services to networked Providers when possible
• Identify and address opportunities for quality improvement in all aspects of serving our customers. Assist in planning and implementation of systems changes and procedures to achieve overall organizational objectives
• Preferred- Two (2) years’ experience providing case management and/or utilization review functions within health plan or integrated system
• Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements. Report findings to the Director, Medical Management, Vice President of Medical Management, Medical Director and Center Manager
• Responsible for patient care management to assure appropriate care is provided; reinforce patient education regarding preventative care, dietary restrictions, medications and other therapeutic regimens; coordinate home health and DME requests and provide recommendations to the Center Medical Director
• Assist with the monitoring of utilization management and make recommendations as necessary
• Experience with Case Management
• Ability to perform case management
• Ability to explain medical instructions to center personnel
• Ability to establish and maintain effective working relationships with JSA, Health Plans, and local personnel
• Ability to learn and understand appropriate Federal, State, and local regulations
• Ability to interact and deal tactfully with the public
• Ability to read, write, speak and understand the English language fluently
• Ability to communicate effectively, get along with coworkers and management, and deal effectively and professionally under pressure
• Monitor inpatient, outpatient, and SNF patients and initiate patient care arrangements. Report findings to Medical Management, Medical Director and Center Administrator
• Assist with the contestation of Part A and Part B /claims as needed
• 3 to 5 years of recent clinical nursing experience
• Ability to travel locally at times for coverage of Care Managers at Clinic locations
• Monitors utilization of hospitalized and skilled nursing home members and assists with discharge planning needs
• Reviews all non-urgent referral requests for medical necessity using approved criteria, and selection of participating providers
• Assists with education and collection of data for HCC coding and STARS/HEDIS measures. Identifies members to refer to the JSA Disease Management/High Risk Programs
• Reviews medical and pharmacy claims monthly and discusses findings with the PCP. Conducts monthly meetings with physicians and office staff to review utilization data, pharmacy opportunities, high cost members, network and health plan updates
• Works in conjunction with the Provider Relations Reps to provide excellent service for Affiliate Primary Care Physicians
• Minimum: Clinical experience required physician office or managed care experience
• Ability to monitor the utilization of hospitalized and skilled nursing home members
• Ability to assist with discharge planning needs
• Ability to explain managed care principles to physicians and center personnel
• Ability to read, writes, speak and understand the English language fluently
• Ability to communicate effectively, get along with coworkers and management, perform effectively and professionally under pressure
• Travel within the JSA service area required
• Assure compliance with HCFA guidelines and covered service guidelines
• Participate in QI projects. Attend Care Management Meetings
• Preferred: Managed care experience
• Ability to perform Care management
• Ability to travel locally
• Minimum 2 years' relevant experience working with individuals with active, serious mental health issues/conditions
• The ability to work cooperatively and collegially within a diverse environment
• Demonstrated ability to establish rapport quickly with a wide range of people from diverse social, cultural, or socio-cultural backgrounds
• Knowledge of community resources for middle aged adults
• Experience providing culturally competent services for middle-aged men
• Experience treating middle-aged male patients using short-term models of individual psychotherapy/counseling
• Experience assessing and intervening when individuals present in crisis
• Skills to perform in-depth analysis of medical records (electronic and/or paper) to obtain accurate, relevant clinical information, and to convey that information to other clinical team members in a concise, informative manner
• Provides care management (CM) and care coordination to both QI community and institutional members. Completes the Face to Face Health Functional Assessment and Service plan. Care management is provided across the continuum of health care needs - the community, hospital, skilled nursing facility or institution
• Maintains required documentation using KPHC electronic health record. Updates members' service plan, updates and documents assessments and health care in medical records to indicate progress, changes and continuity of care
• Works closely with the Member Care Services Associate to navigate home community based services, supplies and equipment for LTSS needing members
• Promotes Early and Periodic Screening, Diagnosis and Treatment (EPSDT) for members 0-20 years of age. Works closely with Member Care services Associates for EPSDT tracking and audits
• May provide direct patient care per DHS Face to Face HFA requirements
• Provides direct patient care on an as needed basis. Provides services that are within scope of license and in compliance with all legal, regulatory, and policy requirements relevant to clinical role performed
• One (1) year Case Management experience in a hospital or clinical setting
• One (1) year recent experience in a clinical area or equivalent preferred
• Community case management experience preferred
• This is an office position at 1 East Washington Street, Phoenix, AZ*
• Conduct project / product management activities
• Monitor, evaluate and communicate process improvements
• Coordinates Clinical Functions with the UHC Community Plan programs
• Assess barriers to care and assist members to address concerns
• Develop workflow activities & activities for designated programs
• Provides monthly statistics and reports on assigned clinical programs
• Results-oriented, self-starter with ability to learn quickly, adapt to changing priorities and multi-task
• 5+ years clinical, behavioral or case management experience
• Self-directed in work case load
• A background working with the AZ Regional Behavioral Health Authorities
• Ensure open communication regarding patient interactions with physicians and office staff
• Help patients with problems in arranging referrals, screenings, and test procedures
• Screen and refer as appropriate for depression and other psychological treatments
• Assume an advocate role on patient’s behalf with the carrier to coordinate benefit management for appropriate supplies and services for the patient in a timely fashion
• Identify and utilize cultural and community resources; establish and maintain relationships with identified service providers
• Coordinates care with external disease management or case management organizations
• Provide medication management, including medication reconciliation and making recommendations to primary care for medication changes based on evidence-based protocols
• Collaborate with primary care to establish and update a shared care plan
• Provide support for improving health behaviors and self-management skills: Goal Setting, Action Planning and Problem Solving
• Provide more intensive follow-up during care transitions and other high-risk periods
• Provide information and education regarding screenings and test results
• Care Managers play an important role in supporting quality improvement for chronic care, such as participating in and supporting planned and group visits, and development of new forms and procedures
• Care Managers play a key role in providing clinical and self-management support training to non-RN and other practice staff as needed
• Using a holistic approach consults with clinical colleagues, supervisors, Medical Directors and/or other programs to overcome barriers to meeting goals and objectives. Presents cases at case rounds/conferences to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes
• Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promotes lifestyle/behavior changes to achieve optimum level of health
• Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices
• Helps member actively and knowledgably participate with their provider in healthcare decision-making
• Analyzes all utilization, self-report and clinical data available to consolidate information and begin to identify comprehensive member needs
• This position requires the candidate to be located in Cincinnati, OH as home visits are a part of the job requirements**
• Extensive knowledge of community resources/services
• Complete telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider and for emergency, urgent, and routine referrals
• Coordinates with other Care Managers within VO as well as within other facilities/agencies to ensure that patient comprehensive treatment needs are met
• Coordinates member’s service needs with community agencies
• Provide education to member about Behavioral Health and/or Substance Abuse Diagnosis and medication management
• Provide clinical guidance and support to assist member in achieving their goals
• Prepares for and participates in all clinical rounds and clinical
• Analyzes specific utilization problems. Plans and Implements solutions that directly influence quality of care and financial liability
• Interacts with physicians and other members of the provider clinical team for discharge planning
• Performs concurrent reviews for inpatient care and other levels of care as allowed by scope, practice and experience
• Experience in TAY, older adults with MH/SA conditions, SMI, SUD, co-occurring disorders (MH with SUD, IDD or physical health); MATI, etc. preferred
• Experience and knowledge with the following preferred
• Collaborates and coordinates with providers and/or members of the treatment team to evaluate clinical appropriateness of treatment and interventions, and assist with the management of treatment across the continuum of care
• Works to ensure treatment provided is timely, and designed to meet the member’s individual needs
• Works with providers and facilities to monitor and evaluate care at regular intervals to ensure progress towards goals
• Uses Beacon Health Options’ clinical policy and procedures to administer benefits as designed by the member’s plan
• Documents clinical data and certification decisions into the appropriate system, consistent with established guidelines and policies
• Excellent written and verbal communications skills required
• Excellent PC Skills
• Working online in various clinical information systems, the Care Manager collects clinical data from the caller that is sufficient to make appropriate referrals, level of care recommendations, and certification decisions
• The Care Manager collaborates with providers to determine adequate and essential levels of care and to facilitate transfers to appropriate facilities and providers
• Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply Beacon Health Options criteria and render certification decisions that are within the scope of practice that is relevant to the clinical areas under review. Utilizes professional knowledge to apply Beacon Health Options and contract-specific criteria in render certification decisions. Applies Beacon Health Options policies and procedures consistently
• Strong customer service orientation and excellent written and verbal communications skills
• Ability to function in interdisciplinary setting
• Directs members to an appropriate therapist or provider and reviews care on a regular basis to determine whether treatment meets criteria for medical necessity
• Coordinates with other Care Managers to assure that patient comprehensive treatment needs are met
• Completes telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
• Empowers providers to coordinate member care whenever possible, directly coordinates member care when necessary
• Manages Intensive Case Management (ICM) case load as assigned
• Ensures continuity of patient care through contact with providers
• Assists in managing treatment waiting lists through member engagement and provider contact
• Utilizes rounds and case consultations to Clinical Supervisor and Medical Director for cases outside criteria or not progressing
• Negotiates with provider if treatment does not meet criteria and refers cases to an MD or Senior Clinical Consultant if unable to compromise with the provider
• Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply criteria and renders certification decisions
• Refers cases that do not meet criteria and need non-decision to Medical Director
• Monitors local service center compliance with HIPAA Privacy and Confidentiality Standards and recommends corrective action as needed to regional manager
• Provide beneficiaries and external customers with accurate information regarding benefits and utilization management practices, in accordance to Policies and Procedures and Standard Operational Procedure (SOP)
• Reviews the ABA initial behavioral plan, psychometric testing standards, and progress report(s) submitted by treating provider(s). Determines if all TRICARE standardize components are indicated such as support targeted skills, goals and objectives that are measurable, time limited and appropriate for beneficiaries
• Reviews ECHO referrals received through all reports, directly referred by fax, telephonic, or web based pend system. Verifies that beneficiary meets ECHO criteria. Attempts to contact eligible beneficiaries/families to offer ECHO services in compliance with TRICARE, VO and URAC standards and timeframe. Open referral or factually deny as appropriate
• Demonstrates a working knowledge of the benefits of the Extended Care Health Option (ECHO) and Autism Spectrum Demonstration (ASD) and application requirements. For beneficiary’s approved for ECHO benefits, authorize appropriate provider(s) for services under ECHO (such as respite care and Durable Equipment) and for ASD ABA Reinforcement in accordance with Standard Operational Procedures (SOP)
• Ensures integration of care and effective utilization of resources through review of existing documentation, discussion of services with providers and members, application of clinical guidelines and appropriate authorization of services
• Responsible for initial and concurrent clinical review and authorization of medically necessary services for assigned contracts
• Documentation and Coding Entries - Demonstrates thorough, relevant clinical documentation and accurate coding on electronic health record computer screens
• Contractual Adherence - Adheres to contract specific work flows and related policies and procedures. Attention to detail and accuracy of completed work is essential
• Emergency Call Management – Triage members calling in crisis for immediate clinical assessment and referral to appropriate care
• Excellent telephonic customer service skills and computer skills are required
• Successful candidate must have proven track record of customer service, strong work ethic and be prepared to support teammates in the mission of excellent service to providers and members
• This is an exempt position and the successful candidate will be considered essential personnel for call center coverage and operations support
• Complete telephone and in-person assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider and for emergency, urgent, and routine referrals
• Coordinates with other Care Managers within Beacon as well as within other facilities/agencies such as primary care physicians and specialists to ensure that patient comprehensive treatment needs are met
• Prepares for and participates in all clinical rounds and clinical meetings and as needed in person meetings at the Manhattan office
• Identification of all assigned ICM Members
• Independent and individualized assessment of members enrolled in ICM
• Development of a member centric care plan in collaboration with the member and his/her treatment team
• Managing, coordinating care, and identifying strategies to meet care plan goals of assigned ICM Members
• Collaboration with community based providers
• Utilization Review for designated ICM Clients for diversionary levels of care
• Assist in collection of outcomes information, annual analysis and other reporting and initiatives
• Telephonic collaboration and coordination with provider and community agencies regarding ICM members and care planning meetings as needed
• Urgent and crisis calls
• Treatment Record Reviews
• Utilization Review of non-ICM members as needed
• Managing, coordinating care, tracking and reporting of all assigned Members in care management
• Telephonic collaboration with provider and county agencies regarding members in treatment
• Collaborate with Primary Care Physician (PCP), Behavioral Health Professionals (BHP), and other members of the health care team, including health plan medical care managers and others to arrange and coordinate services for the member and optimize the member’s ability to engage in the appropriate plan of care
• Urgent calls
• Telephonic collaboration with Members
• Advanced computer skills required, including working knowledge of MS Office: Word, Excel, and PowerPoint
• Reviews for medical appropriateness of psychiatric and substance abuse treatment utilizing ValueOptions’ clinical criteria, policies and guidelines
• Generates the appropriate correspondence within established timeframes
• Provides appropriate referrals and assistance to members and providers in an effort to promote timely, quality care in the most appropriate treatment setting
• Utilizes clinical rounds and case consultation with clinical supervisor, peer advisors and/or medical director for cases outside the criteria or those that are not progressing
• Documents rounds consults as required in the system
• Refers cases formally to the peer advisor when unable to render a certification decision using ValueOptions’ clinical criteria and guidelines
• Documents VSP cases as required per standards
• Assists facilities in transition and discharge planning. Ensuring appropriate discharge plans
• Assists with activities to promote continuous quality improvement in the department
• Performs concurrent reviews for inpatient care and other levels of care as allowed by scope and practice and experience
• Provides information to members and providers regarding mental health and substance abuse benefits, and community treatment resources
• Interacts with providers and facilities in a professional, respectful manner that facilitates the treatment process
• Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria
• Complies with Beacon’s standards for documentation of clinical information, clinical contacts and authorization of care
• Schedules outpatient appointments as necessary based on urgency and clinical need
• Assists with NCQA, URAC and other QI initiatives
• Experience in SMI, SUD, co-occurring disorders
• Participates in assessment of member needs and develops a person centered service plan (PCSP) of care to address identified needs. Utilizes whole person focus when assessing needs including behavioral, physical, psychosocial, and activities of daily living
• Develops, coordinates and assists with implementation and facilitation of services for community support and services program members as defined by the PCSP
• Responsible for facilitating and coordinating with the inter-disciplinary team to review the PCSP and ensure access to services and active care team participation. Collaborates with FIDA program member/family, physician and all members of the healthcare team, both internally and externally
• Coordinates the delivery of high quality-cost effective care based on the members’ needs and the integrated support and services model supported by clinical practice guidelines established by the plan
• Advocates for the FIDA services member/family among various sites to coordinate resource utilization and evaluation of services
• Bi-Lingual Spanish/English Preferred
• Knowledge of treatment care resources as well as available levels of care, ability to relate effectively with behavioral health and medical treatment providers, including MLTSS Members, family members and other professionals
• Must be authorized to drive and have a valid license
• Coordinates with the member and provider to assure that members’ comprehensive treatment needs are met
• Completes telephone assessments and referrals; gathers demographic and clinical information to connect member with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent, and routine referrals
• Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply VBH-PA criteria and renders authorization decisions. Refers cases that do not meet criteria and need non-authorization decision to Peer Advisor
• Applies utilization management policies and procedures for determination of initial, concurrent and retrospective review
• Utilizes clinical rounds/supervision and case consultations with Clinical Supervisor/Manager and Peer Advisor for cases that do not meet medical necessity criteria
• Previous managed care experience preferred
• Must have prior experience in settings that include inpatient, partial, and/or outpatient care
• Completes intakes with callers to connect them with both clinical and non-clinical resources to address issues presented. Strong use of motivational counseling strategies to assist callers in following through with accessing resources. Ability to identify additional resources beyond counseling to assist callers in resolving concerns
• Participates actively as a team member to take on projects, utilizes rounds and case consultations with Clinical Supervisor/Manager/Director and Medical Director for direction and for increasing scope of knowledge
• Maintains productivity standards by effective management of calls, adherence to schedule, and developing in-depth knowledge of client and procedural nuances
• Uses technology both as a tool for documentation of case interactions and for providing relevant information to callers as a means of self-education
• 2+ years of experience in a clinical acute care position(s)
• 1+ year of experience in care/case
• Healthcare Management Systems (Generic) knowledge
• Proficient in Microsoft Office, particularly Excel
• Experience in in home health, physician’s office or public health
• Conduct advising interactions via phone and through secure messaging
• Review results of health screenings and wellness activities with program members, and make effective lifestyle recommendations that lead to meaningful behavioral changes
• Deliver diabetes-related presentations through webinars and workshops
• Design and evaluate diabetes-related programs
• Maintain a thorough knowledge of applicable Viverae policies and procedures
• Associates or Bachelor degree in Nursing or Bachelor of Science degree in Nutrition
• Registration through the Commission on Dietetic Registration (RD) orUnrestricted Texas RN license preferred
• 2 - 3 years nursing experience in a hospital setting, acute/direct care, or as a telephonic Case Manager/Disease Manager
• Certified as Diabetic Educator (CDE) required
• Certified Case Manager preferred
• Experience in health promotion/wellness a plus
• Able to use Microsoft Office Suite (Word, PowerPoint, Excel), email and the Internet
• Must be able to work a 20 hour per week consistent schedule (working hours/schedule can be set by Care Manager anytime Monday-Thursday 7a-7:30p and Friday 7a-6p but must be the same schedule each week). One late night per week until 7:30p is required - excluding Fridays)
• Carries a caseload consistent with contract expectations. Perform on-site case management at targeted community locations
• Coordinate service delivery ensuring continuity of care
• Be knowledgeable about in and out of plan benefits
• Engage hard to reach members in case management transitioning cases to office based case managers as appropriate
• Assist members in accessing care by educating providers and members
• Obtain signed releases of information from members via on site, face to face collaboration with providers and members
• Identify individual limitations, deficits, and strengths and aggressively attempt to provide patients with what they need in relation to medical, behavioral and social needs
• Help reduce the negative consequences to the individual when there is a lack of follow up and participation in treatment
• Access case management software systems remotely from provider sites to expedite referrals to case management and educate providers with referral information for other services, providers, and overall care continuum.Educate providers about Beacon’s Case Management program inclusive of the referral process
• Collaborate with hospital liaisons at the local Community Mental Health Centers and Emergency Service Teams to assist in expedited linkage to diversionary levels of care for members
• Collaborate with hospital liaisons at the local Community Mental Health Centers and with emergency service teams (including local emergency rooms) to assist in expedited linkage to care for members
• Attend/participate in acute care discharge planning meetings as appropriate
• Participate in daily rounds from provider sites, when applicable
• Participate in meetings, as needed, to discuss feedback from providers/members regarding the continuum of care. Additionally, assist in identifying gaps in covered services
• Coordinate referrals to Medical Management Case Management as appropriate and assist with identification of and outreach to medically compromised members
• Identify opportunities for collaboration with providers, state agencies, and other community organizations
• Supports the development of solutions for issues and presents recommendations to the Manager of Clinical Operations and/or Clinical Director
• Works with members, providers and community stakeholders to ensure that members receive education, coordinated services and advocacy that support optimal clinical outcomes
• Assist in the collection of outcomes information, annual analysis, and other reporting and initiatives
• Educate providers, state agencies, and other community organizations regarding Beacon case management and the continuum of care
• Up to 50% of travel required
• Case Managers are required to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management and must be a licensed behavioral health clinician. Re-verification to occur at a minimum of every 3 years
• Coordinates with other Care Managers within the organization as well as within other facilities/agencies to ensure that patient comprehensive treatment needs are met
• Have extensive knowledge of community resources/services
• Prepares for and participates in all clinical rounds
• Identification of all members eligible for Case Management
• Outreach and engagement of identified members
• Independent and individualized assessment of members enrolled in Case Management
• Managing, coordinating care, and identifying strategies to meet care plan goals of members enrolled in Case Management
• Utilization Review for members admitted to inpatient and non-24 hour levels of care
• Telephonic collaboration and coordination with provider and community agencies regarding Care Manager members and care planning meetings as needed
• Site visits to high volume inpatient providers and complex case treatment team meetings
• A current valid unrestricted NY license in behavioral health (LCSW, LMHC, LMFT) or Nursing RN
• Minimum of three (3) years of combined direct behavioral health clinical and/or managed care experience
• Current, valid and unrestricted independent licensure for practice required with proof on date of hire. Re-verification will take place no less than every 3 years
• Demonstrated experience establishing relationships and effectively engaging with members and providers through telephonic communication to obtain necessary information for the purposes of care management and coordination
• Demonstrated work experience meeting strict deadlines and established cycle times through effective prioritization and follow-up skills
• Care Managers are required to be educated in current principles, procedures and knowledge domains of case management based on nationally recognized standards of case management and must be a licensed behavioral health clinician or RN. All case managers must practice within the scope of their license
• Assess the needs of students in regards to campus and community resources and make the appropriate referrals
• Assist students to plan, coordinate, advocate and navigate through referred services on campus
• Follow up with students and clinical staff in regards to referral services and conduct ongoing assessment to determine continued needs
• Collaborate with campus and community programs/services and advocate for students and their needs as appropriate
• Collaborate with campus partners, staff/faculty, and parents as appropriate
• Maintain continuity of care for students by providing support and coordination of care and services with other mental health professionals
• Coordinate, maintain and update the campus and community referral database
• Providing assessment and time-limited counseling services for individuals and couples
• Managing clinical crisis and triage services
• Providing group counseling services through a general therapy group or a group that addresses a specific clinical issue or the needs of a particular population of students
• Providing outreach and clinical services that address the needs of the general student population as well as the needs of traditionally underserved populations
• Participating in psychological emergency and trauma response
• Training/supervising doctoral interns, practicum counselors and undergraduate paraprofessional service providers
• Participating in other outreach, training, and consultation team activities
• Participating in various Student Affairs activities and committees
• Demonstrated experience functioning at a high level as a generalist counselor in a diverse setting is required
• Demonstrated interest, expertise, and experience in case management in a mental health setting is required
• Previous experience in a college counseling center preferred
• Associate's Degree with 2+ years of experience or Bachelor's Degree
• 3 years of relevant clinical experience within a Home Health function
• Experience screening for common mental health and/or substance abuse disorders
• Experience caring for children in the welfare system
• Experience working with the underserved, transient populations
• Familiarity with brief, structured intervention techniques
• Knowledgeable in psychosocial treatments
• Registered Nurse or Social Worker license
• Assist patients through the healthcare system, while supporting self-management of disease
• Provide patient education in self-management
• Assist patient in understanding their plan of care and anticipated outcomes
• Coordinate with community partners and other healthcare entities for continuity of care
• Participate in community outreach and sponsored community events
• Participate in data collection to help monitor health outcomes
• May supervise student volunteer or student clinical experience
• Attend required meetings
• Have the ability to communicate effectively in English & Spanish to meet the needs of the clinic constituents
• Have the ability to communicate effectively verbally and written form
• Be proficient in Microsoft applications to include Outlook, Office Word, PowerPoint, & Excel
• Exhibit a positive professional demeanor at all times when working with patients
• Ability to work in a team setting or individually with little to no supervision
• Ability to think critically to meet goals and timelines
• Ability to be a self-starter, be self-innovative, be self-disciplined,
• Exhibit confidence in communicating working with patients, families, team, and community
• Have experience working with electronic medical records (EMR)
• Have experience working community partners and developing relationships
• Have at least 3 years experience working with patients in a medicalmbulatory healthcare setting
• Be BLS certified
• Location/Facility – Baylor Scott & White Hillcrest Medical Center
• Associate’s Degree in Nursing Required
• Texas RN License Required
• 2+ Years’ Experience Required
• 2+ years of clinical nursing experience in an acute care or community setting and 1+ years of case management experience in a managed care setting is required
• Current state’s RN License is required
• Long Term Acute Care Experience or Home Health Experience translates well into this position (preferred)
• Previous Medicare experience (preferred)
• Conduct comprehensive patient assessments to include: psychosocial needs, functional needs and patient understanding of their chronic conditions in order to identify gaps and barriers to optimal care
• Act as a patient advocate by coordinating with and referring to health plan(s) utilization and disease management program(s) where appropriate
• Assess clinical information to develop an individualized care or transition plan, as appropriate, to address services necessary to safely transition the patient to the community, including but not limited to, patient needs related to housing, transportation, availability of caregivers and other transition needs and supports
• Develop collaborate care plans, in conjunction with physician, patient and health plan to address and achieve immediate and ongoing needs and goals, especially those patients identified as high risk
• Coordinate with patient’s primary care provider, specialists, and other providers and care programs to ensure comprehensive, holistic, person-centered approach to care
• Routinely assess and monitor patient’s status, needs, and progress. If progress is static or regressive, determine reason and proactively encourage appropriate adjustments in their plan of care, providers and/or services to promote better outcomes
• Maintain current knowledge of disease processes, treatment protocols and evidence-based guidelines
• Consistently and thoroughly document activities and interactions
• Educate patient and/or caregivers regarding treatment plan(s), medication use and adherence, preventive care and self-management skills
• Monitor and encourage utilization of covered services including, physical health, behavioral health, and/or home and community based resources as a cost-effective patient alternative
• Develop, implement, and evaluate targeted program strategies to improve health, functional, or quality of life outcomes, such as disease management or pharmacy management
• Minimum of three years’ experience in a physician practice, acute care hospital and/or care/disease management program required
• Three to five years of experience in care management, disease management, population health management or other related health care environments preferred
• Strong clinical knowledge of chronic disease pathophysiology, treatment, patient assessment, and patient/family/support system education required
• Excellent verbal and written communication skills, including strong presentation skills required
• Skills and experience in establishing and maintaining effective working relationships with physicians, patients, staff, teammates and the public preferred
• Must be PC proficient with knowledge of Microsoft Office Suite including: Excel, Outlook, Word and PowerPoint
• Responsible for initiating contact with a designated minimum number of assigned members; explaining and enrolling them in the care management organization. This may involve phone contact, written contact and/or face to face contact in the community in order to reach members
• Responsible for meeting the required face to face direct contact hours with Members in the community
• Once members have been enrolled, conduct, convene, and lead treatment planning/care coordination meetings in community with collaterals. Utilize individual Member medical, behavioral, pharmacy and utilization data to co-create, with Members’ individual crisis plans and coordinate their care
• Implements the comprehensive plan of care. Build relationships and assist members and families/supports in understanding and carrying out treatment care plans with a primary emphasis on meeting members face to face and in the community
• Represents the department as an active contributing member and/or in a leadership or project management role on projects and initiatives, such as performance incentive teams, committees, and task forces, as determined appropriate by the supervisor
• The position requires excellent communication skills, both verbal and written, and the demonstrated ability to relate effectively to behavioral health and medical treatment providers, Members and family members, and other professionals involved in the treatment of the Member
• Familiarity with and ability to effectively utilize computer technology is also required
• Conduct prospective, concurrent, and retrospective review of active patient care on-site or telephonic, where assigned. Review patients' clinical records within 48 hours of SNF admission. Review patient referrals within the specified CM policy time frame
• Communicate authorization/denial for services to appropriate parties. Communication may include patient (or agent), attending/referring physician, and facility administration as necessary
• Initiate and/or oversee data entry into IS systems on all patients within 24 hours of patient contact. Maintain accurate and complete documentation of care rendered including LOC, CPT code, ICD 10, referral type, date, and etc
• Telephonic assessments, collecting sufficient clinical information to make appropriate referral and certification decision for emergency/urgent referrals that require alternate levels of care
• Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible.Screen incoming subscriber and provider calls/inquiries and take data to initiate cases
• Evaluates clinical appropriateness of treatment using professional knowledge within ValueOptions clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions
• Facilitates coordination of care with other managers to assure continuity of care
• Strong customer service orientation and excellent written and verbal communication skills required
• Maintains a caseload of higher level of care cases(IP, RTC, PHP, IOP) and, completes concurrent reviews, scheduling MD-MD reviews as needed and coordinates with facility discharge planner on post discharge follow up care
• Participate in scheduled staff meetings and trainings
• Current California Licensure as a Registered Nurse
• Have either a current, valid, unrestricted independent license in behavioral health or nursing (RN) and practice within the scope of their licensure
• Advanced level of PC skills required
• Determines appropriate level of care related to mental health and substance use treatment for members based on Beacon medical necessity level of care criteria
• Consults with Beacon Physician Advisors (PA) when requests for services do not meet medical necessity criteria
• Interacts with Physician Advisors to discuss clinical/authorization questions, alternative treatment options and concerns regarding specific cases
• Provides information to members and providers regarding mental health and substance use benefits and community treatment resources
• Provides telephone triage and crisis intervention to callers and, when necessary, assists with ensuring members have access to local services and resources
• Identifies and refers high risk members to care management
• Recognizes quality of care issues and reports them appropriately through internal and external processes
• Interacts with providers and facilities in a professional, respectful manner
• Complies with all Beacon policy guidelines, external regulatory requirements and URAC/NCQA accreditation standards
• Demonstrates thorough understanding of product lines and benefit structure for all contracts assigned
• Participates in clinical rounds
• Make timely referrals for community based services
• Document care management activities in FlexCare according to Beacon Standard Operating Procedures
• Demonstrate flexibility and creativity in the design of innovative and individualized care plans in order to achieve maximum effectiveness and optimal outcomes for members and their families
• Participate in member/family meetings to support integrated efforts and collaboration with the health care team
• Provide assistance, advocacy, and empowerment to members in efforts to achieve optimal health
• Clinicians are required to be educated in current principles, procedures of behavior health care. Managed care and state specific expertise and knowledge of community resources experience preferred
• Completes UAS and other relevant screening and assessment tools in the member's home
• Develops, implements and monitors the care plan, assisting members in obtaining reasonable accommodations when appropriate
• As the lead of the interdisciplinary team, facilitates the activities and communication within an interdisciplinary team of providers, vendors, facilities, discharge planners, field nurses, social workers, care coordinators, and member/caregivers to effectively manage care plans and transitions of care settings
• Maintains timely, complete and accurate documentation using both hard copy and technology based solutions in compliance with regulatory policies and procedures
• Monitors inpatient and intermediate level of care services related to mental health and substance abuse treatment to ensure medical necessity and effectiveness
• Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria
• Interacts with Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases

