Case Management Manager

Lisa Dixon

Beaumont, CA ***** *********@*****.*** +1-951-***-****

Professional Summary

•Certified Case Manager with over 25 years of Case Management experience and proven ability toprovide quality, evidence-based care management services.

•Telephonic RN Case Management

•Expertise in development of customized patient care plans for positive outcomes.

•Dedicated to in-depth patient and caregiver education for disease management and care coordination.

•Engaged in collaboration with multidisciplinary team for delivery of quality care services.

Work Experience

Manager, Case Management Dual Special Needs Plan MOC

Blueshield of California-Long Beach, CA

October 2024 to Present

•Led a team of 16 employees, providing guidance and support to ensure efficient operations

•Developed and implemented strategies to improve productivity and streamline processes

•Conducted performance evaluations for team members, identifying areas for improvement andimplementing training programs

•Oversaw the hiring process, conducting interviews and making hiring decisions based on qualificationsand fit with company culture

•Provided ongoing coaching and mentoring to team members, supporting their professionaldevelopment

Sr. RN Care Manager, Model of Care

Blue Shield of California Promise Health Plan-Long Beach, CA December 2021 to October 2024

Remote telephonic RN assessment and follow up reviews for Managed Care Plan members. Research EMR, Physician medical records, and Claims data, to design

Individualized Care Plans based on Health Risk Assessment questionnaire.

Participation in and documentation of Interdisciplinary team meetings. Transition of Care Discharge Follow up calls, weekly follow up calls, patient teaching and liaison between member and physicians when needed. Determines referral needs for

CCM, mental health and social services. Makes recommendations to physicians and consults with vendors, contractors, and community resources. Uses strong documentation skills- Care Connect and Case Trakker system. collaborates with colleagues as well as works independently to complete assignments and Special

Projects within CMS, NCQA, and plan regulations.

Home Health RN

Nuclear Care Partners-Scottsdale, AZ

July 2023 to July 2023

Part time weekends. Home visits for persons with illnesses directly related to nuclear radiation exposure with oversight by the Department of Labor. Security

Clearance. Physical assessments, Medication administration, Wound Vac, Colostomy care, Tube feeding, Patient and family education, Supervision of LVNs and HHA including family caregivers/HHAs hired by the company. Interdisciplinary Team meetings – remote. Documentation utilizing Quick-Base Electronic Medical Record.

Sr. RN Care Manager

Talent Software Services Inc, Blue Shield of California Promise Health Plan-Saint Paul, MN

September 2021 to December 2021

Remote telephonic RN assessment and follow up reviews for Managed Care Plan members. Research EMR, Physician medical records, and Claims data, to design

Individualized Care Plans based on Health Risk Assessment questionnaire.

Participation in and documentation of Interdisciplinary team meetings. Transition of Care Discharge Follow up calls, weekly follow up calls, patient teaching and liaison between member and physicians when needed. Determines referral needs for

CCM, mental health and social services. Makes recommendations to physicians and consults with vendors, contractors, and community resources. Uses strong documentation skills- Care Connect and Case Trakker system. collaborates with colleagues as well as works independently to complete assignments and Special

Projects within CMS, NCQA, and plan regulations.

RN Care Manager

Clearlink Partners-Charleston, SC August 2021 to December 2021

Temporary Evening consultation

Contract employee working for CareMore Health Plan. Remote Telephonic Care management. Updating Individualized Care Plan backlog for the Care Management department.

RN Care Manager Contractor

Analyst Consulting, Health Map Solutions-Duluth, GA

February 2021 to April 2021

Remote Telephonic Disease Management: Chronic Kidney Disease and End Stage Kidney Disease.

Disease management for Commercial members in Washington State with CKD stage 3 and

4, and End State Kidney Disease. Utilized Motivational Interviewing and Healthwise Educational mailings.

