Senior Case Management Leader with 10+ Years Experience
Resume:
DENISE PATTON RN, BSN
MARICOPA, AZ *****
760-***-**** -************@*****.***
PROFESSIONAL SUMMARY
SKILLS
WORK HISTORY
Case Management Supervisor with 10 years of functional case management leadership experience. Extensive Case Management team experience. Enacts strong and collaborative approach across care continuum and manages workflow to support dynamic teams. Spearheads operational effectiveness and efficiencies to develop quality improvement activities and achieve financial goals.
• Demonstrated leadership skills • Case Management, admission through
• Strong verbal, written and presentation discharge skills • Medical Records Management
• Interdisciplinary collaboration • Interviewing skills
• Staff education and training • Written and verbal communication
• Staff Management
12/2023to 01/2025 Senior Care Manager
Centene Corporation-Healthnet Federal Services
• Provide Case Management services to active-duty family members and retired beneficiaries and their family members
• Provide education on the Tricare benefit
• Coordinate medical care and assist with accessing primary care and specialty providers
• Assisted Utilization Management with authorizations 07/2023 to 12//2023 Case Manager II
HealthCare Support- Contract Position with HealthNet Federal Services
• Provide Case Management services to active-duty family members and retired beneficiaries and their family members
• Provide education on the Tricare benefit
• Coordinate medical care and assist with accessing primary care and specialty providers
• Coordinate care between the provider and the beneficiary 07/2015 to 09/2022 Case Management Supervisor
Sharp Healthcare - San Diego, CA
• Worked for Sharp Community Medical Group (IPA) under Sharp Healthcare umbreJla.
• Managed Ambulatory Case Management Teams for Post Discharge, Disease Management, Triage and Care Coordinators.
• Supervised 18 licensed and on-licensed direct reports.
• Actively participated in new hire interviews and hiring process.
• Collaborated with HMO, ACO and Special Need Health Plans contracted with SCMG to identify high risk members.
• Managed and assisted staff to resolve identified attendance, perfonnance, learning and behavior issues through feedback, counseling, corrective action and goal-setting.
• Monitored daily productivity goals with 1-1 feedback.
• Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
• Reviewed and developed intake and discharge planning strategies to encourage client engagement and retention.
• Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
• Managed and monitored program activities and evaluated quality for improvement recommendations.
• Leveraged case management tools and conflict management techniques to
help interdisciplinary teams achieve optimal outcomes.
• Collaborated with interdisciplinary team to determine timely delivery of
services.
08/2013
to
07/2015
RN
Case
Manager-Post
Discharge
Call
Program
Sharp
Healthcare
-
San Diego, CA
• Conducted telephonic outreach to members post hospitalization and skilled nursing facility stay within
1-3
days
of
discharge.
• Evaluated healthcare needs, goals for treatment, and available resources of
each patient and connected to optimal providers and care.
• Advocated for patients by communicating care preferences to
practitioners,
verifying interventions met treatment goals and identifying insurance coverage limitations.
• Participated
in
patient and family planning process, as well
as
provided
instructions and addressed question and concerns.
• Conducted regular re-evaluations to address changes in needs and conditions, introducing revisions to care plans.
• Assessed and examined patients and documented history of
current and
previous conditions, diseases and injuries along with medications currently being taken.
• Examined patients and documented history
of
current and previous
conditions, illnesses, injuries and current medications.
• Coordinated with interdisciplinary professionals to develop plans of
care,
administer tests and monitor patient status.
• Liaised with physicians regarding patient needs, performance and changes.
• Effectively communicated with physicians regarding patient needs, performance, medications and changes.
04/2010 to 02/2013 Manager/Clinical Liaison RN-TRICARE Service Center TriWest
Healthcare
Alliance
-
San Diego, CA
• Supervised daily operations ofTRICARE Service Center at
Naval Training
Center.
• Liaison between military treatment facilities and TriWest, which administered TRJCARE benefit.
• Educated staff on updates, policy revisions and performance outcomes.
• Collaborated with physicians and Military Utilization Management Team.
• Educated active-duty military and their beneficiaries on TRICARE benefit. 04/2009 to 04/2010 C11se M11n11gement Supervisor
02/2006 to 04/2009
TriWest He11lthc11re Alliance - San Diego, CA
• Supervised daily operations of Case Management Program.
• Monitored individual case manager case load to ensure delivery of care, productivity and timeliness.
• Educated staff on updates, policy revisions and performance outcomes.
• Structured standardized case management processes to comply with regulatory agency statutes and standards.
• Collaborated with multidisciplinary teams to facilitate client care and reduce case management barriers.
• Managed and monitored program activities and evaluated quality for improvement recommendations.
• Trained and guided team members to maintain high productivity and performance metrics.
• Observed each employee's individual strengths and initiated mentoring program to improve areas of weakness.
Medical Case Manager
TriWest Healthcare Alliance-San Diego, CA
• Explained medical care options to assist retired and active-duty beneficiary families make informed healthcare decisions telephonically.
• Updated treatment plans on monthly basis with latest intervention strategies and progress notes.
• Formulated treatment plan strategies with multidisciplinary teams to provide comprehensive and continuous care plan.
• 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.
• Consulted with clinicians to devise and manage ongoing care plans for at-risk patients.
• Documented case notes daily and coordinated follow-up for seamless case management.
• Worked with medical teams, patients and families to implement effective treatment plans.
• Conducted first level reviews utilizing CDST and InterQual Criteria. 02/2004 to 01/2006 Utilization Review Specialist
Rehab West - Escondido, CA
• Conducted prospective, retrospective and concurrent file review for worker's compensation using ACOEM guidelines.
• Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
01/1981 to 07/2003 RN Patient Flow Coordinator
St. Luke's University
Hospital
-
Bethlehem,
PA
• Facilitate
timely
patient
care
in
Emergency
Department
•
Manage
daily operations
within
budgeted
parameters
• Conduct customer service activities
•
Resolve
patient complaints
• Clinical resource
to
staff
• Participate
in
unit based
and
hospital
committees
07
/
1989
to
01/1991
Registered
Nurse,
Emergency
Department
EDUCATION
LICENSES
St.
Luke's
University
Hospital - Bethlehem,
PA
• Collaborated with physicians
to
quickly
assess
patients
and
deliver
appropriate treatment while
managing
rapidly changing conditions.
• Provided direct patient care, stabilized patients, and determined next course of
action.
• Implemented medication
and
IV
administration, catheter insertion,
and
airway
management.
• Managed care
from
admission to patient disposition.
Bachelor of
Science:
Nursing
Kutztown
University
of
Pennsylvania -
Kutztown,
PA
Associate of
Arts:
Commercial
Art
Northampton
Community
College
-
Bethlehem,
PA
Registered Nurse
in
the State
of
California,
632698
and
Arizona,
278592
CERTIFICATIONS
Certified Case Manager (CCM) #00104230
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