Body Care Manager Resume Examples & Samples

• 1-2 years of experience with body care and/or related experience
• 1-2 years of experience supervising others, preferred
• Ability to manage changing priorities
• Possesses a sense of urgency in the completion of tasks
• Possesses excellent customer service skills
• Ability to stay focused with the task at hand
• Must be cashier trained
• Proficient in MS word, excel and outlook
• Previous experience in a retail environment; natural foods background a plus
• Manage crisis calls from individual and corporate clients
• Assess risk
• Create safety plans
• Determine appropriate next steps to minimize risk
• Performs initial triage of calls and performs crisis stabilization, where warranted
• Frequently makes decisions to adjust his/her schedule to manage crisis calls and determine and provide appropriate critical clinical intervention
• Assess members for risk issues and creates safety plans
• Follows up on cases in accordance with Division Standard Operating Procedures (SOP)
• Participates in clinical reviews and collaborates with supervisor for treatment plans for high risk cases
• Coordinates and provides on-site Critical Incident Stress Debriefing (CISDs) 24/7 as needed
• Responds to after hours and weekend crisis calls for assistance
• Performs other duties as assigned assisting in creating SOPs, making recommendations, etc
• Minimum 3 years of mental health experience required preferably in a health care environment
• Experience assessing and referring individuals seeking care for variety of mental health issues including substance abuse concerns
• Proven track record performing case management responsibilities
• Manage, coordinate care, track and report all assigned Member in Care Management
• Maintain accurate information in Beacon’s clinical documentation systems as directed
• Telephonic collaboration with provider and county agencies regarding members in care management
• Participate in systems meetings as needed
• Collaborate with Primary Care Physician (PCP), behavioral health professionals, County personnel, and other members of the health care team, including health plan Medical Care Managers, pharmacies, community based providers and others to coordinate services and optimize the member’s ability to engage in the appropriate plan of care
• Develop a member-centric care plan in collaboration with the member
• Oversee the plan of care for each assigned member, adhering to documentation timelines
• Conduct an assessment of health needs, and monitor and evaluate care outcomes
• Respond to urgent and crisis calls
• Other duties assigned
• Educated in current principles and procedures of behavior health care. Knowledge of managed care and state specific expertise preferred
• Responsible for clinical decisions related to beneficiaries seeking access to their benefits for Mental HEalth or Substance Abuse Services for all levels of care using established criteri, guidelines and policies
• Builds positive professional rapport with providers and communicates effectively
• Utilizes rounds and case consultations woth Clinical Supervisor, Peer Advisor for cases outside criteria or not progressing
• Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are met and that there is continuity of patient care
• Maintains confidentiality, ethical and professional standards, adhering to Clinical Policy and Procedures and Benefit Plan requirements
• Microsoft operating systems
• Carelink and/or MHS
• CANVAS/PRISM

Care Manager Senior Resume Examples & Samples

• Performs concurrent reviews with treatment team providing ABA services
• Performs initial case requests for autism services, behavioral health and ABA. Reviews all submitted materials and consultation with treatment team providers. Reviews IEP, psych testing and other case evaluation materials
• Provides information to members and providers regarding mental health and autism benefits, community treatment resources, mental health managed care programs, and company policies and procedures, and criteria
• Interacts with the company's Medical and Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
• Leads or participates in activities as requested that help improve Care Center performance, excellence and culture. Supports team members and participates in team activities to help build a high-performance team. Demonstrates flexibility in areas such as job duties and schedule in order to aid Care Center in better serving its members and to help the company achieve its business and operational goals. Assists Care Center efforts to continuously improve by assuming responsibility for identifying and bringing to the attention of responsible entities operations problems and/or inefficiencies
• Maintains an active work load in accordance with Care Manager Performance Standards. Works with community agencies as appropriate. Proposes alternative plans of treatment when requests for services do not meet medical necessity criteria. Assists network by identifying gaps in the network and quality providers. Advocates for the patient to ensure treatment needs are met. Interacts with providers in a professional, respectful manner that facilitates the treatment process
• Performs concurrent reviews for inpatient care and other levels of care as allowed by scope of practice and experience. In conjunction with providers and facilities, develops discharge plans and oversee their implementation. Provides telephone triage, crisis intervention and emergency authorizations
• Provides information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Magellan Health Services policies and procedures, and criteria
• Interacts with the company's Medical or Associate Medical Directors and/or Physician Advisors to discuss clinical and authorization questions and concerns regarding specific cases
• TRF's to be reviewed by Master's level Care Manager only. RN's may perform all other related duties

Expert Care Manager English Resume Examples & Samples

• Provides Expert Care help desk coverage via telephone, email and internet for all Expert Care customers
• Keeps all customer-specific documentation and Knowledge@Ariba content items updated for their assigned customers
• Acts as an internal advocate for customer-specific application needs – championing customer’s interests within Ariba
• Assists customer’s Expert Care contacts with understanding of new features and functionality due to product upgrades
• Assists customer’s Expert Care contacts with knowledge of known product defects and workarounds
• Coordinates communication regarding site issues and outages including site upgrades
• Fluency in English' English and French
• Minimum of three years of related experience, preferably supporting or implementing Ariba products in a customer-facing environment
• Works in a high-volume, clinical call center environment, answering inbound calls to assist members access mental health, substance use and employee assistance programs
• Conducts brief telephonic, clinical assessments to determine appropriate level of care, per Beacon Health Options/ValueOptions of California (VOC) criteria for medical necessity, and connects callers accordingly
• Must be knowledgeable about care resources and levels of care available
• Coordinates with other Clinical Care Managers to assure that patient comprehensive treatment needs are met
• Maintains individual productivity and performance standard, as well as the telephone service standards with are in effect at the time; Maintains positive working relationships with internal and external co-workers and customers to ensure optimal efficiency of service; Maintains confidentiality and ethical and professional standards at all times
• Strong customer service orientation, excellent written and verbal communication skills
• Knowledge of Microsoft Communicator/Skype for Business (Instant Message usage)

Pain Management Lcsw Care Manager Resume Examples & Samples

• Completes relevant screening and assessment tools to determine member readiness, level of risk and need for chronic pain case management
• Develops, implements and monitors the individualized Chronic Pain Plan, with specific, quantifiable goals and desired outcomes for members who meet criteria for intensive chronic pain case management
• Follows guidelines of the Chronic Pain Case Management Program with respect to engagement, enrollment, case management activities, and discharge
• Gathers and summarizes data for reports
• Conduct participant standardized assessments, including the verification of medical history and document all responses within a web-based software system accessible to the entire care team
• Conduct telephonic education of self-management strategies for specific chronic diseases or other health conditions (asthma, diabetes, cardiovascular disease, COPD, or maternity)
• Develop individualized care plan for disease management participants as indicated by program protocols
• Remain current in the key patient educational concepts for self-management of specific chronic diseases or other health conditions (asthma, diabetes, and cardiovascular disease, COPD, or maternity)
• Participate with team on case conferences as scheduled to ensure support from colleagues in optimizing strategies to assist our members
• Coordinate disease management activities with the respective health plan teams by referring to UM, MCM, MS, HE as necessary to support the wellness of the member. Contact the participants' PCPs as necessary to support the member in the disease management program
• Meet department goals and metrics
• Corporate Disease Management – Provide DM services for all programs - CA, UT, WA, MI, NM, TX, OH, MO, FL, WI
• Bachelor's degree in health education or other related health science fields
• At least two-years experience conducting patient teaching related to chronic disease within an acute facility, ambulatory medical group practice, or community outpatient clinic required
• At least one- year experience working with culturally diverse and low-income populations
• Managed care experience is highly desirable

LVN, Care Manager Resume Examples & Samples

• Minimum: At least 1 year of recent clinical experience
• Preferred: 3 to 5 years of recent clinical nursing experience
• Thorough understanding of LVN scope of practice

Pastoral Care Manager Resume Examples & Samples

• Recent Supervisory experience required
• Bachelor's Degree in related field required
• Certified by the National Association of Catholic Chaplains or College of Chaplains preferred but not required
• Two(2) years of related work experience preferred
• Case management and discharge planning experience
• Crisis intervention skills
• Knowledge of Microsoft Office suite
• Experience working in the field highly preferred
• Respond to member’s crisis by providing crisis counseling, refers to providers or community resources to assess member needs, and reviews requests for service authorizations for designated services
• Provide prior authorizations, peer reviews and referrals to facilities, providers and group practices and other services as appropriate
• Provide comprehensive evaluation and treatment planning by providing concurrent reviews and discharge planning for continuity of care to members
• Present and review cases with the Medical Director and Associate Medical Directors to promote member treatment and after care
• Basic computer skills, PC and Win Fax
• Knowledge of MS Applications
• Knowledge of AIS systems
• Assists with education and collection of data for HCC coding and STARS/HEDIS measures
• Identifies members to refer to Disease Management and /or High Risk Programs
• Ability to establish and maintain effective working relationships with Health Plans, and local personnel
• Has 2 years nursing experience or 1 year of Hospice experience
• Has current BLS certification
• Hospice nursing experience is preferred

Transitional Care Manager, Team Lead Resume Examples & Samples

• Responsible for the direct supervision of the transitions team including clinical and non-clinical staff
• Provides clinical oversight and supervision to non-registered nurse staff
• Works in conjunction with the Manager of Care Management on training and team development
• Designs transition of care plans with the patient. Collaborates with the patient/family, hospital team, primary care team, specialists, SCHN Medical Director, Extended Care Case Managers, Social Workers, Wellness Coordinators and other Steward Health Care Network programs, community services, and other members of the health care team to ensure safe transitions of care, effective coordination of services, and full understanding and execution of the care plan
• Actively reviews available reports, considers care management (CM) impact; recommends and makes modifications to the plan of care, as needed
• Maintains required medical documentation for case management activities in the system's care management module (electronic medical records), according to the standards of work
• Meets regularly with each direct report individually to review cases and provide coaching and mentoring; conducts regular staff meetings
• Identifies staffing needs to support the organization and develops staffing strategies to ensure appropriate coverage to meet daily and unexpected requirements
• Follows standards of work and consistently maintains department established caseloads and timeframes for case completion. Participates in the refinement of and development of new standards of work
• Responsible for implementation, monitoring and adherence of time off policies and procedures
• Identifies on-going educational needs and opportunities for staff based on the requirements of the position and specific needs of the individual
• Develops plans for corrective action in areas identified for improvement
• Evaluates processes, identifies problems, and proposes improvement strategies to enhance the delivery of care for patients throughout continuum of care. Maintains awareness of key performance indicators/metrics and manages caseload through appropriate management of medical expenses. Coordinates interventions to prevent adverse events such as ED visits, hospital admissions and readmissions
• Meets regularly 1-1 with the Manager of Care Management to review caseload and discuss barriers/challenges and review performance compared to current targets/expectations
• Demonstrates leadership that creates and fosters a culture of continuous improvement in the department
• Documents and reports all quality and patient safety events by recording and adhering to all of Steward Health Care Network's safety reporting guidelines
• Performs all job functions in compliance with applicable federal, state, local, and company policies and procedures
• Must exhibit excellent critical thinking skills, problem solving, interpersonal, and good patient interviewing skills
• Highly motivated and self-directed
• Ability to interpret clinical information, assess the implication of treatment and develop and implement a plan of care
• Ability to lead and motivate others to execute a plan in a rapidly changing environment
• Demonstrated ability to prioritize, multitask, and work in a rapidly changing environment with multiple demands
• Ability to work collaboratively with health care professionals at all levels to achieve established goals and improve outcomes
• Strong current working knowledge of care management and health care across the continuum
• Ability to utilize tools for the effective documentation of the care management process
• Ability to work effectively in a team
• Ability to travel to attend chapter POD meetings as necessary and to visit select practice sites for meetings with patients, PCPs and other members of the care team
• Attend staff meetings and education offerings both in person and via teleconference as required
• Implements current policies and procedures set by the Care Management department
• Reviews patients’ clinical records of acute inpatient assignment within 24 hours of notification
• Reviews patient referrals within the specified care management policy timeframe (Type and Timeline Policy)
• Coordinates treatment plans and discharge expectations. Discusses DPA and DNR status with attending physician when applicable
• Prioritizes patient care needs. Meets with patients, patients’ family and caregivers as needed to discuss care and treatment plan
• Acts as patient care liaison and initiates pre-admission discharge planning by screening for patients who are high-risk, fragile or scheduled for procedures that may require caregiver assistance, placement or home health follow-up
• Identifies and assists with the follow-up of high-risk patients in acute care settings, skilled nursing facilities, custodial and ambulatory settings. Consults with physician and other team members to ensure that care plan is successfully implemented
• Attends all assigned Care Management Committee meetings and reports on patient status a defined by the region
• Maintains effective communication with the health plans, physicians, hospitals, extended care facilities, patients and families
• Provides accurate information to patients and families regarding health plan benefits, community resources, specialty referrals and other related issues
• Follows patients on ambulatory care management programs, including CHF and home health, in order to optimize clinical outcomes

Neurology Integrated Care Manager Resume Examples & Samples

• Achieve assigned sales goals by interacting with HCP’s to educate and drive demand for Eisai’s Epilepsy Brands
• Analyze the local environment and identify/understand influencers within the assigned ECE accounts, translate knowledge into actionable market insights to develop customer plans that optimize brand positioning, drive demand and improve patient outcomes
• Develop internal cross functional relationships with sales, market access, medical, HEOR and other necessary cross-functional team members to ensure a high level of integrated planning to facilitate collaboration and the exchange of information including ECE customer knowledge
• Develop and maintain relationships with key stakeholders within accounts (e.g., KOLs, Medical Director, Quality Director, C-suite, Director of Pharmacy, Industry Relations, etc.) and identify opportunities for further engagement
• Monitor progress in accounts and evolve action plans as appropriate (contacts, plan execution, volume growth, and market share); Manage overall commercial performance of accounts
• Align budgets and resources to account(s) in a way that optimizes return on investment
• Partner with local representatives and DMs to ensure pull-thru and progress of the plans and goals built for the surrounding communities of the ECE
• Accountability and adherence to corporate, FDA, and PDMA guidelines
• BA/BS Degree required; MBA or advanced degree in a related field preferred
• 7-10 years of previous specialty pharmaceutical, biotech, or medical marketing/sales and account management experience required
• Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in local area required/highly preferred
• Understanding of integrated health system operations and integrated care delivery models, including economics, supporting processes and behaviors
• Knowledge of IDN needs, population health management, ACOs, and risk-based payment models; Understanding of the application of HEOR
• Understanding of the processes for developing formularies, protocols, and order sets, and how they are used to influence treatment decisions at the physician level
• Thorough clinical understanding of the epilepsy therapeutic area preferred, including in-patient and out-patient care management
• Ability to develop and manage relationships, and tailor communications to a variety of audiences in both a B2B and clinical context, especially at C-Suite level (e.g., executive presence)
• Understanding of the market access and reimbursement landscape, hospital buying process, hospital contracting process,
• Entrepreneurial nature and ability to think strategically and creatively to influence, meet, and adapt to changing customer needs
• Demonstrated ability to develop account budgets and conduct account sales analysis
• Ability to effectively collaborate with a variety of stakeholders, internal and external to the organization
• Ability to meet the travel requirements of the role based on assigned ECE’s

Associate Director Neurology Integrated Care Manager Resume Examples & Samples

• Lead their NICM team in deriving, validating, and leveraging customer and account insights on a regular basis. Work with NICMs to develop solutions that best address those needs while facilitating involvement of the necessary business personnel inclusive of support, service, and resource management in order to meet key account performance objectives
• Responsible for gaining and applying a deep understating of relevant markets, business models, strategic priorities, future direction, financial drivers and leadership profiles of key customers within Epilepsy Centers of Excellence accounts. This includes understanding and engaging in key local and national, health care issues/strategies, customer issues/trends and best practices to establish credibility beyond product and therapeutic areas
• Take an active leadership role with NICMs to ensure the development and pull through of Strategic Account plans consistent with achieving regional and corporate goals
• Cultivate effective relationships with Key C-Suite and administrative roles within an account (CEO, CFO, CMO, Pharmacy Director, Medical Director, Case Management, Dir. of Quality, Industry Relations, etc.)
• Recruit, develop, train, coach, assess, motivate and retain talent to achieve Neurology portfolio goals
• Develop and present in conjunction with the NICM sound clinical, pharmaco-economic and business presentations to appropriate customers based on mutual needs/benefits
• Maintain open communication throughout the organization by partnering with relevant cross functional departments to provide leadership and insights that lead to strong relationships and the development of appropriate business strategies that support brand(s) objectives in ECE accounts
• Review and analyze product performance at the regional level and communicate account performance broadly with key internal stakeholders
• 7-10 years of previous pharmaceutical, biotech, or medical marketing/sales and account management experience required
• Experience managing major accounts and understanding influence patterns, and previous IDN/Health System selling experience in geographic area highly preferred
• A minimum of 4 - 5 years successful experience leading and coaching teams in the pharmaceutical industry (within IDN’s, Epilepsy Centers preferred)
• Understanding of integrated health system (IDNs) operations and integrated care delivery models, including economics, supporting processes and behaviors. This includes, population health management, value based care and understanding of the application of HEOR
• Thorough clinical understanding of the epilepsy therapeutic area preferred, including in-patient and out-patient care management Ability to develop and manage relationships, and tailor communications to a variety of audiences in both a B2B and clinical context, especially at C-Suite level (e.g., executive presence)
• Understanding of the market access and reimbursement landscape, hospital buying process, hospital contracting process, processes for developing formularies, protocols, and order sets, and how they are used to influence treatment decisions at the physician level
• Entrepreneurial nature and ability to think strategically and creatively to lead, influence, meet, and adapt to changing needs of both internal NCM team and external customers
• Ability to effectively lead collaborations in a dynamic environment with a variety of stakeholders, internal and external to the organization
• Ability to meet the travel requirements of the role of up to 60%
• Must be able to organize, prioritize, and work effectively to meet deadlines within in a constantly changing environment
• Strong understanding of healthcare regulatory and enforcement environments along with demonstrated integrity on the job
• Essential Elements for Success
• 2 year’s clinical experience in an acute care setting
• Strong case management skills
• 2 years of managed care case management experience
• Medicare and MLTC managed care experience
• 50-75% of field based travel is required
• One of the following licenses is required: Registered nurse (RN) with unrestricted active state license; BSN preferred; OR a state licensed independent practice behavioral health clinician (e.g. LCSW, LPC, LMFT, PhD, or Psy.D)
• Case management and discharge planning experience is strongly preferred
• Managed Care experience is strongly preferred
• Crisis intervention skills preferred
• Previous experience conducting face-to-face care management is a plus; qualified candidates must have the ability to support the complexity of members needs including face-to-face visitation
• Computer literacy and proficiency with Microsoft Excel, Word, including navigating multiple systems and keyboarding
• Knowledge of community resources and provider networks
• Familiarity with local health care delivery systems
• Familiarity with IPA (Independent Practice Association) is preferred
• Behavioral Health experience is a plus
• Strong communication skills, written and oral
• Ability to travel in the field required

P/T Clinical Care Manager Resume Examples & Samples

• Completes telephone assessments and referrals, gathers demographic and clinical information as necessary for voluntary and management-referred employees, as well as urgent and emergent EAP referrals
• Responds to client organization requests for services:Mandatory/Management referrals of employees under performance improvement plans or conditional work agreements. Intake, monitoring and case management to conclusion of treatment plan
• Will facilitate all tracking necessary quality indicators to meet these necessary accrediting bodies (NCQA, URAC)
• Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets ValueOptions criteria for medical necessity
• Establish and deliver knowledge about care resources and levels of care availability
• Must possess the ability to function in an interdisciplinary setting
• Must have knowledge and experience using management information systems
• Must be knowledgeable about care resources and levels of care availability
• Provide holistic assessment and care and complex care planning and management services
• Coordinate amongst all Interdisciplinary Care Team (ICT) members to develop the Individualized Care Plan (ICP) and oversee ICP implementation by the Care Coordinator
• Be available to the health plan and community based Case Management provider agencies for consultation when issues with regards to behavioral health management or treatment arise
• Facilitate clinical policies implementation and maintenance, assess training and development needs for, and identify clinical resources and tools to improve program effectiveness and quality. S/He will be responsible for maintaining accurate information in Beacon’s and the Health Plan’s clinical documentation systems as directed
• Identify, assess, and holistically manage complex behavioral health cases for those members who are in the dual eligible program as appropriate
• Proficiency with Microsoft Excel, Word, navigating multiple systems and keyboarding required
• Ability to multitask, prioritize and effectively adapt to a fast paced changing environment required
• Ability to work both independently and as part of a team required
• Strong written and verbal communication skills required
• Behavioral Health experience preferred
• Independent license in Behavior Health (AZ) required
• 2 years in case management experience required
• Critical areas to succeed - organization, critical thinking, collaboration and time management

Technical Care Manager Resume Examples & Samples

• Collaborate with Spectrum Care teams to identify trends in call/service reasons, resolution times, customer satisfaction results and report findings and to understand the impact of product launches, new promotions and policy and process changes
• Assist in the development and implementation of tactics in support overall Care strategy
• Maintain the Care processes and coordinate modifications through the customer care leadership team
• Manage integration and execution of new products, services and marketing campaigns
• Develop, maintain and enhance highly efficient and effective customer service deliver including coordination of information flow to and from key customer touch points and Care operations teams
• Support Corporate goals by facilitating innovations that promote continuous improvement and result in improved service delivery and/or reduced operating expenses
• Reinforce a culture of Care through the delivery of high performance customer care
• Identify trends and improve processes including more effective workflow, integration and productivity
• Assist with planning, budgeting, implementation and cost controls
• Identify Care technology improvements and trends that will drive a cost effective, positive customer experience
• Provide executive summary of monthly key performance metrics
• Implement initiatives to drive performance in Care, Sales and other key metrics
• Coach and develop direct reports and others as needed
• Participate with cross-functional team members in issue identification, process impacts, and solution development discussions
• Build relationships with all departments to ensure alignment of projects to maintain a positive customer experience
• Work closely with Field Operations to reduce contact rates and drive single contact resolution to customer complaints or problems
• Prioritize initiative and operational work to ensure resources are properly allocated to achieve business objectives
• Influence by defining best practices, identifying technologies and contributing to knowledge capital to support strategic Care direction
• Build awareness of both Spectrum and industry best practices, be a recognized leader in the broader organization
• Assist in maintaining technical and procedural documentation and standard operating procedure manuals including online media as needed
• Champion the adoption of tools and processes that conform to Care standards and best practices as defined Care and Organizational leadership
• Provide advice and assistance in the planning, implementation, and evaluations of modifications to existing operations, systems, and procedures
• Ability to work in fast-paced environment while maintaining a high level of employee morale
• Excellent planning and organization skills with ability to implement/track and deliver on quantitative goals/metrics
• Problem solving and decision-making capabilities; strong analytical skills
• Ability to collaborate and drive results in a matrix-management environment
• Minimum five years experience in a Customer Care management role
• Ability to become BASA/FASA certified
• Experience in a high volume, inbounds contact centers
• Graduate from an accredited Associate’s or Bachelor’s of Science Degree in Nursing program required; BSN preferred
• Graduate of an accredited BS program in Nursing preferred
• Licensed to practice professional nursing as a Registered Nurse in the Commonwealth of Massachusetts
• A minimum of 3-5 years recent clinical experience required, and 1-3 years of recent acute, Inpatient Care Management experience required
• Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology, how to obtain an accurate history; establish treatment goals; establish working relationships with referral sources; develop treatment plans
• Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand the physical and psychological characteristics of illness; ability to assist individuals with the development of short- and long-term health goals
• Ability to understand the requirements for prior approval by payer; be able to evaluate the quality of necessary medical services; be able to acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings
• Ability to understand case management philosophy and principles; apply problem solving techniques to the care management process; document care management services; understand liability issues for care management activities
• Knowledgeable on how to access and evaluate the available resources to meet a client's needs; able to develop new resources
• Excellent interpersonal, verbal, and written communication and negotiation skills
• Serves as a Care Manager for a designated group of patients
• Performs admission review on inpatients hospitalized longer than 48 hours and subsequent concurrent reviews using approved tools to determine severity of illness and intensity of service to ensure appropriateness of level of care. This includes intakes from outside referral sources and consult from other departments within the hospital (i.e. Emergency Room, ICU, Med/Surg, Behavior Health and Outpatient Services)
• Certifies all managed care and commercial admissions requiring approval by the insurance carrier on the next business day after admission and performs concurrent phone calls as indicated by insurance carrier to ensure hospital reimbursement
• Organizes individual patient care meetings with multidisciplinary team members and the patient/family to evaluate progress and to identify and resolve problems that may interfere with a positive patient outcome
• Assesses discharge planning needs to ensure a safe, timely and efficient discharge
• Arranges for community services (including short and long term placement) prior to discharge to meet patient’s needs with recognition and documentation of patient choice of service providers
• Provides patient education and advocacy as needed
• Identifies variances during the patient’s stay in order to evaluate and improve processes that effect the efficiency and quality of patient care
• Demonstrates effective use of hospital and community resources within established reimbursement guidelines
• Initiates physician advisor reviews on all cases not meeting established criteria for admission and/or continued stay to insure appropriate utilization of services
• Intervenes with physicians and ancillary departments concerning clinical and utilization issues to ensure an optimal patient outcome
• Communicates denials from third party payors to the physician, and/or Chief of Service or designee and the Director to ensure a timely appeals process. Reports known and/or suspected underutilization, overutilization or inappropriate scheduling of services to Director and/or UM Administration
• Keeps abreast of all current rules, regulations, policies and procedures related to Utilization Management and Discharge Planning
• 1+ year of related Case Management experience
• Master's Degree in Nursing and/or Social Work
• NYS Licensed Master Social Worker (LMSW) and/or Licensed Clinical Social Worker (LCSW)
• Previous experience as a Care Manager
• Experience with Medicaid population and/or persons with Physical Disabilities
• Initiates contact with members identified for the ICMP; explaining the care management program and completing an enrollment and assessment of members to engage them in the program. Engagement activities may involve outreach by phone, mail, and face-to-face contact in the community in order to reach members
• Implements an individualized and comprehensive plan of care using a care management software program to document member goals and track plan process
• Builds relationships and assists members and families in understanding and carrying out treatment care plans with a primary emphasis on meeting members face-to-face in the community
• Develops written and oral clinical case presentations to deliver to ICMP staff, MBHP supervisors and physician advisors in one-to-one and group settings
• Promotes and facilitates specific communication and coordination of care with Members and their PCC Plan Primary Care Practitioner(s) and Behavioral Health Provider(s)
• Participates in discharge planning activities that include aftercare referrals and referrals to community resources when engaged ICMP Members are being discharged from inpatient psychiatric or medical hospitalizations
• Consults with providers to assist Members with transportation, pharmacy, and daily living needs as they relate to individualized care plans

Lead / Complex Care Manager Resume Examples & Samples

• 4+ years of Clinical experience
• Current NYS Registered Nurse (RN) license
• Previous experience with Healthcare Plans
• As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management
• Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services and case management
• Reviews the healthcare information with healthcare team. Reviews the admitting diagnosis/problems with the healthcare team. Monitors the course of patients and the adherence of this course to clinical pathways or the patients' treatment plan
• Reviews the plan with physician, primary nurse and other members of the team as appropriate and insures that communication is taking place with patient and family
• Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations
• Facilitates communication within the health care team and with the primary care physician and other disciplines to coordinate patient's progress through clinical pathways or the patient's treatment plan
• Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient's treatment plan
• Optimizes the efficiency of hospital systems which impact quality and/or length of stay
• Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan
• Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations
• Identifies trends, themes, and consistent barriers and work collaboratively with healthcare team
• Intervenes when necessary to correct delays and to address any barriers for patients
• Utilizes information obtained from various resources available to
• Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team
• Collaborate with health care team to initiate referrals to the appropriate service and/or provider, ensuring that adequate insurance coverage and reimbursement are obtained
• Identify patients who are likely to have unmet insurance and resource needs and communicate with healthcare team members and other appropriate departments
• Communicate as needed with third party payors regarding the patient's progress with the treatment plan
• Collaborates with case manager and representatives from third party payor regarding services available when barriers are identified
• Review admissions daily to ensure appropriateness
• Assist clinicians in documenting the appropriateness of admissions and continued stays
• Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials
• Appeal of inappropriate insurance denials
• Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include
• Identifying service, treatment and funding options
• Advocating for individual needs as indicated
• Identifying gaps in the treatment and/or discharge plan
• Utilizing knowledge of internal and external resources to meet patient needs
• Identifying barriers to wellness within the treatment plan
• Coordinating and scheduling interdisciplinary meetings with the patient and family regarding discharge needs and the plan
• Ensures and/or coordinates counseling and teaching for discharge preparation
• Ensures that the discharge plan provides a continuum of care with the appropriate outpatient physician and needed services
• Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through
• Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum
• Ensure that appropriate services are provided and that necessary certifications for these services are carried out
• Works collaboratively with PSM and unit leadership team to actively involve clinical nurses in the assessment and planning for patient's discharge to facility
• Along with other members of the health care team, acts as a patient advocate
• Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk
• Educates patients and families regarding the care manager role, as needed
• Facilitates and ensures open communication among the health care team and the patient/family
• Performs miscellaneous duties as required or requested
• Formulates and implements a psychosocial care plan that addresses member identified needs by assessing member/family needs, issues, resources and care goals
• Works in interdisciplinary team to assist with complicated and high risk cases to foster positive outcomes
• LMHC, required
• Minimum of three (3) years experience in two (2) or more of the following: case management, discharge planning, advocacy, outreach, screening, referral, supportive counseling, required
• Knowledge of third party payer requirements, required
• Receives and responds to Behavioral Telehealth consult requests
• Conducts initial psychosocial assessment through Telehealth interview with patient, family and/or significant others to determine patient condition/needs
• Reports on patient to Attending Psychiatrist for psychiatric evaluation
• Receives behavioral care plan from attending Psychiatrist to coordinate treatment
• Coordinates necessary resources to move patient along continuum in a timely manner and performs administrative aspects of care management
• Completes documentation in accordance with policies and procedures of the organization, State and Federal regulations
• Excellent computer skills required: rapid typing and rapid learning of new software (8+ EMRs in use simultaneously)
• Flexibility to work weekdays and weekends, days and overnights. Cannot be days-only or nights-only or weekends-only

