Hello, I'm A*****

Champion mentor and supervisory roles, ensuring success of health care professionals and service providers, as well as patients, consumers, and members wanting to optimize health and well-being. Provide front-line leadership, communicating with excellence and inspiring others with a positive, can-do attitude. Take analytical approaches to problem solving, being thorough and attentive to details. Manage time efficiently, adapting to constantly changing environments and learning new information quickly and comprehensively.


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Skill Index

I am skilled in...

Telephonic Case Manager
460
Case Manager
305
Hospice
131
Psychiatric
102

Industry Density

Top 5 Industry Experience, Expressed in Percentages

Hospital & Health Care

100%

Career History

Current

Telephonic Case Manager @ (HIDDEN)

May 01, 2016 - Current

Responsibilities:

    • Performed comprehensive telephonic assessments, identifying patient / family needs and risks and developing / maintaining care plans.
    • Performed ongoing HEDIS compliance reviews and continually assessed member status and needs, leading to appropriate referrals for care and resources.
    • Utilized Motivational Interviewing techniques, educating, motivating and inspiring members to achieve optimal wellness.
    • Strive for quality compliance with company expectations and customer care, consistently performing 30% above peers in timely model of care calls according to My Performance Sheet (MPS), a report generated weekly that showed process statistics and comparison to peers.
    • Achieved and maintained 90% or higher on call quality scores, receiving score from auditors according to checklist items that addressed stating the disclaimer, identifying member through required criteria, following HIPAA guidelines, utilizing MI techniques, listening skills, and providing value to member.
    • Received peer / manager recognition for extensive knowledge and expertise in health, acknowledging positive knowledge feedback in 1:1s with manager, staying on top of health-related information, and having higher than average rate of addressing Advance Directives with members.

Skill Strengths (Breakdown in Percentages)

  • Telephonic Case Manager (100%)

2015

Telephonic Case Coordinator @ (HIDDEN)

May 10, 2015 - April 01, 2016

Responsibilities:

    • Provided backup utilization review services for initial post-acute authorization and continued stay reviews. 
    • Consulted with physicians and inpatient care coordinators on best care setting for post-acute care. 
    • Educated providers and case managers on CMS guidelines for appropriate care and placement.
    • Performed InterQual and LiveSafe assessments, determining appropriate post-acute care placement.
    • Consulted and advised physicians on best post-acute care placement for inpatients being discharged based on CMS guidelines and InterQual results.


Skill Strengths (Breakdown in Percentages)

  • Telephonic Case Manager (100%)

2012

Telephonic Case Manager @ (HIDDEN)

April 01, 2012 - November 01, 2014

Responsibilities:

    • Performed comprehensive telephonic assessments, identifying patient / family needs and risks and continually re-assessing patient status and needs with appropriate referrals and care coordination.
    • Identified high-risk areas and collaborated with resources and providers, meeting patient needs, minimizing risks and promoting optimal health in the most cost-effective manner.
    • Monitored care through Medicare ACO data collection and analysis, maximizing clinical, quality, and fiscal outcomes for targeted population.
    • Recognized by managers and peers as expert in educating families in areas of hospice discipline, including pain / symptom management and philosophy, for an average of 60 patients / month.
    • Developed reputation as go to person in dealing with difficult or uncomfortable situations and people, promoting customer and employee satisfaction.
    • Received positive feedback on working relationship with others, maintaining satisfaction through advocacy, assistance and tranquil approach to patient care and staff interaction.
    • Recognized by entire hospice team as integrative medicine expert, developing staff guidelines for aromatherapy and music appropriate to symptomatology.

Skill Strengths (Breakdown in Percentages)

  • Hospice (50%)

  • Telephonic Case Manager (50%)

2011

Registered Nurse @ (HIDDEN)

April 01, 2011 - April 01, 2012

Responsibilities:

    • Managed and mentored counselor assistants and nurses (4 6). Managed work flow in a concise and organized manner.
    • Created and implemented relaxation techniques for patient population, providing thorough assessments, monitoring and counseling of psychiatric patients.
    • Audited charts, consistently revealing thorough, concise, and regulatory compliant documentation.

     


Skill Strengths (Breakdown in Percentages)

  • Psychiatric (100%)

2008

Registered Nurse @ (HIDDEN)

May 10, 2008 - May 10, 2011

Responsibilities:

    • Developed and implemented care plans for case load of 10 15 patients per week with measurable goals and interventions to which effectiveness of care plan was evaluated.
    • Conducted 4 6 visits daily with average case load of 15 patients. 
    • Provided comprehensive range of clinical functions, including direct patient care, patient assessments, and OASIS admissions. 
    • Oriented and mentored new on-boarding nurses.
    • Managed care of home patients, coordinating needs for services and supplies.
    • Assisted patients with achieving optimal outcomes by advocating and liaising with physicians and other healthcare providers for appropriate treatment, products and services.
    • Built solid, trusting relationships with patients, families, and physicians offices through effective communication and compassion, including positive physician to corporate feedback and testimony.


Skill Strengths (Breakdown in Percentages)

  • Case Manager (100%)

Education History

Awards & Certificates

  • BLS