Care Coord Resume Samples

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S Spinka

Shaniya

Spinka

3105 Kamryn Meadow

Phoenix

+1 (555) 775 8017

3105 Kamryn Meadow

Phoenix

Phone

p +1 (555) 775 8017

Experience Experience

Dallas, TX

Care Coord

Dallas, TX

Hilll-Schamberger

Dallas, TX

Care Coord

Leads and/or supports transition/discharge planning for patients moving between levels of care
The RN Care Coordinator provides clinical coordination services including assessment, planning, and intervention
Promote effective utilization of health care and monitoring of outcomes
Identify and initiate referrals for social service programs; including financial, psychosocial, community, and state supportive services
Assist with ongoing data collections
Responsible for following standards of care, policies and procedures as established within Allina and the Midwest Fetal Care Center
Provide regular updates to referring providers and sub specialists

San Francisco, CA

Clinical Services Care Coord

San Francisco, CA

Dooley-Hudson

San Francisco, CA

Clinical Services Care Coord

Contact both medical and behavioral health providers to ensure coordination of care and services, as per direction and supervision of care manager and manager
Work closely with network services team to identify and close network gaps
Assist UM staff in addressing access to care issues by coordinating with Aftercare staff, UM staff and facility and community MH providers
Identify resources for Beacon members or providers including coordination of access to 24 hour levels of care with providers with indicated
Provides support to the member navigating any type of provider service activity, including but not exclusively
Data entry of out of network treatment requests and coordination of out of network request process
Manage incoming faxes

present

Houston, TX

Assoc Patient Care Coord, Rancho, Las Vegas

Houston, TX

Conroy, Zemlak and Schuppe

present

Houston, TX

Assoc Patient Care Coord, Rancho, Las Vegas

present

Assist co - workers and team members with duties when requested, to include but not limited to, floating to other areas
Responsible for waiting room management and implementation of efficient customer friendly processes
Work cooperatively with all members of the care team and supports Patient satisfaction goals
Notify case management staff for HPN patient without defined PCP. Schedule appointments as necessary
Receive direction from Supervisor, Clinic Operations, and RN Manager
Notify patients of abnormal results with direction from provider or RN
Work with back office and front office staff to ensure smooth patient flow

Education Education

Bachelor’s Degree in Nursing

Rowan University

Bachelor’s Degree in Nursing

Skills Skills

Self-starter, highly motivated with high energy level
Interpersonal skills to drive collaboration, commitment and productivity when working with cross-functional teams, customers and end users
Flexibility to adapt to ongoing change and work in a fast-paced, customer driven environment
Evaluate, develop, mentor, coach, counsel and discipline department staff. Supports community personnel from other departments through coaching and mentoring to help achieve optimum standard of excellence. Addresses
Assist in maintaining the department budget, place orders for equipment and supplies as necessary
Demonstrates superior written and verbal communication and presentation skills
Basic to intermediate proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.); basic knowledge and experience with electronic mail and calendaring system in PC LAN environment. Ability to type

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Care Coord Resume Examples & Samples

Provide effective care coordination, assessment and oversight across a continuum of services and settings for the high risk obstetric population with a focus on fetal anomalies
Responsible for following standards of care, policies and procedures as established within Allina and the Midwest Fetal Care Center
Serve as a patient/family advocate
Serve as a role model in promoting the interdisciplinary team approach
Collaborate with an interdisciplinary team to ensure comprehensive coordination of care
Participates in facilitation of weekly neonatal rounds team case discussion
Works collaboratively with fetal team in development of clinical care pathways
Facilitates chart prep, accessing and ensuring pertinent records are available for visits
Triage patient care needs while in clinic and via telephone encounters
Assess learning readiness based on cultural, age and educational level
Update and create patient EMR to accurately reflect plan of care
Provide regular updates to referring providers and sub specialists
Assist with ongoing data collections
Participate in quality assessment activities
Effectively engage/communicate/lead a multidisciplinary team in a group setting, including planning, coordination, of monthly multi-disciplinary fetal care meetings (bi-monthly and potentially cross campuses)
Promote effective utilization of health care and monitoring of outcomes