Care Manager Non-rn Resume Examples & Samples

• Conducts initial psychosocial assessment of members through interviews of member, family, significant others to determine support structure, religious needs, emotional and psychological needs, needed community resources and barriers to successful transitions
• Collaborates with healthcare team involved in patient’s care to enhance care plan and integration of services. Contributes to the understanding of social and emotional elements of patient’s life related to their diagnoses and treatment
• Current, valid New York State Driver’s license, required
• Ability to communicate well and effectively interact with members and families. Sensitive to cultural diversity and low literacy issues in care provision
• Assist member with transition of care between health care facilities including sharing of clinical information and the plan of care
• Conduct comprehensive face to face assessments that include the medical, behavioral, pharmacy, and social needs of the member. Review UPMC Health Plan data and documentation in the member electronic health records as appropriate and identify gaps in care based on clinical standards of care
• Contact members with gaps in preventive health care services and assist them to schedule required screening or diagnostic tests with their providers. Assist member to schedule a follow up appointment after emergency room visits or hospitalizations
• Document all activities in the Health Plan's care management tracking system following Health
• Plan standards and identify trends and opportunities for improvement based on information obtained from interaction with members and providers
• Present or contribute to complex case reviews by the interdisciplinary team summarizing clinical and social history, healthcare resource utilization, case management interventions. Update the plan of care following review and communicate recommendations to the member and providers
• Review member's current medication profile; identify issues related to medication adherence, and address with the member and providers as necessary. Refer member for Comprehensive Medication Review as appropriate
• Successfully engage member to develop an individualized plan of care in collaboration with their primary care provider that promotes healthy lifestyles, closes gaps in care, and reduces unnecessary ER utilization and hospital readmissions. Coordinate and modify the care plan with member, caregivers, PCP, specialists, community resources, behavioral health contractor, and other health plan and system departments as appropriate
• Minimum 1 year of health insurance experience required
• 1 year of experience in clinical, utilization management, home care, discharge planning, and/or case management preferred
• High level of oral and written communication skills

Behavioral Clinical Care Manager Resume Examples & Samples

• Clearly and effectively communicates with the project team, residents and faculty, PCPs, Pharm D staff, and specialty providers via written, electronic and oral reports
• Convene multidisciplinary case conferences, implementing and leading group visits, working closely with the Family Medicine Residency faculty and residents to create new outreach programs to service-intensive patients (including home visits). Learn and establish working relationship with mental and behavioral health community resources
• In conjunction with support staff and medical team, maintains an accurate and up-to-date registry/database of all patients. Work with IT staff for data mining, data review, and presentation of data for meetings and publication as well as for tracking outcomes and quality improvement/research projects. Prepares quarterly grant reports for the Foundation and individual grantors of the Project
• Provide leadership to the Integrated Project staff (three LCSW's at the three Family Health Centers), including planning, directing, and implementation of project initiatives. Contribute to the development and achievement of the project goals and objectives, and continually evaluate processes to ensure that services are delivered in an effective and culturally competent manner
• Systematically screen patients for depression and unhealthy substance use using evidenced based screening instruments assigned by the project
• The clinical care manager will assure that direct service staff meets funding source requirements, monitor productivity/case load, track no shows/cancellations, as well as all outside referrals, and continually assess, and revise service delivery processes as needed to assure payment for services
• The clinical care manager will be invested in his/her own professional development by reading, attending appropriate conferences, and taking the initiative to be informed of developments and changes in the field, the results of recent studies, national standards, and the activities of similar organizations
• The clinical care manager will directly supervise the LCSW staff at each of the three health centers. In addition, he/she will work closely with, family medicine residents, medical students, and nursing/front office staff on behalf of the health center patients as well as in an education role. He/she will be required to communicate and monitor performance and productivity standards, appraise performance and implement a staff development plan that enhances service, and/or the learning experience of students and residents
• The clinical care manager will ensure efficient operations by scheduling staff coverage sufficient to maintain responsive services, designing and improving processes that continuously improve patient care services, auditing records and other documents for accuracy and timely completion in order to meet requirements, preparing information and reports for internal management and quality control using an electronic information system (Epicare) and excel or access databases
• Uses a variety of educational materials, brief intervention techniques and community resources to engage and increase patient motivation to manage their chronic behavioral and medical conditions
• Uses standardized intervention techniques and community resources to support patients in achieving their goals: In collaboration with patients and their primary care provider and LCSW staff, develop initial treatment plan for care and stepped care plan to achieve patient derived outcomes of care. Provides ongoing evaluation of patient's progress throughout the acute, continuation and maintenance phases of the Stepped Care Model and coordinates with collaborative care team to augment care as needed. Establishes relapse prevention plan and follow-up schedule with patient to monitor patients' progress throughout the maintenance phase. Review caseload weekly with psychiatrist, focusing on patients not adequately improved within specified timeframe and when needed assist patient in scheduling appointment with the psychiatrist or any type of mental health referral
• Master's degree in Social Work, Psychology or related field OR
• Licensed Psychiatric Nurse
• Three (3) years of progressively responsible experience in social services required
• One (1) year of supervisory experience recommended
• Clinical and management experience in behavioral health and knowledge of chronic medical conditions is imperative
• Experience working in a primary care setting, and collaborating with family medicine residents is a plus
• Training in the three evidenced based practices will be provided at no cost to the Behavioral Specialist

Precert Care Manager Resume Examples & Samples

• Assist with moving members to in network facilities or coordinating with appropriate Community Care contracts regarding approval for out of network service utilization
• Assumes responsibility for completion of acute and non-ambulatory precerts and application of appropriate medical necessity guidelines. Precerts include adult and child/adolescent members from all Community Care being admitted to mental health and substance use disorder services, as well as afterhours/weekend completion of precerts for UPMC Health Plan Commercial and SNP lines of business
• Consults with appropriate physician advisors as needed for case collaboration and care planning
• Coordinates, reviews, and maintains daily logs for reporting purposes and for weekly preparation and analysis of trending reports to address member incidents, provider deficiencies, and quality of care concerns
• Demonstrates advanced level of computer operation with electronic medical record systems and Microsoft Outlook, Word, and Excel Programs, as well as advanced typing proficiency
• Develops specific clinical interventions and coordinates with the assigned Community Care contract and care management team for members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care
• Identify need for and facilitate linkages for members and families between primary care and behavioral health providers and other social service or provider agencies to develop and coordinate service plans
• Independently problem solves based on advanced-level knowledge of the service delivery system, clinical treatment, diversion resources, and the provider network for adult and child/adolescent members for behavioral health and SUD providers from the requested region, member services policies, members' rights and responsibilities, and the operating practices of the organization
• Maintains an understanding of behavioral health benefits and remains current on covered benefits, limitations, exclusions, and policies and procedures, in regards to services. Is able to provide members, providers and other stakeholders with accurate information concerning benefits and coverage
• Participates in professional development activities to further clinical skills and knowledge. Works as part of a team providing clinical expertise and knowledge to member services and other care management staff
• Receives and responds appropriately to complex calls, including Afterhours/Weekend Employee Assistance Program calls, triage calls, and provider or member complaints. Ensures accurate, thorough, and correct documentation of these calls
• Responds to deadlines and has work completed on or before deadline 95% of the time
• Utilizes supervision with team coordinator and clinical manager regularly
• Pennsylvania Licensure in health or human services field (LSW, LCSW, LPC, LMFT) and masters degree OR licensed RN (BSN preferred)
• Minimum of three years of relevant clinical experience
• Experience with both adult and child/adolescent populations and mental health and substance use disorder services strongly preferred
• Certification in substance use disorders helpful. PCPC 3rd Edition, ASAM, and Confidentiality Training preferred

Licensed Pro Care Manager Ccbh Resume Examples & Samples

• Attends case conferences, interagency and provider treatment planning meetings for assigned members
• Conducts all clinical reviews, service authorization and care coordination (or oversight and supervision) for all assigned members receiving behavioral health services
• Encourages coordination of care with primary care physician and other service providers integral to the member's life
• Facilitates linkages for members and families between primary care and behavioral health providers and other social service or provider agencies as needed to develop and coordinate service plans
• Makes authorization determinations for medically necessary services independently, within the scope of the practice of held licensure
• Monitors and evaluates effectiveness and outcome of treatment and service plans and recommends, modifications as necessary to provide optimal clinically appropriate services with a goal of maintenance in the community at the least restrictive level of care
• Possesses excellent clinical skills with sophisticated understanding of the over-all needs of individual members assigned to him or her
• Utilizes supervision with medical director and clinical manager regularly
• Works as part of a team providing clinical expertise and knowledge to member services and other care management staff
• Works with Member Services, Network Management and Quality Management staff to assure that systematic revisions to improve services are developed and implemented
• Pennsylvania Licensure in health or human services field and masters degree OR licensed RN (BSN preferred) OR Licensed Behavior Specialist (For BHRS levels of care only)

Clinical Care Manager Team Lead Resume Examples & Samples

• Leads the clinical and member services teams by directing the activities of team members and draws upon accreditation standards, medical necessity criteria, and clinical expertise to manage all aspects of the ASO
• Serves as the primary liaison between the ASO and the County in discussions specific to level of care determinations, medical necessity evaluations, and second opinions
• Establishes goals and objectives for the ASO clinical and member services teams and individual team members’ roles and responsibilities
• Troubleshoots issues and submits recommendations to the ASO Clinical Manager and Program Director
• Assists with the design, development, and modification of workflows for the ASO clinical and member services teams in collaboration with the County
• Works with providers to ensure available resources are being used in a timely and cost effective manner
• Experience in supervising other
• Educated in current principles and procedures of behavior health care.Knowledge of managed care and state specific expertise preferred
• Strong interpersonal skills and good written and verbal communication skills

Jmc-care Manager Resume Examples & Samples

• Current Registered Nurse (RN) license issued by the State of California
• A professional Degree in related Healthcare discipline
• BART or BLS at time of hire with commitment to get BART w/in 6 months of hire date
• Prior case management experience in large,acute care Hospital
• Proficiency in Information Systems,databases, and computer programs including MS Office: Word, Excel, Outlook, PowerPoint, etc
• Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice is essential
• Must possess strong interpersonal skills,leadership, negotiation skills, and knowledge of hospital operations

Care Manager / Utililization Review Resume Examples & Samples

• Admission and continued stay reviews to ensure that care meets the clinical needs of the clients and reduces financial risk to the facility
• Participates in measures to improve the delivery and utilization of care and to evaluate the effectiveness of these. Enters all authorizations into the MS4/Midas daily
• Expert in documentation, communication, teamwork, and customer service. Advocates for internal and external customers including the client, family, physician, Treatment Team and Managed Care Organization
• Works in partnership with the Physician through rounds and staffing to facilitate compassionate patient communication and advocacy, effective Treatment Team planning and timely discharge planning
• Provides a strategic link between the Managed Care Organization, Treatment Team goals and the financial aspects of care

Area Tire Care Manager Resume Examples & Samples

• Provide exceptional customer service and verify that tire care employees are doing the same
• Recognize and resolve customer issues or complaints by determining optimal solutions in a timely manne
• Collaborate with local District Manager to effectively manage employee turnover and retention. Recruit, hire, train, evaluate and coach employees. Make personnel changes as necessary
• Responsible for having familiarity with talent stop to ensure onboarding of new employees is happening properly
• Utilize the Learning Management System and other necessary training tools to verify that training is complete and consistent. Responsible for following up on training regularly
• Address employee issues in an appropriate and timely manner. Utilize the progressive discipline policy to manage employee issues. Collaborate with the local District manager as necessary to manage employee issues
• Ensure proper labor management and effective scheduling at each tire care location
• Delegate tasks as needed and follow-up with employees to ensure that tasks are being completed
• Verify proper invoicing and payment processing for services performed at each location
• Effectively manage fleet of tire care trucks and ensure each location is taking proper care of tire care truck, and providing routine safety training to prevent accidents in the tire care truck
• Identify areas of opportunity on the monthly P&Ls and 13 weeker reports and implement plans to correct any issues
• Ensure each tire shop facility is clean, organized and secure
• Ensure HAZCOM Manuel and Safety Data Sheets are being updated regularly
• Promote safety-first work practices. Maintain a safe facility and use safety first practices to remain accident free
• Maintain personal grooming standards
• Other duties assigned by your supervisor

Rn Transitional Care Manager Resume Examples & Samples

• One (1) year of clinical experience in post-acute care setting preferred
• Prior case management, utilization review, and discharge planning experience preferred
• Certified Case Manager (CCM) or Board Certification in Nursing Case Management (RN-BC) preferred
• Admissions experience preferred
• Must implement the standards of practice for care management, ethical performance, and functions relevant to coordination of care
• Must be able to read, write, speak, and understand the English language
• Support the development and implementation of care management activities for high risk patients such as those who are not meeting desired clinical outcomes, who have frequent hospitalizations or ER visits, and those with uncontrolled multiple chronic conditions in the ambulatory setting
• Develop comprehensive care plans and document progress and interventions in the Electronic Health Record (EHR)
• Develop and implement a patient risk stratification model that aims to identify patients with chronic disease who are at risk and may require focused care management support to achieve the patients’ optimal health goals
• Collaborate with Data Analyst to create, use, and maintain a care management reporting structure that identifies patients who are likely to benefit from care management services and is able to track the progress of eligible patients who are receiving care management services
• Targeted clinical assessments, medication reconciliation, psychosocial and self-management assessment and support, multi-disciplinary care planning, identification of relevant social determinants of health, and ongoing treatment plan adjustment and evaluation

LVN Medication Care Manager Resume Examples & Samples

• Overseeing coordination of residents’ health and wellness needs
• Have a current state license as a Practical Nurse/Vocational Nurse
• Ability to handle multiple priorities
• Provides discharge/transition assessments
• Participates in system-wide development of clinical best practice pathways
• Provides patient education materials, order sets, and implements successfully

Memory Care Manager Resume Examples & Samples

• Conduct pre-residency assessments and screening of potential residents and make recommendations for appropriate level of residency in conjunction with the Admissions Committee and other team members
• Evaluate the psychosocial and activity of daily living (ADL) needs of residents in Memory Care and coordinating care and services as needed
• Monitor the successful engagement of activities for residents with cognitive impairment throughout the Continuum of Care
• Lead a holistic, Person-Centered approach to assessment and service/care planning
• Work with interdisciplinary team to communicate with residents and families before plan of care is changed (when possible) or when there is a change in the resident’s condition
• Partner with Assisted Living Manager to develop support groups and educational programming opportunities for residents and family members in the Memory Care neighborhood and partner with Independent Living and Post-Acute Social Workers to effectively support Residents transitioning between levels of care
• Educates residents about the importance of Advance Directives and facilitates completion of such documents
• Maintains a working knowledge and ensures compliance of Federal, State, and local regulations, as well as facility policies regarding Memory Care (and level of care – LTC or ALF)
• Social Work degree or degree in related field is required
• Greater than 5 years related experience in providing services for residents with cognitive impairment and or managing/leading a Memory Care neighborhood required
• Demonstration of progressive approaches to supporting and enhancing the quality of life for seniors with cognitive impairment
• Must demonstrate knowledge of geriatric population and the aging process; including the physical, psychological and social needs of the elderly
• Coordinates the clinical care with the patient, family, physician(s), and other members of the interdisciplinary team
• Completes and documents admission, concurrent, and discharge reviews of all inpatients and selected outpatients
• Develops and implements an effective discharge plan while incorporating input from the patient, family, physician(s), and other members of the interdisciplinary team
• Identifies, analyzes, collects, and communicates data relative to quality and cost issues related to the assigned patient population
• Expands industry knowledge base for professional growth and development while providing ongoing applicable education to the patient, family, physician(s), and other members of the interdisciplinary team (IDT) including, but not limited to, appropriateness of care, documentation requirements, severity of illness and intensity of services criteria, insurance benefits/requirements/limits, discharge planning requirements, length of stay and resource utilization issues
• Adheres to the policies, procedures, rules, regulations, and laws of the hospital and all federal and state regulatory bodies
• Performs a comprehensive assessment on a targeted patient population as defined by MGH/MGHPO and contractual constituents
• Identifies key barriers to care and patient’s ability to manage their health and wellness through initial and on-going assessments
• Develops and ensures the implementation of a comprehensive plan of care in conjunction with the patient’s PCP, appropriately utilizing the menu of services for patients, as well as, insurance approved, community and practice-based and MGH services
• Ensures that all elements critical to the plan and trajectory of care have been communicated to the patient/family and members of the Interdisciplinary Team
• Communicates and collaborates with care teams during the various points of transition of care and monitors patients in non-acute facilities in collaboration with the iCMP Care Team
• Attends patient/family Team meetings as appropriate
• Identifies patients/families with complex psychosocial and non-medical discharge planning issues and refers to and collaborates with other iCMP team, members as appropriate
• In collaboration with iCMP team, monitors the patient’s progress and plan of care with the aid of internal and external utilization and quality guidelines. Identifies, documents, and reports issues and system barriers
• Facilitates and participates in iCMP team meetings, team conferences, and case review meetings
• Graduate of an accredited clinical program is required. (for RNs: BSN strongly preferred; new grads must have BSN)
• 3 years of clinical experience strongly preferred; Case Management experience preferred
• Provide coordinated care management services to persons with psychiatric disabilities and other chronic behavioral and physical health conditions in accordance with agency/SBU, NYS OMH, NYS DOH, Health Home, Suffolk County DMH and Medicaid guidelines and regulations, policies and procedures
• Care Management services are provided to clients in the field which requires use of one's own vehicle for travel to/from appointments and for transporting clients as necessary
• Perform Health Home services and support agency clients in the development and fulfillment of life and recovery goals in an individual and group format
• Assist clients to improve health outcomes and to increase independent control over their lives and become active and contributing members of their community
• Complete required client and program record keeping and documentation in accordance with professional standards and the guidelines and regulations stipulated by the NYS DOH Health Home Initiative, the NYS OMH Suffolk County Division of Community Mental Hygiene and the Office of Compliance and Audit for SBU
• Develop systematic and comprehensive knowledge of client rights and entitlements, community, behavioral and physical health, other resources and referral and grievance procedures
• Develop practices in accordance with the advocacy/empowerment theoretical model, operating from a client-centered, strengths and recovery-based social work practice orientation
• Develop necessary education and skills to assume the role of the Care Manager in the Medicaid Health Home Initiative
• Participate in outreach activities to potential and former clients
• Provide health education to client community and take leadership in implementing community based programs and initiatives and advocacy-oriented projects, to organize and educate others on health and recovery oriented issues and obstacles faced by client population
• Attend required and recommended component, staff, in-service and web-based training, meetings and activities
• Participate in critical reflection of one's practice and provide feedback and support to staff and colleagues
• Perform other duties and responsibilities assigned by the agency Director and in specific those necessary for the successful conversion of the agency's case management program to the Medicaid Health Home Initiative

R.N Transitional Care Manager Resume Examples & Samples

• Interact with all levels of nursing and other departments to assure effective utilization of resources meet the physiological and safety needs of the patient and their families
• Coordinate the transfer of patients as instructed by the Medical Director or PCP
• Contact RN/Social Worker at the hospital or facility receiving the patient, to communicate plan of care
• Arrange direct admissions to hospitals and placement in nursing homes. Assist PCP in placing patients in skilled nursing facilities
• Proficiency with computers including Microsoft products, Word, Excel, and Outlook
• Ability to travel locally, within the Greater Tampa Area, up to 75%
• Respects the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws. Practices within the scope of ethical principles
• Utilizes outcomes data to improve ongoing care management services
• Be enthusiastic, innovative, and flexible
• An RN license for Arizona is required
• 3-5 years of clinical practice experience is required
• Strong organizational skills are required
• Minimum of 3-5 years of clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
• Some familiarity with the Spanish language required
• Active, unrestricted RN License for State of FL required
• Experience with the adult population highly preferred
• Discharge Planning experience preferred
• Minimum of 3-5 years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required
• Home Care experience is preferred
• Program of All-Inclusive Care for the Elderly (PACE) is preferred
• Certified Home Health Aide (CHHA) is preferred

Expert Care Manager SAP Ariba English Resume Examples & Samples

• Works with designated contacts from the customer to answer their functional questions regarding supported Ariba products
• Conducts site visits (maximum of two per year) to the customer to better understand their support needs
• Provides monthly customized reports to the customer of their Ariba Customer Support activity in a format and including data as agreed with the customer, which may include service request status and updates, categorization of issues raised, identification of recurrent issues and related training needs, service level tracking, etc
• Fluency in English or English and French
• Ability to work effectively under pressure
• Experience with INTERQUAL or Milliman
• Electronic Medical Record (EMR) experience; Cerner strongly preferred
• One year of care management experience in a hospital setting; three years of hospital based care management experience preferred. An equivalent combination of education and/or experience may be considered
• Knowledge of admission and continued stay criteria
• Knowledge and skills necessary to evaluate appropriate care for patients from neonates to geriatrics
• Knowledge of federal, state and managed care rules and regulations including CMS and AHCCCS
• Excellent interpersonal skills and the ability to effectively communicate verbally and in writing providing excellent customer service
• Computer literacy and proficiency in Microsoft Windows
• Basic proficiency with MS Office (Outlook, Word, Excel, PowerPoint, Publisher)

Licensed Pro Care Manager Resume Examples & Samples

• Demonstrates excellent clinical, written and oral communication skills
• Demonstrates knowledge of clinical treatment, case management and community resources
• Develops specific outreach plans for assigned members who do not maintain regular contact with their behavioral health provider as recommended contributing to frequent crises, recidivism, and interfering with maximum benefit from available care
• Identifies provider issues and recommendations for improvement
• Independently problem solves based on advanced-level knowledge of the service delivery system, the provider network, member services policies, members' rights and responsibilities, and the operating practices of the organization
• Maintains contact with and refers members to community based case management services as appropriate
• Participates in CQI activities and provider training
• Responds to member and provider complaints according to Community Care's policies and procedures
• Works with members and providers to customize services to best meet members' needs within the scope of Community Care's obligations to its members
• Experience in managed care strongly preferred
• Certification in substance use disorders helpful
• Supervisory or other leadership experience in behavioral health also preferred

Lead Med Care Manager Resume Examples & Samples

• Checks for medication updates with Resident Care Director (RCD) or Wellness Nurse
• Partners with community team to ensure community is in compliance with OSHA requirements and promotion of Risk Management programs and policies; adherences to safety rules and regulations
• Reports all unsafe and hazardous conditions/equipment immediately
• Utilizes the Sunrise Problem Resolution system
• Minimum of one (1) year experience working with seniors in assisted living, home health, independent living, hospital or long term care environment and desire to serve and care for seniors
• Medication Management Certified with a successful completion of Sunrise University mediation management training
• Demonstrates leadership competencies
• Ability to make choices, decisions and act in the resident's best interest
• Assesses for appropriateness of level of care setting from admission through discharge
• Identifies patients requiring care management and takes the lead as care manager for those requiring intervention, especially with clinically complex cases
• Conduct on-site review of medical records at clinical facilities according to organization standards
• Maintain frequent telephone contact with clinical service providers to perform defined duties and facilitate communication between the organization and the provider
• Document UR/case management activities such as precertifications, concurrent and retrospective reviews
• Consult regularly with other organization staff to review treatment plans when level of clinical care requires further clarification
• Maintain a tracking system and clear, concise records for monitoring and reviewing cases
• Prepare documentation/case synopsis upon closure of cases as required by clients
• Provide phone crisis intervention services and precertification evaluations for inpatient hospitalization and other levels of care
• Provide consultation and training to providers regarding authorization procedures and utilization review for a specific course or nature of treatment
• Contribute to policy review and procedure development and evaluation
• Performs other duties as assigned, some of which may be essential to the job
• BSN required within 5 years of employment
• Minimum of 3 years of clinical nursing experience, required
• Knowledge and experience with managed care, required

Cost of Care Manager Resume Examples & Samples

• Requires a BS/BA degree; Financial, Business, and Leadership acumen; at least 5 years relevant experience in Health Care; or any combination of education and experience, which would provide an equivalent background
• MBA, MHA, MA preferred. PMP or Six Sigma Green Belt preferred
• Prior experience with provider network contracting, provider networks, claims, finance, and operations preferred
• Medicaid business experience preferred
• Knowledge of FACETS, WGS, or other claims software systems
• Prior Managed Long-term Care experience
• Demonstrated home care knowledge
• Bilingual, English and Russian or Cantonese/Mandarin
• As part of the interdisciplinary health care team, coordinates and ensures the implementation of the plan of care, utilizing the principles of case management. 1.1. Establishes a system for coordinating the care of a patient throughout the continuum of care, linking the inpatient care with outpatient care, services and case management. 1.2. Reviews the healthcare information with healthcare team. Reviews the admitting diagnosis/problems with the healthcare team. Monitors the course of patients and the adherence of this course to clinical pathways or the patients' treatment plan. 1.3. Reviews the plan with physician, primary nurse and other members of the team as appropriate and insures that communication is taking place with patient and family. 1.4. Demonstrates the knowledge and skills necessary to provide care needs appropriate to the age of the patients served on his or her assigned patient populations. 1.5. Facilitates communication within the health care team and with the primary care physician and other disciplines to coordinate patient's progress through clinical pathways or the patient's treatment plan. 1.6. Ensures that the sequencing and scheduling of interventions, treatment, and procedures are in accordance with the clinical pathways or the patient's treatment plan
• Optimizes the efficiency of hospital systems which impact quality and/or length of stay 2.1. Identifies and monitors compliance with documenting variances from established parameters in the clinical pathway or treatment plan. 2.2. Collaborates with other departments to accelerate scheduling and to facilitate access to tests and consultations. 2.3. Identifies trends, themes, and consistent barriers and work collaboratively with healthcare team 2.4. Intervenes when necessary to correct delays and to address any barriers for patients
• Utilizes information obtained from various resources available to: 3.1. Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team. 3.2. Collaborate with health care team to initiate referrals to the appropriate service and/or provider, ensuring that adequate insurance coverage and reimbursement are obtained. 3.3. Identify patients who are likely to have unmet insurance and resource needs and communicate with healthcare team members and other appropriate departments. 3.4. Communicate as needed with third party payors regarding the patient's progress with the treatment plan. 3.5. Collaborates with case manager and representatives from third party payor regarding services available when barriers are identified. 3.6. Review admissions daily to ensure appropriateness
• Assist clinicians in documenting the appropriateness of admissions and continued stays 4.1. Responsible for Medicare notices of non-coverage and help provide appropriate documentation to appeal inappropriate denials. 4.2. Appeal of inappropriate insurance denials
• Ensures that an appropriate discharge plan is developed and implemented with the health care teams members to include: 5.1. Identifying service, treatment and funding options; 5.2. Advocating for individual needs as indicated; 5.3. Identifying gaps in the treatment and/or discharge plan 5.4. Utilizing knowledge of internal and external resources to meet patient needs; 5.5. Identifying barriers to wellness within the treatment plan; 5.6. Coordinating and scheduling interdisciplinary meetings with the patient and family regarding discharge needs and the plan; 5.7. Ensures and/or coordinates counseling and teaching for discharge preparation
• Ensure that the appropriate outside agencies are contacted and necessary referrals are initiated and followed through. 7.1. Links patient and family with the appropriate institutional or community resources, advocating on their behalf for scarce resources, and developing new resources where gaps exist in the service continuum. 7.2. Ensure that appropriate services are provided and that necessary certifications for these services are carried out
• Along with other members of the health care team, acts as a patient advocate. 9.1. Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk. 9.2. Educates patients and families regarding the care manager role, as needed. 9.3. Facilitates and ensures open communication among the health care team and the patient/family. 9.4. Performs miscellaneous duties as required or requested
• Collaborates with multiple departments within UPMC (e.g. Fiscal, Patient Access, DEC, and PBS)
• Completes accurate, timely, and thorough documentation in the Psych Consult Care Management application
• Completes pre-certification and continued stay reviews within the designated MCO timeframes
• Coordinates MD-MD reviews with the MDs and CM administrative staff
• Demonstrates proficiency in Psych Consult Care Management, Psych Consult Provider, Medipac, & SharePoint
• Displays a positive attitude and be a helpful team member within the CM department
• Documents pertinent clinical information on the Care Management Abstract
• Effective communication with WPIC management regarding authorization challenges, MCO changes, disposition challenges, updates regarding cases in denial, etc
• Gathers and maintains current patient progress from unit documentation, treatment team meetings, disposition meetings, etc
• Maintains a thorough understanding of Care Management standards and processes as defined the various managed care organizations
• Participates in departmental performance improvement projects
• Participates in telecons, grievance hearings, and DPW pre-hearings/hearings
• Reviews and completes MA late pick-ups
• Writes letters for provider appeals, member grievances, & DPW requests
• Master’s degree prepared – OR – Registered Nurse
• 3 years clinical experience required
• Behavioral health background preferred
• Exemplifying integrity, responsibility, and excellence and adhering to all policies
• Creating an inviting, full and shopable department
• Ordering for the body care department and maintaining accurate inventory levels
• Managing margin and overall department profitability including minimizing shrink and maximizing effective purchasing
• Ensuring all in-stock products/conditions meet company standards
• Merchandising shelves, endcaps and dynamic displays
• Managing and participating in tagging, facing, rotating, cleaning, markdowns, stocking, and backstock
• Training and monitoring department personnel including assigning and following up on tasks
• Working with other department managers to cross-train staff to accomplish all needed tasks
• Assisting in interviewing and hiring for department needs
• Working with the store manager to address performance and/or disciplinary issues within the department
• Opening and closing of store, including DSR and the closing cash process
• Handling register functions including backup cashiering, managing customer returns, addressing customer complaints, and covering register shift changes, including those for scheduled breaks
• Answering customer questions per company standards and policies, including the use of Structure/Function statements and/or statements of nutritional support
• Continually increasing product knowledge
• Using SAP and inventory management software, running and analyzing reports on BEx, emailing and utilizing other IS programs as needed
• Working a schedule based on store needs which includes evenings, weekends, holidays. Position requires working five days, 40 hours per week and attending mandatory store meetings
• 1-2 years of experience in retail experience in a grocery or retail environment preferred; natural foods background is a plus
• 1-2 years of experience supervising others preferred
• Knowledge of treatment care resources as well as available levels of care
• Ability to relate effectively with behavioral health and medical treatment providers
• Use of multiple clinical systems
• Desktop technology skills
• Provide a brief initial screen to discern risk and/or immediate intervention, and triages callers as needed to the appropriate resource
• Provides direct assistance to callers requesting information about services, including eligibility and scope of service
• Conducts assessment of the user’s need for core Employee Assistance Program and work/life services, and links to appropriate resources
• Gathers all required demographics and eligibility data from the caller, enters data into the case management system
• Knowledge of counseling principles
• Some experience in core service areas of child development, parenting, adoption, education, services for older adults, addictions, emotional well-being, work issues, and critical incident stress debriefing
• Knowledge of mandated reporting procedures
• Knowledge of case management standards
• Strong computer skills, excellent communication and telephone skills
• Ability to prioritize and multi-task in a high volume call center environment

