Case Manager

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CONTACT

Address : Hartsville, SC *****

Phone : 813-***-****

Email : *************@*****.***

SKILLS

Issue Research

Co-Payment Collection

Patient Interviews

Electronic Patient Medical Record

Patient Data Management Systems

Clinical Messaging

Electronic Health Records Systems

Problem Resolution

Patient Insurance Authorizations

Medical Terminology

Legal Requirements

Medical Coding

Basic Medical Terminology

Effective Communication Skills

Explaining Patient Benefits

Product Knowledge

Prescription Coordination

Demographics Information

Benefit Coverage

Efficient Service

Eligibility Checks

Client Relationships

Software Applications

Encryption Software

Health Insurance Plan Knowledge

Patient Profiles

Service Quality Tracking

Spreadsheets

Electronic Records Management

Compassionate Communication

Retro-Authorizations

Authorizations

Discharge Planning

Client Advocacy

Chronic Disease Management

Patient Support

Needs Assessment

Community Outreach

Care Coordination

Referral Coordination

Utilization Review

Case Management

Documentation Proficiency

Cross-Functional Collaboration

Progress Evaluations

Social Work

Documentation and Reporting

Positive Attitude

Problem-Solving

Email and Telephone Etiquette

Patient Needs Assessment

Medical Records Management

Community Resources

Annual Case Reviews

MS Office

Staff Education and Training

Home Visits and Inspections

Relationship Building

Patient Assessment

Case Planning

Case Documentation

Multitasking Abilities

Critical Thinking

Interpersonal Communication

Attention to Detail

Active Listening

Adaptability

Time Management

Stress Management

Customer Service

Goal Setting

Computer Literacy

Interviewing Skills

Proficient in Software

PROFESSIONAL SUMMARY

Detail-oriented professional with excellent communication, interpersonal, and creative thinking skills. Aiming to leverage my abilities to successfully fill the vacancy at your company. Frequently praised as hard-working by my peers, I can be relied upon to help your company achieve its goals.

WORK HISTORY

PRIOR AUTHORIZATION REPRESENTATIVE, 09/2022 to Current

Cigna

Adhered to HIPAA regulations while maintaining confidentiality of patient information at all times

Maintained records of all authorizations granted or denied in accordance with departmental guidelines

Analyzed insurance benefits, coverage limitations, network restrictions, provider contracts, and other factors related to prior authorization requests

Successfully processed and obtained authorization for medical services requested by providers in a timely manner

Assisted other departments with special projects or tasks that required knowledge of prior authorization protocols

Provided guidance and support for junior staff members when needed throughout the day-to-day operations

Interpreted health plan policies and regulations pertaining to prior authorizations in order to make accurate decisions on each case presented

Provided exceptional customer service to both internal and external customers in order to resolve inquiries and issues effectively

Demonstrated excellent telephone etiquette while communicating with providers regarding their requests

Actively participated in educational meetings regarding new changes or updates made by insurance companies concerning prior authorization requirements

Maintained up-to-date knowledge of current healthcare industry trends by attending seminars or reading trade publications regularly

Researched discrepancies between provider submitted documentation versus health plan policies and regulations in order to determine eligibility for services requested

Processed urgent requests within specified timeframes in order to provide immediate care for patients in need

Collaborated with team members on complex cases to ensure successful resolution of claims

Developed strong organizational skills to manage workloads efficiently and accurately

Utilized data entry skills to input information into various systems accurately and quickly

Conducted appeals process when appropriate as well as investigated any discrepancies found during the appeal process.

VENUE MANAGER, 12/2014 to 05/2021

Southern Stream Ranch LLC

Worked closely with event planners in organizing large scale events such as weddings or corporate functions

Maintained accurate records of financial transactions related to payments, deposits, budgets

Developed relationships with vendors to ensure successful delivery of services and products for each event

Created standard operating procedures for all departments to ensure consistent service quality across the venue

Negotiated contracts with vendors for food and beverage services as well as other supplies needed by the venue

Resolved conflicts between guests or staff members in an efficient yet professional manner

Conducted weekly inspections of the facility to ensure compliance with health codes and safety regulations

Ensured that all equipment was properly maintained and serviced regularly according to manufacturer guidelines

Monitored inventory levels of supplies used on a daily basis; placed orders when necessary

Collaborated with external partners such as caterers or decorators in order to provide additional services for clients

Planned and coordinated events, meetings, conferences and conventions from start to finish in a timely manner

Supervised a team of 15+ employees; provided training, guidance, feedback and disciplinary action when necessary

Prepared detailed reports regarding attendance numbers, income generated, which were presented at monthly board meetings

Provided excellent customer service by responding promptly to inquiries or complaints from guests and clients

Analyzed sales data on a regular basis to identify trends and develop strategies for increasing revenue

Managed daily operations of the venue including budgeting, scheduling staff, and ensuring customer satisfaction

Organized special activities such as live music performances or art exhibitions during peak season times

Implemented innovative marketing strategies to enhance brand awareness and attract new customers.