CM Ext Care Coord Rn-pd Resume Examples & Samples

Monitors levels and appropriateness of therapeutic and/or rehabilitative care
Conducts individual and team conferences to assist patients and family identify risk factors
Orders DME as ordered by the physician
Notifies members about the co-payment associated with the Skilled Nursing transfer
Communicates with physicians and other care givers regarding patient progress by monitoring, evaluating and analyzing clinical, functional and psycho-social status/progress
Bachelor's degree in nursing or healthcare related field preferred or current equivalent related work experience preferred
Case Management experience current, Team oriented and works collaboratively with multiple stakeholders
Assist in Quality and PI metrics and Innovations
Proficient in customer service and Medicare Guidelines

Rn-patient Care Coord Resume Examples & Samples

Minimum two (2) years recent Nursing experience in area of specialty in an acute care facility
Minimum one (1) year charge/management experience preferred
Membership in professional organization preferred

Assoc Patient Care Coord, Rancho, Las Vegas Resume Examples & Samples

Greet patients and check patients in and out
Ensure demographics including insurance information are correct in IDX. Update as necessary
Confirm Primary Care Physician with patient at check in
Answer phones and take messages or route incoming calls as per company policy
Receive direction from Supervisor, Clinic Operations, and RN Manager
Work cooperatively with all members of the care team and supports Patient satisfaction goals
Ensure all patients greeted and checked in and out, demographics are accurate, collect co pays, and enters charges
1+ year experience in a health care environment

CM Cont Care Coord RN Resume Examples & Samples

Experience with educating/completing POLST and Advance Directives, either individually or in a class setting
Experience with providing patient and family education about managing symptoms of advanced illness, as well as adjusting to illness/preparing for end of life changes
Experience with articulating hospice/palliative care to patients who have been referred to those respective programs
Experience in research studies and recruitment of patients for those research studies
Experience in working in a multi-disciplinary team setting
ICU or Hematology/Oncology experience preferred
Position will require working in both Anaheim/Irvine Clinics as well as providing coverage for vacations

Resp Care Coord Resume Examples & Samples

Educate patients in a class room setting on various sleep disorders
Instruct patients on home diagnostic sleep equipment
Reading sleep studies and providing preliminary diagnosis to patients
Instruct patients on the proper use of therapeutic equipment used for Obstructive Sleep Apnea and other home ventilatory support systems
Process referrals to other sleep entities and healthy living providers
Assists in the planning, development and implementation of respiratory care programs that coordinate high quality, cost-effective care for patients with COPD, hypoventilation, neuro-muscular disease, Sleep Apnea and all other sleep disorders
Collaborates with managers, physicians and patient care staff to identify and resolve Sleep Disorder issues as well as Pulmonary Care Issues
Conduct follow up consultations with CPAP users to ensure adherence or refer patients to alternative treatment
Inform patients of the sleep physician's final results
Provide case manager consultations to patients referred by the physicians
In addition to defined technical requirements, accountable for consistently demonstrating service behaviors and principles defined by the Kaiser Permanente Service Quality Credo, the KP Mission as well as specific departmental/organizational initiatives
Kaiser Permanente is an EEO/AA Employer
Minimum one (1) year of sleep disorder-related experience required
Recent experience facilitating performance improvement projects and experience planning, coordinating and implement programs preferred
Recent experience in patient education in respiratory disease and sleep disorders preferred
National Board of Respiratory Care-Sleep Disorder Specialist preferred
Certified Sleep Disorder Specialist and/or Certified Polysomnographic Technologist preferred

Acute Care Coord, RN Resume Examples & Samples

Coordinates care of patients in acute care. Assumes coordination role at the point of admission and through discharge with targeted coordination and follow-up. Identifies patient discharge needs. Assists in implementing patient care strategies to close gaps in medical care upon discharge. Identifies resources for patient self-management planning and discharge. Assists in developing and implementing care plans for medically complex patients. Identifies barriers to a successful discharge plan
Coordinates use of clinical and ancillary resources within and outside of the health system to achieve treatment goals specified in the patient care plan and facilities discharge
Participates in development of discharge plan with short and long-range care plan goals for patients. Keeping abreast of organizational developments and practices that may impact operations by participating in continuing education courses, professional organizations and seminars, reading current literature and maintaining professional contacts in the community. Assisting with the development of current evidence based protocols, policies, work flow/flow sheets, guidelines, etc. related to the provision of care within the acute care coordinator, RN model. Participating in committees as assigned
Interacts effectively with physicians, the acute care coordinator team, patients and their caregivers
Accountable for patient discharge
Adheres to infection control/safety guidelines
Adheres to HIPAA, TJC,CMS and OSHA regulations and policies
Attends Bi-weekly Acute Care Coordinator Meetings and Patient Family Services Meetings as scheduled

