Case Management Patient Care
Resume:
T R
Tiffany Risner
Professional Summary
Proven leader in building and leading high-performance case management teams, utilizing strategic planning and relationship-building to enhance care coordination. Demonstrated success in implementing effective solutions that improve patient care and operational efficiency. Adept at driving positive outcomes through a combination of strong leadership skills and a deep understanding of healthcare industry best practices. Work History
Aetna - Director of Case Management
Pace, FL
11/2023 - Current
Aetna - Senior Manager of Case Management
Findlay, OH
01/2022 - 11/2023
Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
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Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
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Created care plans that addressed clinical and financial challenges, family requirements and facilitated patient quality of life.
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Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
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Managed and monitored program activities and evaluated quality for improvement recommendations.
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Fostered professional networks and relationships with service and resource providers to promote continuity and quality of care for clients.
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Served as corporate resource for compliance and audits to facilitate legal process and appeals.
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Developed and administered budgets, authorized expenditures and monitored financial indicators to improve profitability.
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Reduced healthcare costs by streamlining case management protocols and maximizing resource utilization.
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Analyzed trends and data to inform decision-making and program development.
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● Provided strong leadership to enhance team productivity and morale. **************@*****.***
Pace, FL 32571
Bold Profile
Skills
● Clinical assessment
● Risk management
● Strategic planning
● Clinical quality incentives
● Readmission reduction
● Transitions of care
● Utilization management
● Budget management
● Quality management
● Quality improvement
● Care coordination
● Clinical assessment
Education
06/2021
Herzing University
Milwaukee, WI
Bachelor of Science: Nursing
Hardin Memorial Hospital - Administrative Nurse Manager- PRN Kenton, OH
10/2022 - 12/2022
Aetna - LTSS (Long Term Support Services) Manager
Findlay, OH
10/2018 - 01/2022
Led cross-functional teams to achieve project milestones and deliver high-quality results.
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Established strong relationships with clients and stakeholders, ensuring long-term partnerships and repeat business.
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Improved team performance by providing comprehensive training and fostering a collaborative work environment.
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Reduced costs, optimized resource allocation, and improved efficiency in managing projects.
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Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
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Implemented and developed operational standards, policies and procedures.
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Conducted performance evaluations, compensations and hiring to maintain appropriate staffing requirements.
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Utilized data-driven insights to make informed decisions that resulted in higher returns on investments.
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Spearheaded change management efforts for seamless adoption of new systems or processes among employees.
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Negotiated high-value contracts with new suppliers, securing better pricing and terms, which improved profit margins.
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Facilitated regular staff meetings to encourage open communication, maintain high morale, and address concerns promptly.
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Collaborated closely with executive leadership to develop long-term strategic goals for the nursing department''s continued success.
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Streamlined budget management, identifying cost-saving opportunities without compromising patient care quality or staff satisfaction.
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Implemented data-driven performance evaluation systems, promoting ongoing professional growth for nursing staff.
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Conducted regular performance evaluations for team members, identifying areas for improvement and providing constructive feedback.
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Managed vendor contracts, optimizing resource allocation and cost savings.
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Assisted with the recruitment process by interviewing potential candidates, evaluating skills fit for open positions within the Support Services department.
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Enhanced customer satisfaction by implementing efficient support services strategies.
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Analyzed and solved multi-faceted problems that effected executive leaders and business initiatives.
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Buckeye Health Plan - Supervisor of Case Management Findlay, OH
10/2013 - 10/2018
Built highly-efficient administrative team through ongoing coaching and professional development opportunities.
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Improved office operations by automating client correspondence, record tracking and data communications.
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Built and managed processes for tracking and monitoring department performance.
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Cultivated strong relationships with vendors and partners supporting administrative operations.
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● Negotiated and executed contracts on behalf of department. Developed internal requirements and standards to minimize regulatory risks and liability across programs.
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Optimized resource allocation by analyzing caseload data and adjusting staff assignments accordingly.
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Developed and maintained comprehensive policies and procedures for the case management department, ensuring consistency in practice across all team members.
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Created a supportive work environment that encouraged open communication among team members, fostering collaboration and continuous improvement efforts.
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Reduced backlog of pending cases by implementing efficient triage procedures and prioritizing high-need clients.
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Led a team of case managers to achieve higher success rates in client outcomes through regular training and performance evaluations.
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Structured standardized case management processes to comply with regulatory agency statutes and standards.
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