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. Communicate as needed with third party payors regarding the patient's progress with the treatment plan. ), 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, 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. 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, 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, 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, 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, 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, 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, Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information, Authorizes recommended modalities of treatment. 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. 4.2. 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. Exhibits awareness of ethical/legal issues concerning patient care and strives to manage situations to reduce risk. Below, you'll find detailed information on skills to highlight on your resume, along with management resume examples for a variety of management jobs (including customer service, finance, human resources, operations, technical, and general management positions). Ensure that each patient meets the clinical needs for admission, treatment, and discharge and initiates appropriate follow through with the health care team. Educates patients and families regarding the care manager role, as needed. 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, 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). Investigates and suggests alternatives. Tracked client movement on and off the unit by documenting times and destinations of clients. 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, 1-2 years of experience with body care and/or related experience, 1-2 years of experience supervising others, preferred, Possesses a sense of urgency in the completion of tasks, Possesses excellent customer service skills, Ability to stay focused with the task at hand, Previous experience in a retail environment; natural foods background a plus, Manage crisis calls from individual and corporate clients, 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, Educated in current principles and procedures of behavior health care. Performs various duties as needed to successfully fulfill the function of the position, 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. 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. 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, Writes letters for provider appeals, member grievances, & DPW requests, Master’s degree prepared – OR – Registered Nurse, 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, 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. diabetes, sickle cell, asthma, etc. Maintains awareness of key performance indicators/metrics and manages caseload through appropriate management of medical expenses. Utilizes professional knowledge to apply national medical necessity criteria and contract-specific criteria in rendering certification decisions. 9.1. The resume examples below will help you create your direct support professional resume … 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. Dakota Boys and Girls Ranch Treatment Center. ), 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. When you want to write the perfect resume, it … Intervenes when necessary to correct delays and to address any barriers for patients, Utilizes information obtained from various resources available to: 3.1. 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, Location/Facility – Baylor Scott & White Hillcrest Medical Center, 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, Long Term Acute Care Experience or Home Health Experience translates well into this position (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. Advocates for the patient to ensure treatment needs are met. Confers with physician to clarify diagnosis, prognosis, therapies, daily living activities, and to share information. Work requires sitting for extended periods, talking on the telephone and typing on the computer, Typical office working environment with productivity and quality expectations, 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. 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. 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. 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. 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, 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, 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. 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