A Medical case manager acts as a liaison between the patients and the medical staff, while these case managers don’t provide direct medical treatment or diagnosis to the patient, they are involved in monitoring the treatment plan and disburse various other roles and responsibilities such as – conducting pre-screening interviews, verifying medical care plans of the patient, corresponding with physicians in case of any omissions or corrections, compiling and auditing patient record, recommending policies and processes to improve patient service, reporting about findings and ensuring that the patient receive fair treatment.
The requirements that are expected from the medical case managers are excellent knowledge of case management principles, reimbursement policies, healthcare management; excellent multi-tasking skills and technical emerging knowledge. Apart from holding a valid current license, these managers should depict a degree in the field of healthcare or the relevant in the Medical Case Manager Resume.
Objective : Proven ability to communicate effectively in diverse environments, exhibit strong leadership qualities to effectively provide patient care. Ability to work well with others in a team environment.
Skills : Microsoft Office, Provide System, Cornerstone System.
Description :
Conducted calls with patients, reviewing the case file and completing a medical interview to obtain the required information as designated by the interview system.
Used a consulting approach supported by medical knowledge and defined policies and procedures to uncover and collect information.
Providing an excellent customer service experience to all patients, acting as an advocate for them by providing information about preventative care.
Acted as a courteous, professional medical representative and customer advocate to obtain the necessary information to document.
Collected information efficiently and credibly to ensure a complete and accurate medical interview is completed and filed with the insurance carrier.
Responsible for following defined policies, procedures, and standards for professional conduct.
Performed within quality standards to ensure consistent, accurate, and professional patient interactions.
Accepted responsibility for actions and executed transactions with the information collected generating legal documents that are filed with the insurance carrier.
Experience
2-5 Years
Level
Junior
Education
Associate
Medical Case Manager I Resume
Objective : Seeking to secure a position with a well-established school/organization and a stable environment, that will enable the use of strong organizational skills, educational background, and ability to work as a team player with other staff.
Received inbound calls from insurance applicants, reviewed the case file and completed a medical interview to obtain the required information.
Used a consultative approach supported by medical knowledge and defined policies and procedures to uncover and collect additional critical details.
Proactively served as an advocate to assist the applicant in the collection of vital medical information by contacting medical care facilities and medical offices, physicians, etc.
Acted as a courteous, professional medical representative and customer advocate to obtain necessary information.
Worked accurately and efficiently to maximize service to clients, adhered to designated guidelines for phone availability and work to become highly proficient with the client.
Worked interactively with Team Leader to discuss performance, obtain guidance as needed and grow skills to continually achieve a higher level of quality.
Provides information and referrals to a targeted patient population.
Experience
2-5 Years
Level
Junior
Education
Medical
Field Medical Case Manager Resume
Objective : Seeking a nursing position within a progressive setting where critical thinking skills, medication expertise, and exceptional patient care skills will be an asset.
Skills : Microsoft Office, Clerical, Counseling and Case Management, De-escalation, Motivational Interviewing, Type 45 wpm.
Description :
Acting as a customer advocate ensures a professional, efficient, thorough and accurate interview is completed to meet the needs of the client and the company.
Receives inbound calls from insurance applicants, reviews the case file and completes a medical interview to obtain the required information.
Uses a consultative approach supported by medical knowledge and defined policies and procedures to uncover and collect additional critical details.
Acts in compliance with all HIPAA guidelines and standards of care in client interactions.
Uses good judgment, tact, and compassion to handle the delicacy of exchanging personal health information.
Approaches the job with a focus on quality and completing cases each day with the objective to follow policies and procedures consistently.
Acts like an owner of the company and expect their peers to follow company policies, procedures, standards for quality and standards for patient care.
Addresses issues directly with peers who are not acting in the best interests of the Client, the Team or RSA OR informs their Team Leader of the issues.
