Search Resume Examples

St Joseph Medical Center And Heights - Imterim Director Case Managemaent Resume Example

Nsriea Ldwaet
XXXX XXXX XXXX, HOUSTON, TX 77038
XXXX XXXX XXXX, 77038, HOUSTON TX
XXX XXX XXXX
XXXXXXXXXXXXXXXX
Professional Summary


Seasoned Certified Case Manager with more than 18 years of experience in fast-paced Health Care Industry. Currently working as  Manager with Star Kids Program/Managed Care Organization for Medicaid population members. Assist with Care Coordination and Personal Center Care for the members we serve in our health plan.
Past experience as,  Interim Director Case Management position with Excellent Medical Coding and Disease Management skills. Track record of achieving exceptional results in seeking maximum reimbursement services rendered to patient and extensive knowledge in Critical Thinking skills to transition patients lower level continuum care as needed.

Skills
  • Complex Problem Solving
  • Operations Analysis and Monitoring
  • Administration and Management
  • Care Coordination Management
  • Critical Thinking
  • Systems Evaluation
Experience
Manager/ Care Management Health Plan Jul 2016Current Texas Children Health Plan Houston, TX
  • Perform payroll functions, such as maintaining timekeeping information and processing and submitting payroll.
  • Direct and Managed team of 13 employees on staff( Register Nurses and Master Social Workers)
  • Manage assigned territory of  1400-1500 members monthly
  • Routine decision include evaluating department process and initiating ,directing and completing quality improvement efforts to improve and facilitate interdepartmental efficiency
  • Coordinate case conference meeting and discussing patient clinical status to prevent hospital readmission
  • Audits and monitoring for performance improvement opportunities
  • Resolve conflict with staff, patient and families
  • Knowledgeable of contracts  and or agreements with suppliers,  federal or state agencies, or other organizational entities.
  • Coordinate the development of budgetary control systems to increase productivity
  • Explain policies, rules, regulations, or laws to Parent Engagement Meeting Committee meetings and individuals.
  • Initiate Disciplinary Action Process for poor performance
Team Leader/Case Manager/Interim Director Case Management Dec 2013Jul 2016 ST JOSEPH HOSPITAL IN HEIGHTS/DOWN TOWN MEDICAL CENTER HOUSTON, TX
  • Appeal  insurance denial timely manner, to recuperate reimbursement services provided.
  •  Provide assistants with (CMOR) Clinical Monthly Operation Report ,operating budgets, budget reports, and pertinent financial reports.
  • Incorporated market analysis of industry status to capitalize on  improved observation status criteria and analyzed procedures, resulting in decreased avoidable days hospital(from 2-10 days by using Interqual software) .
  • Increased St Joseph Hospital Heights revenue by 10-15% within 9 months by coordinating with Physician and  HIM coding specialist medically necessary procedure that improved quality care of patients and maximized reimbursment .
  • Assist performance metrics to assess efficiency of care and pinpoint agency weakness by decreasing MCR ALOS vs GMLOS variance from 1.09 to -0.45( from Oct /2014 to June/2015)
  • Perform payroll functions, such as maintaining timekeeping information and processing and submitting payroll.
  • Coordinate and organize Utilization Review Committee and make recommendation opportunities improvement
  • Supervise clinical and clerical staff. Provide training and orientation to new hired staff.
  • Complete CMOR Report (Clinical Monthly Operating Report for department) and implement action plan if  standard goal are not met. Daily coordinate and run IDT (Interdisciplinary Care Team) meeting and discussing patient clinical status and anticipated discharge plan needs to lower level care
  • Participate Documentation Improvement Program with Medical Record department to increase maximum reimbursement opportunities
  • Participate Payer JOC (Joint Operation Committee) monthly regarding manage care contracts issues/ concerns and opportunity improvement Case Management department audits and monitoring for performance improvement opportunities
  • Resolve conflict  with staff, patient and families daily
  • Negotiate  contracts or agreements with suppliers,  federal or state agencies, or other organizational entities to transition patient to lower level care safely
  • Coordinate the development or implementation of budgetary control systems to increase employee productivity
  • Explain policies, rules, regulations, or laws to  monthly Committee meetings and individuals as needed
ASSISTANT DIRECTOR NURSING Dec 2012Nov 2013 TEXAS SPECIALTY HOSPITAL HOUSTON, TX
  • Reduced company expenses by 20% through no agency staffing used in  hospital.  Encourage PRN and full time staff pickup extra shifts
  • Improved resource allocation resulting in the reduction of expenses in  decreasing NHPPD(Nursing Hour Per Patient Day)  hours by taking patient assignment and performing administrative duties simultaneously (from 10.11 to 9.08) .
  • Analyzed and improved random chart audits and procedures, resulting in improved quality care delivered to patient.
  • Scrutinized contract performance budgets, forecasts, and bids, which led to decreased staffing agency use hospital wide(saved company $5-10,000 per month)
  • Employed cross-functional expertise in the collaboration with Nursing and Case Management department to achieve increase census and maximize continued stay criteria.
  • Interviewed, hired, and developed 5 new staff members for Nursing department, within six months.
CASE MANAGER/UTILIZATION MANAGEMENT,HOUSE SUPERVISIOR,LAISION,INFECTION CONTROL NURSE Mar 2004Dec 2012 TRIUMPH NORTH WEST( now KINDRED SPRING) HOUSTON, TX