Member Care Manager, Lead Resume Examples & Samples

• Act as a direct liaison between hoteliers and internal teams, in addition to being the primary point of contact for internal issues that require advanced troubleshooting
• Assist in the hiring process for new Member Care Managers
• Effectively manage hotelier expectations related to reservation contribution, service delivery, etc
• Review hotelier concerns including, but not limited to hotel operations, reservation delivery, feedback scores, quality assurance scores, sales and marketing techniques, revenue management, etc
• Implement Action Plans to achieve a solid Return on Investment (ROI), and assist team members in doing so as well
• Assist with and administer special projects when needed
• Track and record all hotelier correspondence
• Previous experience in the hospitality industry is preferred (front office, reservations, or sales background)
• Must have served in the Member Care Manager role for a minimum of one year
• Working knowledge of industry revenue production and distribution channels (OTA, GDS, FIT, Consortia, etc.)
• Must possess and be able to demonstrate exceptional customer service and leadership skills
• Customer-oriented work approach including issue resolution/problem solving
• Ability to work independently and in a team environment, effectively helping to set and meet deadlines
• Ability to multi-task, completing priorities
• Must possess professional correspondence and written skills
• Proficient in MS Office, including Word, Excel, Outlook, and PowerPoint
• Position is located in Coral Springs, FL; however, candidate must be able to travel a minimum of two weeks per year

California Care Manager Resume Examples & Samples

• Completes telephone assessments and referrals; gathers demographic and clinical information to connect patient with appropriate provider, including outpatient treatment as necessary; and for emergency, urgent and routine referrals
• Reviews for medical appropriateness psychiatric/substance abuse cases utilizing professional knowledge to apply national medical criteria and certification decisions that are within the scope of practice that is relevant to the clinical areas under review. Utilizes professional knowledge to apply national medical necessity criteria and contract-specific criteria in rendering certification decisions. Applies Beacon Health Options policies and procedures consistently
• Documents all clinical information in the appropriate system following appropriate policy or account specific procedures
• Maintains individual productivity and performance standards, as well as the telephone service standards which are in effect at the time
• Knowledge of treatment care resources and levels of care available

Care Manager Behavioral Telehealth Resume Examples & Samples

• Obtains patient information from referring healthcare team and available medical records
• Coordinates with referring healthcare team to setup appointment, space, and telecommunication technology
• Contributes to healthcare team’s, patient’s and family’s understanding of social and emotional elements of patient’s life related to diagnose and treatment
• Identifies and effectively utilizes community resources to help meet patient needs
• Monitors patient’s progress and intervenes, as necessary, to ensure care provided is patient focused, high quality, efficient, and cost effective
• Master’s Degree in Social Work or Master’s Degree in Counseling, required
• Licensed Mental Health Counselor (LMHC) or Licensed Master’s Social Work (LMSW) Required
• Previous Acute Psychiatry experience required: CPEP (preferred), Mobile Crisis, Inpatient Psychiatry, Hospital-based Outpatient Psychiatry
• Ability to communicate well and effectively interact with team members and patients
• Authorize Care based on pre-existing criteria and follow the member thorough discharge, step down and out patient care
• Assist with discharge planning referrals
• Receive member calls that are escalated, either from customer via crisis line or directly from the member
• Care manager may handle telephonic/web-video consultation with EAP members
• Review risk assessments and provide problem solving assistance
• Social Work License (LCSW, MSW)
• OR Licensed Professional Counselor (LPC)
• OR Licensed Marriage and Family Therapist (LMFT)
• OR PHD related field
• Conducts reviews for medical necessity of psychiatric/substance abuse cases utilizing professional knowledge while applying Beacon Health Options criteria consistently and render certification decisions that are within the scope of practice that is relevant to the clinical areas under review
• Utilizes rounds and case consultations with Clinical Supervisor/Manager/Director and Medical Director/Peer Advisor for cases outside criteria or not progressing
• Refers cases to Peer Advisors that do not meet criteria for decision of medical necessity
• Assesses the patient’s needs, goals, and barriers in relation to the patient’s clinical condition, psychosocial environment, and socioeconomic resources
• Assures compliance with regulatory and payor source requirements regarding patient status and case management
• Collaborates with the patient, family or other caregivers and the multidisciplinary team to design a discharge plan respective of the patient’s needs and goals. Re-evaluates and revises discharge plan of care as additional information is obtained or goals change

Utilization Care Manager, LVN Resume Examples & Samples

• California LVN unrestricted, active license
• Education, skills, knowledge and competencies as defined for the Utilization Management Nurse Associate Knowledge of NCQA and federal and state requirements highly desirable
• Proficient computer skills, use of Word and Outlook, Excel preferred
• 2 years managed care experience preferred 2-3 years acute clinical experience required
• This is primarily office work Requires being seated for several hours a day
• The employee regularly communicates via telephone, computer and in writing
• Non-telecommuters can expect to work in a climate controlled environment with generally quiet noise levels
• Responsible for maintaining accurate information in Beacon’s clinical documentation systems
• Identify, assess, and holistically manage complex behavioral health cases for assigned members
• Provide health coaching and wellness education to members as appropriate
• Develop or oversee the ICP for each member in collaboration with all team members (i.e. Primary Care Providers, Behavioral Health Providers, Health Plan Case Managers), adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes
• Utilize the evidence based guides to identify problem areas
• Call Center, Customer Service experience a plus

Hosting Care Manager Resume Examples & Samples

• Create a productive, high-energy, and achievement oriented team environment
• Empower your teams to make the customer’s experience truly exceptional
• Promote a learning organization
• Set examples for operation in areas of personal character, commitment, organizational and communication skills, and work ethic
• Conduct one-on-one reviews on a bi-weekly basis with all supervisors to build more effective communications, bring focus to alignment of activity and outcomes, understand training and development needs, and to provide insight for the improvement of overall teams’ performances
• Perform weekly staff meetings with supervisors for personal and group learning
• Always be moving and visible on floor to have connections with employees and customers
• Be the voice of the teams to other departments – escalate issues that impact our customers or inhibit our employee’s ability to succeed
• Drive the commitment to continuous improvement for the team, department and company
• Oversee action and performance plans for individuals as well as for teams
• Assist in the development and implementation of customer programs in Customer Care Center
• Review staffing needs and monitor multiple inbound call, chat, ticket and outbound queues
• P&L Responsibility
• Collaborates with providers to determine alternate levels of care and to facilitate transfers to network facilities and providers whenever possible
• Evaluates clinical appropriateness of treatment using professional knowledge within Beacon clinical and work site guidelines and renders certification decisions or seeks consultations for non-certification decisions
• Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis to determine whether treatment meets Beacon criteria for medical necessity

Access Care Manager / Sjmc Pacu Resume Examples & Samples

• Previous experience in Utilization Review, Milman, Interqual highly desired*
• 2 - 4 years Clinical Healthcare (Required)
• 2 - 4 years UR or CM with working knowledge of InterQual or Milliman. (Required) 4 - 6 years Acute Hospital (Preferred)
• 4 - 6 years UR or Care Management (Preferred)

R N Transitional Care Manager Resume Examples & Samples

• Coordinate and evaluate the transition of care needs for patients admitted to acute facilities and skilled nursing facilities to achieve high quality care
• Communicate with hospital, attending physician and Primary Care Physician (PCP) the daily tracking of all hospital and nursing home admissions and discharges for both statistical and cost management purposes
• Communicate with Center Administrators and Care Coach on members’ discharged from inpatient facilities to assure appropriate medical care follow up
• Monitor length of stay (LOS) for both hospital and nursing home patients and make necessary discharge arrangements
• Verify membership eligibility prior to delivery of services
• Obtain routine updates on all nursing home patients
• Maintain daily logs of hospital admissions and discharges
• Collect, prepare and maintain data utilized for quality and utilization management
• Prepare reports as requested by management
• Active FL RN license without restrictions
• Active CPR-BLS from the American Heart Association or ability to obtain prior to start date
• Minimum of 1 year prior acute care experience or inpatient Utilization Review experience
• Ability to problem solve and take initiative to best meet patient needs
• Must be able to interact and communicate effectively with patients
• Ability to travel locally, within the Broward County Area, up to 75%
• If selected for this role, you will be required to complete and pass a background check/investigation for AHCA compliance
• Knowledge of MCG, Interqual, or CMS guidelines
• Prior Disease Management or Case Management experience
• Prior Electronic Medical Records experience
• Communication. Effectively communicates with patients, family members, caretakers, physicians, other providers, and their staff on a regular basis
• Records Management. Ensures clinical information in the medical record and/or care management software is clear, complete, and reflects the patient’s true severity of illness by interacting with providers and staff to improve the overall quality of the clinical documentation
• Regulations. Maintains HIPAA standards and ensures confidentiality of protected health information
• As Assigned. Performs various duties as needed to successfully fulfill the function of the position

Practice Based Care Manager Resume Examples & Samples

• Assess patient's appropriateness for enrollment into the Chronic Care Management program in terms of meeting criteria, approval by PCP, and patient and families willingness to participate. This will include in depth chart review to assess patient eligibility into the Focused Care Program
• Perform telephonic outreach to all Medicare Focused Care Program eligible patients to discuss their current health state and encourage them to participate in this Medicare-sponsored program
• Documents all assessments, interventions and plans of care completely and accurately into the electronic health record
• Follows up with patient and/or care givers on a regularly scheduled basis to assess patient's medical status or compliance to plan or to offer assistance as needed
• In collaboration with the team, develops and coordinates an individualized plan of care with the patient, patient's family, health insurance plan, providers and community agencies as applicable. Involves additional providers as needed to support the individualized plan of care based on identified needs of the patient and family and/or care giver. Plan designed to promote health, close gaps in care, decrease unplanned care
• Maintains availability to patient and /or care giver as needed by phone or visit. Rotates call by phone according to systems developed in the practice for Chronic Care Management program
• Meets face to face with patients and family members as needed to build a relationship, assess the patient's medical, behavioral health and social needs, identify barriers
• Actively participates in and collaborates planned team meetings with physician office clinical staff and/or physicians to monitor patient's status, evaluate the effectiveness of the individualized plan of care, and identify new needs and strategize for next steps
• Works very closely with and maintains open communications with the Primary Care Physician of the extensive care program for direction and collaboration related to patient needs and assessment
• Two (2) years of nursing experience in an outpatient setting required
• BSN or related Bachelors degree preferred, but not required
• Experience in a physician practice and/or home health care highly desired
• Previous telephonic nursing experience a plus, but not required
• Ability to interact with physicians and other health care professionals in a professional manner required
• Must have an understanding of health care disparity issues and have the ability to interact with members from diverse backgrounds in a culturally appropriate manner
• Ability to use independent judgment and compassion when carrying out tasks
• Must be flexible with work schedule and may occasionally have to travel between offices as needed

Behavioral Care Manager, Per-diem Resume Examples & Samples

• Uses language and behavior to promote dignity and respect
• Uses psycho-ed and self-help linkage to promote self reliance
• Understands concepts of empowerment and recovery
• Can identify major classes of psychotropic medications and their intended effect and side effects, possible interactions with other substances, and addictive potential
• Can provide behavioral tailoring and support for medication adherence
• Mediates, advocate and negotiates with care providers and engages additional providers when needed in order to improve individual outcomes for a Member
• Collaborates with the Department of Children and Families and the Department of Social Service as necessary to improve outcomes for a Member
• Participates in multidisciplinary team reviews when convened to review existing care plans to ensure they adequately address the complex behavioral health issues
• Responsible for the intensive care management of designated Members who meet ICM criteria in a designated DCF local area; will at times work out of a local area office when space is available
• Works no less than 20% of the time in the field providing care management services and consultation
• Graduate of an accredited Associate’s or Bachelor’s of Science Degree in Nursing program required
• Graduate of an accredited BSN program in Nursing preferred
• A minimum of 3-5 years recent clinical experience required, 1-3 years of recent acute, Inpatient Care Management experience required
• Ability to understand confidentiality and the legal and ethical issues pertaining to patient health; understand medical terminology: establish treatment goals; establish working relationships with referral sources; develop treatment plans
• Knowledge and understanding of methods for assessing an individual's level of physical/mental impairment; understand the physical and psychological characteristics of illness and assist individuals with the development of short- and long-term health goals
• Ability to understand the requirements for prior approval by payer; evaluate the quality of necessary medical services, acquire and analyze the cost of care; understand the various health care delivery systems and payer plan contracts; be able to demonstrate cost savings
• Work independently and exercise sound judgment in interactions with physicians, payers, and patients and their families
• Execute on Claims Department strategies to achieve Claims quality, customer service and operational objectives
• Manage, lead and develop claims staff
• Create an environment to provide opportunities for all associates to reach their full potential
• Develop a partnership with sales and underwriting to deliver customer service and foster agency relationships consistent with State Auto’s mission, vision and values
• May work closely with claims counsel, general counsel, and reinsurers
• Prepare and manage department budgets
• 10 years or more in property and casualty claims handling experience preferred
• 3 or more years experience in training, leading, and supervising the work of others is required
• High school degree or equivalent; college degree preferred
• Insurance designation preferred
• Basic computer skills and Microsoft applications
• Provides telephonic member assessment as the result of inbound and outbound member phone calls
• In conjunction with the PCP and member, completes a comprehensive assessment and develops a care plan utilizing clinical expertise to evaluate the member's need for alternative services. Assess short-term and long-term needs and establishes care management objectives
• Manages 60+ members based on case intensity and acuity. Specialty Care Manager case loads may vary
• Schedules or facilitates scheduling appointments and follow-up services
• Contacts members to remind them about upcoming appointments and/or missed appointments
• Some state/market care managers may be responsible for Utilization Management and uses prescribed criteria to provide timely, appropriate, and medically necessary service authorizations

Emergent Care Manager Resume Examples & Samples

• Serve on the SDC LT and own the shared responsibilities for the whole strategy of staff training, development, and care
• Ensure the integration of training, development, and care into the life cycle and health of all Navigators in partnership with the Missions, ministries, networks, and departments
• Ensure consistency and quality in staff training and development throughout the organization
• Steward The Navigators Core while developing individuals for aligned organizational and personal outcomes
• Platform the strategic priorities of the NLT in staff training and development, to ensure these priorities are valued, owned, and practiced by all Navigator staff
• Execute best practices in developing all of our staff throughout their entire career with The Navigators
• Create a culture of valuing one’s unique design and encourages the pursuit of life-long learning
• Work directly with the Director of Staff Care to develop and implement emergent care resources and practices throughout the Navigator organization to effectively respond to instances of urgent need for staff in crisis
• Manage all emergent care resources and practices for The Navigators
• Lead the establishment of long term plans and practices for follow-up care after the emergent need is over, coordinating with staff and supervisors
• Manage the availability of qualified emergent care resources through godly, certified counselors, trained to meet the particular emergent (crisis) needs common to the Navigator work
• Evaluate the effectiveness of emergent care including
• Raise and maintain personal funding to meet salary, benefits, and personal ministry needs
• Directly supervise the Emergent Care staff team, and oversee and manager a network of trained, certified counselors
• Perform annual Plan and Progress Reviews (PPR) for all direct reports
• Approve expense reports for direct reporting staff
• Model The Navigators Core Leadership Model (lead, develop, care), lead with a developmental bias, and engage in lifelong learning
• Serve on additional job related teams as needed
• Belief in and adherence to The Navigators Statement of Faith
• Is strongly grounded in the Scriptures
• Master’s Degree or above in related areas of understanding and competence, or equivalent experience
• Minimum 7 years Field ministry or equivalent experience
• Navigator experience strongly preferred
• Experienced in leading and managing a team and other leaders
• Experienced in leading people development and training
• Demonstrated high collaborative ability
• Possesses high emotional and cultural intelligence
• Able to lead and develop the next generation
• Understands and has experience to lead and instruct in change leadership
• Demonstrates effective communication skills, both verbal and written
• Able to align resources to achieve strategic goals
• Has passion and conviction in developing the maturity of our staff

Licensed Field Based Care Manager Resume Examples & Samples

• Performing care management activities to ensure that patients move through the continuum of care efficiently and safely
• Assessing and interpreting customer needs and requirements
• Reviews cases and analyzes clinical information in conjunction with Medical Directors to determine the appropriateness of hospitalization
• Performing Clinician to Physician interaction to acquire additional clinical information or discuss alternatives to current treatment plans
• Escalates cases to the Medical Director for case discussion or peer - to - peer intervention as appropriate
• Performs anticipatory discharge planning in accordance with the patient's benefits and available alternative resources
• Collaborates with Medical peers on consideration of discharge planning needs
• Refers patients to disease management or case management programs
• Assists with the development of treatment plans
• Documents activities according to established standards
• Identifies solutions to non - standard requests and problems
• Develop plans and supportive services for patients to achieve stability and adaptive functioning to become independent
• Support mental services and integrated substance abuse treatment, supporting medication management, symptoms management, rehabilitation, crisis stabilization and psychosocial education on an outpatient basis
• Perform administrative duties related to a client's care including applications for services
• It is essential for this position to work with members at various locations, such as the streets, shelter, group home, provider’s offices, facilities and other community locations
• An RN with 2+ years of experience in behavioral health OR Licensed Master's Degree level clinician in: Psychology, Social Work, Counseling or Marriage & Family Counseling; or Licensed Ph.D. or Licensed PsyD; Licensed Marriage Family Therapist, Licensed Clinical Social Worker
• Licensure must be current and unrestricted
• 2+ years of behavioral health clinical experience in an inpatient / acute setting or outpatient setting
• Ability to convey complex or technical information in a manner that others can understand, as well as ability to understand and interpret complex information from others
• Intermediate computer skills (Microsoft Word, Outlook and Internet) with the ability to navigate a Windows environment and to create, edit, save and send documents utilizing Microsoft Work
• Ability to work in an ever changing work environment
• Knowledge of Level of Care Guidelines (i.e. Milliman, Interqual etc.)
• Prior Case Management experience
• Experience with social security and disability services
• A background that involves utilization review for an insurance company or in a managed care environment
• Previous experience in a telephonic, office based role
• Position requires proficiency with computer skills which includes navigating multiple systems and keyboarding
• Sedentary work involving periods of sitting, talking, listening. Work requires sitting for extended periods, talking on the telephone and typing on the computer
• Typical office working environment with productivity and quality expectations
• Bilingual a plus but not mandatory
• Develops, coordinates and implements clinical care management through partnership with Social Work Care Manager and Care Management Assistant in collaboration with clinical leadership, physicians, nursing staff, and other interdisciplinary clinicians
• Participates in psychosocial management of patients
• Facilitates plans for the transitions of patient care to the next level and location of care
• Partners with system care navigation resources and care navigators from other settings to provide continuity of care and effective transitions
• Maintains accountability for utilization management and communication with payers to assure continued stay authorization and assists with financial activities affecting the hospital stay
• Conducts review activities on a daily basis following InterQual guidelines
• Performs concurrent reviews to respond to payers
• Registered Nurse with current Minnesota license
• Associate's degree from an accredited school of Nursing required. Bachelor's degree preferred
• Minimum of one to three years working as an RN in an acute care setting including experience working with physicians and various levels of hospital personnel required
• One year of inpatient Care Management / Case Management / Utilization Review preferred
• Professional Practice: Demonstrates behavior consistent with the standards, scope of practice, ethics, and characteristics of a licensed professional
• Bachelor’s degree in Social Work
• 2+ years of social work experience in an acute care or community setting
• Knowledge of government sponsored managed care programs preferred
• Prior case management experience in large, acute care Hospital
• Utilization review/discharge planning experience
• Proficiency in Information Systems, databases, and computer programs including MS Office: Word, Excel, Outlook, PowerPoint, etc
• Fast and accurate typing and data entry skills
• Must possess strong interpersonal skills, leadership, negotiation skills, and knowledge of hospital operations
• Skilled in conflict management and resolution
• Three to five (3-5) years clinical experience or in an acute care setting
• Previous Supervisory/Management experience
• ACM and/or CCM certificate
• Experience with Epic, Midas, ECIN, Interqual
• RN License issued by the State of California
• BART or BLS at time of hire with commitment to get BART within 6 months of hire date
• A professional degree in a healthcare discipline
• Three (3) years of acute nursing experience
• One (1) year of Acute Case Management or Discharge planning experience
• Background in case management, utilization review and discharge planning, home care or managed care or equivalent experience
• Proficiency in Information Systems, databases, and in the use of technology and computer programs including MS Office (Word, Excel, Power Point, Outlook, etc.)
• Knowledge of payer industry, resource management, reimbursement, and evidence-based clinical practice
• Excellent relationship and management skills, including a high degree of psychological sophistication and non-aggressive assertiveness
• Ability to problem solve, engage in abstract thought, and successfully manage conflicts
• Strong negotiation, organizational, delegation and task prioritization skills
• Ability to construct grammatically correct correspondence and reports using standard medical terminology
• BSN and/or MSN
• EMR, EPIC, Midas, ECIN, Interqual/Milliman, ACOEM experience

LPN Care Manager Resume Examples & Samples

• Minimum: Over 3 years and up to and including 5 years of experience in clinical setting demonstrating the ability to assess, document and implement the nursing care plan
• Preferred: 3 to 5 years of acute nursing experience in critical care
• Preferred: HMO experience
• Make clinical decisions related to assessment, referral, coordination of care, and appropriateness of care for members seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care covered by contracts
• Meet departmental standards related to clinical documentation, clinical policies and procedures, accreditation and regulatory standards and contract compliance
• Actively participate in clinical rounds/case review process, and seeks consultation with the Clinical Director and Medical Director
• As necessary, provide clinical oversight and consultation for non-clinical, unlicensed staff members
• Actively participate in designated processes for managing the care of high-risk members
• Critical thinking skills and ability to work independently
• Computer and typing skills necessary
• Must be able to work one weekend shift per month
• Potential work from home opportunity after in office training
• High school diploma or GED required. Bachelor degree in a human service field preferred
• Current valid (per hospital policy) US driver’s license required
• One year experience in a psychiatric or human services setting
• Basic typing skills required
• Receives and responds to behavioral telehealth consult requests
• Conducts initial psychosocial assessment through telehealth interview with patient, family and/or significant others to determine patient condition/needs
• Reports on patient to attending Psychiatrist for psychiatric evaluation
• Master’s Degree in Social Work or Counseling, required
• Licensed Master Social Worker (LMSW) or Licensed Mental Health Counselor (LMHC), required
• Bachelor’s Degree in Nursing, required. Master’s Degree in Nurse Practitioner Program, preferred
• Prior experience in one of the following areas: outreach, screening, supportive counseling, or case management, required
• Working knowledge of computer applications (i.e. Microsoft, Electronic Medical Record, etc.), required
• Ability to communicate well and effectively interact with team members and patients. Sensitive to cultural diversity and low literacy issues in care provision
• 3-5 years of Clinical experience
• Clinical experience in Behavioral Health
• Managed Care experience (Case Management & Discharge Planning)
• Certified Case Manager preferred (CCM)
• Associate's Degree in Nursing for a candidate with an active RN License
• A Master's Degree for a candidate with a LCSW or LPCC
• Registered Nurse License (RN)
• Licensed Clinical Social Worker (LCSW)
• Licensed Professional Clinical Counselor (LPCC)

Clinical Care Manager Clinical Care Manager Resume Examples & Samples

• Assume responsibility in coordinating care to assigned clients, establishing a goal directed care plan from admission to discharge which includes a comprehensive ongoing assessment of clients’ needs
• Perform on site supervisory visits to assess client, family, environment, and clinical care givers and complete follow-up documentation
• Ensure availability and proper operation of necessary equipment and supplies related to patient care
• Provide direct client care as needed
• Promote and manage expectations and satisfaction with internal and external customers
• Evaluate the quality and effectiveness of nurse practice and nursing services, analyzing appropriate data and information to identify opportunities for collaboration with all stakeholders in order to improve services and patient outcomes
• Provide nursing updates and obtain re-authorization for continued care
• Provide ongoing supervision, orientation, training, education, and evaluation of clinical field staff
• Identify professional practice standards within the organization and identify areas of strengths as well as areas for professional practice development
• Contribute to nursing education and professional development of staff, students, and colleagues
• Participate in employment decisions affecting nursing staff, including hiring and termination as appropriate
• Maintain compliance in accordance with company policies and procedures, laws and regulations, and professional standards within the state of practice
• Maintain a professional demeanor consistent with registered nurse standards of practice
• Provide best practice in delivery of nursing care to the appropriate population and adhere to the standards of professional nursing practice
• Base decisions and actions on ethical principles and foster a non-judgmental, non-discriminatory climate in which care is delivered in a manner sensitive to socio-cultural diversity
• Participate in call for after hour’s client care
• Promote an environment of quality and safe client care through participation, development, and adherence to the QA plan and associated activities and metrics
• If supervising Private Duty has a minimum of two years experience in private duty, home care, or health care and the knowledge, experience and ability to effectively administer the private duty program
• Perform other duties as assigned by supervisor
• Proof of eligibility to work in the United States
• RN licensure in designated states as appropriate
• Knowledge and understanding of compliance with adherence to regulations
• Diploma, Associate, or Bachelor degree in nursing from state accredited RN program
• Strong commitment to clinical excellence
• Ability to resolve conflicts
• Ability to assess clients and provide direct client care as needed
• Possess critical thinking skills
• Valid Driver’s license and Acceptable MVR
• At least 2-5 or more years clinical practice experience, e.g., hospital setting, alternative care setting such as home health or ambulatory care required. (3 or more years is preferred.)
• Independent clinical license required, LPC, LMSW or RN
• If RN Behavioral Health is preferred
• Strong computer skills including MS Office, Excel, Word and Outlook
• Strong keyboarding skills and organization skills needed!
• Responsible for inpatient clinical decisions related to beneficiaries seeking access to their benefits for Mental Health or Substance Abuse services for all levels of care using established criteria, guidelines and policies
• Responsible for building positive professional rapport with providers and communicating in a clear and timely manner
• Coordinates with providers and other Care Managers to assure that patient comprehensive treatment needs are net and that there is continuity of patient care
• Carelink and or MHS

EAP Care Manager Resume Examples & Samples

• Applying Beacon criteria consistently to manage risk and urgent situations as well as to deliver services consistently across client organizations and individual situations
• Maintains confidentiality, ethical and professional standards, adhering to Beacon Clinical Policy and Procedures and Benefit Plan requirements
• Basic computer skills required, including Windows, Word, Outlook, Excel, keyboard and mouse operation
• Ability to function an interdisciplinary setting
• Assesses members to determine care coordination and case management needs for all referred members
• Completes comprehensive assessments of environmental, psycho-social and support needs
• Identifies problems/barriers for care coordination and appropriate care management interventions
• Creates a plan of care to assist members in reducing/resolving problems and or barriers so that members may achieve their optimal level of health
• Shares goals with members and their families as appropriate
• Identifies and implements the appropriate level of intervention based upon the member’s needs and clinical progress
• Schedules follow-up calls as necessary and makes appropriate referrals to management
• Documents progress towards meeting goals and resolving problems
• Coordinates care and services with members and family members as appropriate, PCP’s, specialists and facility/vendor providers
• Collaborates with department staff to assist members in receiving quality and cost effective services
• Facilitates access to entitlement programs and/or community resources
• Monitors and documents member’s on going progress
• Participates in the discharge planning process for hospitalized members
• Assists members in the transitional process from home to a skilled nursing facility for long-term placement
• Arranges for services/appointments
• Participates on project teams as requested
• Maintains confidentiality of all company, provider and member information
• Identifies and refers potential and actual quality issues to quality management staff
• Keeps up-to-date with case management initiatives
• Attends scheduled meetings
• Obtains necessary educational requirements to maintain professional licensure and certifications
• Complies with AMFC and HIPAA confidentiality requirements to protect member personal identifiable health information
• Performs other related duties and projects as assigned
• Graduate of an accredited college or university with at least a Bachelor’s in Science degree (BSN) or equivalent education and experience
• Three (3) years practice experience
• Three (3) to five (5) years of Care Management experience preferred
• Knowledge of Windows and Microsoft Office applications
• Familiar with accreditation processes such as URAC/NCQA
• Bilingual Spanish preferred
• Current, unrestricted SC Registered Nurse license
• CCM credential with 2 years of hire
• Minimum 1 year of Care Management experience
• Requires relevant experience/education to work with members with complex health, behavioral health, and supports and/or psychosocial needs
• Active South Carolina RN license
• Minimum 5 years nursing experience in managed care and/or hospital setting working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
• Minimum 3 years of Case Management experience along with a knowledge of common behavioral health conditions is preferred
• Must have experience and be comfortable with using technology (e.g., MS Office including Outlook, Word, and Excel) and electronic medical record and documentation programs
• Obtain Certification in Case Management within two years of accepting position
• Complete a comprehensive initial assessment and gathers pertinent information about the member’s needs by interviewing the member, appropriate family members, physicians and other members of the Interdisciplinary Care Team to develop, monitor and evaluate the member’s Individualized Care Plan and update as needed
• Serve as an advocate for the member and acts as a liaison between the member and other community based agencies, facilities, providers, and practitioners in coordinating the member’s care
• Coordinate and perform transition planning for members transitioning between levels of care
• Monitor appropriate utilization of the member’s benefits and coordinates services with other payer sources
• Perform all other duties and projects as assigned
• Minimum 1 year of care management experience
• Associate's Degree, BSN desirable or Social Worker Master's Degree (LMSW)
• Registered Nurse preferred
• 1 – 3 yrs Care Management experience
• The Care Coordinator (RN/LMSW) must have relevant experience and education to work with members with complex health, behavioral health, and/or supports psychosocial needs
• Active Michigan RN license
• 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
• 2 + years’ experience in Behavioral Health Nursing preferred
• Minimum of 3+ years of Case Management experience preferred
• Must have experience and be comfortable with using technology (e.g. MS Office including Outlook, Word, and Excel) and electronic medical records
• Three to five years of Case Management experience preferred
• This position will require the selected candidate to go to provider offices within Wayne and Oakland counties
• Valid driver's license and car insurance
• Minimum 3 years’ experience in behavioral health/human services required, or other equivalent background and experience that would translate well to this position
• Must hold a valid, unrestricted state license in a behavioral health specialty or nursing; acceptable licenses include but are not limited to LBSW, LMSW, RN, LPC
• Must obtain CCM credential within 2 years of hire
• Minimum 1 year of Care Management experience is preferred
• Requires relevant experience/education to work with members with complex health, behavioral health, and psychosocial needs
• The hours will be Monday-Friday 9:00 AM to 5:30 PM
• Unrestricted PA RN licensure required
• Minimum of 3 years' clinical experience with an adult population in an acute care setting (e.g. Medical Surgical floor in a hospital) and/or home care required; behavioral health experience preferred
• 3 to 5 years of Case Management experience within a managed care organization preferred; telephonic case management experience preferred
• Demonstrated ability to assess and engage adult members/patients in the case management program/process