Experience
2-5 Years
Level
Junior
Education
AAS
Nuring Medical Case Manager Resume
Objective : Responsible for Maintaining a consistent knowledge of all client programs which trained on, and accepted additional training to expand skills to become capable of servicing a higher number of patients.
Skills : Microsoft Office, ICE.
Description :
Provided medical and vocational assistance and coordination services for the school district account to assist injured workers in reaching maximum medical improvement.
Proactively identified needs and problems in order to implement an appropriate resolution.
Facilitated effective communication between all parties including the injured worker, the adjuster, the employer, treating physician(s) and ancillary providers.
Properly assessed rehabilitation needs and made appropriate recommendations with an emphasis on the injured worker recovering and returning to work.
Assisted the employer with job modifications necessary to allow the injured worker to return to work within the applicable physical restrictions assigned by the doctor.
Facilitated authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment as per regulations.
Worked closely with attorneys and gave depositions as needed.
Experience
2-5 Years
Level
Junior
Education
Diploma
Medical Case Manager II Resume
Summary : Over 22 years of experience in a clinical and community setting. Provide ongoing direct services to consumers and their families. Assisting, supporting and instructing individuals in self-help skills designed to encourage independence.
Skills : Management, POS Systems, Well Organized.
Description :
Provide primary and emergency care for occupational and non-occupational illnesses, worker's compensation case management, legal and regulatory compliance.
Providing drug testing, maintained OSHA, State, and Team Member health records, participating incorporate safety, ergonomics programs, and emergency response.
Provide Team Member health education and training programs such as CPR/First Aid/AED training.
Collaborate and act as a liaison between injured/ill team members, the company and healthcare providers.
Provide health cost containment services by facilitating early return to work, medical care, communication and resolving case management issues promptly.
Assisted the employer with job modifications necessary to allow the injured worker to return to work within the applicable physical restrictions assigned by the doctor.
Facilitated authorization/certification of procedures, diagnostic testing, physical therapy/occupational therapy and durable medical equipment.
Experience
10+ Years
Level
Senior
Education
Associate
Independent Medical Case Manager Resume
Headline : Responsible for Directly supervising three airmen-ensure upgrade training requirements are achieved, mentor and promote based on evaluation and performance reports,Motivating over 30 personnel to develop professional military decorum, effective human relation skills, and social skills for improving interpersonal and military relations.
Skills : Administration, Skilled and Proficient in Insurance.
Description :
Improve HIV medication adherence, linkage to care, and care retention for at-risk HIV positive patients leading to the final outcome of viral load suppression.
Provides social work services including treatment adherence counseling, coordination of supportive services, referral and advocacy for community services.
Works in a collaborative manner with patients, community liaisons, community-based organizations to link new patients to HIV medical care.
Ensure visits for patients at risk of falling out of care, and decreased viral loads for at-risk patients.
Designing and following a goal-oriented plan that responds to health, social, and environmental needs identified through face to face formal assessment interviews.
Link and Empower clients to use resources available in the community.
Ensure that the client obtains timely access to needed services, the appropriate level of care and promotes adherence to the individual treatment.
Identify barriers to care, referrals to resources and coordination with other providers.
Experience
5-7 Years
Level
Executive
Education
BS
Jr. Medical Case Manager Resume
Objective : Worked in the healthcare industry for more than 4 years, of applied management and supervisory experience in both for-profit and non-profit organizations providing medical case management and mental health services to the underserved population.
Skills : Microsoft Word, Microsoft EXCEL.
Description :
Directly responsible for facilitating ongoing medical treatment for over 20 injured service members.
Responsible for managing military orders for members to ensure proper fiscal and resource management.
Identify/Initiate/Track/Trend line-of-duty processing for military-related injuries.
Prepare activity reports to inform upper management of the status and implementation plans of programs, services, and quality initiatives.
Briefs the Chief of the 315th Aerospace Medicine Squadron (AMDS), 18 Unit Commanders and the 315th Air Wing Commander.