Acute Care Coord, RN Resume Examples & Samples

Coordinates care of patients in acute care.Assumes coordination role at the point of admission and through discharge with targeted coordination and follow-up.Identifies patient discharge needs.Assists in implementing patient care strategies to close gaps in medical care upon discharge.Identifies resources for patient self-management planning and discharge.Assists in developing and implementing care plans for medically complex patients.Identifies barriers to a successful discharge plan
Participates in development of discharge plan with short and long-range care plan goals for patients.Keeping abreast of organizational developments and practices that may impact operations by participating in continuing education courses, professional organizations and seminars, reading current literature and maintaining professional contacts in the community.Assisting with the development of current evidence based protocols, policies, work flow/flow sheets, guidelines, etc. related to the provision of care within the acute care coordinator, RN model.Participating in committees as assigned
Accountable for patient discharge,provide coverage to all units as needed for vacancies due to illness, disabilities and vacations.Will act as educator and preceptor to new employees
Adheres to HIPAA, TJC, CMS and OSHA regulations and policies
Will provide coverage for Manager absences; assisting the scheduler and acting as a resource for Home Care and Care Coordination questions

Provider Practice RN Care Coord Resume Examples & Samples

Requires 5 years nursing experience required for RN BSN (Bachelor degree in Nursing) or
7 years nursing experience required for diploma or AD RN (Associate degree)
Multi-state licensure is required if this individual is providing services in multiple states
Experience in home health care preferred

CM Cont Care Coord Rn-pd Resume Examples & Samples

Recommends alternative levels of care and ensures compliance with federal, state, and local requirements
Coordinates transmission of clinical and benefit treatment to patients, families and outside agencies
Interprets regulations, health plan benefits, policies,and procedures for members, physicians, medical office staff, contract providers, and outside agencies
Acts as liaison for outside agencies, non-plan facilities, and outside providers
Minimum one (1) year clinical experience as an RN in an acute care setting, plus two (2) years of clinical experience as an RN in a licensed home health or hospice agency required
Hospice/ Palliative Care experience preferred

Care Coord / Auth / Scheduling Specialist Resume Examples & Samples

Types all patient referral correspondence for department
Retrieves journal articles for the faculty and residents
Maintains Colposcopy Results and Census Reports as per guidelines established
Distributes interdepartmental mail twice daily between the departmental office and the Family Practice Center

Supv Care Coord Ortho / Spine Resume Examples & Samples

Minimum of 5 years office experience required; 10-years office experience, preferred
Minimum of 5- years Patient Navigator/Coordinator, required
Must possess the leadership and communication skills to develop and coordinate an interdisciplinary program
Must be able to plan/coordinate patient care within the framework of standard clinical practice guidelines
Leadership and communication skills to coordinate care with the Orthopedic and Spine Program
Ability to effectively educate families and peers

Care Coord / Auth / Sched Spec Resume Examples & Samples

Answers multi-line telephone, screen calls, take messages and forwards to appropriate person
Maintains books and journals in the Departmental Library
Records and maintains the database for resident attendance for all departmental conferences
Coordinates and distributes emergency room billing sheets for the attending faculty

Clinical Services Care Coord Resume Examples & Samples

Responsible for routing utilization management requests, via fax and/or phone call to clinicians
Update authorization information in Beacon’s clinical system
Identify resources for Beacon members or providers including coordination of access to 24 hour levels of care with providers with indicated
Data entry of outpatient treatment requests
Data entry of out of network treatment requests and coordination of out of network request process
Assist UM staff in addressing access to care issues by coordinating with Aftercare staff, UM staff and facility and community MH providers
Work with supervisor on data collection
Manage incoming faxes
Serve as a backup support for all other administrative duties within the clinical department
Knowledge of Microsoft Office Suite and Share Point preferred
Excellent communication and organizational skills required

Clinical Services Care Coord Resume Examples & Samples

Contact members to assess, plan and monitor services members need to be maintained in the community
Contact both medical and behavioral health providers to ensure coordination of care and services
Develop appropriate treatment plans for members, monitoring outcomes
Identify resources that are available to allow members to be maintained in the community
Work with UM staff to ensure appropriate follow-up and follow-through for members being discharged from higher levels of care
Work with outpatient care management staff to proactively identify members needing additional support to be maintained in the community
Basic computer skills required, including MS Office; CareConnect
Will seek direction from licensed care management when dealing with members who need urgent or emergent triage for services