Care Manager, LPN Resume Examples & Samples

• Consistently exhibits behavior and communication skills that demonstrate commitment to superior customer service, including quality and care and concern with each and every internal and external customer
• Monitors inpatient, outpatient, and SNF patients and initiate patient care arrangements. Reports findings to Medical Management, Medical Director and Center Administrator
• Provides oversight in patient care evaluation, coordinate the collaboration of the Primary Care Provider and Consultants, and make suggestions to improve plans to meet patient needs
• Assists with the monitoring of utilization management and make recommendations regarding effectiveness of health care resources, trending and intervention
• Ensures compliance with HCFA guidelines and covered service guidelines
• Assists with the contestation of Part A and Part B /claims as needed
• Consistently applies guidelines to the medical record review process
• Evaluates and recommends health delivery network changes with the site Medical Director and Center Administrator
• Participates in QI projects. Attends Care Management Meetings
• Participates in patient satisfaction programs as required and follows up on all inpatient/outpatient discharges
• Assists the Center Medical Director with the management of high-risk patient populations and appropriate Care management plans
• 1-2 years of previous care management, utilization review or discharge planning experience is preferred
• Ability to perform accurate telephonic triages, accurately record findings with follow-up
• Knowledge and skill in the applications of the techniques and practices of the nursing profession
• Ability to explain medical instructions to patients and their families
• Ability to be a clinical resource for non-licensed office staff
• Ability to prioritize and multi- task in a high paced environment with good organizational skills
• Display initiative, accountability and resourcefulness
• Ability to perform care management
• Coordinate the member care, services and health benefits with members and their healthcare providers across the continuum of illness
• Collaborate with members of an inter-disciplinary team to meet the needs of the individual and the population
• Maintain current and accurate documentation of enrollment in care management program
• Maintain appropriate and timely documentation of care plans, case notes, referrals, assessments and other pertinent information in documentation system
• Assist in education of members and Health Partners regarding healthcare access and benefits, and provide them with health education and wellness materials
• Maximize the member’s health, wellness, safety adaptation and self-care through effective care coordination and case management
• Participate in meetings with Health Partners to inform them of Lock-In Program and case management services and benefits available to members
• Facilitate coordination, communication and collaboration with stakeholders in order to achieve goals and maximize positive member
• RN License required
• Three to five (3 to 5) years of experience in nursing, social work or in a healthcare (discharge planning, case management, care coordination and/or community/home health) environment is required
• Five (5) or more years of clinical experience is preferred
• Three (3) or more years of Medicaid/Medicare is preferred
• Intermediate proficiency level with Microsoft Office Suite to include Outlook, Word and Excel
• Ability to communicate effectively with a very diverse group of individuals
• Ability to operate a smart phone, iPad, or other technical equipment to ensure productivity & ability to perform essential functions
• Knowledge of local, state and federal healthcare laws, regulations and environment
• Awareness of community and state support resources for population served
• Effective listening and critical thinking skills
• Adhere to code of ethics that aligns with professional practice
• Critical listening and thinking skills
• Bachelor’s of Science in Nursing (BSN) preferred
• Three to five (3-5) years of experience in nursing, social work, or healthcare field (discharge planning, case management, care coordination, and/or home/community health experience) is required
• Five (5) years or more clinical experience is preferred
• Collaborate with team members to optimize outcomes for members
• Knowledge of local, state & federal healthcare laws and regulations & all company policies regarding case management practices
• Strong advocate for members at all levels of care
• Proven track record for improving processes to make things easier for those you have served
• Determine member and/or caregivers needs regarding financial supports, social supports, psychological supports, and counseling; provide information and referral
• Practice and adhere to departmental and state guidelines
• Managed care experience; must be able to comply with and understand complex organizational, State, and Federal guidelines
• 1 - 3 years required
• Must be NYS licensed as a Registered Nurse
• Assess and evaluate member needs by using various data tools and resources
• Assist members and their families in the administration of their health plan benefits, promote medication compliance, align with healthcare professionals, as well as assist in shared decision-making
• Collaborate within a team of professionals (supervisors, managers, account representatives, member service associates, and physicians) to provide care coordination appropriate for members
• Interpret and apply case management criteria, processes, policies, and regulatory standards
• Interact with treatment providers, PCPs, and physicians as needed to support the plan of care
• Monitor for clinical quality concerns and refers appropriately
• Ability to adapt and be flexible to change
• Ability to analyze information to construct effective solutions
• Execution and results (ability to set goals, follow processes, meet deadlines, and deliver expected outcomes with appropriate sense of urgency)
• Cultural competence (demonstration of awareness, attitude, knowledge, and skills to work effectively with a culturally and demographically diverse population)
• Clinical assessment (ability to interpret, evaluate, and clearly document complex medical information using a directive and focused approach in order to identify relevant and actionable conditions, circumstances, and behaviors)
• Care planning (ability to identify and clearly document member-driven, specific, measurable activities that address actionable conditions, circumstances, and behaviors in order to improve health outcomes and cost-effectiveness of services)
• Member collaboration and engagement (ability to secure and maintain the motivation, participation, and collaboration of all relevant parties in a purposeful plan to improve health outcomes and cost-effectiveness of service delivery
• 5-10 years direct clinical experience

Lead Care Manager Resume Examples & Samples

• Oversee the clinical aspects of Care Coordination as delivered by a pod of Intake and Assessment specialists and Care Coordination staff, which includes review and sign off of assessment of the behavioral health, psychosocial and medical needs of identified members
• Oversee and approve clinical aspects of the creation of a person centered and culturally competent Individualized Care Plans (ICP) to include problem identification, goal-setting in collaboration with members, community based behavioral health providers, primary care physicians and other interdisciplinary care team members to develop a comprehensive and integrated approach to care coordination interventions and expected outcomes
• Develop and/or oversee the ICP for each member in collaboration with all team members, adhering to timelines and including assessment of health needs, individualized care management plans, implementation, monitoring and evaluation of care outcomes
• Oversee clinical aspects of the Interdisciplinary Care Team (ICT) to ensure that the member goals are being addressed from a treatment team approach and collaborating with the team to complete care plan updates as required
• Ensure member crisis plans are comprehensive and provide clinical oversight on behavioral health crises and emergencies as needed
• Excellent clinical skills with a proven ability to provide clinical supervision to non-clinicians
• Ability to prioritize and manage multiple tasks simultaneously while meeting deadlines for deliverables
• Excellent written, oral and presentation skills
• Strong organization skills, ability to multi-task, ability to manage multiple priorities and work collaboratively within a team environment
• Must be detail oriented; able to work independently in an ever changing environment
• Minimum 5 years nursing experience in managed care and/or hospital settings working with patients with chronic disease states (e.g. diabetes, sickle cell, asthma, etc.)
• Minimum 2 years behavioral health experience working either clinic or inpatient setting with patients that have behavioral health conditions
• Minimum 3 years Case Management experience preferred
• Must have experience and be comfortable with using technology (e.g., MS Office including Outlook, Word, and Excel), and electronic medical record and documentation programs
• Ability and willingness to obtain Certification in Case Management within two (2) years of start date
• RN with at least 2-5 years clinical practice experience is required, (inpatient, behavioral health mixed with clinical is preferred as well as pediatrics highly preferred, home health preferred!)
• Managed Care experience preferred !
• Bilingual a plus!
• Must have excellent computer skills including Microsoft Word and outlook and the ability to toggle in multiple windows
• Strong keyboarding experience needed
• Three (3) years acute care nursing or long-term care experience required
• Must possess knowledge and skills necessary to complete the essential functions of the position
• Experience with utilization management, discharge planning and/or case management is preferred
• Must be able to communicate effectively with patients, families and all levels of health care providers
• Must possess critical thinking skills and be able to work independently with little or no supervision
• Implement all care management reviews according to accepted and established criteria, as well as other approved guidelines and medical policies
• Promote quality and efficiency in the delivery of care management services
• Respect the member’s right to privacy, sharing only information relevant to the member’s care and within the framework of applicable laws
• Practice within the scope of ethical principles
• Identify and refer members whose healthcare outcomes might be enhanced by Health Coaching/case management interventions
• Educate professional and facility providers and vendors for the purpose of streamlining and improving processes, while developing network rapport and relationships
• Utilize outcomes data to improve ongoing care management services
• 5-10 years of related, progressive experience in the area of specialization
• Experience in a clinical setting
• Ability to multi task and perform in a fast paced and often intense environment

Related Job Titles

Resume Worded   |  Proven Resume Examples

• Resume Examples
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• Care Coordinator Resume Guide & Examples

Patient Care Coordinator Resume Examples: Proven To Get You Hired In 2024

Jump to a template:

• Patient Care Coordinator
• Medical Office Assistant
• Clinical Care Coordinator
• Health Services Coordinator
• Clinic Coordinator
• Patient Services Manager

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• Patient Care Coordinator Resume Tips

Patient Care Coordinator Resume Template

Download in google doc, word or pdf for free. designed to pass resume screening software in 2022., patient care coordinator resume sample.

As the name suggests, a patient care coordinator is very patient-focused. You could almost call them advocates and caretakers for patients suffering prolonged illness or disability. Your tasks will include creating a care plan, educating patients on their illness and treatment plan, being the middleman between healthcare institutions and the patient, etc. Apart from having the required certification, you will need to have excellent communication skills as well as empathy and patience when it comes to the patient. Use this resume sample to elevate yours.

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Recruiter Insight: Why this resume works in 2022

Tips to help you write your patient care coordinator resume in 2024,    emphasis your experience dealing directly with patients..

Because this position requires interaction with patients and coordinating with other healthcare professionals interacting with patients, highlight experiences where you dealt with patients regularly and any noticeable success or recognition you got as a result. It will show recruiters that you are well versed in how patients need to be cared for and that you are experienced doing the same.

   Make sure your tools list is in line with industry standards.

There are industry standard tools that healthcare professionals use to care for patients. Show recruiters that you are qualified and experienced by having your tools list reflect industry standards. Also, make sure you continually update this list as you learn to use new tools. Lastly, if you complete any courses that teach you how to use these tools, list these as well.

Medical Office Assistant Resume Sample

Clinical care coordinator resume sample, health services coordinator resume sample, clinic coordinator resume sample, patient services manager resume sample.

As a hiring manager who has recruited Patient Care Coordinators at top healthcare organizations like Mayo Clinic, Cleveland Clinic, and Johns Hopkins Medicine, I've seen countless resumes for this role. The best ones always stand out by highlighting the right skills and experiences that are most relevant to the job. In this article, we'll share some tips on how to create a strong Patient Care Coordinator resume that will catch the attention of hiring managers and help you land your dream job.

   Highlight your healthcare experience

Hiring managers want to see that you have relevant experience working in healthcare settings. Make sure to include:

• Specific healthcare facilities you've worked at, such as "Coordinated care for 50+ patients per day at XYZ Hospital"
• Types of patients you've worked with, like "Managed care plans for elderly patients with chronic conditions"
• Healthcare-specific skills, such as "Proficient in EMR systems like Epic and Cerner"

Avoid being too general with your experience. Instead of just saying "Healthcare experience", give concrete examples:

• Healthcare experience
• Knowledge of medical terminology

   Quantify your impact with numbers

Numbers jump off the page and grab the attention of hiring managers. Whenever possible, use specific metrics to show the impact you had in previous roles:

• Reduced patient wait times by 25% by implementing a new scheduling system
• Improved patient satisfaction scores by 30% through proactive communication and follow-up
• Coordinated care for a panel of 150+ patients while maintaining 95%+ patient retention rate

Compare those strong, results-driven bullet points to weaker ones that lack numbers:

• Responsible for scheduling patient appointments
• Helped improve patient satisfaction
• Coordinated patient care

   Emphasize your communication skills

Patient Care Coordinators are the main point of contact for patients. You need excellent verbal and written communication skills to succeed in this role. Highlight this by including:

• Specific examples of how you communicated with patients, like "Clearly explained complex medical information to 20+ patients per day"
• Interpersonal skills, such as "Collaborated with a 10-person interdisciplinary care team to develop personalized patient care plans"
• Conflict resolution, like "Resolved 100% of patient complaints and concerns through active listening and problem-solving"

Don't just say you have "strong communication skills". Prove it with concrete examples.

   Tailor your resume to the job description

Every Patient Care Coordinator job is a bit different. Some may focus more on administrative tasks, while others involve direct patient interaction. Read the job description closely and customize your resume accordingly:

• If the job emphasizes EHR experience, include bullet points like "Managed and updated electronic health records for 75+ patients using Allscripts"
• For positions focused on care coordination, say something like "Liaised between patients, physicians, and insurance companies to ensure seamless care delivery"

Avoid sending a generic resume that doesn't address the specific needs of the role. Hiring managers can spot a one-size-fits-all resume from a mile away.

   Show your career progression

Hiring managers like to see candidates who have grown and taken on more responsibility over time. If you've been promoted or taken on leadership roles, make that clear:

Patient Care Coordinator, ABC Medical Group, 2018-2022 Senior Patient Care Coordinator, ABC Medical Group, 2022-Present Promoted to Senior Patient Care Coordinator after training and mentoring 5 new hires Managed a team of 8 Patient Care Coordinators while handling a caseload of 200+ patients

Even if your job title didn't change, you can still show growth by highlighting how you took on additional responsibilities:

• Volunteered to lead a quality improvement project that reduced medication errors by 15%
• Trained 10+ new hires on EHR systems and patient communication protocols

   Include relevant certifications

Patient Care Coordinators don't necessarily need certifications, but they can help you stand out. Some certifications to consider include:

• Certified Patient Care Coordinator (CPCC)
• Certified Medical Administrative Assistant (CMAA)
• Certified Electronic Health Records Specialist (CEHRS)

If you have any of these certifications, make sure to list them on your resume. You can include them in a separate "Certifications" section or list them under your education.

However, don't include irrelevant certifications that won't impress a hiring manager. Leave off things like CPR certifications or basic computer proficiencies.

Writing Your Patient Care Coordinator Resume: Section By Section

  experience.

Your work experience section is the heart of your resume. It's where you show hiring managers what you've accomplished in previous roles and how you can drive results for their team. For patient care coordinators, this section is especially important to demonstrate your ability to manage patient care, coordinate with healthcare providers, and ensure smooth operations.

Here are some key tips to make your work experience section stand out:

1. Highlight relevant patient care achievements

Focus on your most impressive and relevant accomplishments in each role. Instead of simply listing responsibilities, quantify your impact with metrics:

• Managed care for 150+ patients per week, ensuring timely appointments and follow-ups
• Reduced patient wait times by 25% through implementing a new scheduling system
• Coordinated with 10+ specialists to develop personalized care plans for high-risk patients

Avoid vague or generic statements that could apply to any candidate, like:

• Responsible for patient scheduling and coordination
• Collaborated with healthcare providers on patient care

2. Use strong patient care action verbs

Start each bullet point with a powerful action verb that demonstrates your patient care capabilities:

• Coordinated complex care plans for elderly patients
• Facilitated communication between patients, families and providers
• Streamlined referral processes to reduce delays

Avoid starting with weak or vague verbs like:

• Helped with patient care tasks
• Worked on improving communication

Strong verbs help paint a vivid picture of your healthcare contributions.

3. Showcase your healthcare tech skills

Many healthcare employers look for patient care coordinators proficient with certain tools and technologies. Weave in your experience with relevant systems, such as:

• Electronic health records (EHR) systems like Epic or Cerner
• Patient scheduling software like Acuity Scheduling
• Care coordination platforms like CareCloud or Axxess
• Medical billing and coding systems

Leveraged Epic EHR to efficiently document patient interactions, monitor care plans and communicate with providers, ensuring seamless coordination for 200+ patients monthly.

4. Highlight progression and leadership

Show how you've grown within the patient care field and taken on increasing responsibilities. This demonstrates your initiative and leadership potential.

For example, instead of just listing each role separately, illustrate your trajectory:

• Promoted to manage a team of 5 care coordinators...
• Recognized as top performer and selected for coordinator training...

Also highlight any leadership experience you've had, even informally, like training new hires or proposing process improvements.

  Education

The education section of your patient care coordinator resume should be concise yet impactful. It's a chance to showcase your relevant academic background and any specialized training that makes you a strong candidate for the role. Here are some key tips to keep in mind as you write this section:

1. Put your education section in the right spot

Where you place your education section depends on your level of experience and how recently you completed your education.

If you're a recent graduate or have limited work experience, put your education section above your work history. This way, the hiring manager will see your relevant coursework and academic achievements first. However, if you have several years of relevant work experience, place your education below your work history section, as your professional experience will be more important to the employer.

2. Include relevant coursework and honors

If you're a recent graduate or your coursework is highly relevant to the patient care coordinator role, consider listing your relevant courses under your education entry. This can help showcase your knowledge and skills, even if you don't have much work experience yet.

Additionally, if you graduated with honors or received any academic awards, be sure to include them. For example:

• Bachelor of Science in Health Administration, XYZ University, Graduated Summa Cum Laude
• Relevant Coursework: Healthcare Ethics, Medical Terminology, Patient Communication Strategies

3. Keep it brief if you're a seasoned professional

If you have several years of experience as a patient care coordinator or in a related role, your education section should be brief. The employer will be more interested in your work history and accomplishments than your academic background.

In this case, simply list your degree, university, and graduation year. For example:

• Master of Healthcare Administration, ABC University
• Bachelor of Science in Nursing, XYZ College

Avoid listing your graduation year if it was more than 10-15 years ago, as it can unnecessarily reveal your age and lead to potential bias.

4. Include relevant certifications

If you have any relevant certifications for the patient care coordinator role, you can include them in your education section or create a separate section titled 'Certifications.' Some examples might include:

These certifications show your commitment to the field and can make you a more competitive candidate. Be sure to include the full name of the certification, the issuing organization, and the year you earned it.

  Skills

The skills section is a key part of your patient care coordinator resume. It's where you highlight your most relevant abilities and expertise to show hiring managers you're a great fit. Your skills section should be tailored, compelling and easy to quickly scan.

Here are our top tips for writing a strong skills section for your patient care coordinator resume:

1. Choose patient care skills from the job description

Many companies use Applicant Tracking Systems (ATS) to automatically scan your resume. These systems look for specific skills the hiring manager has predetermined. Tailor your resume skills section by studying the job description and including skills you find there, as long as you actually have them.

Let's look at an example of a job description for a patient care coordinator role:

Responsibilities: Coordinate patient care by scheduling appointments, tests and procedures Obtain insurance authorizations and manage referrals Collaborate with medical staff to develop and implement care plans Utilize EMR systems to document patient interactions Requirements: Knowledge of medical terminology, insurance guidelines and HIPAA regulations Proficiency in EMR systems (Epic preferred) Excellent organizational, communication and customer service skills

Based on this, good skills to include on your resume would be:

• Patient Scheduling
• Care Coordination
• Insurance Authorizations
• HIPAA Compliance
• Medical Terminology

2. Categorize your skills

Grouping your skills into categories helps make your skills section easy to read. Common categories for patient care coordinators include:

• Clinical Skills : Patient Assessment, Care Planning, Triage, Medical Terminology
• Administrative Skills : Scheduling, EMR, Insurance Verification, Referral Management
• Communication Skills : Patient Education, Physician Liaison, Telephone Etiquette
• Regulatory Knowledge : HIPAA, Medicare Guidelines, JCAHO Standards

Avoid broad categories like "Soft Skills" or "Computer Skills." Instead, use specific categories that relate directly to the patient care coordinator role.

Here's an example of a well-categorized skills section:

Care Coordination : Patient Scheduling, Referral Management, Insurance Authorization, Utilization Review Clinical Knowledge : Medical Terminology, Care Planning, Patient Education, Clinical Pathways EMR Systems : Epic, Cerner, Meditech, Allscripts Regulatory Compliance : HIPAA, Medicare, Medicaid, JCAHO

3. Avoid generic soft skills

Many resumes are filled with vague, generic "soft skills" - things like communication, teamwork, and organization. While these are important, they don't really tell employers much. Anyone can say they have "strong communication skills."

Instead of relying on these overused buzzwords, look for ways to show these soft skills through your work experience and achievements. Did you train and mentor new team members? That shows leadership and communication skills. Did you redesign scheduling processes to improve efficiency? That demonstrates your organizational abilities.

Let's look at a skills section that's too heavy on the soft skills:

Communication Teamwork Organization Multitasking Problem Solving Detail Oriented Adaptable

While the candidate may possess all these skills, this doesn't give the hiring manager a strong idea of their suitability for a patient care coordinator role. Compare that to a skills section focused on job-relevant technical skills:

Patient Scheduling Epic EMR ICD-10 Coding Insurance Verification Care Plan Development HIPAA Compliance Clinical Documentation

This gives a much clearer picture of the candidate's qualifications. Aim to emphasize these kinds of hard skills over generic soft skills.

Skills For Patient Care Coordinator Resumes

Here are examples of popular skills from Patient Care Coordinator job descriptions that you can include on your resume.

• Electronic Medical Record (EMR)
• Patient Care
• Quality Patient Care
• U.S. Health Insurance Portability and Accountability Act (HIPAA)
• Patient Safety
• Healthcare Management
• Medical Records
• Office Administration
• Patient Education

Skills Word Cloud For Patient Care Coordinator Resumes

This word cloud highlights the important keywords that appear on Patient Care Coordinator job descriptions and resumes. The bigger the word, the more frequently it appears on job postings, and the more likely you should include it in your resume.

How to use these skills?

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Patient Care Coordinator Resumes

• Template #1: Patient Care Coordinator
• Template #2: Patient Care Coordinator
• Template #3: Medical Office Assistant
• Template #4: Clinical Care Coordinator
• Template #5: Health Services Coordinator
• Template #6: Clinic Coordinator
• Template #7: Patient Services Manager
• Skills for Patient Care Coordinator Resumes
• Free Patient Care Coordinator Resume Review
• Other Medical Resumes
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Patient Care Manager

Patient Care Manager Resume Sample

Complete Name Complete Address Phone # / Cell Phone # E-mail Address

PATIENT CARE MANAGER

High-powered, enthusiastic, and seasoned manager offering immeasurable success in healthcare administration, compliance facilitation, and auditing. Possess stellar reputation in planning, creating, and developing strategies and plans while maintaining compliance with all regulatory agencies. Recognized as a natural born leader and hands-on manager proficient in healthcare trends as well as in new and emerging technologies. Knowledgeable of other information pertinent in achieving the key goals of cost containment, effective service, and high quality health care. Proven effectiveness in a fiercely competitive, challenging, and team-oriented environment while juggling to multiple priorities.

Key Strengths

• Healthcare Administration and Operations
• Program Management and Development
• Quality Control and Regulatory Compliance
• Process / Performance Improvement
• Outstanding Patient Care and Relations
• Leadership, Training, and Team Building
• Budget and Time Management
• Problem Resolution and Decision Making

Technical Skills

Microsoft Office (Outlook, Word, Excel, Power Point, Visio), Meditech (Magic and 6.0), ProClarity, DR Systems Web Ambassador/PACS, PICIS OR Manager, Imprivata

Professional Experience

Abc Hospital | Little Rock, AR | 2012-Present Patient Care Manager | Oct 2015–Present

Leverage outstanding interpersonal skills in establishing rapport with diverse professional staff of all departments to attain hospital goals and meet the established guidelines. Competently function as a customer service liaison tasked to investigate complaints and provide resolutions to patient/family grievance, care provider issues, and other staff concerns. Administer all aspects of coordinating and managing staff training for implementation of new policies or processes. Render dynamic leadership in coaching and mentoring more than 70 staff, accountable for maintaining the ACH behavior standards. Perform administrative duties, such as managing staffing schedule, time off requests, call-ins, and clinic cancellations.

Career Highlights:

• Gained recognition as a role model professional demonstrating notable developmental and critical thinking.
• Proficiently performed human resources duties, such as overseeing applicant screening, interview, orientation, and competency review as well as conducting 90-day and annual employee evaluations.
• Ensured superior clinical proficiency and staff performance efficiency in the clinic.
• Contributed in leading the entire dental outreach programs, from start up to implementation and daily operations.
• Fully orchestrated overall spectrum of the ongoing South Wing Project (ENT and Dental Clinics) development, including current equipment inventory, analysis of projected equipment needs, new equipment quote requests, and budget proposals.

Specialty Nurse , Gastroenterology | Feb 2014–Oct 2015

Delivered exemplary performance in interviewing patients and their family regarding health history, performing complete physical exam, as well as monitoring and reporting symptoms and changes in patients’ conditions. Managed and scheduled patient appointments for the clinic, ambulatory surgery center, day medicine infusion therapy, as well as laboratory and radiology procedures while working with PCPs offices regarding new patient appointments and treatment.

• Provided accurate information to patients and their families concerning symptoms, disease process, and treatment plan.
• Vastly contributed as a co-organizer and MC for the 1st Annual Inflammatory Bowel Disease Day.
• Imparted knowledge and skills by presenting and discussing various topics at GI specialists for Certified Pediatric Nurses review class at Arkansas Children’s Hospital (ACH).

Staff Nurse , Pediatric Intensive Care Unit | Jan 2012–Feb 2014 Provided utmost primary nursing care for critically ill pediatric patients.

Bachelor of Science in Nursing | 2018| ABC University at Little Rock | Little Rock, AR Diploma in Registered Nurse Program | 2011| Baptist School of Nursing | Little Rock, AR Bachelor of Arts in Psychology | 2008 | ABC University at Little Rock | Little Rock, AR

Professional Development

Pediatric Advanced Life Support (PALS) Certified Basic Life Support (BLS) Certified Telephone Triage Conference Patient Care Manager Skill Set Briefings

• Employee Relations
• Just Culture
• Evidence-Based Practice
• Performance Management
• Communication Excellence in the Workplace
• InSite (Electronic Staff Self Schedule System, Ambulatory Care Services Representative)
• Bedside Medication Verification
• Electronic Telephone Interaction Form
• Meditech 6.0 Electronic Medical Record Conversion

Awards and Honors

“Crossing the Creek” by Director Terri Songer, Ambulatory Care Services “Teamwork” by Vice President Katie Brandon, Patient Care Services “Teamwork” by Vice President Carol Graham, Ambulatory Care Services “Quality Improvement” by Director Terri Songer, Ambulatory Care Services

Activities and Affiliations

Clinical Emergency Preparedness Instructor (2015–Present) Basic Life Support (BLS) Instructor (2013–2017) Facilitator

• Shared Governance Unit Base Council, Arkansas Children’s Hospital
• Little Rock CARE Clinic, Little Rock, AR
• Annual Arkansas Children’s Hospital Wellness Fair
• Meditech 6.0 PCS Core Team, Arkansas Children’s Hospital
• Nursing Pharmacy Committee, Arkansas Children’s Hospital
• University of Arkansas at Little Rock Alumni Association
• Healthcare Information and Management Systems Society
• Arkansas Nurses Association
• American Nurses Association
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• Construction
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Top 18 Care Manager Resume Objective Examples

Updated July 8, 2023 13 min read

A resume objective is a brief statement that summarizes your career goals and accomplishments, and is typically included at the top of your resume. When writing an objective for a care manager position, you should focus on how you can use your skills and experience to benefit the organization. You should also include any relevant certifications or qualifications, such as a degree in social work or healthcare management. To make sure that your objective stands out, be sure to include key words from the job posting. For example: "Seeking a Care Manager role at ABC Company to utilize my 10+ years of experience in health care management and advanced knowledge of medical terminology." Or, "To leverage my MSW degree and expertise in patient-centered care to support ABC Company's mission of providing quality care." Finally, keep it concise—no more than two sentences—and make sure it’s tailored to the specific job opportunity.