Processes and supervises information security clearance for all commanders and upper leadership for the 315th Airlift Wing.
Monitor and manage current certificates necessary for access to our information applications.
Experience
2-5 Years
Level
Junior
Education
MBA
Medical Case Manager-Temp Resume
Objective : Seeking to secure a challenging career in the Human Services field, where one may utilize skills that emphasizes increasing responsibility.
Participate in HIV QA Department activities to ensure compliance with HRSA Standards of Care.
Conduct an initial comprehensive assessment of the client's needs and personal support system; enroll clients in all relevant Federal, State, and local programs.
Coordination of inpatient and outpatient care, referrals to specialist, follow up with referrals and missed appointments, and interdisciplinary care team at Optimus Health.
Assessment of the client's needs, strengths, and deficits an initial plan will be developed with the client, based on the level of acuity of his/her needs.
Conduct ongoing individual care planning, including re-evaluation and CareWare updating as required by the office.
Ensure that financial and support services assessment is conducted every (6) months.
Complete all necessary monthly internal reports as well as reports required by the office.
Experience
2-5 Years
Level
Junior
Education
HS
Medical Case Manager-Clinical Resume
Headline : Seeking to obtain a Management position with a dynamic company where one can use energy and skills to develop, motivate, lead and encourage employee productivity.
Work with patients to ensure all their medical care is current with no interruptions along with infectious disease specialist and medical team.
Assess the patient's unmet health and social needs.
Facilitate patient access to appropriate medical and specialty providers in the community.
Cultivate and support primary care and specialty provider co-management with timely communication, inquiry, follow-up, and integration of information.
Provide proactive primary medical case management to HIV-infected consumers including intake, assessment, and service delivery with a focus on entry to medical care.
Data Entry-Complete all documentation for and medical case management into electronic medical records/utilize ECW to track the needs of consumers.
Compile/edit forms for data entry and prepare monthly statistical reports.
Experience
5-7 Years
Level
Executive
Education
MS
Associate Medical Case Manager Resume
Headline : Highly motivated, goal-oriented individual with clinical and leadership skills with proven ability to work independently and effectively as a leader and team player with peers and managers.
Skills : Geriatrics, Palliative Care, Case Management, Avaya, Microsoft Office, Notary Public, Typing.
Description :
Assessed the needs of Children with Special Needs for medical issues.
Formulates a plan of care with clients/ caregivers based on identified issues.
Planned, and monitored specific objectives, goals, and actions designed the client/caregivers' needs as identified through the assessment.
Implemented and executed specific case management activities and or interventions that will lead to the accomplishment of goals and actions.
Coordinated and ensured delivery of health care services that address the clients' needs through the process of organizing integrating and monitoring resources.
Collaborated with members of the multidisciplinary team.
Acted as a liaison for the client/caregiver with DHMH, WCC, or other providers ensuring appropriate outcomes.
Ensured that all services were delivered and documented the outcome of services and the impact on the client /caregiver.
Experience
5-7 Years
Level
Junior
Education
BS
Medical Case Manager-Part Time Resume
Headline : Dependability and diligence in performing assigned duties. Ability to effectively communicate and maintain a professional relationship with clients. Ability to advocate for services on behalf of the clients.
Skills : Call Center, Certified Nursing Assistant.
Description :
Develops comprehensive, individualized service plans for assigned patients.
Provides ongoing follow-up and support to assist patient retention in programs related to medical care.
Builds rapport and trust with patients, and engages patients in problem-solving.
Provides patients with assistants in assessing eligibility and applying for state and federal programs including.
Integrates social and medical services in a holistic approach to patient care.
Maintains required paperwork for federal, state and private assistant programs within the framework of state and federal program guidelines and requirements.
Maintains an accurate database of services, contact information, and other required patient documentation in Provide Enterprise software system.