RN Care Manager Consultant

Toney Healthcare Consulting, LA CARE Health Plan-Houston, TX

December 2019 to February 2021

Remote Telephonic care management, Disease management, Quality Management for

Managed Medicare, and Managed Medi-Cal Members. Schedule Assessments and follow up calls, and facilitate Communication with Member, Physicians, Peers, Management. Home Office setting that is HIPPA compliant, has VPN secure connection, PC,

Tablet, Multiple Screens, Cisco Jabber Telephone System, Electronic Medical Record documentation, Outlook, Excel, Word, PowerPoint

· Management of 60-80 Complex and High-Risk Cases using the 9 components of the

Case Management Process: Screening, Assessing, Stratifying Risk, Planning,

Implementing, Resource Follow-Up, Transitioning, Monitoring Progress toward Goals,

Evaluating Effectiveness of the Plan

· Integrate Medical Records and Comprehensive Assessments including Social

Determinants of Health into Prioritized and Individualized Care Plans per Member

Preference and NCQA and Medicare Guidelines

· Reviewed Cases for quality based on CMS and NCQA measures.

RN Care Manager-Managed Care

Inland Empire Health Plan-Rancho Cucamonga, CA

May 2019 to November 2019

Telephonic case management and disease management for the Medi-Cal Direct health plan product.

Outreach and engagement to Medi-Cal members using Translation

Services when needed. Utilized PCs with Multiple Screens, Word, Outlook, Excel,

PowerPoint, Cisco Jabber Telephone System

· Managed a rotating caseload of 40 Medi-Cal Members with Medical and Behavioral

Health needs, opening and resolving cases according to NCQA, DMHC, and CM guidelines.

· Used Motivational Interviewing to encourage members to promote education and understanding of Physical and Mental Health, and to promote Self-management of

Chronic Conditions

· Provided Care Coordination Services: Community Resource Recommendations, plan

Benefit referrals, Transitions of Care management, and educate Member and Family on Service Utilization-the Right Level of Care at the Right Time

· Collaboration with Integrated Care Team including Members, Families, and other professionals.

ACO Registered Nurse Case Manager

NAMM Prime Care (Part of Optum Care)-Ontario, CA

August 2017 to March 2019

Telephonic case management and disease management for the Accountable Care

Organization contract of several Health Plans. Strong inbound and outbound telephonic skills, and electronic documentation. Skilled talking while documenting. Utilized PCs with multiple screens, Office Products.

· Identified High-risk members through the Health Plan Data Base, engaged them into the ACO program, and case management, disease management, and coordination of care. · Extensive use of the Nursing Process, and collaboration with the Health Plan Clinical Consultant, Medical Directors, Pharmacists, Social Workers, and Health Plan Case Managers.

· Instrumental in developing the ACO Department. Revised the correspondence that provides members vital information concerning the Case Management program and, additionally, revised the letter urging the members to maintain contact with the program. Developed Job aids, Process Walk Through documents, and educational materials for new Case Managers and Case Management Coordinators. Traveled to most contracted Independent Physician Associations and provided a Power Point presentation re-introducing the ACO Program to the Office Managers, Physicians, Clinical and office staff.

ACO Registered Nurse Case Manager

Prime Care (Part of Optum Care) (UHG), The Judge Group-Miami, FL

May 2017 to August 2017

Care coordination/Case Management and disease management of commercial members via telephone and mail. Helped to close Care Gaps and direct members to appropriate care sites. Provided disease education for members with chronic diseases. Utilized health plan databases and excel spreadsheets to export and filter members for engagement.

Registered Nurse Case Manager

Mission Hospice-Ontario, CA

May 2016 to May 2017

Directed team of licensed vocational nurses and certified home health aides through execution of day-to-day tasks using effective workload management strategies. Orchestrated hospice patient care in collaboration with multidisciplinary team implementing principles of case management. Organized training efforts for inexperienced case managers for consistent practices. Engaged in referrals for services, equipment, and medications in alignment with patient needs and supporting fiscal responsibility. Enforced regulatory compliance through care delivery for positive outcomes.