Case Manager/Utilization Management:

  • Presented utilization of Intensive Care Unit to Quality Improvement Council(QI) to document criteria for admission, resulting in successfully developing Intermediate Unit(IMU).
  • Verified financial benefit to Chief Financial Officer(CFO) for procedure and test rational patient care. Implemented process increase profit from $20-100,000 on some cases.
  • Assistant /Arrange coordination vendor education monthly to family/patients disease management
  • Coordinated weekly Interdisciplinary Care Conference and provided reports meeting
  • Participated weekly meeting with Wound Care Medical Director coordinating maximized DRG reimbursement and criteria continued stay.
  • Collaborated  daily and weekly with Coders to seek maximum reimbursement DRG ,Present On Admission (POA) diagnosis and identify comorbidity(CC/MCC)
  • Negotiated contracts with commercial insurance length stay admission
  • Appeal insurance denial and obtained 90-95% reimbursement cost

House Supervisor:

  • Improved team morale and reduced staff turnover by enhancing communication methods and establishing

   solution-oriented approach to dispute management.

  • Analyzed complaints and incident reports and recommended appropriate resolutions to involved parties.
  • Managed recruitment, hiring, training, and mentoring of 5-10 new employees annually, providing on-the-job coaching to support new hires.
  • Verified accurate completion of all patient admission and discharge paperwork, ensuring thorough description of care provided and subsequent patient responses.
  • Ensured swift response to Code Red pages,  monitoring patient condition and assigning appropriate staff.
  • Evaluate daily census; clinical staffing assignment ratio; discharges; aadmission and  constantly monitoring NHPPD(nursing hours per patient day) .

Liaison:

  • Served as public face of organization, communicating agency services to target population and maintaining positive community representation.
  • Participated community health fair and promoted hospital referral awareness  open 24/7

Infection Control:

  • Advised clinical team on patient relations, sanitation standards, and safety practices to ensure consistent delivery of quality care.
  • Measured (VAP,BSI,CAUTI,NOS Infection) success through the development of metrics reports that identified opportunity quality improvement.
  • Organized staff education and documented trends post education to verify quality improvement
Education
CERTIFIED CASEMANAGER : CASE MANAGER Jan 2013 CMSA HOUSTON, TX
MBA : Business Dec 2011 Texas Women University Houston, Tx
Bachelor of Science : Nursing May 1998 Prairie View A&M University Houston, Tx
Associate of Science : Nursing May 1995 Galveston College Galveston, Tx
Love this resume?

Resume Details

This is a real resume for a Imterim Director Case Managemaent in HOUSTON, Texas with experience working for such companies as Texas Children Health Plan, St Joseph Hospital In Heightsdown Town Medical Center, Texas Specialty Hospital. This is one of the hundreds of Imterim Director Case Managemaent resumes available on our site for free. Use these resumes as templates to get help creating the best Imterim Director Case Managemaent resume.

Previous Companies:

  • Texas Children Health Plan
  • ST JOSEPH HOSPITAL IN HEIGHTSDOWN TOWN MEDICAL CENTER
  • TEXAS SPECIALTY HOSPITAL

Previous Job Positions:

  • Manager
  • Team Leader
  • Case Manager

Schools:

  • CMSA
  • Texas Women University
  • Prairie View A&M University
  • Galveston College

Level of Education:

  • CERTIFIED CASEMANAGER
  • MBA
  • Bachelor of Science
  • Associate of Science

The Easiest Way to Create a Professional Resume.

Create a job-winning resume in minutes.

create your resume

Similar Resumes

View More

Shift Manager

little rock, Arkansas

Companies Worked For:

UAMS University of Arkansas for Medical Sciences,...

Assistant Manager

Branchland, West Virginia

Companies Worked For:

West Hamlin Foodfair, Hudson Iga, Branchland Iga

Service Manager

Aurora, Colorado

Companies Worked For:

Audio Video Colorado dba AV Colorado, Knoise Knat...

Team Leader

Rochester, New York

Companies Worked For:

Career Start, United States Army Reserves, United...

Warehouse Team Leade...

Miami Gardens, Florida

Companies Worked For:

Plated, Permoda LTDA, Nestle

Store Team Leader

Mountain House, California

Companies Worked For:

Target Stores, Aspen Dental, Goodwill Industries,...

Case Manager

Murfreesboro, Tennessee

Companies Worked For:

AIG, Lexus of Cool Springs

Case Manager

Tekonsha, Michigan

Companies Worked For:

Summit Pointe Community Mental Health for Calhoun...

Get Started on Your Job-winning Resume Today!

Get all the help you need to create a professional resume in minutes. Includes thousands of pre-written examples for hundreds of jobs.

create your resume
Get Started on Your Job-winning Resume Today!