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Top 18 Care Manager Resume Objective Samples

• To obtain a Care Manager position utilizing my experience in providing quality care and support to clients.
• To leverage my expertise in managing complex cases, developing care plans, and coordinating services to benefit the organization.
• Seeking a Care Manager role with an organization that values quality care and customer service.
• To secure a Care Manager role where I can use my knowledge of healthcare regulations and standards to ensure compliance.
• To utilize my skills in client advocacy, case management, and problem-solving to help improve the lives of clients as a Care Manager.
• Seeking a challenging position as a Care Manager where I can utilize my experience in providing support services for individuals with disabilities.
• To apply my strong organizational skills and knowledge of best practices to provide excellent care management services as a Care Manager.
• Aiming for a Care Manager position that will allow me to use my interpersonal skills and compassion for helping others.
• Looking for an opportunity to contribute to the success of an organization by using my experience as a Care Manager.
• Seeking a position as a Care Manager where I can use my extensive knowledge of health insurance policies and procedures.
• To obtain employment as a Care Manager where I can demonstrate effective communication, problem-solving, and leadership skills while providing exceptional patient care.
• Applying for the position of Care Manager with the goal of utilizing my expertise in medical terminology, billing processes, and professional documentation practices.
• Searching for an opportunity to become part of an organization that values quality care management by leveraging my experience in developing individualized plans of care for patients.
• Aiming for a position as a Care Manager where I can use my knowledge of community resources to assist clients in finding appropriate services and supports.
• Looking for an opportunity to work with an organization that values compassionate patient care by applying my experience as a qualified Care Manager.
• Utilizing strong communication skills and attention to detail while providing comprehensive case management services as part of the team at [Organization Name].
• Applying for the role of Care Manager with the goal of using my expertise in assessing client needs, creating individualized treatment plans, monitoring progress, and advocating on behalf of clients.
• Seeking employment as a Care Manager where I can use my understanding of HIPAA regulations and other relevant laws to ensure compliance within the organization’s operations

How to Write a Care Manager Resume Objective

A Care Manager Resume Objective is an essential part of any job application, as it will help employers determine if you are the right person for the job. A Care Manager Resume Objective should highlight your experience and qualifications in a concise manner that will make you stand out from other applicants. It should also demonstrate your ability to effectively manage and coordinate care services.

When writing a Care Manager Resume Objective, begin by stating your professional title and years of experience in the field. This will give employers an idea of your qualifications and expertise. You can then explain why you are interested in the position and how you can contribute to the organization’s success. Be sure to include any specialized knowledge or skills that may be relevant to the role.

In addition to your professional qualifications, it is important to mention any related certifications or licenses you possess, such as a Registered Nurse or Certified Nursing Assistant certification. Any awards or recognition received for outstanding work performance should also be included in your objective statement. This will show employers that you have achieved success in past roles and are capable of performing well in this one too.

Finally, end with a clear statement about what kind of impact you would have on the organization if hired for this position. This could include providing quality care services, meeting goals and targets, creating efficient processes, or developing new strategies for improving patient outcomes.

By following these tips, you can create a successful Care Manager Resume Objective that will set you apart from other applicants and get noticed by potential employers!

Related : What does a Care Manager do?

Key Skills to Highlight in Your Care Manager Resume Objective

When crafting a resume for a Care Manager position, it's crucial to highlight specific skills in your objective statement that align with the job requirements. This section is not only an opportunity to express your career goals but also a platform to showcase your expertise and abilities. The key skills you choose to emphasize can significantly influence potential employers' perception of you as a candidate. In this section, we will discuss the essential skills you should consider including in your Care Manager resume objective.

A Care Manager needs to have empathy as they are responsible for providing support and assistance to individuals who may be dealing with various health or personal issues. This skill is crucial in understanding and addressing the emotional, social, and physical needs of their clients. It helps them build trust, foster positive relationships, and deliver personalized care plans that can improve the quality of life for their clients. In a resume objective, highlighting this skill can show potential employers that the candidate is capable of providing compassionate and effective care management services.

2. Organization

A Care Manager must handle multiple tasks and responsibilities simultaneously, such as coordinating care plans, managing healthcare services, and communicating with various healthcare professionals. Therefore, strong organizational skills are essential to manage all these tasks effectively and efficiently. This skill is needed for a resume objective to show potential employers that the candidate can maintain order, prioritize tasks, meet deadlines and provide high-quality care service without overlooking any details.

3. Communication

A Care Manager needs strong communication skills to effectively coordinate and manage the care plans of patients. They need to clearly convey information between patients, families, and healthcare professionals. Additionally, they must be able to listen and understand the needs and concerns of their patients. This skill is crucial for a resume objective as it showcases the candidate's ability to facilitate efficient care services while ensuring patient satisfaction.

4. Problem-solving

A Care Manager often faces complex situations involving patient care, family dynamics, healthcare systems and resources. Problem-solving skills are crucial in these scenarios to develop effective care plans, coordinate with various healthcare providers and navigate any obstacles that may arise. This skill is essential for a resume objective as it demonstrates the candidate's ability to handle challenges and ensure the best possible care for patients.

5. Time-management

A Care Manager often has to juggle multiple tasks, patients, and responsibilities at once. They need to coordinate with different healthcare professionals, schedule appointments, manage patient care plans and ensure all tasks are completed in a timely manner. Therefore, having strong time-management skills is crucial for this role. It allows the Care Manager to effectively prioritize tasks and ensure that all patients receive the care they need when they need it. Including this skill in a resume objective can highlight the candidate's ability to handle the demanding nature of the job efficiently.

6. Decision-making

A Care Manager often needs to make critical decisions regarding the care plans and treatment strategies for their clients or patients. They may need to decide on the best course of action in emergency situations, allocate resources efficiently, or choose between different care options based on a patient's specific needs and circumstances. Demonstrating strong decision-making skills in a resume objective can therefore show potential employers that the candidate is capable of making informed, effective choices that will benefit both the patient and the healthcare organization.

7. Conflict-resolution

A Care Manager often deals with situations where there may be disagreements or conflicts between patients, their families, and healthcare providers. Having conflict-resolution skills is crucial to ensure that these situations are handled in a way that respects everyone's needs and concerns. It also helps in maintaining a harmonious environment, leading to more effective care for patients. This skill demonstrates the candidate's ability to navigate difficult situations professionally and constructively, which is essential in the healthcare setting.

8. Active-listening

A Care Manager needs active listening skills to effectively understand the needs, concerns, and preferences of their clients. This skill is crucial in developing personalized care plans and providing appropriate support. In a resume objective, highlighting this skill can show potential employers that the candidate is capable of providing high-quality care by accurately understanding and responding to client's needs.

9. Adaptability

A Care Manager often needs to work in dynamic environments with different clients, each having unique needs and circumstances. Adaptability is crucial as it allows the Care Manager to adjust their approach and strategies effectively according to each client's situation. This skill also helps them to cope with unexpected changes or challenges that may arise in their role, ensuring they can continue providing high-quality care and support. In a resume objective, highlighting adaptability can demonstrate a candidate's readiness and flexibility in managing various care situations, making them potentially more appealing to employers.

10. Teamwork

A Care Manager often works in a multidisciplinary team environment, coordinating with various healthcare professionals, social workers, and family members to provide optimal care for patients or clients. Teamwork is essential to ensure effective communication, collaboration, and coordinated efforts in managing the care plan. It helps in building positive relationships, resolving conflicts and making collective decisions that enhance patient outcomes. Including teamwork as a skill in a resume objective can demonstrate the candidate's ability to work cohesively within diverse teams and contribute positively towards achieving common goals.

In conclusion, your Care Manager resume objective should effectively encapsulate and highlight your key skills, demonstrating your competency and suitability for the role. This section is a crucial part of your resume as it provides potential employers with a snapshot of your abilities right at the outset. It's important to ensure that it is compelling and succinctly communicates your value as a candidate. Remember, this is your first opportunity to make an impression, so make sure you present a strong showcase of the unique skills you bring to the table.

Related : Care Manager Skills: Definition and Examples

Common Mistakes When Writing a Care Manager Resume Objective

Writing a resume objective as a care manager can be tricky because it’s important to make sure that you present yourself in the best possible light. Unfortunately, many people make mistakes when crafting their resume objective that can hurt their chances of getting an interview. Here are some of the most common mistakes to avoid when writing your care manager resume objective:

1. Focusing too much on your own goals and ambitions – Your resume objective should focus on how you can help the employer rather than what you hope to gain from them. Make sure your objective is tailored to the specific job you are applying for and highlights your skills, experience, and qualifications that make you the best candidate for the position.

2. Being too general – Generic statements like “I am looking for a challenging role in healthcare” are not effective because they don’t provide any real insight into who you are or why you would be a great fit for the job. Be specific about what makes you unique and why you are the ideal candidate for this particular role.

3. Using jargon – Avoid using industry-specific jargon or acronyms as these may not be familiar to potential employers outside of the healthcare field. Stick with language that is easily understood by all readers and get straight to the point without any unnecessary words or phrases.

4. Not proofreading – Before submitting your resume, read through it carefully to ensure there aren’t any typos or grammatical errors that could give off a negative impression of your professionalism and attention to detail. Even one small mistake can cost you an opportunity so take time to double-check everything before sending out your application materials.

By avoiding these common mistakes, you can create an effective care manager resume objective that will help make a good first impression on potential employers and increase your chances of landing an interview for the position!

Related : Care Manager Resume Examples

A right resume objective for a Care Manager should clearly articulate the candidate's knowledge, skills, and experience related to the job they are seeking, while a wrong resume objective may focus on what the candidate expects to gain from the position.

Editorial staff

Brenna Goyette

Brenna is a certified professional resume writer, career expert, and the content manager of the ResumeCat team. She has a background in corporate recruiting and human resources and has been writing resumes for over 10 years. Brenna has experience in recruiting for tech, finance, and marketing roles and has a passion for helping people find their dream jobs. She creates expert resources to help job seekers write the best resumes and cover letters, land the job, and succeed in the workplace.

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This paper is in the following e-collection/theme issue:

Published on 11.4.2024 in Vol 26 (2024)

Evaluating the Digital Health Experience for Patients in Primary Care: Mixed Methods Study

Authors of this article:

Original Paper

• Melinda Ada Choy 1, 2 , BMed, MMed, DCH, MD   ; 
• Kathleen O'Brien 1 , BSc, GDipStats, MBBS, DCH   ; 
• Katelyn Barnes 1, 2 , BAPSC, MND, PhD   ; 
• Elizabeth Ann Sturgiss 3 , BMed, MPH, MForensMed, PhD   ; 
• Elizabeth Rieger 1 , BA, MClinPsych, PhD   ; 
• Kirsty Douglas 1, 2 , MBBS, DipRACOG, Grad Cert HE, MD  

1 School of Medicine and Psychology, College of Health and Medicine, The Australian National University, Canberra, Australia

2 Academic Unit of General Practice, Office of Professional Leadership and Education, ACT Health Directorate, Canberra, Australia

3 School of Primary and Allied Health Care, Monash University, Melbourne, Australia

Corresponding Author:

Melinda Ada Choy, BMed, MMed, DCH, MD

School of Medicine and Psychology

College of Health and Medicine

The Australian National University

Phone: 61 51244947

Email: [email protected]

Background: The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged, who are already marginalized through reduced access to face-to-face health care, are additionally hindered through less access to patient-initiated digital health. A comprehensive understanding of how patients with socioeconomic disadvantage access and experience digital health is essential for improving the digital health divide. Primary care patients, especially those with chronic disease, have experience of the stages of initial help seeking and self-management of their health, which renders them a key demographic for research on patient-initiated digital health access.

Objective: This study aims to provide comprehensive primary mixed methods data on the patient experience of barriers to digital health access, with a focus on the digital health divide.

Methods: We applied an exploratory mixed methods design to ensure that our survey was primarily shaped by the experiences of our interviewees. First, we qualitatively explored the experience of digital health for 19 patients with socioeconomic disadvantage and chronic disease and second, we quantitatively measured some of these findings by designing and administering a survey to 487 Australian general practice patients from 24 general practices.

Results: In our qualitative first phase, the key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health. In our quantitative second phase, 31% (151/487) of the survey participants were found to have never used a form of digital health, while 10.7% (52/487) were low- to medium-frequency users and 48.5% (236/487) were high-frequency users. High-frequency users were more likely to be interested in digital health and had higher self-efficacy. Low-frequency users were more likely to report difficulty affording the financial costs needed for digital access.

Conclusions: While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers. Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be part of addressing the digital health divide.

Introduction

The promise of ehealth.

The rapid growth of digital health, sped up by the COVID-19 pandemic and associated lockdowns, brings the promise of improved health care efficiency, empowerment of consumers, and health care equity [ 1 ]. Digital health is the use of information and communication technology to improve health [ 2 ]. eHealth, which is a type of digital health, refers to the use of internet-based technology for health care and can be used by systems, providers, and patients [ 2 ]. At the time of this study (before COVID-19), examples of eHealth used by patients in Australia included searching for web-based health information, booking appointments on the web, participating in online peer-support health forums, using mobile phone health apps (mobile health), emailing health care providers, and patient portals for electronic health records.

Digital health is expected to improve chronic disease management and has already shown great potential in improving chronic disease health outcomes [ 3 , 4 ]. Just under half of the Australian population (47.3%) has at least 1 chronic disease [ 5 ]. Rates of chronic disease and complications from chronic disease are overrepresented among those with socioeconomic disadvantage [ 6 ]. Therefore, patients with chronic disease and socioeconomic disadvantage have a greater need for the potential benefits of digital health, such as an improvement in their health outcomes. However, there is a risk that those who could benefit most from digital health services are the least likely to receive them, exemplifying the inverse care law in the digital age by Hart [ 7 ].

Our Current Understanding of the Digital Health Divide

While the rapid growth of digital health brings the promise of health care equity, it may also intensify existing inequities [ 8 ]. The digital health divide for socioeconomic disadvantage describes a pattern in which patients considered socioeconomically disadvantaged who are already marginalized through poor access to traditional health care are additionally hindered through poor access to digital health [ 9 ]. In Australia, only 67.4% of households in the lowest household income quintile have home internet access, compared to 86% of the general population and 96.9% of households in the highest household income quintile [ 10 ]. Survey-based studies have also shown that even with internet access, effective eHealth use is lower in populations considered disadvantaged, which speaks to broader barriers to digital health access [ 11 ].

The ongoing COVID-19 global pandemic has sped up digital health transitions with the rapid uptake of telephone and video consultations, e-prescription, and the ongoing rollout of e-mental health in Australia. These have supported the continuation of health care delivery while limiting physical contact and the pandemic spread; however, the early evidence shows that the digital health divide remains problematic. A rapid review identified challenges with reduced digital access and digital literacy among the older adults and racial and ethnic minority groups, which are both groups at greater health risk from COVID-19 infections [ 12 ]. An Australian population study showed that the rapid uptake of telehealth during peak pandemic was not uniform, with the older adults, very young, and those with limited English language proficiency having a lower uptake of general practitioner (GP) telehealth services [ 13 ].

To ensure that digital health improves health care outcome gaps, it is essential to better understand the nature and nuance of the digital health divide for socioeconomic disadvantage. The nature of the digital health divide for socioeconomic disadvantage has been explored primarily through quantitative survey data, some qualitative papers, a few mixed methods papers, and systematic reviews [ 11 , 14 - 16 ]. Identified barriers include a lack of physical hardware and adequate internet bandwidth, a reduced inclination to seek out digital health, and a low ability and confidence to use digital health effectively [ 16 ]. The few mixed methods studies that exist on the digital health divide generally triangulate quantitative and qualitative data on a specific disease type or population subgroup to draw a combined conclusion [ 17 , 18 ]. These studies have found digital health access to be associated with education, ethnicity, and gender as well as trust, complementary face-to-face services, and the desire for alternative sources of information [ 17 , 19 ].

What This Work Adds

This project sought to extend previous research by using an exploratory mixed methods design to ensure that the first step and driver of our survey of a larger population was primarily shaped by the experiences of our interviewees within primary care. This differs from the triangulation method, which places the qualitative and quantitative data as equal first contributors to the findings and does not allow one type of data to determine the direction of the other [ 18 ]. We qualitatively explored the experience of digital health for patients with socioeconomic disadvantage and chronic disease and then quantitatively measured some of the qualitative findings via a survey of the Australian general practice patient population. Our key objective was to provide comprehensive primary mixed methods data, describing the experience and extent of barriers to accessing digital health and its benefits, with a focus on the digital health divide. We completed this research in a primary care context to investigate a diverse community-based population with conceivable reasons to seek digital help in managing their health. Findings from this mixed methods study were intended to provide health care providers and policy makers with a more detailed understanding of how specific barriers affect different aspects or steps of accessing digital health. Ultimately, understanding digital health access can influence the future design and implementation of digital health services by more effectively avoiding certain barriers or building in enablers to achieve improved digital health access not only for everyone but also especially for those in need.

Study Design

We conducted a sequential exploratory mixed methods study to explore a complex phenomenon in depth and then measure its prevalence. We qualitatively explored the experience of digital health for patients with chronic disease and socioeconomic disadvantage in the first phase. Data from the first phase informed a quantitative survey of the phenomenon across a wider population in the second phase [ 18 ]. Both stages of research were conducted before the COVID-19 pandemic in Australia.

Recruitment

Qualitative phase participants.

The eligibility criteria for the qualitative phase were as follows: English-speaking adults aged ≥18 years with at least 1 self-reported chronic disease and 1 marker of socioeconomic disadvantage (indicated by ownership of a Health Care Card or receiving a disability pension, unemployment, or a user of public housing). A chronic disease was defined to potential participants as a diagnosed long-term health condition that had lasted at least 6 months (or is expected to last for at least 6 months; examples are listed in Multimedia Appendix 1 ). The markers of socioeconomic disadvantage we used to identify potential participants were based on criteria typically used by local general practices to determine which patients can have lower or no out-of-pocket expenses. Apart from unemployment, the 3 other criteria to identify socioeconomic disadvantage are means-tested government-allocated public social services [ 20 ]. Qualitative phase participants were recruited from May to July 2019 through 3 general practices and 1 service organization that serve populations considered socioeconomically disadvantaged across urban, regional, and rural regions in the Australian Capital Territory and South Eastern New South Wales. A total of 2 recruitment methods were used in consultation with and as per the choice of the participating organizations. Potential participants were either provided with an opportunity to engage with researchers (KB and MAC) in the general practice waiting room or identified by the practice or organization as suitable for an interview. Interested participants were given a detailed verbal and written description of the project in a private space before providing written consent to be interviewed. All interview participants received an Aus $50 (US $32.68) grocery shopping voucher in acknowledgment of their time.

Quantitative Phase Participants

Eligibility for the quantitative phase was English-speaking adults aged ≥18 years. The eligibility criteria for the quantitative phase were deliberately broader than those for the qualitative phase to achieve a larger sample size within the limitations of recruitment and with the intention that the factors of socioeconomic disadvantage and having a chronic disease could be compared to the digital health access of a more general population. The quantitative phase participants were recruited from November 2019 to February 2020. Study information and paper-based surveys were distributed and collected through 24 general practices across the Australian Capital Territory and South Eastern New South Wales regions, with an option for web-based completion.

Ethical Considerations

Qualitative and quantitative phase research protocols, including the participant information sheet, were approved by the Australian Capital Territory Health Human Research Ethics Committee (2019/ETH/00013) and the Australian National University Human Research Ethics Committee (2019/ETH00003). Qualitative phase participants were given a verbal and written explanation of the study, including how and when they could opt out, before they provided written consent. All interview participants received an Aus $50 (US $32.68) grocery shopping voucher in acknowledgment of their time. Quantitative participants were given a written explanation and their informed consent was implied by return of a completed survey. Participants in both phases of the study were told that all their data was deidentified. Consent was implied through the return of a completed survey.

Qualitative Data Collection and Analysis

Participants were purposively sampled to represent a range in age, gender, degree of socioeconomic disadvantage, and experience of digital health. The sampling and sample size were reviewed regularly by the research team as the interviews were being completed to identify potential thematic saturation.

The interview guide was developed by the research team based on a review of the literature and the patient dimensions of the framework of access by Levesque et al [ 21 ]. The framework by Levesque et al [ 21 ] is a conceptualization of health care access comprising 5 service and patient dimensions of accessibility and ability. The patient dimensions are as follows: (1) ability to perceive, (2) ability to seek, (3) ability to reach, (4) ability to pay, and (5) ability to engage [ 21 ]. The key interview topics included (1) digital health use and access, including facilitators and barriers; (2) attitudes toward digital health; and (3) self-perception of digital health skills and potential training. The interview guide was reviewed for face and content validity by the whole research team, a patient advocate, a digital inclusion charity representative, and the general practices where recruitment occurred. The questions and guide were iteratively refined by the research team to ensure relevance and support reaching data saturation. The interview guide has been provided as Multimedia Appendix 1 . The interviews, which took 45 minutes on average, were taped and transcribed. An interview summary sheet and reflective journal were completed by the interviewer after each interview to also capture nonverbal cues and tone.

Interview transcriptions were coded and processed by inductive thematic analysis. Data collection and analysis were completed in parallel to support the identification of data saturation. Data saturation was defined as no significant new information arising from new interviews and was identified by discussion with the research team [ 22 ]. The 2 interviewers (MAC and KB) independently coded the first 5 transcripts and reflected on them with another researcher (EAS) to ensure intercoder validity and reliability. The rest of the interviews were coded independently by the 2 interviewers, who regularly met to reflect on emerging themes and thematic saturation. Data saturation was initially indicated after 15 interviews and subsequently confirmed with a total of 19 interviews. Coding disagreements and theme development were discussed with at least 1 other researcher (EAS, ER, and KD). Thematic saturation and the final themes were agreed upon by the entire research team.

Quantitative Survey Development

The final themes derived in the qualitative phase of the project guided the specific quantitative phase research questions. The final themes were a list of ordered cumulative barriers experienced by participants in accessing digital health and its benefits ( Figure 1 ). The quantitative survey was designed to test the association between barriers to access and the frequency of use of digital health as a proxy measure for digital health access.

In the survey, the participants were asked about their demographic details, health and chronic diseases, knowledge, use and experience of digital health tools, internet access, perception of digital resource affordability, trust in digital health and traditional health services, perceived capability, health care empowerment, eHealth literacy, and relationship with their GP.

Existing scales and questions from the literature and standardized Australian-based surveys were used whenever possible. We used selected questions and scales from the Australian Bureau of Statistics standards, the eHealth Literacy Scale (eHEALS), the eHealth Literacy Questionnaire, and the Southgate Institute for Health Society and Equity [ 17 , 23 - 26 ]. We adapted other scales from the ICEpop Capability Measure for Adults, the Health Care Empowerment Inventory (HCEI), the Patient-Doctor Relationship Questionnaire, and the Chao continuity questionnaire [ 23 , 27 - 29 ]. Where an existing scale to measure a barrier or theme did not exist, the research team designed the questions based on the literature. Our questions around the frequency of digital health use were informed by multiple existing Australian-based surveys on general technology use [ 30 , 31 ]. Most of the questions used a Likert scale. Every choice regarding the design, adaptation, or copy of questions for the survey was influenced by the qualitative findings and decided on by full agreement among the 2 researchers who completed and coded the interviews. A complete copy of the survey is provided in Multimedia Appendix 2 .

Pilot-testing of the survey was completed with 5 patients, 2 experts on digital inclusion, and 3 local GPs for both the paper surveys and web-based surveys via Qualtrics Core XM (Qualtrics LLC). The resulting feedback on face and content validity, functionality of the survey logic, and feasibility of questionnaire completion was incorporated into the final version of the survey.

The survey was offered on paper with a participant information sheet, which gave the patients the option to complete the web-based survey. The survey was handed out to every patient on paper to avoid sampling bias through the exclusion of participants who could not complete the web-based survey [ 32 ].

Quantitative Data Treatment and Analysis

Data were exported from Qualtrics Core XM to an SPSS (version 26; IBM Corp) data set. Data cleaning and screening were undertaken (KB and KO).

Descriptive statistics (number and percentage) were used to summarize participant characteristics, preference measures, and frequency of eHealth use. Significance testing was conducted using chi-square tests, with a threshold of P <.05; effect sizes were measured by the φ coefficient for 2×2 comparisons and Cramer V statistic for all others. Where the cells sizes were too small, the categories were collapsed for the purposes of significance testing. The interpretation of effect sizes was as per the study by Cohen [ 33 ]. The analysis was conducted in SPSS and SAS (version 9.4; SAS Institute).

Participant Characteristics

Participants’ self-reported characteristics included gender, indigenous status, income category, highest level of education, marital status, and language spoken at home.

Age was derived from participant-reported year of birth and year of survey completion as of 2019 and stratified into age groups. The state or territory of residence was derived from the participant-reported postcode. The remoteness area was derived using the postcode reported by the participants and mapped to a modified concordance from the Australian Bureau of Statistics. Occupation-free text responses were coded using the Australian Bureau of Statistics Census statistics level 1 and 2 descriptors. The country of birth was mapped to Australia, other Organisation for Economic Cooperation and Development countries, and non–Organisation for Economic Cooperation and Development countries.

Frequency of eHealth Use

A summary measure of the frequency of eHealth use was derived from the questions on the use of different types of eHealth.

Specifically, respondents were asked if they had ever used any form of web-based health (“eHealth“) and, if so, to rate how often (never, at least once, every now and then, and most days) against 6 types of “eHealth” (searching for health information online, booking appointments online, emailing health care providers, using health-related mobile phone apps, accessing My Health Record, and accessing online health forums). The frequency of eHealth use was then classified as follows:

• High user: answered “most days” to at least 1 question on eHealth use OR answered “every now and then” to at least 2 questions on eHealth use
• Never user: answered “no” to having ever used any form of eHealth OR “never” to all 6 questions on eHealth use
• Low or medium user: all other respondents.

The frequency of eHealth use was reported as unweighted descriptive statistics (counts and percentages) against demographic characteristics and for the elements of each of the themes identified in phase 1.

Overview of Key Themes

Data were reported against the 6 themes from the phase 1 results of preference, trust, cost, structural access, capacity to engage, and self-efficacy. Where the components of trust, cost, capacity to engage, and self-efficacy had missing data (for less than half of the components only), mean imputation was used to minimize data loss. For each theme, the analysis excluded those for whom the frequency of eHealth use was unknown.

Preference measures (survey section D1 parts 1 to 3) asked participants to report against measures with a 4-point Likert scale (strongly disagree, disagree, agree, and strongly agree). Chi-square tests were conducted after the categories were condensed into 2 by combining strongly disagree and as well as combining strongly agree and agree.

Summary measures for trust were created in 4 domains: trust from the eHealth Literacy Questionnaire (survey section D1 parts 4 to 8), trust from Southgate—GPs, specialists, or allied health (survey section D2 parts 1 to 5), trust from Southgate—digital health (survey section D2 parts 6, 7, 9, and 10), and trust from Southgate—books or pamphlets (survey section D2 part 8). The data were grouped as low, moderate, and high trust based on the assigned scores from the component data. Chi-square tests were conducted comparing low-to-moderate trust against high trust for GP, specialists, or allied health and comparing low trust against moderate-to-high trust for book or pamphlet.

Summary measures for cost were created from survey item C10. To measure cost, participants were asked about whether they considered certain items or services to be affordable. These included cost items mentioned in the qualitative phase interviews relating to mobile phones (1 that connects to the internet, 1 with enough memory space to download apps, downloads or apps requiring payment, repairs, and maintenance costs), having an iPad or tablet with internet connectivity, a home computer or laptop (owning, repairs, and maintenance), home fixed internet access, and an adequate monthly data allowance. These 9 items were scored as “yes definitely”=1 or 0 otherwise. Chi-square tests were conducted with never and low or medium eHealth users combined.

Structural Access

Structural access included asking where the internet is used by participants (survey section C8) and factors relating to internet access (survey section C8 parts 1-3) reporting against a 4-point Likert scale (strongly disagree, disagree, agree, and strongly agree). Chi-square tests were conducted with strongly disagree, disagree, agree, or strongly agree, and never, low, or medium eHealth use combined.

Capacity to Engage

Summary measures for capacity to engage were created from survey section E1. To measure the capacity to engage, participants were asked about feeling “settled and secure,” “being independent,” and “achievement and progress” as an adaptation of the ICEpop Capability Measure for Adults [ 27 ], reporting against a 4-point Likert-like scale. Responses were scored from 1 (“I am unable to feel settled and secure in any areas of my life”) to 4 (“I am able to feel settled and secure in all areas of my life”).

The summary capacity measure was derived by the summation of responses across the 3 questions, which were classified into 4 groups, A to D, based on these scores. Where fewer than half of the responses were missing, mean imputation was used; otherwise, the record was excluded. Groups A and B were combined for significance testing.

Self-Efficacy

Summary measures for self-efficacy were adapted from the eHEALS (E3) and the HCEI (E2) [ 23 , 24 ].

Survey section E3—eHEALS—comprised 8 questions, with participants reporting against a 5-point Likert scale for each (strongly disagree, disagree, neither, agree, and strongly agree). These responses were assigned 1 to 5 points, respectively. The summary eHEALS measure was derived by the summation of responses across the 8 questions, which were classified into 5 groups, A to E, based on these scores. Where fewer than half of the responses were missing, mean imputation was used; otherwise, the record was excluded. Groups A to C and D to E were combined for significance testing.

Survey section E2—HCEI—comprised 5 questions, with participants reporting against a 5-point Likert scale for each (strongly disagree, disagree, neither, agree, and strongly agree). Strongly disagree and disagree and neither were combined, and similarly agree and strongly agree were combined for significance testing.

Qualitative Results

The demographic characteristics of the patients that we interviewed are presented in Table 1 .

The key barriers found to accessing digital health included (1) strong patient preference for human-based health services; (2) low trust in digital health services; (3) high financial costs of necessary tools, maintenance, and repairs; (4) poor publicly available internet access options; (5) reduced capacity to engage due to increased life pressures; and (6) low self-efficacy and confidence in using digital health.

Rather than being an equal list of factors, our interviewees described these barriers as a stepped series of cumulative hurdles, which is illustrated in Figure 1 . Initial issues of preference and trust were foundational to a person even when considering the option of digital health, while digital health confidence and literacy were barriers to full engagement with and optimal use of digital health. Alternatively, interviewees who did use digital health had been enabled by the same factors that were barriers to others.

a GP: general practitioner.

b Multiple answers per respondent.

Strong Patient Preference for Human-Based Health Services

Some patients expressed a strong preference for human-based health services rather than digital health services. In answer to a question about how digital health services could be improved, a patient said the following:

Well, having an option where you can actually bypass actually having to go through the app and actually talk directly to someone. [Participant #10]

For some patients, this preference for human-based health services appeared to be related to a lack of exposure to eHealth. These patients were not at all interested in or had never thought about digital health options. A participant responded the following to the interviewer’s questions:

Interviewer: So when...something feels not right, how do you find out what’s going on?

Respondent: I talk to Doctor XX.

Interviewer: Do you ever Google your symptoms or look online for information?