Experience
5-7 Years
Level
Executive
Education
MSW
Medical Case Manager III Resume
Objective : An experienced Medical Case Manager, Medical Case Manager is responsible for the clinical care of patients in a hospital setting.
Skills : Program/Contract Management, Human Resources, Financial Analysis/Management, Marketing.
Description :
Prioritize and manage an assigned caseload of medical and disability workers' compensation claims, performing UR and telephonic case management, as indicated.
Communicate with injured employees, medical professionals, claims staff and employers timely and regularly to obtain information necessary to make sound medical assessments.
Assess injury severity, the extent of disability, treatment plans, functional abilities, and physical job requirements to establish a target.
Utilize and manage resources appropriately, including external field case managers, vendors, UR/peer review, and medical director.
Respond to various written and telephone inquiries timely regarding the status of the case.
Facilitate earliest appropriate return to work release and coordinate return to work efforts with all parties, as appropriate.
Facilitate Maximum Medical Improvement and discharge from care.
Experience
2-5 Years
Level
Junior
Education
BS
Assistant Medical Case Manager Resume
Headline : Experienced Case Management and Utilization Review Professional with a diverse background encompassing Acute Care, Rehabilitation and Long Term Care, and Worker's Compensation. Registered Nurse with certifications in Worker's Compensation and Risk Management and expertise as an onsite Nurse.
Skills : Bartending, MS Office, Medical Terminology.
Description :
Provided health care counseling and education to families on disease initiatives.
Coordinated diabetes study with cases across the state at the Diabetes Clinic.
Build and maintain relationships with community service providers through collaborating, networking and educating providers at community functions.
Collaborated with community agencies and organizations as an advocate for Medicaid eligible families in need of resources.
Targeted Medicaid patients who have experienced a significant increase in medical costs or emergency department/hospital visits.
Evaluated families through treatment plans and/or family partnerships to give the appropriate services needed.
Developed a proposal for AccessCare, use as a method of reaching out to the community service providers.
Conducted interviews with patients for a diabetes research study.
Experience
5-7 Years
Level
Executive
Education
MBA
Lead Medical Case Manager Resume
Objective : Medical Case Manager is responsible for creating and maintaining a database of patients with health insurance, billing, and other administrative needs. Responsible for collecting information from customers about their medical histories and taking necessary steps to ensure the proper care for each patient.
Skills : Microsoft Office, ICE.
Description :
Clients Interact continuously with a client, physicians, and pharmacy as well as other providers utilizing clinical knowledge and expertise.
Assesses client's options for care including but not limited to the use of benefits and community resources to update the client's plan of care.
Acts as a liaison and advocate between client and community resources which also include client's physician and other care providers.
Maintains accurate and updated records of client case management which fall within federal and grant maintenance required guidelines.
Coordinates community resources and emphasis on medical, social, and behavioral services.
Applies all federally regulatory, grant, and HIPPA standards and maintains the confidentiality of guarded health information.
Reports all critical information as required in regard to the quality of care concerns.
Experience
2-5 Years
Level
Junior
Education
BS
Medical Case Manager Resume
Objective : Seeking to obtain a leadership position that would utilize skills, education, and experience while providing quality care and services for the agency clientele.
Skills : Microsoft Excel, Windows, Powerpoint, Data Entry.
Description :
Interviewed and assessed clients affected by HIV, AIDS, mental health, and drug abuse issues during Psychosocial Assessments.
Advocated for the client's best interest during treatment plans.
Assisted clients with complete applications for SSI, Social Security benefits, food stamps, Medicaid, Medicare, financial assistance, and housing assistance.
Researched and referred clients to resources available in their community.
Completed a detailed service plan outlining the client's goals, medication schedule, and doctor's appointments.
Performed daily face-to-face contact with clients from different economic, social, and cultural backgrounds.
Performed daily follow-up calls and visits to ensure clients are linked to the services needed.
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