· Developed and implemented customized patient care plans in collaboration with the Interdisciplinary Care Team.

· Ensured compliance with execution of Care plan as designed by Staff Nurses and Hospice Aides.

· Delivered in-depth end of life education to patients and caregivers through home and facility visits.

· Executed recertification evaluations confirming compliant practices with local coverage determinations criteria for hospice care.

Case Manager, Medicare, and Medicaid

Molina Healthcare of Washington-Bothell, WA

March 2013 to February 2016

Telephonic complex case management and disease management focused on multiple chronic diseases including COPD, Diabetes, Heart Failure, CAD. Coordinated delivery of care services per individual criteria and preferences. Assisted with integration of healthcare services for behavioral health and long-term care.

Conducted case management activities through home visits and telephone appointments for WMIP program (Washington Medicaid Integration Program).

· Orchestrated multidisciplinary care in close collaboration with physicians and ancillary staff. Developed personalized care plan including patient and caregiver education, ongoing monitoring, and establishment of self-management goals.

· Delivered evidenced based care plans through in-depth assessment of patient needs and care barriers.

· Coordinated patient and caregiver education about chronic conditions and provided ongoing monitoring of care plan progress. Engaged in referrals to other care services as needed.

· Performed treatment pre-authorizations as well as concurrent reviews to determine services covered.

Case Manager/Minimum Data Set Coordinator

Kindred Hospital Subacute Unit-Seattle, WA

February 2012 to March 2013

Coordinated the performance of Resident Assessment Instrument (RAI) processes to determine specific patient needs and further develop customized care plans for submission to insurance providers. Developed plans for delivery of high quality and cost-effective services.

· Collaborated with the patient and caregivers to develop thorough care plans according to individual preferences and inclusive of disease process, management, and maintenance of stability.

· Delivered comprehensive discharge plans including appropriate follow up information for ongoing monitoring of disease progression.

Case Manager

Ballard Care and Rehabilitation Center-Seattle, WA

February 2011 to February 2012

Offered direction for thorough execution of RAI processes for the development of care plans. Delivered efficient case management and minimum data set services for various insurance providers from admissions through discharge.

· Orchestrated the delivery of high quality and cost-effective care services.

Coordinated care plans, assessments, education, and assisted with removing barriers to care access.

· Coordinated acquisition of durable medical equipment and professional care givers as needed.

Health Care Coordinator (Director of Nursing)

Sunrise of Snohomish, Assisted Living-Snohomish, WA

May 2009 to January 2010

Assumed nursing team leadership and mentoring for provision of best care practices for 80+ facility residents. Delivered in-depth training and development for nursing staff and medication technicians for consistent practices in medication assistance and administration.

· Harmonized training efforts for medication technicians ensuring compliance with organizational policies and regulatory standards of quality.

· Coordinated patient workload management per individual resident health and wellness needs. Managed custom care plans for 10+ patients diagnosed with dementia.

Education

Bachelor of Science in Nursing

Pacific Lutheran University-Parkland, WA January 1996 to December 1996

Associate of Applied Science in Nursing

Highline Community College-Des Moines, WA

January 1995 to December 1995

Nursing Licenses

RN

Skills

•Quality Management

•Microsoft Office Computer Skills

•Communication

•Integrated Complex Case Management

•Managed Care

•Case Management Process

•Medicare

•DC Planning/Transition Manager

•Motivational Interviewing

•Word Excel Power Point Teams

•Problem Solving

•Telephonic Disease Management

•Interdisciplinary Team Collaboration

•Remote Work, Time Management

•Telephonic Care Management

•Critical thinker, Initiative taker

•Treatment Planning

•Medicaid

•Nursing

•Case management

•Microsoft Office

•Leadership

•Management

•Supervising experience

•Communication skills

Certifications and Licenses

RN License

Certified Case Manager

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