CASE MANAGER, 09/2015 to 04/2021

Humana

Implemented case management plans, provided assessments, and offered counseling and support

Demonstrated success in building relationships with clients and providing emotional support

Facilitated referrals to collaborative specialty health providers to drive continuity of care

Provided advocacy services on behalf of clients when necessary

Maintained accurate records of client progress and documentation of all contacts with clients

Prepared clients' discharge by reviewing and amplifying discharge plans and coordinating discharge and post- discharge requirements

Used adaptive communication style and practiced empathy to build trust and rapport with clients

Facilitated care and treatment via scheduling, information sharing and case coordination

Organized activities that promote healthy lifestyle choices among at-risk populations

Helped patients reach plan of care goals through case reviews

Coordinated meetings between clients, family members and other health care providers involved in the treatment process

Monitored and evaluated case management services to ensure quality and effectiveness

Participated in team meetings to discuss case management strategies for individual cases

Advocated for patients in healthcare or social service environments to promote wellness and autonomy

Communicated clients' progress by conducting weekly interdisciplinary meetings and evaluations

Facilitated referrals to community resources for support services including financial assistance programs

Maintained clients' records by reviewing case notes and logging events and progress

Collaborated closely with treatment teams to appropriately coordinate client care services

Educated clients on available community resources and how to access them effectively

Adhered to legal requirements regarding confidentiality of information related to clients' cases

Created individualized service plans in collaboration with clients, families, and other professionals

Provided ongoing evaluation of client progress towards goals established in service plans

Developed comprehensive assessment plans to evaluate client needs and develop appropriate interventions

Monitored client compliance with medication regimens prescribed by physicians

Met directly with patient to assess needs and develop individualized continuing care plan in collaboration with physician

Evaluated client eligibility for government benefits or entitlements such as Social Security Disability Insurance.

Achieved positive client outcomes by developing and implementing comprehensive case management plans.

Enhanced communication between clients and providers through consistent follow-ups and progress updates.

Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.

Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.

Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.

Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.

Improved client satisfaction by efficiently addressing concerns or grievances in a timely manner.

Strengthened relationships with community organizations to increase access to supportive resources for clients in need.

Provided crisis intervention support for clients experiencing emergencies, using appropriate techniques to de-escalate situations safely.

Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.

Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.

Streamlined service coordination efforts through diligent maintenance of client files and efficient use of case management software tools.

Assisted clients in setting achievable goals while providing ongoing encouragement and support throughout the process of reaching those objectives.

Advocated for client rights when interacting with external agencies or institutions, ensuring fair treatment at all times.

Contributed to team discussions and case conferences actively, sharing insights and expertise with colleagues to optimize client support strategies.

Developed and implemented comprehensive case management plans to address client needs and goals.

Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.

Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.

Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.

Liaised with social worker to expedite financial assistance not covered by insurance.

Referred clients to appropriate team members, community agencies and organizations to meet treatment needs.

Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks.

TRANSPORTATION MANAGER, 02/2003 to 02/2013

Affordable Transport Inc

Developed detailed plans for efficient transportation and delivery of goods to customers, ensuring timely arrival and minimal cost

Directed activities of staff performing repairs and maintenance to equipment, vehicles and facilities

Provided training on safe driving practices, route optimization techniques and other topics related to transport operations

Evaluated new technologies that could improve the efficiency of transport operations

Monitored fleet performance to ensure compliance with company standards and relevant laws and regulations

Communicated emergencies, delays due to weather and carrier schedule changes to customers and supervisors

Created reports summarizing transport metrics such as miles driven per day, week, month, average speed of vehicles

Implemented efficient routes and schedules for employees, promoting fuel consumption

Managed a team of drivers, dispatchers and other personnel involved in the transport process

Planned routes using GPS systems or road maps while taking into consideration traffic conditions or construction sites

Ensured all vehicles were properly maintained according to manufacturer specifications

Conducted training on safety procedures and regulations for transportation staff members

Forecasted manpower requirements based on daily workload and company targets

Built and maintained relationships with core transportation partners and brokers to provide on-time service

Analyzed transportation trends and data to identify areas for improvement in efficiency, safety and customer satisfaction

Resolved customer complaints regarding late deliveries or damaged goods promptly and professionally

Reviewed invoices from vendors for accuracy before processing payments

Supervised staff members during loading and unloading activities at dockside facilities

Analyzed expenditures and other financial information to develop transportation department plans, policies and budgets.

EDUCATION

COMPLETED COURSEWORK TOWARDS BACHELOR OF ARTS (B.A.), 01/2006

Southeastern University - Lakeland, FL

ASSOCIATE IN ARTS (A.A.), 05/2004

Polk State - Lakeland, FL

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ANGELA CROSLAND

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