Assoc Patient Care Coord Resume Examples & Samples

Confirm primary care physician with patient at check in
Notify case management staff for HPN patient without defined PCP. Schedule appointments as necessary
Enter charges correctly and collect appropriate payments
Document all calls and messages appropriately according to company policy
Work with back office and front office staff to ensure smooth patient flow
Assist coworkers and team members with duties when requested, to include but not limited to, floating to other areas
Answer phone, take messages and route calls appropriately
Notify patients of abnormal results with direction from provider or RN
Work cooperatively with all members of the care team and support patient satisfaction goals
Resolve moderately complex issues and defer appropriately to supervision
Computer skills including Windows based applications
Medical assistant

Clinical Care Coord Resume Examples & Samples

Current license to practice nursing in Michigan is necessary
Demonstrates competence in coordinating care and multi-tasking
Experience in extreme flexibility in daily operations; ability to prioritize and re-prioritize multitude of daily calls
Demonstrates knowledge and experience with Continuous Quality Improvement
Demonstrates active participation on unit activities including but not limited to Professional Practice Councils, other committee or QI work
Willing to obtain Transplant certification- CCTC within one year of hire

Care Coord Resume Examples & Samples

Provide effective care coordination, assessment and oversight of cancer rehabilitation needs across a continuum of services and settings
Promoting effective utilization of health care and monitoring of outcomes based on the needs of individuals served
Network with oncology care coordinators and acute care case management teams to facilitate connections with CKRI cancer rehabilitation services

Case Manager Cont Care Coord Rn-pd Resume Examples & Samples

Encourages member to follow prescribed course of care (e.g., drug therapy, physical therapy)
Makes referrals to appropriate community services and outside providers
Participates with healthcare team/providers in actualizing outcomes by planning, evaluating and implementing decisions and strategies to achieve predetermined cost, clinical, quality, utilization and service outcomes
Strong communication skills, teamwork, and flexibility preferred

Oms Medical Care Coord Resume Examples & Samples

Resolve escalated complex transportation services PA reviews/dispositions based on business rules and workflow policies
Work with the Prior Authorization Unit staff members to monitor work queues and complete assigned tasks
Perform other duties and responsibilities as may be assigned from time to time

Care Coord Resume Examples & Samples

The RN Care Coordinator provides clinical coordination services including assessment, planning, and intervention
Patients are identified through predictive tools and referrals from providers, staff or community caregivers to facilitate clinical transition planning from the hospital when medically indicated
The RN Care Coordinator: Provides services for individual patients and on identified patient care areas to facilitate optimal patient outcomes
Collaborates with the healthcare team including, but not limited to: Attending/Specialty Physicians, Social Worker, Pharmacist, Admission Notification, Medicare Admission Review and Nursing to ensure the progression of an effective treatment plan and smooth clinical transitions in care
Addresses issues related to Intensity of Service and Severity of Illness to confirm medical necessity for admission and continued stay in conjunction with the centralized Medicare Admission Review Department

Care Coord Resume Examples & Samples

Utilizes professional education, clinical experience and established criteria and registries to determine and collaborate on suitability for effective care management
Utilizes and assists with design of predictive models to identify patients at risk and in need of care management
Assessment
Works with the patient/family/healthcare provider to develop a treatment plan which enhances patient outcomes – initiates and implements plan modifications as necessary through monitoring and re-evaluation to accommodate changes
Supports planning across the continuum independently and in collaboration with other care management professionals in specialty and inpatient areas as patient needs those services
Supports planning with community resources and external healthcare agencies to provide broadest available integrated network of support as needs indicate
Implementation/Coordination
Identifies barriers and works with patient/family to resolve them
Facilitates communication between patient/family and all members of the health care team
Addresses complex communication and planning issues as patient receives services across the continuum (in particular for patients with multiple consultants and services)
Monitoring/Evaluation

