Experienced Case Manager and Care Coordinator

Tyisha Thompson

**********@******.*** 205-***-**** Birmingham, AL

SUMMARY

Results-driven Case Manager / Care Coordinator with over 10 years of experience supporting diverse patient populations in medical, behavioral health, or social services settings. Skilled in care coordination, utilization review, discharge planning, and interdisciplinary collaboration. Strong background in remote case management, documentation, compliance, and patient-centered care. Adept at managing high caseloads while ensuring quality outcomes, regulatory adherence, and member satisfaction. WORK EXPERIENCE

Social Security Administration Remote

Social Claims Case Manager Aug 2021 - Present

• Provided telephonic and virtual case management support to ensure continuity of care

• Monitored progress toward care goals and referred members to plans as needed to improve health outcomes

• Ensured compliance with HIPAA, CMS, Medicaid, and organizational policies

• Maintained accurate, timely documentation in EHR and case management systems

• Advocated for members to improve access to care, reduce hospitalizations, and prevent readmission Post Entitlement Technical Expert Jul 2018 - Aug 2021

• Managed 40-60 daily inbound calls concerning eligibility and payments, achieving a call quality score exceeding 94%.

• Collaborated with internal departments to expedite claim investigations, enhancing the timeliness and accuracy of updates provided to members.

• Managed a caseload of 100+ members a month, providing comprehensive care coordination for medical, behavioral health, and social service needs

Legal Adminstration Benefit Specialist Jul 2014 - Jul 2018

• Managed Tier I and Tier II escalations in a high-volume call center, ensuring prompt resolution of complaints and inquiries within service level agreements and compliance guidelines.

• Collaborated with internal departments to resolve complex healthcare and insurance issues, enhancing communication and coordination.

• Led the implementation of a new LMS training, increasing training completion rates by 30%.

• Provided care coordination and case management support for patients across the continuum of care

• Collaborated with physicians, nurses, social workers, and community agencies EDUCATION

Strayer University

Master of Science, Management

Birmingham, AL

Dec 2014

SKILLS

Problem-Solving • Time Management • Team Collaboration • Salesforce • Zoom • Multitasking • Attention to Detail • Effective Communication • Healthcare Eligibility • CMS&Medicaid Guidelines • Patient Advocacy • Case Management • HIPPA Compliance • Social Determinants of Health (SDOH) • Medical Necessity Review • Utilization Management • EHR • Care Coordination • Care Plans &Treatment Planning CUSTOM SECTION

Key Achievements, Social Security Administration Jan 2024 - Jan 2026

• Reduced hospital readmissions by 25% through proactive follow-up and care coordination

• Improved member engagement or satisfaction scores by 37%

• Successfully managed high-volume caseload while meeting productivity and quality metrics

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