Respondent: No, I have never even thought of doing that actually. [Participant #11]

For other patients, their preference for human-based health care stemmed from negative experiences with technology. These patients reported actively disliking computers and technology in general and were generally frustrated with what they saw as the pitfalls of technology. A patient stated the following:

If computers and internet weren’t so frigging slow because everything is on like the slowest speed network ever and there’s ads blocking everything. Ads, (expletive) ads. [Participant #9]

A patient felt that he was pushed out of the workforce due his inability to keep up with technology-based changes and thus made a decision to never own a computer:

But, you know, in those days when I was a lot younger those sorts of things weren’t about and they’re just going ahead in leaps and bounds and that’s one of the reasons why I retired early. I retired at 63 because it was just moving too fast and it’s all computers and all those sorts of things and I just couldn’t keep up. [Participant #17]

Low Trust in Digital Health Services

Several patients described low trust levels for digital and internet-based technology in general. Their low trust was generally based on stories they had heard of other people’s negative experiences. A patient said the following:

I don’t trust the internet to be quite honest. You hear all these stories about people getting ripped off and I’ve worked too hard to get what I’ve got rather than let some clown get it on the internet for me. [Participant #11]

Some of this distrust was specific to eHealth. For example, some patients were highly suspicious of the government’s motives with regard to digital health and were concerned about the privacy of their health information, which made them hesitant about the concept of a universal electronic health record. In response to the interviewer’s question, a participant said the following:

Interviewer: Are there any other ways you think that eHealth might help you?

Respondent: I’m sorry but it just keeps coming back to me, Big Brother. [Participant #7]

Another participant said the following:

I just would run a mile from it because I just wouldn’t trust it. It wouldn’t be used to, as I said, for insurance or job information. [Participant #16]

High Financial Costs of the Necessary Tools, Maintenance, and Repairs

A wide variety of patients described affordability issues across several different aspects of the costs involved in digital health. They expressed difficulty in paying for the following items: a mobile phone that could connect to the internet, a mobile phone with enough memory space to download apps, mobile phone apps requiring extra payment without advertisements, mobile phone repair costs such as a broken screen, a computer or laptop, home internet access, and adequate monthly data allowance and speeds to functionally use the internet. Current popular payment systems, such as plans, were not feasible for some patients. A participant stated the following:

I don’t have a computer...I’m not in the income bracket to own a computer really. Like I could, if I got one on a plan kind of thing or if I saved up for x-amount of time. But then like if I was going on the plan I’d be paying interest for having it on like lay-buy kind of thing, paying it off, and if it ever got lost or stolen I would still have to repay that off, which is always a hassle. And yeah. Yeah, I’m like financially not in the state where I’m able to...own a computer right now as I’m kind of paying off a number of debts. [Participant #9]

Poor Publicly Available Internet Access Options

Some patients described struggling without home internet access. While they noted some cost-free public internet access points, such as libraries, hotel bars, and restaurants, they often found these to be inconvenient, lacking in privacy, and constituting low-quality options for digital health. A patient stated the following:

...it’s incredibly slow at the library. And I know why...a friend I went to school with used to belong to the council and the way they set it up, they just got the raw end of the stick and it is really, really slow. It’s bizarre but you can go to the X Hotel and it’s heaps quicker. [Participant #15]

In response to the interviewer's question, a participant said the following:

Interviewer: And do you feel comfortable doing private stuff on computers at the library...?

Respondent: Not really, no, but I don’t have any other choice, so, yeah. [Participant #9]

Reduced Capacity to Engage Due to Increased Life Pressures

When discussing why they were not using digital health or why they had stopped using digital health, patients often described significant competing priorities and life pressures that affected their capacity to engage. An unemployed patient mentioned that his time and energy on the internet were focused primarily on finding work and that he barely had time to focus on his health in general, let alone engage in digital health.

Other patients reported that they often felt that their ability to learn about and spend time on digital health was taken up by caring for sick family members, paying basic bills, or learning English. Some patients said that the time they would have spent learning digital skills when they were growing up had been lost to adverse life circumstances such as being in jail:

So we didn’t have computers in the house when I was growing up. And I didn’t know I’ve never...I’ve been in and out of jail for 28 odd years so it sort of takes away from learning from this cause it’s a whole different… it’s a whole different way of using a telephone from a prison. [Participant #11]

Low Self-Efficacy and Confidence in Starting the Digital Health Process

Some patients had a pervasive self-perception of being slow learners and being unable to use technology. Their stories of being unconfident learners seemed to stem from the fact that they had been told throughout their lives that they were intellectually behind. A patient said the following:

The computer people...wouldn’t take my calls because I’ve always been dumb with that sort of stuff. Like I only found out this later on in life, but I’m actually severely numerically dyslexic. Like I have to triple-check everything with numbers. [Participant #7]

Another patient stated the following:

I like went to two English classes like a normal English class with all the kids and then another English class with about seven kids in there because I just couldn’t I don’t know maybe because I spoke another language at home and they sort of like know I was a bit backward. [Participant #6]

These patients and others had multiple missing pieces of information that they felt made it harder to engage in digital health compared to “easier” human-based services. A patient said the following:

Yeah I’ve heard of booking online but I just I don’t know I find it easier just to ring up. And I’ll answer an email from a health care provider but I wouldn’t know where to start to look for their email address. [Participant #11]

In contrast, the patients who did connect with digital health described themselves as independent question askers and proactive people. Even when they did not know how to use a specific digital health tool, they were confident in attempting to and asking for help when they needed it. A patient said the following:

I’m a “I will find my way through this, no matter how long it takes me” kind of person. So maybe it’s more my personality...If I have to ask for help from somewhere, wherever it is, I will definitely do that. [Participant #3]

Quantitative Results

A total of 487 valid survey responses were received from participants across 24 general practices. The participant characteristics are presented in detail in Table S1 in Multimedia Appendix 3 .

The mean age of the participants was approximately 50 years (females 48.9, SD 19.4 years; males 52.8, SD 20.0 years), and 68.2% (332/487) of the participants identified as female. Overall, 34.3% (151/439) of respondents reported never using eHealth, and 53.8% (236/439) reported high eHealth use.

There were statistically significant ( P <.05) differences in the frequency of eHealth use in terms of age group, gender, state, remoteness, highest level of education, employment status, occupation group, marital status, and language spoken at home, with effect sizes being small to medium. Specifically, high eHealth characteristics were associated with younger age, being female, living in an urban area, and being employed.

Table 2 presents the frequency of eHealth use against 3 internet preference questions.

Preference for using the internet and technology in general and for health needs in particular were significantly related to the frequency of eHealth use ( P <.05 for each), with the effect sizes being small to medium.

a Excludes those for whom frequency of eHealth use is unknown.

b Chi-square tests conducted with strongly disagree and disagree combined, and agree and strongly agree combined.

Table 3 presents the frequency of eHealth use against 4 measures of trust.

The degree of trust was not statistically significantly different for the frequency of eHealth use for any of the domains.

b eHLQ: eHealth Literacy Questionnaire.

c Derived from survey question D1, parts 4 to 8. Mean imputation used where ≤2 responses were missing. If >2 responses were missing, the records were excluded.

d Derived from survey question D2, parts 1 to 5. Mean imputation used where ≤2 responses were missing. If >2 responses were missing, the records were excluded.

e Chi-square test conducted comparing low-to-moderate trust against high trust.

f Derived from survey question D2, parts 6, 7, 9, and 10. Mean imputation used where ≤2 responses were missing. If >2 responses were missing, the records were excluded.

g Derived from survey question D2 part 8.

h Chi-square test conducted comparing low trust against moderate-to-high trust.

Affordability of items and services was reported as No cost difficulty or Cost difficulty. eHealth frequency of use responses were available for 273 participants; among those with no cost difficulty , 1% (2/204) were never users, 14.2% (29/204) were low or medium users, and 84.8% (173/204) were high users of eHealth; among those with cost difficulty , 1% (1/69) were never users, 26% (18/69) were low or medium users, and 73% (50/69) were high users. There was a statistically significant difference in the presence of cost as a barrier between never and low or medium eHealth users compared to high users ( χ 2 1 =5.25; P =.02), although the effect size was small.

Table 4 presents the frequency of eHealth use for elements of structural access.

Quality of internet access and feeling limited in access to the internet were significantly associated with frequency of eHealth use ( P <.05), although the effect sizes were small.

b N/A: not applicable (cell sizes insufficient for chi-square test).

c Chi-square tests conducted with strongly disagree and disagree combined, agree and strongly agree combined, and never and low or medium categories combined.

Table 5 presents the frequency of eHealth use against respondents’ capacity to engage.

Capacity to engage was not significantly different for the frequency of eHealth use ( P =.54). 

b Derived from survey item E1. Where 1 response was missing, the mean imputation was used. If >1 response was missing, the record was excluded.

c Chi-square tests conducted with groups A and B combined.

Table 6 presents the frequency of eHealth use for elements of self-efficacy.

Statistically significant results were observed for the relationship between self-efficacy by eHEALS (moderate effect size) and frequency of eHealth use as well as for some of the questions from the HCEI (reliance on health professionals or others to access and explain information; small effect size; P <.05).

b eHEALS: eHealth Literacy Scale.

c eHEALS derived from item E3 (8 parts). Where ≤ 4 responses were missing, mean imputation was used. If >4 responses were missing, the records were excluded. Groups A to C as well as groups D to E were combined for the chi-square test.

d Strongly disagree, disagree, neither, and agree or strongly agree combined for significance testing.

Principal Findings

This paper reports on the findings of a sequential exploratory mixed methods study on the barriers to digital health access for a group of patients in Australian family medicine, with a particular focus on chronic disease and socioeconomic disadvantage.

In the qualitative first phase, the patients with socioeconomic disadvantage and chronic disease described 6 cumulative barriers, as demonstrated in Figure 1 . Many nonusers of digital health preferred human-based services and were not interested in technology, while others were highly suspicious of the technology in general. Some digitally interested patients could not afford quality hardware and internet connectivity, a barrier that was doubled by low quality and privacy when accessing publicly available internet connections. Furthermore, although some digitally interested patients had internet access, their urgent life circumstances left scarce opportunity to access digital health and develop digital health skills and confidence.

In our quantitative second phase, 31% (151/487) of the survey participants from Australian general practices were found to have never used a form of digital health. Survey participants were more likely to use digital health tools frequently when they also had a general digital interest and a digital health interest. Those who did not frequently access digital health were more likely to report difficulty affording the financial costs needed for digital access. The survey participants who frequently accessed digital health were more likely to have high eHealth literacy and high levels of patient empowerment.

Comparison With Prior Work

In terms of general digital health access, the finding that 31% (151/487) of the survey participants had never used one of the described forms of eHealth is in keeping with an Australian-based general digital participation study that found that approximately 9% of the participants were nonusers and 17% rarely engaged with the internet at all [ 34 ]. With regard to the digital health divide, another Australian-based digital health divide study found that increased age, living in a lower socioeconomic area, being Aboriginal or Torres Strait Islander, being male, and having no tertiary education were factors negatively associated with access to digital health services [ 17 ]. Their findings correspond to our findings that higher-frequency users of eHealth were associated with younger age, being female, living in an urban area, and being employed. Both studies reinforce the evidence of the digital health divide based on gender, age, and socioeconomic disadvantage in Australia.

With regard to digital health barriers, our findings provide expanded details on the range of digital health items and services that present a cost barrier to consumers. Affordability is a known factor in digital access and digital health access, and it is measured often by general self-report or relative expenditure on internet access to income [ 30 ]. Our study revealed the comprehensive list of relevant costs for patients. Our study also demonstrated factors of cost affordability beyond the dollar value of an item, as interviewees described the struggle of using slow public internet access without privacy features and the risks involved in buying a computer in installments. When we reflected on the complexity and detail of the cost barrier in our survey, participants demonstrated a clear association between cost and the frequency of digital health use. This suggests that a way to improve digital health access for some people is to improve the quality, security, and accessibility of public internet access options as well as to provide free or subsidized hardware, internet connection, and maintenance options for those in need, work that is being done by at least 1 digital inclusion charity in the United Kingdom [ 35 ].

Many studies recognize the factors of eHealth literacy and digital confidence for beneficial digital health access [ 36 ]. Our interviews demonstrated that some patients with socioeconomic disadvantage have low digital confidence, but that this is often underlined by a socially reinforced lifelong low self-confidence in their intellectual ability. In contrast, active users, regardless of other demographic factors, described themselves as innately proactive question askers. This was reinforced by our finding of a relationship between health care empowerment and the frequency of eHealth use. This suggests that while digital health education and eHealth literacy programs can improve access for some patients, broader and deeper long-term solutions addressing socioeconomic drivers of digital exclusion are needed to improve digital health access for some patients with socioeconomic disadvantage [ 8 ]. The deep permeation of socially enforced low self-confidence and lifelong poverty experienced by some interviewees demonstrate that the provision of free hardware and a class on digital health skills can be, for some, a superficial offering when the key underlying factor is persistent general socioeconomic inequality.

The digital health divide literature tends to identify the digital health divide, the factors and barriers that contribute to it, and the potential for it to widen if not specifically addressed [ 16 ]. Our findings have also identified the divide and the barriers, but what this study adds through our qualitative phase in particular is a description of the complex interaction of those barriers and the stepped nature of some of those barriers as part of the individual’s experience in trying to access digital health.

Strengths and Limitations

A key strength of this study is the use of a sequential exploratory mixed methods design. The initial qualitative phase guided a phenomenological exploration of digital health access experiences for patients with chronic disease and socioeconomic disadvantage. Our results in both study phases stem from the patients’ real-life experiences of digital health access. While some of our results echo the findings of other survey-based studies on general digital and digital health participation, our method revealed a greater depth and detail of some of these barriers, as demonstrated in how our findings compare to prior work.

As mentioned previously, the emphasis of this study on the qualitative first phase is a strength that helped describe the interactions between different barriers. The interviewees described their experiences as cumulative unequal stepped barriers rather than as producing a nonordered list of equal barriers. These findings expand on the known complexity of the issue of digital exclusion and add weight to the understanding that improving digital health access needs diverse, complex solutions [ 17 ]. There is no panacea for every individual’s digital health access, and thus, patient-centered digital health services, often guided by health professionals within the continuity of primary care, are also required to address the digital health divide [ 37 ].

While the sequential exploratory design is a strength of the study, it also created some limitations for the second quantitative phase. Our commitment to using the qualitative interview findings to inform the survey questions meant that we were unable to use previously validated scales for every question and that our results were less likely to lead to a normal distribution. This likely affected our ability to demonstrate significant associations for some barriers. We expect that further modeling is required to control for baseline characteristics and determine barrier patterns for different types of users.

One strength of this study is that the survey was administered to a broad population of Australian family medicine patients with diverse patterns of health via both paper-based and digital options. Many other digital health studies use solely digital surveys, which can affect the sample. However, we cannot draw conclusions from our survey about patients with chronic disease due to the limitations of the sample size for these subgroups.

Another sample-based limitation of this study was that our qualitative population did not include anyone aged from 18 to 24 years, despite multiple efforts to recruit. Future research will hopefully address this demographic more specifically.

While not strictly a limitation, we recognize that because this research was before COVID-19, it did not include questions about telehealth, which has become much more mainstream in recent years. The patients may also have changed their frequency of eHealth use because of COVID-19 and an increased reliance on digital services in general. Future work in this area or future versions of this survey should include telehealth and acknowledge the impact of COVID-19. However, the larger concept of the digital health divide exists before and after COVID-19, and in fact, our widespread increased reliance on digital services makes the digital divide an even more pressing issue [ 12 ].

Conclusions

The experience of digital health access across Australian primary care is highly variable and more difficult to access for those with socioeconomic disadvantage. While general digital interest, financial cost, and digital health literacy and empowerment are clear factors in digital health access in a broad primary care population, the digital health divide is also facilitated in part by a stepped series of complex and cumulative barriers.

Genuinely improving digital health access for 1 cohort or even 1 person requires a series of multiple different interventions tailored to specific sequential barriers. Given the rapid expansion of digital health during the global COVID-19 pandemic, attention to these issues is necessary if we are to avoid entrenching inequities in access to health care. Within primary care, patient-centered care that continues to recognize the complex individual needs of, and barriers facing, each patient should be a part of addressing the digital health divide.

Acknowledgments

The authors are thankful to the patients who shared their experiences with them via interview and survey completion. The authors are also very grateful to the general practices in the Australian Capital Territory and New South Wales who kindly gave their time and effort to help organize interviews, administer, and post surveys in the midst of the stress of day-to-day practice life and the bushfires of 2018-2019. The authors thank and acknowledge the creators of the eHealth Literacy Scale, the eHealth Literacy Questionnaire, the ICEpop Capability Measure for Adults, the Health Care Empowerment Inventory, the Patient-Doctor Relationship Questionnaire, the Chao continuity questionnaire, and the Southgate Institute for Health Society and Equity for their generosity in sharing their work with the authors [ 17 , 19 - 25 ]. This study would not have been possible without the support of the administrative team of the Academic Unit of General Practice. This project was funded by the Royal Australian College of General Practitioners (RACGP) through the RACGP Foundation IPN Medical Centres Grant, and the authors gratefully acknowledge their support.

Data Availability

The data sets generated during this study are not publicly available due to the nature of our original ethics approval but are available from the corresponding author on reasonable request.

Authors' Contributions

MAC acquired the funding, conceptualized the project, and organized interview recruitment. MAC and KB conducted interviews and analyzed the qualitative data. EAS, ER, and KD contributed to project planning, supervision and qualitative data analysis. MAC, KB and KO wrote the survey and planned quantitative data analysis. MAC and KB recruited practices for survey administration. KO and KB conducted the quantitative data analysis. MAC and KO, with KB drafted the paper. EAS, ER, and KD helped with reviewing and editing the paper.

Conflicts of Interest

None declared.

Phase 1 interview guide.

Phase 2 survey: eHealth and digital divide.

Phase 2 participant characteristics by frequency of eHealth use.

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Abbreviations

Edited by T Leung; submitted 03.07.23; peer-reviewed by T Freeman, H Shen; comments to author 16.08.23; revised version received 30.11.23; accepted 31.01.24; published 11.04.24.

©Melinda Ada Choy, Kathleen O'Brien, Katelyn Barnes, Elizabeth Ann Sturgiss, Elizabeth Rieger, Kirsty Douglas. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 11.04.2024.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on https://www.jmir.org/, as well as this copyright and license information must be included.

Care Management Resume Sample

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Work Experience

• Understands and self-manages to support facility/CIN-level success goals, including improvements in quality, cost of care and member experience for the facility/CIN’s population
• Maintains current knowledge of care management topics and acts as the unit’s subject matter expert (SME) on care management at department and company meetings
• Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
• Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
• Commitment to and role model of DaVita’s values of Service Excellence, Integrity, Team, Continuous Improvement, Accountability, Fulfillment and Fun with ability to demonstrate those positively and proactively to patients, teammates, management, physicians, and/or vendors in every day performance and interactions
• Build the infrastructure within existing Sharepoint “shells” for each Care Management team (3-4) including
• In conjuction with the local Care Management Committee Provider Chair, leads activities related to the utilization review process
• Expertise with various software applications/databases (i.e., Microsoft Office)
• Problem solving – moderate complexity
• Work autonomously with minimal supervision in various settings
• Basic care coordination concepts
• Oversees the operations of care management support staff in their day to day functions within a department
• Monitors and evaluates the effectiveness of programs and procedures and recommends and/or implements changes as indicated
• Reviews production and quality data to ensure accuracy and consistent application of policies and procedures
• Ensures appropriate levels of care and utilization of medical facilities and services within the parameters of the patient’s benefits and/or CMC decisions
• Responsible for identification of learning needs regarding the ability of the staff to assist in other areas of the multidisciplinary health care team and participate in development and implementation of in-services and resource materials to promote education and mutual understanding
• Responsible for monthly reporting statistics for department
• Assist with recruitment and selection of new staff, including training, mentoring, staff competencies, performance reviews, discipline and discharge
• Assist with and/or conducts staff meetings, assuring policy and procedures are adhered to and when necessary, modified to address changing strategic objectives
• Performs audits of staff documentation and calls to maintain accuracy and quality standards
• Apply the CARE model of leadership to position responsibilities (Coaching Accountability, Relationship; Engagement)
• Familiarity with basic medical terminology and ICD-9 and CPT coding

Professional Skills

• Strong interpersonal, oral and written communication skills: effective interpersonal and problem solving skills
• Strong leadership skills to identify opportunities to improve operating efficiency, increase revenues and effectively control expenses, and grow the business
• Strong organizational skills with the ability to work well under pressure with conflicting priorities
• Organized, demonstrated excellent team management skills
• Two years of related healthcare work experience that demonstrates the attainment of the requisite job knowledge skills/abilities required
• Excellent communication, customer service, and phone skills, as well as the ability to build trust and credibility while working independently
• Excellent conceptual, organizational, and problem solving skills

How to write Care Management Resume

Care Management role is responsible for interpersonal, organizational, customer, leadership, medical, health, training, multimedia, general, word. To write great resume for care management job, your resume must include:

• Your contact information
• Work experience
• Skill listing

Contact Information For Care Management Resume

The section contact information is important in your care management resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

• First and last name
• Telephone number

Work Experience in Your Care Management Resume

The section work experience is an essential part of your care management resume. It’s the one thing the recruiter really cares about and pays the most attention to. This section, however, is not just a list of your previous care management responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular care management position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Care Management resume experience can include:

• Strong customer service skills, strong phone skills
• Ten years multidisciplinary clinical experience including 7 years case management experience and two years management level supervisory experience
• Strong computer skills to include Microsoft Word, Microsoft Office and Excel
• Effective employee management skills are necessary
• Excellent organizational, analytical and interpersonal skills required
• Strong Utilization Review, discharge planning and case management experience from an acute setting

Education on a Care Management Resume

Make sure to make education a priority on your care management resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your care management experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

• School you graduated from
• Major/ minor
• Year of graduation
• Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Care Management Resume

When listing skills on your care management resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical care management skills:

• Demonstrated leadership skills: Excellent interpersonal skills and ability to develop and lead multidisciplinary teams
• Excellentconceptual, organizational, and problem solving skills
• Experience with a medical management application and the ability to work effectively with multiple computer programs.(Flow Cast, EMR, Sales Force, etc.)
• Strong communication skills to articulate needs, requirements and strategies
• Excellentpublic relations and communication skills
• Demonstrated experience with interviewing and selecting staff, mentoring new teams, conducting new employee training, and onboarding is required

List of Typical Experience For a Care Management Resume

Experience for director, care management resume.

• Care management experience in an acute care setting/environment or comparable experience
• Care Management experience including one year experience in a supervisory/management role
• Strong working knowledge of managed care functional areas, including terms and definitions
• 3-years’ experience in a variety of acute patient care settings including ICU or intermediate care units, Medical-Surgical Nursing and/or Home Health
• Experience working in multiple systems to support clinical operations related to UM, CM, DM
• Experience in the following areas: Managed Care, Provider Relations or Clinic Operations
• Experience working in a call center environment

Experience For Care Management Coordinator Resume

• Experience in utilization management, case management, discharge planning, disease management and other cost/quality management programs
• Professional utilization management clinical review experience
• Maintaintracking and monitoring of assigned referrals at all levels of review forinstant retrieval
• Understanding of quality improvement: Adept at data collection, interpretation, and use for decision-making
• Using the medical software criteria, establishes the appropriate level of care NICU/newborn care for continued stay
• Understanding of CT ALSA compliance

Experience For Director of Care Management Resume

• Working knowledge of NCQA/CMS regulations, policies and procedures
• Working knowledge of SQL or similar database languages
• Willing to act and is not immobilized by fear of failure
• Assist in planning, consulting and evaluating nursing care for patients with diabetes throughout the continuum of care
• Create a positive work environment by acknowledging team contributions, soliciting input, and offering personal assistance, when needed

Experience For Manager of Care Management Resume

• Assists with staffing/scheduling activities, soliciting input from managers
• Participates in recruitment, selection, hiring, orientation, counseling and evaluation of staff
• Serve as a content model expert and mentor to the team regarding practice standards, quality of interventions, problem resolution and critical thinking
• Identify complex learning needs and health teaching
• Acts as the discharge planning contact for the patient and family during hospitalization
• Responsible for planning and implementing assigned market and regional market success initiatives with each market care management and operations team
• Provides coaching and counseling to improve productivity of staff members
• Works closely with Medical Director on case specific review as well as trending and planning for improvement in outcomes

Experience For Care Management Assistant Resume

• Monitor high risk patient’s scheduled appointments contacting patient same day for “no show or cancelled” rescheduling immediately
• Coordinates, reviews and maintains data for reporting purposes and for weekly preparation and analysis of trending reports
• Participates in making presentations to participating providers, state and federal agencies, community groups and other interested parties
• Facile understanding of criteria sets (e.g. MCG, Interqual) requirements and practices, including third party requirements
• Oversight of all UM/CM/DM functions including operations, staffing, program development and system requirements
• Ensure implementation and monitoring of best practice approaches and innovations to better address the member's needs across the continuum of care
• Ensures the team's understanding and use of information system capability and functionality
• Expertise with various software applications/databases (i.e., Microsoft Office). Problem solving – moderate complexity
• Collaborates with the Director to develop action plans to address areas needing improvement and methods to track variances for the care and services delivered

Experience For Senior Medical Director of Care Management Resume

• Provides follow-up for hospitalized patients, ensuring subsequent agency referral
• Actively participates in department meetings and operations including process development or improvement
• Manages multiple inquiries and presents referral based on location and services provided; appropriate follow up on active or pending inquires
• Coordinates with referral sources on bed availability, new product and services; maintains current database of existing and potential referral sources
• Care Coordination Steering Committee
• Provides coaching for performance success, recommends merit increases, and consistency executes disciplinary actions
• Monthly reporting to the manager of all development initiatives
• Develop reporting systems for CM activities to outside audiences, physician oversight committees

Experience For Care Management Supervisor Resume

• Development of timelines, action plans and reporting
• Provide outreach and scheduling for renewal medications and associated needed test/lab
• Document all encounters with patient in EMR and Salesforce. And/or enters all referral activity into the computer system according to THPG policy and procedure
• Provide healthcare coaching, medication education, and disease-specific education
• Provide operational oversight of care coordination, discharge planning, clinical documentation
• Actively manages the Care Management budget including all post-acute charity services provided to patients for a safe discharge
• Notifies attending physician, treatment team, and others as needed

Experience For Supervisor, Care Management Resume

• Integrates information obtained from the patient's chart and from communications with various sources when discussing the level and intensity of care needed
• Provide planning and direction for the operation of UMMG care management program
• Participates in CQI activities and provider training, and participates in professional development activities
• Provides accurate information concerning benefits and coverage to staff or other persons as required
• Provides oversight of the teams providing clinical reviews, service authorization, and care coordination for all Community Care members
• Responsible for providing after-hours call support and supervision as required by the scheduled personnel

Experience For Care Management Specialist Resume

• Knowledge of Federal and State regulations related to discharge planning and patient's rights
• Work collaboratively across the care continuum, including ambulatory care providers, home care, community services, and other post-acute services
• Current New York State nursing licensure
• Identifies inpatient admissions no longer meeting criteria for NICU or transitional level of care and refers care to plan Medical Directors for evaluation
• Adheres to guiding principles of the organization
• Manage data and generate reports using current computer programs

Experience For Director, Care Management Operations Resume

• Provide both phone and face to face Behavioral Activation and Structured Problem Solving Treatment
• Registration and/or appointment scheduling
• Membership in a related professional organization, pursuing advanced educational preparation or certification
• Not applicable Prolonged sitting and data entry
• Keeps abreast of governmental rules and regulations as pertains to case management, CMS auditors, and discharge planning
• Comfortable implementing new workflows and technology
• Agency Affiliated Counselor or one of the following
• Three (3) years management in acute care setting required

List of Typical Skills For a Care Management Resume

Skills for director, care management resume.

• Demonstrated experience working with and educating NP’s and PA’s
• Ten years of healthcare experience working in a clinical setting and three years of management experience
• Management/supervisory experience or experience leading/working on project teams
• Utilization review/case management experience or social work experience in an in-patient acute care setting
• Demonstrated experience in leading clinicians, clinical operations, care management, utilization review, or other closely related quality programs
• Communicates timely and effectively with the Patient Financial Services Department to ensure appropriate and accurate billing
• Care / Case Management experience; 3+ years of experience in a Supervisory role
• Work effectively as a member of a management team in a large health care organization

Skills For Care Management Coordinator Resume

• Effectively plan, organize, manage staff and direct a busy acute care division in a large health and hospital system
• Proficient with computers and keyboard skills, telephone etiquette and general knowledge of office equipment
• Curiosity and improvement mindset: A systems thinker with process improvement skills to analyze, implement, and evaluate new ideas
• Basic computer skills in a Windows environment required
• Experience of progressive healthcare experience
• Exceptional communication skills on all levels
• Prior experience with Mcg Care Guidelines, Touchwork, IDX, Meditech

Skills For Director of Care Management Resume

• Previous experience with Allscripts, Touchwork, Meditech, Enterprise and/or IDX experience highly
• Five years’ experience in both Utilization Management and Case Management, three years supervisory/management experience required
• Manages and evaluates appropriate staff levels, assignments, skills, learning needs and deployment of all staff
• Effectively hire, orient and supervise Care Management staff
• Collaborate effectively with ACUs (Ambulatory Care Units), ancillary services, care management and commercial payer group
• Responsible for selection and hiring of qualified staff, ensuring an effective on-boarding and provides ongoing comprehensive training and regular feedback

Skills For Manager of Care Management Resume

• Experience working in a clinical healthcare setting
• Experience translating and executing a strategic plan
• Experience utilizing medical terminology in a professional work setting
• Experience in creating and implementing outcome measures of new programs
• Experience navigating the NYC & NY State systems of care, including Home & Community Based Services (HCBS)
• Nursing experience (three of which were in an acute care setting)
• Strong clinical background in nursing
• Prioritize task by importance delivering assignments in a timely manner
• Proven leadership qualities including ability to train, motivate, coach, manage, and supervise a staff of professionals

Skills For Care Management Assistant Resume

• Entry Rate: $17.37+ depending on experience
• Three years of R.N./Social Work clinical experience in focused areas working with multidisciplinary teams
• Experience in Sales and Marketing
• Experience in healthcare, working with providers and/or payers at a management level required
• Experience in discharge planning from a hospital
• Three or more years of experience working in a call center environment

Skills For Senior Medical Director of Care Management Resume

• Experience working with DME companies or other post-acute care organizations
• Registration and appointment scheduling experience with EPIC
• Experience working with Durable Medical Equipment (DME) companies or other post-acute care organizations
• Clinical license in good standing in the state of Oregon
• Medical Management experience; preferably in a managed care setting
• Health care information technology (HCIT) project management, sales or consulting work experience
• Hospital discharge planning work experience

Skills For Care Management Supervisor Resume

• Clinical leadership work experience running a Care Management department
• 2~3 years clerical experience in a health care setting
• Medical Assistant, Certified Nursing Assistant, or Unit Clerk experience
• Hands-on experience implementing programs
• Over 7 years and up to and including 10 years of experience
• Management experience preferably in a medical group/IPA or HMO setting
• Experience with third party contacting

Skills For Supervisor, Care Management Resume

• Experience in third party contracting, URAC, HEDIS, and/or NCQA standards, outcome analysis, project management and data systems required
• At least two years of experience in case/care management in an inpatient or outpatient setting, or Health Plan
• Demonstrates a working knowledge of payer benefits (Medicare, Medicaid as well as managed care and commercial payers)
• Progressive leadership experience in a health care setting required
• Valid State Nursing License required; BLS required
• Supervisory or Care Management experience
• Previous experience with Disease Management and Utilization Review
• Post-Master’s Supervisory experience

Skills For Care Management Specialist Resume

• Experience as a manager or director
• Experience in hospital UR / Care Management
• Experience in case management with an emphasis in pediatric care
• Prioritize and manage comprehensive projects, and implement and monitor large systems and change processes
• Constantly demonstrates the ability to serve as a model change agent and lead change efforts
• Exceptional case management experience

Skills For Director, Care Management Operations Resume

• Three to five years clinical experience
• Experience in health care with emphasis in case management
• Coordination experience required
• Administrative experience in healthcare industry
• Experience with electronic medical record systems, Microsoft suite and Internet

List of Typical Responsibilities For a Care Management Resume

Responsibilities for director, care management resume.