Case Mgmt Care Coord MSW Resume Examples & Samples

Initiates the case management process to ensure patients receive the appropriate level of services across the continuum. Ensures plan meets patient's clinical, psychological and discharge needs in collaboration with attending physician and interdisciplinary team
Ensures all admission and continued stays meet clinical criteria for appropriateness and medical necessity. Assesses discharge-planning needs and coordinates the delivery of services to meet these needs
Evaluates the health status of assigned patients by collecting and analyzing patient and family information. Expedites and coordinates the delivery of services to facilitate patients' progression through the healthcare system
Participates in interdisciplinary team meetings to ensure optimum patient care
Develops and maintains effective relationships with appropriate community resources, post-acute care facilities and medical-equipment providers to support patient care needs post discharge
Establishes rapport and works collaboratively with insurance companies to facilitate the patient’s transition to an appropriate level of care
Facilitates the discharge planning process through coordination with the interdisciplinary team and serves as a liaison to safely transition patients to the appropriate level of care. Proactively identifies and resolves issues
Acts as an educational resource and provides consultation to hospital medical staff regarding discharge planning process and applicable federal, state and local regulations; identifies benefits, implications and limitations of home care as appropriate
Evaluates patients’ educational needs concerning continuum of care and available services and provides information and materials regarding community resources, discharge options, and pre and post treatment options and costs to patient and patient families. Provides assistance in resolving clinical, psychosocial and financial barriers
Maintains documentation on discharge planning notes and charts on patient's record as performed
Monitors and controls the use of healthcare resources to achieve desired patient outcomes, decrease length of stay, and decrease resource utilization. Identifies and documents delays in case and service and reports findings to department director
Utilization philosophies and practices to support Patient Service Excellence, such as AIDET, rounding with purpose, and discharge calls, etc. to optimize healing environment and patient outcomes
Tracks and trends barriers to care; Makes recommendations and develops action plans to improve processes and systems

Tslc Clin Care Coord Rn-ltc Resume Examples & Samples

Determine departmental staffing requirements and assist in the recruitment, interviewing, and selection of personnel for the community or department
Monitor department work hours to ensure proper workflow and adequate staffing levels in compliance with state minimum regulations and sanctuary budgeted PPD hours
Evaluate, develop, mentor, coach, counsel and discipline department staff. Support community personnel from other departments through coaching and mentoring to help achieve optimum standard of excellence
Participate in community surveys and when necessary, develop a plan of correction for department deficiencies
Perform administrative duties such as completing medical forms, assessments, reports, evaluations, studies, charting, etc
Attend various committee meetings of the community as required. assist in preparing written and/or oral reports of the nursing service programs and activities to submit to such committees
Monitor compliance and accuracy in department charting requirements

Assoc Patient Care Coord, Rancho Dr Resume Examples & Samples

Responsible for waiting room management and implementation of efficient customer friendly processes
Communicate with clinical and clerical personnel about service issues and complaints
Handle patient calls accessing EMR and addressing patient concerns
Address and complete tasks, referrals, and stats on a daily basis, and access Imagecast to enter radiology orders
Receive direction from supervisor, clinic operations and RN manager
Make recommendations to adapt procedures, processes and techniques to accomplish the requirements of the position

LPN, Lcsw Managed Care Coord Resume Examples & Samples

Identifies members for high risk complications
Obtains clinical data
Identifies members that would benefit from an alternative level of care or other waiver programs
Enters all information collected into our internal clinical program, verifies and interprets the information, conducts additional assessments, as necessary, and develops, monitors, evaluates, and revises the member's care plan to meet the member's needs
Participates in coordinating care for members with chronic illnesses, co-morbidities, and/or disabilities, in conjunction with the member and the health care team, to ensure cost effective and efficient utilization of health benefits
Current, active, unrestricted LPN or LCSW license required in the state of Virginia
Candidate must reside in the state of Virginia
Occasional local travel required, as needed, to meet with members in their residence, hospitals, nursing facility, etc. Mileage/tolls reimbursed
Computer Skills: MS Office (Word, Excel, Outlook)
Telephonic case management exp. preferred
Knowledge of DME, ICD-10 codes, medical terminology preferred
Knowledge of community resources preferred

Provider Practice RN Care Coord Resume Examples & Samples

3- 4 years of clinical experience in social work, counseling with broad range of experience with complex psychiatric and substance abuse or substance abuse disorder treatment; or any combination of education and experience OR
5 years nursing experience required for RN BSN (Bachelor degree in Nursing) OR
7 years nursing experience required for diploma or AD RN (Associate degree); 3-5 years case management experience; or any combination of education and experience, which would provide an equivalent background
Previous experience in case management and telephonic coaching with members with a broad range of complex psychiatric/substance abuse and/or medical disorders
Managed care experience required
Current active unrestricted license as an RN, LCSW, LMHC, LPC (as allowed by applicable state laws), LMFT, or Clinical Psychologist to practice as a health professional within the scope of licensure in applicable states or territory of New York state

