Case Manager Utilization Management

Vanessa Daniel

972-***-**** **********@*****.***

Summary

Highly skilled and compassionate Case Manager with 10 years plus of experience in providing comprehensive care coordination and management services to individuals and families in need. Strong background in developing and implementing individualized care plans, collaborating with interdisciplinary teams, and advocating for clients. Excellent communication, problem-solving, and organizational skills, with a proven track record of achieving positive outcomes for clients. Seeking to leverage my expertise and passion for helping others in a challenging and rewarding Case Manager role.

Skills

Forecasting Employment Needs

Bargaining Agreements

Employee Development

Drafting and Administering Contracts

Health and Safety Programs

Performance Management Systems

Human Resources Allocation

Negotiation Tactics

Content Management Expertise

Friendly, Positive Attitude

Active Listening

Conflict Resolution

Preventive Healthcare

Patient Condition Monitoring

Procedure Room Preparation

Immunizations and Vaccinations

Nursing Consultation

New Hire Orientation

Customer Service

Regulatory Compliance

Staff Development and Training

Facilities Maintenance

Experience

1 STOP RECRUITING 02/2022 - 02/2023

Bryans House - 3610 Pipestone Rd, Dallas, United States Collaborated with recruitment and HR professional to achieve hiring goals. Assisted candidates with application processes by answering questions about application, performing background checks, providing I-9 forms and handling drug screening paperwork. Trained and mentored newer recruiters in successful strategies for interviewing and qualifying candidates. Executed strategies to achieve scalability and efficiency while meeting retail talent acquisition needs. Developed or implemented recruiting strategies to meet current or anticipated staffing needs. A-LINE STAFFING 01/2018 - 12/2021

Centene - St. Louis, Missouri., United States

Handled clerical functions such as answering telephone calls and retrieving files to keep office functioning properly. Assisted in new hire process by calling and scheduling appointments with candidates, filling out required paperwork and preparing manuals.

Coordinated and planned work shift schedules according to availability. Oversaw staffing and related operations, spanning interviewing, hiring and mentoring personnel. Worked with HR department to devise and update policies as needed for corporate accountability and workplace health.

SUPERVISOR 01/2018 - 12/2021

Cook Children's - Greenville Avenue Ste. 110 Allen, United States Hired and trained new employees, managing a staff of 18 nurses and social workers. Established and enforced clear goals to keep employees working collaboratively. Applied strong leadership talents and problem-solving skills to maintain team efficiency and organize workflows to meet any daily demand.

Prepared, calibrated and monitored production machinery to maintain optimal production levels and consistently achieve daily targets.

Analyzed company's expenditures and developed financial models. Monitored employee performance and provided coaching and constructive guidance to address areas of concern.

SENIOR UTILIZATION MANAGEMENT NURSE SUPERVISOR O 09/2014 - 12/2017 Health Smart - Irving, Texas, United States

Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.

Developed Behavioral Heath Utilization Management Request form for ease of requesting further coverage for inpatient, outpatient, and IOP services.

Develop and implement utilization management policies and procedures that ensure the efficient and effective delivery of healthcare services to patients.

Supervise a team of utilization management nurses and provide guidance and support to ensure adherence to company policies and procedures.

Monitor and evaluate the performance of the utilization management team and provide feedback and coaching to improve performance.

CLINICAL OPERATIONS UNIT MANAGER 10/2013 - 08/2014 BCBSTX - Fort Worth, Texas, United States

Encouraged high morale and staff retention through effective communication, prompt problem resolution, proactive supervisory practices and facilitation of proactive work environment. Managed clinical operations and procedures and enforced adherence to federal and state regulations and healthcare law requirements.

Educated patients and caregivers on diagnoses, treatment plans and wound or disease management. Assist in drafting procedure manuals, instating in- service programs Pro-actively addresses survey and/or standards of care issues.

Managed patient care and clinic services and handled financial management, quality assurance and safety and risk management.

Education and Training

Texas Christian University - 2800 S University Dr, Fort Worth Bachelor's Degree Nursing

William Woods University - 1 University Ave, Fulton Bachelor's Degree Sociology

Certifications

Certified Case Manager (CCM.) 00073027

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