Case Manager Behavioral Health
Resume:
Maria T. Zelko
Manchester, New Jersey 08759 USA
Phone: 732-***-****
*******@***.***
EMPLOYMENT HISTORY
Case Manager II
Encompass Health Toms River, NJ September 2023-- Present
Advocates for patients throughout the care continuum from pre-admission to post-discharge.
Oversees and coordinates care delivery, ensuring interdisciplinary collaboration and timely communication. Facilitates informed decision-making by explaining treatment options, risks, and benefits to patients and their families.
Coordinates team conferences to discuss and adjust care plans as needed.
Identifies potential risks related to patient care and discharge, taking proactive measures to mitigate them.
Manages discharge planning, addressing psychosocial and support needs effectively.
Performs utilization review to ensure cost-effective treatment while adhering to patient rights regulations.
Collaborates with interdisciplinary team to develop treatment plans based on patient preferences and needs.
Conducts early assessments to facilitate timely plan of care implementation.
Identifies and addresses barriers to discharge, establishing contingency plans for high-risk cases.
Ensures successful discharge by confirming plans and reviewing paperwork in advance.
Monitors and evaluates the quality, timeliness, and appropriateness of care and expectations.
Maintains up-to-date knowledge of regulations, policies, and operational procedures to optimize patient outcomes and department impact.
RN Case Manager
Deborah Heart and Lung Browns Mills, NJ May 2022– September 2023
Accountable for coordinating care across the continuum for an identified group of patients
Participate in the development of appropriate plans of care in conjunction with the physicians and other members of the health care team
Responsible for ensuring and facilitating the achievement of quality, clinical, and cost outcomes
Seeking approval for and arranging services and resources needed by the patient and family, intervening at key points for individual patients to meet defined patient outcomes
HIGH RISK CASE MANAGER
United Healthcare Remote December 2021– May 2022
Identify gaps or barriers in treatment plans
Provide Patient Education to assist with self-management
Interact with Medical Directors on challenging cases, including presenting at rounds
Coordinate care for medically complex members
Make referrals to outside sources
Coordinate services as needed, including Home Health, DME, etc.
Educate members on disease processes
Encourage members to adopt healthy lifestyle changes
Document and track findings
Case Manager
USAR Psychological Health Program Ft. Dix, NJ May 2019 – December 2021
Provides support, education, and assistance to Soldiers requiring connection to behavioral health care, employment, housing, finances and other identified needs.
Provide Case Management for Soldiers with behavioral health CCIRs (critical incident), and multiple other identified behavioral health issues. Offer assistance to inpatient facilities with discharge plan.
Outreach to Soldiers with behavioral health needs identified during the Periodic Health Assessment, including Post Deployment Health Assessments.
Communicate with and provide assistance to the Commands regarding the behavioral health status of Soldiers. Provide guidance regarding the procedure for Command Directed Behavioral Health Evaluations.
Attend in-person Yellow Ribbon Events, and Psychological Health Program presentations, in-person and virtually.
RN Care Coordinator
Integrity Health Long Branch, NJ November 2018 — May 2019
Coordination of care for identified high risk patients.
Meet with the medical director to review patient’s records and plan appropriate interventions to ensure best patient outcomes.
Discuss plan of care with patients, staff and all providers on patient’s care team.
Follow up with patients, providers and medical director.
Primary Nurse Case Manager
Horizon Blue Cross Blue Shield of New Jersey Wall, NJ October 2016 — June 2018
Coordinates delivery of high quality, cost-effective care for patients enrolled in case management program.
Monitors patient’s medical care activities, regardless of the site of service, and outcomes for appropriateness and effectiveness.
Communicates with patients, families and multidisciplinary teams, telephonically, striving for continuity and efficiency as the patient is managed along the continuum of care.
Refers patients to Registered Dietitian, Social Worker, and Behavioral Health as appropriate
Completes authorizations for inpatient and outpatient procedures, home health care and hospice. Serves as mentor/trainer to new RN’s as needed.
RN Case Manager
Lourdes Hospital of Southern New Jersey (LTACH) Willingboro, NJ January 2014 — October 2016
Utilization management from admission to discharge
Organization of, and participation in weekly multidisciplinary team meetings for all patients. Participation in daily rounds. Discharge planning for complex patients, including home care, IV therapy, enteral feedings, DME, home ventilators
Referrals to inpatient rehab as needed. Overseeing emergent transfers to higher level of care
Facilitating family meetings with multidisciplinary team. Providing education and emotional support to patients and families. Post discharge follow up.
RN Case Manager
Capital Health Systems Hopewell, New Jersey June 2009 — January 2014
Daily utilization review on various floors, utilizing Milliman Criteria.
Discharge planning from day of admission.
Ongoing communication with patients, families and multidisciplinary team, in order to provide quality care within appropriate length of stay.
Home Care Nurse
Robert Wood Johnson University Hospital New Brunswick, New Jersey May 2005 — December 2008
Obtained and documented patient medical history. Completed and documented initial physical assessment and follow up visits. Communicated with physicians, as needed, reporting abnormal findings. Educated patients and families on disease management. Reviewed and assessed medication compliance
Referred to community and support services as needed. Assisted agency liaison with screening patients in local rehab facilities
Oriented new RN’s.
Staff RN
Robert Wood Johnson University Hospital New Brunswick, New Jersey March 2004 — May 2005
Provided care to patients on ICU step down unit.
Communicated with multidisciplinary team to optimize successful patient outcomes.
Educated patients and families on disease processes, and management of care to obtain optimal health status post discharge.
Health Care Coordinator II
Sierra Military Health Services Fort Monmouth, NJ September 2000 — March 2004
Case management for US Military HMO (Tricare)
Promoted from Health Care Coordinator (HCC) I to HCC II, responsible for complex cases.
Utilization management, and prior authorization of admissions, procedures, and discharge needs.
Concurrent review, utilizing InterQual criteria.
Liaison between military members, dependents, and civilian health care providers.
Mentor for new nurses.
Charge RN
Pulmonary and Critical Care East Brunswick, NJ May 1997 — August 2000
Maintained orderly and efficient environment for busy critical care practice.
Telephone triage, patient assessment.
Pulmonary function testing, health teaching, emergency care.
Scheduling and obtaining preauthorization for outpatient procedures, DME and home care.
Staff RN (following post graduate internship) Hartwyck at Oaktree Edison, NJ
Patient assessment, treatment, medication administration, documentation, on a sub-acute head injury rehab.
Weekend charge nurse on LTC unit.
University of Medicine and Dentistry of New Jersey/Ramapo College
BSN,
Degree date: 2003
University of Medicine and Dentistry of NJ/Middlesex County College
ASN,
Degree date: 1996 Weekend charge nurse on LTC unit.
EDUCATION
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