Patient Care Coord / Fixed Resume Examples & Samples

Communication and delegation skills are essential
Orchestrates patient flow and bed assignments within the shift
Supports Associate's development of skill and knowledge

RN Patient Care Coord Weekend Days Med Resume Examples & Samples

Experience where leadership potential has been demonstrated
Trouble-shoots for patient safety, assessments, and care issues during rounds and throughout shift
Guides and collaborates with Case Managers to ensure appropriate patient resource use and movement
Supports flow of information and communications including interdisciplinary information and communications from Clinical Director to Associates and from Associates to Clinical Director

Clinical Care Coord Resume Examples & Samples

Assumes ten (10) hour responsibility and accountability. Coordinates and directs level of care appropriateness with admission status determination. Uses discretion and independent judgment in applying initial screening criteria standards as well as Medicare regulations and evidence of coverage
Collaborates in developing goals, evaluating staff and maintaining regulatory compliance. Serves as a role model as well as a resource to staff, patients and families, and the interdisciplinary team. Coordinates unit specific quality / process improvement initiatives
Demonstrates leadership abilities and assumes a supervisory role
Collaborates with the Director / Nurse Manager on the hiring, corrective action and evaluation processes for staff as well as labor relations issues / concerns. Assesses and/or completes staff performance appraisals
Assesses the learning needs of staff and assumes responsibility for ensuring continued professional growth and development by promoting an environment conducive to learning. Provides educational opportunities for hospital clinical staff via in-service programs regarding level of care criteria and managed care principles
Ensures the delivery of quality patient care within nursing unit(s). Conducts administrative and clinical support functions in a manner that facilitates effective measures of operation of the hospital during assigned hours. Directs the nurses and unit staff in coordination of care
Completes planning using high risk admission and discharge criteria set. Anticipates needs of medical / psychosocial in high risk patients, e.g. chronic diagnoses, top ten DRGs, patients frequently accessing care, etc. Initiates and follows appropriate clinical pathways and plans of care. Assigns all patient beds and staff assignments for all admissions based on patient acuity, productivity and skill level
Performs daily rounding with physician and care team to proactively progress the patient’s plan of care and discharge. Queries the physician, residents / interns, mid-level clinicians and other clinicians for clarification and to obtain accurate and complete documentation as needed, based on current clinical findings, prescribed treatment, medical interventions and / or procedures
Reviews urgent cases authorized for one (1) day, within 24 hours of admission. Reviews concurrent cases and discharge plans in timeframes determined in the review process with external entities
Completes a discharge needs assessment on all admissions. Coordinates simple discharge planning, i.e., DME, transportation. Coordinates discharge plan related to patient needs and payer requests. Assures patient education is complete and documented. Acts as a clinical role model to the nursing staff
Ensures appropriate clinical documentation to support level of care. Analyzes the patient’s current clinical status, treatment plan and past medical history to identify potential gaps on physician documentation. Identifies the principal diagnosis and all secondary conditions, co-morbidities, complications and procedures that have been documented in the medical record
Monitors quality and appropriateness of treatment and discharge planning, ensuring that goals are obtainable and measurable. Provides information regarding options for discharge planning as outlined by payer benefits
As required, provides clinical data as part of the telephonic or electronic review process to external parties to ensure continued stay authorizations
Coordinates appeals with MD’s, APRN’s and external entities. Responsible for generating appeal requests post discharge. Conducts clinical reviews with third party payers. Initiates and monitors clinical and administrative appeals in order to maximize reimbursement for provision of service. Conducts intermittent chart reviews for all patients admitted to inpatient programs to ensure that patients meet level of care for admission and continuing care. Utilizes Interqual to document level of care appropriateness
Reports any uncovered or at risk days to Director Care Coordination and the treatment team. Appropriately interfaces and attends “denials” meetings with patient accounts regarding uncovered days and status of appeals
Acts as liaison between patient, physician, family and health care team regarding plan of care and progress towards goals
Proactively identifies and removes barriers that impede the progress of care. Assures appropriate sequencing of care / interventions for optimal results and smooth transition along hospital care and continuum
Performs standard of care / core measure audits and accreditation / compliance activities
Adheres to all standards and policies regarding safety / patient safety initiatives
Work requires current license as a Registered Nurse in the State of Massachusetts. A Bachelor’s degree in Nursing, business or other health care related field is preferred with a minimum of three (3) years clinical experience. Clinical expertise in specialty area. Previous supervisory experience strongly preferred
BLS certification required. ACLS and other certifications per unit requirements
Ability to analyze clinical, financial and social situations, identifying problems and alternative courses of action. Willingness to be flexible, resourceful and creative in problem solving. Work is not standardized and requires a high degree of prioritization skills
Ability to act independently and offer suggestions and new ideas for improving performance and operations. Ability to guide and direct the health care team to assure optimal outcomes
Ability to organize and present information clearly and concisely. Keeps supervisor, peers, physicians, interdisciplinary team members, patients and families informed about progress, problems and developments
Work requires the ability to proofread and check documents for errors as well as the ability to use a keyboard to enter, retrieve, and transform data
Demonstrated interpersonal skills in order to effectively communicate with physicians, patients, families and other members of the interdisciplinary team

