Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Crystal Durham

Kingman,AZ

Summary

Compassionate Case Manager with substantial background in social work and providing support to vulnerable populations. Skills include crisis management, care coordination, and advocacy for clients' rights and needs. Demonstrated ability to establish trust with clients while effectively managing high caseloads. Notable impact on improving client well-being through personalized care plans and resource allocation.

Overview

18
18
years of professional experience
1
1
Certification

Work History

Case Manager LTSS LTC

United Healthcare
Kingman, AZ
09.2016 - 06.2024
  • Managed an active caseload based on state mandated ratios according to residential setting, case intensity and acuity.
  • Partnered effectively with PCP, Specialists, Members, Family, and Care Teams to develop a Person Centered Care Plan that assessed short and long term member needs for supportive services that had member driven care objectives.
  • Utilized clinical knowledge and expertise to make strategies aimed at member education to support self-management with optimal health outcomes.
  • Responsible for coordinating service authorizations for meals, transportation, activities of daily living, nursing facilities, respite, medical alert systems, hospice and home health.
  • Provided education on treatment regimens, counseling and chronic illnesses.
  • Ensured comprehensive, assessments and Person Centered Service Plans were completed within required time frames.
  • Liaison and member advocate between member , family, PCP, facilities and agencies.
  • Maintained accurate reports and integrity of care management activities in ECMS with clinical guidelines.
  • Applied care management standards maintained HIPPA and confidentiality of PHI.
  • Ensured compliance with all state and federal regulations and guidelines with day to day activities.
  • Performed other duties and special projects as assigned.

Branch Manager

Accent Care at Home
Kingman, AZ
01.2006 - 09.2016
  • Responsible for providing overall strategic and operational leadership for the branch team.
  • Managed the overall operations of the branch team for the overall quality and depth of the care giver pool, meeting care partners, client and referral source satisfaction goals, adherence to company policy and procedure and compliance guidelines.
  • Successfully implemented business initiatives.
  • Oversaw the day to day activities of the assigned team staff, including recruiting, hiring, assessment activity, staffing, scheduling, risk management requirements, time keeping requirements and all compliance and human resource needs.
  • Ensured on-call oversight and support for clients and field staff needs.
  • Ensured all cross referral opportunities within the branch were identified and sourced appropriately.
  • First Aide, CPR, Direct Care Workforce and OSHA trainer.
  • Completed in home visit assessments to ensure appropriate services were in place to meet clients' needs and ensure care partners were meeting client needs as authorized by state and federal case management.

Education

Some College (No Degree) - Nursing

Mohave Community College
Kingman, AZ

Skills

  • Case Management
  • Regulatory Compliance
  • Discharge Planning
  • Family Education
  • Care Coordination
  • Patient support
  • Health History Documentation
  • Community Outreach
  • Records Management
  • Needs Assessment
  • Client Advocacy
  • Referral Coordination
  • Social Work
  • Case Needs Assessment
  • Problem-Solving
  • Patient Assessments
  • Home Visits and Inspections
  • Crisis Intervention
  • Court Mandated Reporter
  • Annual Case Reviews
  • Case Management Tracking
  • Patient Management
  • Utilization Management
  • Community Resources
  • Documentation proficiency
  • Relationship Building
  • Positive Attitude
  • Data Entry and Analysis
  • Organization and Multitasking
  • Email and Telephone Etiquette
  • Conflict Resolution
  • Documentation And Reporting
  • Written Communication
  • Active Listening
  • Adaptability and Flexibility
  • Problem-solving abilities
  • Goal Setting
  • Self Motivation
  • Interpersonal Communication
  • Analytical Thinking
  • Attention to Detail
  • Time management abilities
  • Professionalism

Certification

  • Health Equity University supporter and champion
  • Documentation/Charts assisted with receiving NCQA Health Plan Accreditation.
  • Documentation/Charts assisted with receiving NCQA LTSS Distinction.

Timeline

Case Manager LTSS LTC

United Healthcare
09.2016 - 06.2024

Branch Manager

Accent Care at Home
01.2006 - 09.2016

Some College (No Degree) - Nursing

Mohave Community College

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Crystal Durham