• Effectively communicates and collaborates with departmental social workers, external liaisons and post acute care facilities
• Educates staff regarding effective allocation of the hospital’s resources while encouraging provision of high quality patient care
• Proven ability to understand Care Management trends and to develop initiatives designed to bend trend while insuring appropriate access to quality care
• Demonstrates a working knowledge of payor benefits (Medicare, Medicaid as well as managed care and commercial payors)
• Assesses daily staffing needs and Provides staffing resources to ensure efficient and effective coordination of services
• Evaluates and ensures each facility’s level of compliance with Medicare Conditions of Participation, ensuring an effective and compliant UM committee
• Leads the short and long-term planning process, and drives prioritization to meet the Enterprise’s financial performance goals

Responsibilities For Care Management Coordinator Resume

• Facilitates effective and appropriate discharge plans
• Continually updates knowledge of community services, resources, programs, and facilities in order to facilitate effective discharge plans
• Coordinating case management by providing hands on assistance for staffing concerns, handling difficult, unusual or emergency situations
• Ensuring and documenting attendance of mandatory education programs and overseeing departmental orientation through the use of preceptors
• Keeping staff up-to-date on compliance with regard to compliance and meeting reporting standards

Responsibilities For Director of Care Management Resume

• Interview and evaluate assigned staff performance including annual performance reviews, performance improvement plans and disciplinary steps pursuant to Hospital’s Human Resource policies and procedures
• Is cognizant of regulations and policies of all review organizations relating to billing of the services provided in the hospital setting, monitors and evaluates options and services to meet patient’s health needs
• In conjunctions with the compliance department, ensures regulatory patient notification requirements are met and document within the patient’s medical record
• Photocopying and faxing appropriate information to above facilities to help facilitate placement as requested by RN Care Managers and/or Social Workers
• Analyzing department efficiency/goals and preparing action plans as needed
• Performing admission and following through with all parties accordingly
• Assists Care Manager/Care Coordination department in collecting data related to patient-care outcomes and auditing data for accuracy
• Makes home care referrals, ensuring forms are completed correctly and compliantly
• Explores availability and updating of community resources

Responsibilities For Manager of Care Management Resume

• Inputs clinical information, and discharge planning details into the medical record
• Develops the CHRUSTUS Health framework that is used to design care management programs and to enhance consistency in services provided and reporting
• The position is responsible to create presentations for internal and external stakeholders explaining care management vision, strategies and processes
• Develops new policies, procedures, job aids, and work flows that enhance operating efficiency of the care management programs or activities
• Evaluates care management staff performance by providing monthly management level and role level report cards

Responsibilities For Care Management Assistant Resume

• Assists with analysis of denied days, denial report preparation and trending of denial data and physician performance
• Responsible for all incoming and outbound clinical requests, questions, concerns and complaints
• Performs daily clinical rounds and monthly audit of charts on care management activities (utilization review, discharge planning and Interrater Reliability)
• Develops department budget and monitors monthly for variance reporting for assigned hospitals
• Is a champion of EBM, and in particular of MCG which currently are the company’s primary review guidelines
• North Carolina Licensed physician; Board Certified in ABMS/ABOMS specialty
• Presents cases to Medical Directors that do not meet established criteria and provides pertinent information regarding member’s medical condition and the potential home care needs
• Oversees and monitors each facility’s UM plan, ensuring compliance with CMS regulations
• Provides leadership, direction and coordination of assignments for staff

Responsibilities For Senior Medical Director of Care Management Resume

• Responsible for performance appraisals, corrective action for team members
• Provides daily input to forecasting and planning activities relevant staffing and facility coverage due to identified utilization trends and membership fluctuations. Inpatient facilities include: Acute Care hospitals, Acute Inpatient Rehab, SNFs
• Manages 4 - 7 direct reports (Managers- with 105 indirect reports, ICMs) including ongoing performance monitoring and completing annual MAP evaluations
• Uses internal performance evaluation system to: establish, discuss and monitor direct report’s performance, create development plans and implement Corrective Action Plans as needed and as described in the performance management guidelines
• Direct supervision of HBH Clinical Managers and oversight of these manager’s teams including personnel hiring, performance monitoring, disciplinary actions, performance reviews, etc
• Routinely meet with currently collaborating PCP’s
• This role as the potential to WFH after 6 - 12 months
• Active Licensed physician; Board Certified in ABMS/ABOMS specialty

Responsibilities For Care Management Supervisor Resume

• Responsible for compiling Care Management data and coordinating Care Management data reports as required by ABQ HP’s contracted partners and regulatory agencies
• Define, Source, Interview, Hire , Onboard, and support Clinical staff
• Holds a current license to practice as an RN, PT, OT or SLP
• Three (3) years’ experience managing region or division level positions. Five-(5) years’ health care management in multi-facility, long-term care organizations
• Knowledge of state and federal regulations, both clinical and financial, as it relates to the RAI process and reimbursement systems

Responsibilities For Supervisor, Care Management Resume

• Proficient in the use of Microsoft office products, specifically excel and Lotus notes
• Conduct review of current care management operations across CHOP, and make recommendations for areas of opportunity and alignment across roles
• Collaborate with executive leadership to formalize the approach and a structure designed to improve health outcomes and patient care experience while reducing costs
• Establish goals, objectives, and metrics of success
• Create and maintain connections throughout the organization in support of care management activities
• Oversee the program’s operational budget and financial management
• Works with the health care team members to verify that both the medical record and the assessment instrument accurately reflect the patient’s status at the time of assessment, intensity of services provided and appropriate medical necessity for the services rendered to the patient

Responsibilities For Care Management Specialist Resume

• Monitors services provided and selects appropriate diagnosis for coding. Verifies the coding of the patient diagnoses and monitors percentage of patients with regulatory-agency-determined appropriate rehabilitation or skilled nursing diagnoses
• Coordinates schedule of patient/resident’s care planning conferences with the interdisciplinary team and invites family participation in the care planning process by issuing a written or verbal invitation to the conferences
• Serves as case manager for all Medicare and Managed Care patients/residents admitted to Medicare unit. Provides clinical services in the incumbent’s respective discipline, i.e. Staff RN, PT, OT, and SLP
• Ensures that team members are clinically competent and adequately trained in motivational interviewing and other engagement techniques in order to achieve the market’s engagement and clinical targets for assigned population. Ensures on-going staff development through education and opportunities for professional development
• COLLABORATION: Collaborates with patient's care team to compile information regarding the patient's needs. Reviews documentation to assist in the development and implementation of a comprehensive care plan/ intervention
• PROFESSIONAL DEVELOPMENT: Participates actively in all program and practice staff meetings, case conferences and work groups, and professional development workgroup sessions

Responsibilities For Director, Care Management Operations Resume

• Learn hospital ambulatory scheduling system, electronic medical record and new applications used for care coordination
• Responsible for the development and execution of care management activities to drive compliance with health plan partners’ models of care
• Have overall responsibility for ensuring that HealthEast’s care management, population management, and transitions of care management activities are effectively operated, resourced, led, and monitored
• Lead and provide technical expertise for the design, development, acceptance, and implementation of HealthEast’s transfer protocols, ensuring that they properly identify candidates for care transition and coordinate closely with broader care management pathways
• Actively monitor the safety, effectiveness, and efficiency of “hand-offs” in care across the continuum of inpatient and outpatient management of HealthEast’s patient population
• Be primarily accountable for the quality, effectiveness, efficiency, coordination, and satisfaction related to HealthEast’s care management relationships with primary, community, and sub-acute care rendered to its patients
• Collaborate with clinical and administrative leadership to develop meaningful analytics and metrics for care management and appropriate IS interoperability, which supports the system’s care management goals
• Relevant clinical or health plan experience in UM or related field
• LPN with MN license without restrictions or pending restrictions

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Healthy Living with Diabetes

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How can I plan what to eat or drink when I have diabetes?

How can physical activity help manage my diabetes, what can i do to reach or maintain a healthy weight, should i quit smoking, how can i take care of my mental health, clinical trials for healthy living with diabetes.

Healthy living is a way to manage diabetes . To have a healthy lifestyle, take steps now to plan healthy meals and snacks, do physical activities, get enough sleep, and quit smoking or using tobacco products.

Healthy living may help keep your body’s blood pressure , cholesterol , and blood glucose level, also called blood sugar level, in the range your primary health care professional recommends. Your primary health care professional may be a doctor, a physician assistant, or a nurse practitioner. Healthy living may also help prevent or delay health problems  from diabetes that can affect your heart, kidneys, eyes, brain, and other parts of your body.

Making lifestyle changes can be hard, but starting with small changes and building from there may benefit your health. You may want to get help from family, loved ones, friends, and other trusted people in your community. You can also get information from your health care professionals.

What you choose to eat, how much you eat, and when you eat are parts of a meal plan. Having healthy foods and drinks can help keep your blood glucose, blood pressure, and cholesterol levels in the ranges your health care professional recommends. If you have overweight or obesity, a healthy meal plan—along with regular physical activity, getting enough sleep, and other healthy behaviors—may help you reach and maintain a healthy weight. In some cases, health care professionals may also recommend diabetes medicines that may help you lose weight, or weight-loss surgery, also called metabolic and bariatric surgery.

Choose healthy foods and drinks

There is no right or wrong way to choose healthy foods and drinks that may help manage your diabetes. Healthy meal plans for people who have diabetes may include

• dairy or plant-based dairy products
• nonstarchy vegetables
• protein foods
• whole grains

Try to choose foods that include nutrients such as vitamins, calcium , fiber , and healthy fats . Also try to choose drinks with little or no added sugar , such as tap or bottled water, low-fat or non-fat milk, and unsweetened tea, coffee, or sparkling water.

Try to plan meals and snacks that have fewer

• foods high in saturated fat
• foods high in sodium, a mineral found in salt
• sugary foods , such as cookies and cakes, and sweet drinks, such as soda, juice, flavored coffee, and sports drinks

Your body turns carbohydrates , or carbs, from food into glucose, which can raise your blood glucose level. Some fruits, beans, and starchy vegetables—such as potatoes and corn—have more carbs than other foods. Keep carbs in mind when planning your meals.

You should also limit how much alcohol you drink. If you take insulin  or certain diabetes medicines , drinking alcohol can make your blood glucose level drop too low, which is called hypoglycemia . If you do drink alcohol, be sure to eat food when you drink and remember to check your blood glucose level after drinking. Talk with your health care team about your alcohol-drinking habits.

Find the best times to eat or drink

Talk with your health care professional or health care team about when you should eat or drink. The best time to have meals and snacks may depend on

• what medicines you take for diabetes
• what your level of physical activity or your work schedule is
• whether you have other health conditions or diseases

Ask your health care team if you should eat before, during, or after physical activity. Some diabetes medicines, such as sulfonylureas  or insulin, may make your blood glucose level drop too low during exercise or if you skip or delay a meal.

Plan how much to eat or drink

You may worry that having diabetes means giving up foods and drinks you enjoy. The good news is you can still have your favorite foods and drinks, but you might need to have them in smaller portions  or enjoy them less often.

For people who have diabetes, carb counting and the plate method are two common ways to plan how much to eat or drink. Talk with your health care professional or health care team to find a method that works for you.

Carb counting

Carbohydrate counting , or carb counting, means planning and keeping track of the amount of carbs you eat and drink in each meal or snack. Not all people with diabetes need to count carbs. However, if you take insulin, counting carbs can help you know how much insulin to take.

Plate method

The plate method helps you control portion sizes  without counting and measuring. This method divides a 9-inch plate into the following three sections to help you choose the types and amounts of foods to eat for each meal.

• Nonstarchy vegetables—such as leafy greens, peppers, carrots, or green beans—should make up half of your plate.
• Carb foods that are high in fiber—such as brown rice, whole grains, beans, or fruits—should make up one-quarter of your plate.
• Protein foods—such as lean meats, fish, dairy, or tofu or other soy products—should make up one quarter of your plate.

If you are not taking insulin, you may not need to count carbs when using the plate method.

Work with your health care team to create a meal plan that works for you. You may want to have a diabetes educator  or a registered dietitian  on your team. A registered dietitian can provide medical nutrition therapy , which includes counseling to help you create and follow a meal plan. Your health care team may be able to recommend other resources, such as a healthy lifestyle coach, to help you with making changes. Ask your health care team or your insurance company if your benefits include medical nutrition therapy or other diabetes care resources.

Talk with your health care professional before taking dietary supplements

There is no clear proof that specific foods, herbs, spices, or dietary supplements —such as vitamins or minerals—can help manage diabetes. Your health care professional may ask you to take vitamins or minerals if you can’t get enough from foods. Talk with your health care professional before you take any supplements, because some may cause side effects or affect how well your diabetes medicines work.

Research shows that regular physical activity helps people manage their diabetes and stay healthy. Benefits of physical activity may include

• lower blood glucose, blood pressure, and cholesterol levels
• better heart health
• healthier weight
• better mood and sleep
• better balance and memory

Talk with your health care professional before starting a new physical activity or changing how much physical activity you do. They may suggest types of activities based on your ability, schedule, meal plan, interests, and diabetes medicines. Your health care professional may also tell you the best times of day to be active or what to do if your blood glucose level goes out of the range recommended for you.

Do different types of physical activity

People with diabetes can be active, even if they take insulin or use technology such as insulin pumps .

Try to do different kinds of activities . While being more active may have more health benefits, any physical activity is better than none. Start slowly with activities you enjoy. You may be able to change your level of effort and try other activities over time. Having a friend or family member join you may help you stick to your routine.

The physical activities you do may need to be different if you are age 65 or older , are pregnant , or have a disability or health condition . Physical activities may also need to be different for children and teens . Ask your health care professional or health care team about activities that are safe for you.

Aerobic activities

Aerobic activities make you breathe harder and make your heart beat faster. You can try walking, dancing, wheelchair rolling, or swimming. Most adults should try to get at least 150 minutes of moderate-intensity physical activity each week. Aim to do 30 minutes a day on most days of the week. You don’t have to do all 30 minutes at one time. You can break up physical activity into small amounts during your day and still get the benefit. 1

Strength training or resistance training

Strength training or resistance training may make your muscles and bones stronger. You can try lifting weights or doing other exercises such as wall pushups or arm raises. Try to do this kind of training two times a week. 1

Balance and stretching activities

Balance and stretching activities may help you move better and have stronger muscles and bones. You may want to try standing on one leg or stretching your legs when sitting on the floor. Try to do these kinds of activities two or three times a week. 1

Some activities that need balance may be unsafe for people with nerve damage or vision problems caused by diabetes. Ask your health care professional or health care team about activities that are safe for you.

Stay safe during physical activity

Staying safe during physical activity is important. Here are some tips to keep in mind.

Drink liquids

Drinking liquids helps prevent dehydration , or the loss of too much water in your body. Drinking water is a way to stay hydrated. Sports drinks often have a lot of sugar and calories , and you don’t need them for most moderate physical activities.

Avoid low blood glucose

Check your blood glucose level before, during, and right after physical activity. Physical activity often lowers the level of glucose in your blood. Low blood glucose levels may last for hours or days after physical activity. You are most likely to have low blood glucose if you take insulin or some other diabetes medicines, such as sulfonylureas.

Ask your health care professional if you should take less insulin or eat carbs before, during, or after physical activity. Low blood glucose can be a serious medical emergency that must be treated right away. Take steps to protect yourself. You can learn how to treat low blood glucose , let other people know what to do if you need help, and use a medical alert bracelet.

Avoid high blood glucose and ketoacidosis

Taking less insulin before physical activity may help prevent low blood glucose, but it may also make you more likely to have high blood glucose. If your body does not have enough insulin, it can’t use glucose as a source of energy and will use fat instead. When your body uses fat for energy, your body makes chemicals called ketones .

High levels of ketones in your blood can lead to a condition called diabetic ketoacidosis (DKA) . DKA is a medical emergency that should be treated right away. DKA is most common in people with type 1 diabetes . Occasionally, DKA may affect people with type 2 diabetes  who have lost their ability to produce insulin. Ask your health care professional how much insulin you should take before physical activity, whether you need to test your urine for ketones, and what level of ketones is dangerous for you.

Take care of your feet

People with diabetes may have problems with their feet because high blood glucose levels can damage blood vessels and nerves. To help prevent foot problems, wear comfortable and supportive shoes and take care of your feet  before, during, and after physical activity.

If you have diabetes, managing your weight  may bring you several health benefits. Ask your health care professional or health care team if you are at a healthy weight  or if you should try to lose weight.

If you are an adult with overweight or obesity, work with your health care team to create a weight-loss plan. Losing 5% to 7% of your current weight may help you prevent or improve some health problems  and manage your blood glucose, cholesterol, and blood pressure levels. 2 If you are worried about your child’s weight  and they have diabetes, talk with their health care professional before your child starts a new weight-loss plan.

You may be able to reach and maintain a healthy weight by

• following a healthy meal plan
• consuming fewer calories
• being physically active
• getting 7 to 8 hours of sleep each night 3

If you have type 2 diabetes, your health care professional may recommend diabetes medicines that may help you lose weight.

Online tools such as the Body Weight Planner  may help you create eating and physical activity plans. You may want to talk with your health care professional about other options for managing your weight, including joining a weight-loss program  that can provide helpful information, support, and behavioral or lifestyle counseling. These options may have a cost, so make sure to check the details of the programs.

Your health care professional may recommend weight-loss surgery  if you aren’t able to reach a healthy weight with meal planning, physical activity, and taking diabetes medicines that help with weight loss.

If you are pregnant , trying to lose weight may not be healthy. However, you should ask your health care professional whether it makes sense to monitor or limit your weight gain during pregnancy.

Both diabetes and smoking —including using tobacco products and e-cigarettes—cause your blood vessels to narrow. Both diabetes and smoking increase your risk of having a heart attack or stroke , nerve damage , kidney disease , eye disease , or amputation . Secondhand smoke can also affect the health of your family or others who live with you.

If you smoke or use other tobacco products, stop. Ask for help . You don’t have to do it alone.

Feeling stressed, sad, or angry can be common for people with diabetes. Managing diabetes or learning to cope with new information about your health can be hard. People with chronic illnesses such as diabetes may develop anxiety or other mental health conditions .

Learn healthy ways to lower your stress , and ask for help from your health care team or a mental health professional. While it may be uncomfortable to talk about your feelings, finding a health care professional whom you trust and want to talk with may help you

• lower your feelings of stress, depression, or anxiety
• manage problems sleeping or remembering things
• see how diabetes affects your family, school, work, or financial situation

Ask your health care team for mental health resources for people with diabetes.

Sleeping too much or too little may raise your blood glucose levels. Your sleep habits may also affect your mental health and vice versa. People with diabetes and overweight or obesity can also have other health conditions that affect sleep, such as sleep apnea , which can raise your blood pressure and risk of heart disease.

NIDDK conducts and supports clinical trials in many diseases and conditions, including diabetes. The trials look to find new ways to prevent, detect, or treat disease and improve quality of life.

What are clinical trials for healthy living with diabetes?

Clinical trials—and other types of clinical studies —are part of medical research and involve people like you. When you volunteer to take part in a clinical study, you help health care professionals and researchers learn more about disease and improve health care for people in the future.

Researchers are studying many aspects of healthy living for people with diabetes, such as

• how changing when you eat may affect body weight and metabolism
• how less access to healthy foods may affect diabetes management, other health problems, and risk of dying
• whether low-carbohydrate meal plans can help lower blood glucose levels
• which diabetes medicines are more likely to help people lose weight

Find out if clinical trials are right for you .

Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials.

What clinical trials for healthy living with diabetes are looking for participants?

You can view a filtered list of clinical studies on healthy living with diabetes that are federally funded, open, and recruiting at www.ClinicalTrials.gov . You can expand or narrow the list to include clinical studies from industry, universities, and individuals; however, the National Institutes of Health does not review these studies and cannot ensure they are safe for you. Always talk with your primary health care professional before you participate in a clinical study.

This content is provided as a service of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Content produced by NIDDK is carefully reviewed by NIDDK scientists and other experts.

NIDDK would like to thank: Elizabeth M. Venditti, Ph.D., University of Pittsburgh School of Medicine.

Senate investigating whether ER care has been harmed by growing role of private-equity firms

A Senate committee has asked three major private-equity firms for information on how they run or staff hospital emergency departments to see if private equity’s management of a large share of the nation’s ERs has harmed patients.

Led by its chairman, Sen. Gary Peters, D.-Mich., the inquiry by the Homeland Security and Governmental Affairs Committee centers on three of the nation’s largest private-equity firms: Apollo Global Management, the Blackstone Group and KKR. According to the information requests, Peters’ staff conducted interviews with over 40 emergency department physicians who expressed “significant concerns” about patient safety and care resulting from the aggressive practices of private-equity firms in the arena. Those practices include improper billing, retaliation and anti-competitive activities, the committee’s letters to the companies said.

Recipients of the letters, which were sent Monday , were asked to provide documents and information by April 17, and to arrange a meeting with the committee no later than May 3.

NBC News recently  estimated  that 40% of U.S. hospital emergency departments were overseen, staffed or managed by companies owned by private-equity firms.

The Homeland Security Committee inquiry is the second Senate investigation focused on private equity’s impact on patient care. In December, the Budget Committee launched a bipartisan investigation  into two hospital systems associated with private-equity firms, seeking to assess the profits they have generated in their deals and whether those transactions harmed patients and clinicians. Sens. Sheldon Whitehouse, D.-R.I., who chairs the committee, and Chuck Grassley of Iowa, the ranking Republican, are leading that examination.

The new letters from the Homeland Security Committee requesting information about emergency department operations also went to four companies backed by the private-equity firms. Three are hospital staffing companies: U.S. Acute Care Solutions, which is financed by Apollo; Envision Healthcare, formerly owned by KKR; and TeamHealth, a Blackstone company. The other recipient is LifePoint Health, owned by Apollo, which operates 62 acute care hospitals in 16 states and runs the largest chain of rural hospitals in the U.S. Apollo and LifePoint Health are also subjects of the Senate Budget Committee investigation.

In recent years, private-equity firms have invested $1 trillion and become significant players in many sectors of the health care industry, including hospitals, nursing homes, physician practices, mental health facilities and emergency department staffing companies. To finance their health care takeovers, private-equity owners typically burden the companies they buy with debt, then slash company costs to increase earnings and appeal to new buyers in a few years.

These cost-saving practices are central to the new Senate inquiry, Peters said in a statement. “I am concerned that our nation’s largest emergency medicine staffing companies may be engaging in cost-saving measures at the expense of patient safety and care, which could put our nation’s emergency preparedness at risk,” Peters’ statement said. “I am pressing these companies and their private equity owners for needed transparency so that we better understand how their business practices could be affecting patient safety, quality care, and physicians’ abilities to exercise independent judgment in providing patient care.”

In a statement, a spokesperson for Apollo said, " We continue to welcome all discussions with the senators regarding our funds’ investing track record in the healthcare space.” A spokesperson for Envision said, “Envision intends to work transparently with Senator Peters on his request. Our clinicians care for patients and communities in their greatest time of need. Our number one priority is always the well-being of our clinicians and the patients they serve.” A spokesperson for Lifepoint said the company "looks forward to responding to Chairman Peters’ inquiry received today and to furthering any conversations with Senators who have an interest in our operations and commitment to our communities."

KKR and Blackstone declined to comment.

As interest rates have risen recently, the costs associated with some of these companies’ debt loads have become onerous, creating financial difficulties. Last year, for example, Envision Healthcare, the staffing company formerly owned by KKR, filed for bankruptcy. It continued operating while in bankruptcy and emerged having restructured. Another emergency department staffing  company collapsed last year — American Physician Partners — leaving hospitals it had served scrambling for replacement staffing.

Academic studies  show that private-equity firms’ involvement in health care is associated with significant cost increases for patients and payers, such as Medicare. A lower quality of care has also been associated with the firms’ investments in health care, including 10% higher mortality rates at  nursing homes  owned by private equity. A  study  last year showed patients at private equity-owned hospitals fell more often and contracted more infections.

A TeamHealth spokesman said the company is reviewing the letter from Peters. “The top priority for TeamHealth and our clinicians is always delivering high-quality, safe patient care,” he added in a statement. “We look forward to engaging with the Committee and demonstrating our uncompromised commitment to our clinicians and communities."

Private-equity firms’ health care deals are also under the microscope at the Federal Trade Commission, which overseas corporate mergers for potential anti-competitive activities. Last fall, the FTC  sued  U.S. Anesthesia Partners Inc., one of the country’s top anesthesia staffing companies, and its private-equity backer, Welsh, Carson, Anderson & Stowe, accusing the entities of scheming for over a decade to acquire  anesthesia practices  in Texas, monopolize the market, drive up prices for patients and generate profits. Both companies are fighting the suit, contending it is “misguided” and “meritless.”

Mitchell Li is one of the emergency physicians interviewed by investigators at the Homeland Security Committee. Founder of  Take Medicine Back , an organization pushing to take the profession of medicine back from corporate control, Li said in an interview, “The emergency department is the canary in the coal mine for the whole U.S. health care system. We are the first to see the breaking point and we are beyond that. Private equity and the corporate practice of medicine puts our nations’ ability to respond to disaster at risk.”

Gretchen Morgenson is the senior financial reporter for the NBC News Investigative Unit. A former stockbroker, she won the Pulitzer Prize in 2002 for her "trenchant and incisive" reporting on Wall Street.

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France is proposing to allow terminally ill patients to take lethal medication

FILE - French President Emmanuel Macron looks on during a joint statement with Serbian President Aleksandar Vucic, before a working dinner at the Elysee Palace in Paris, Monday, April 8, 2024. France’s government presented a bill Wednesday April 10, 2024 to allow adults with terminal cancer or other incurable illness to take lethal medication, amid growing public demand for legal options for aid in dying. Many French people have travelled to neighboring countries to seek such medication where medically assisted suicide or euthanasia are legal. French President Emmanuel Macron has long promised such a bill. (Sarah Meyssonnier/Pool via AP)

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PARIS (AP) — France’s government presented a bill Wednesday to allow adults with terminal cancer or other incurable illness to take lethal medication, as public demands grow for legal options for aid in dying.

Many French people have traveled to neighboring countries where medically assisted suicide or euthanasia are legal. French President Emmanuel Macron has long promised such a bill.

To benefit from the newly proposed measure, patients would need to be over 18 and be French citizens or live in France, Health Minister Catherine Vautrin said after a Cabinet meeting.

A team of medical professionals would need to confirm that the patient has a grave and incurable illness, is suffering from intolerable and untreatable pain, and is seeking lethal medication of their own free will. Those with severe psychiatric conditions and neurodegenerative disorders such as Alzheimer’s disease won’t be eligible.

The patient would initiate the request for lethal medication and confirm the request after a period of reflection, Vautrin said.

If approved, a doctor would then deliver a prescription, valid for three months, for the lethal medication. People would be able to take it at home, at a nursing home or a health care facility, Macron said. If their physical condition doesn’t allow them to do it alone, they will be allowed to get help from someone of their choice or by a doctor or a nurse.

The bill now goes to parliament for debate. Vautrin urged ‘’an enormous amount of listening, an enormous amount of humility, as we are touching subjects of life and death, and an enormous amount of respect for the freedom of conscience of each one of us.’’

She also announced 1.1 billion euros in new spending on palliative and other end-of-life care.

A report last year indicated that most French citizens back legalizing end-of-life options, and opinion polls show growing support over the past 20 years.

A 2016 French law provides that doctors can keep terminally ill patients sedated before death but stops short of allowing assisted suicide or euthanasia.

Medically assisted suicide involves patients taking, of their own free will, a lethal drink or medication that has been prescribed by a doctor to those who meet certain criteria. Euthanasia involves doctors or other health practitioners giving patients who meet certain criteria a lethal injection at their own request.

Assisted suicide is allowed in Switzerland and Portugal and several U.S. states. Euthanasia is currently legal in the Netherlands, Spain, Canada, Australia, Colombia, Belgium and Luxembourg under certain conditions.