Clinical Services Care Coord Resume Examples & Samples

Contact members to assess, plan and monitor services members need to be maintained in the community, as per direction and supervision of care manager and manager
Contact both medical and behavioral health providers to ensure coordination of care and services, as per direction and supervision of care manager and manager
May interface with health plan/customer to coordinate care for members
Work closely with network services team to identify and close network gaps
Support to UM staff to ensure appropriate follow-up and follow-through for members being discharged from higher levels of care
Triage and referral services to ensure appropriate referrals for low acuity members, follow up ICM activities to ensure connection with services, appropriate progress in connection with services
Support to outpatient care management staff to proactively identify members needing additional services, resources or support to be maintained in the community
Research and resolve authorization errors
Demonstrate proficiency and utilization of all Horizon and Beacon systems and serve as subject matter expert on benefits, eligibility and claims issues

ASD & Dev Dis Care Coord Resume Examples & Samples

Serve as a resource and liaison for the medical center departments they are supporting, for the ASD and developmental delayed population
Participate in the development and maintenance of the appropriate data bases necessary to monitor and track the outside vendored therapy services, for the ASD and developmental delayed population
Regional coordination of the therapists (Speech, Occupational Therapy and Physical therapy) in the dissemination of updates and facilitating exchange of information etc., for the ASD and developmental delayed population
Communicate and maintain professional relationships with other integrated departments (e.g. Outside Referrals, Regional Utilization Management, Affiliated Provider Services etc.) Maintain contact with the ASD teams in the local areas
Minimum six (6) years working as a fully licensed Occupational Therapist, with minimum three (3) years working with Pediatric population

Tslc Clin Care Coord Rn-ltc Resume Examples & Samples

Assist in maintaining the department budget, place orders for equipment and supplies as necessary
Monitor department work hours (including vacation and holiday schedules), personnel, work assignments, etc., to ensure proper workflow and adequate staffing levels in compliance with state minimum regulations and sanctuary
Assist the Education Director in developing, implementing, and conducting in-service training programs that relate to the nursing service department. Ensure the continuing education requirements, which allow licensed
Maintains a working knowledge of applicable Federal, State, and local laws and regulations, TSLC Corporate Integrity Program, Code of Ethics, as well as other policies and procedures in order to ensure adherence in a manner that reflects honest, ethical and professional behavior
Must have 1 year experience in a supervisory capacity in a hospital, long-term care environment, or other related healthcare facility
Flexibility to adapt to ongoing change and work in a fast-paced, customer driven environment
Interpersonal skills to drive collaboration, commitment and productivity when working with cross-functional teams, customers and end users
Self-starter, highly motivated with high energy level
Basic to intermediate proficiency with Microsoft product suite (MS Word, Excel, Power Point, etc.); basic knowledge and experience with electronic mail and calendaring system in PC LAN environment. Ability to type
Primarily works inside with frequent kneeling, crouching, reaching, lifting, sitting, walking, bending and lifting. Must be able to push, pull, move and or lift a minimum of 25 pounds to a minimum height of 3 ½ feet and be
Subject to exposure to noise, infectious waste, diseases, conditions, etc. including TB, HIV, HEP B viruses. May be subject to the handling of and exposure to hazardous chemicals
Must be able to speak, read and write the English language in an understandable manner
Must be able to relate to and work with ill, disabled, elderly, emotionally upset and at times hostile individuals within the community. Must possess the ability to deal tactfully with personnel, residents, family members, visitors,