Eleanor Richberg
Mt. Pleasant,SC
Summary
Seasoned Senior Case Manager with a proven track record at Absolute Total Care and Optum, adept at developing patient-centered care plans and reducing hospital readmissions. Expert in coordinating interdisciplinary teams and leveraging community resources, demonstrating compassionate patient advocacy and goal-driven independence. Skilled in crisis intervention and complex case management, enhancing patient outcomes and satisfaction.
Overview
18
18
years of professional experience
Work History
Senior Case Manager
Absolute Total Care
2016.08 - 2023.01
- Assessed member's current health status, resource utilization, past and present treatment plan and services, prognosis, short and long term goals, treatment and provider options either during home visits or telephonically.
- Developed well written member centered care plans based on assessments with specific objectives, goals, and interventions designed to meet member's needs and promote desired outcomes.
- Actively participated in care team rounds and coordinated all interdisciplinary team meetings for case managers.
- Collaborated with interdisciplinary team to determine timely delivery of services and appropriate discharge plans to decrease inpatient admissions.
- Teamed with managers and participated in committees to improve documentation, work flows, and policies to increase patient outcomes and meet regulatory requirements and best practices for case management.
- Coordinated services between Primary Care, specialists, medical providers and non medical staff as necessary to meet the complete medical socio economic needs of members.
- Coordinated and monitored referrals made to community based organizations, medical care, and other services to support members' overall care management plan.
- Managed high-risk cases effectively implementing crisis intervention techniques when necessary to ensure client safety.
- Served as a subject matter expert for questions from case managers, program coordinators, and Medicaid waiver program. Assisted in training of new case managers and provided leadership, guidance, and support to staff members.
- Coordinated transition from the state to health plan for Medicaid waiver program and reviewed/approved all requests.
Case Manager II
Absolute Total Care
2015.08 - 2016.08
Complex Case Manager
Optum
2005.06 - 2015.06
- Managed only complex cases and/or multiple chronic conditions, traumas, and life-limiting illnesses.
- Reduced hospital readmissions through proactive discharge planning and post-discharge follow-up with patients.
- Identified gaps in care or services initiating interventions to address needs proactively and provide savings for health plan.
- Increased patient satisfaction by providing compassionate support, ongoing education, and guidance regarding diagnosis, treatment plan, and second opinions.
- Participated on documentation committee to establish new documentation format with ongoing changes for improvement and continuity for case mangers.
- Coordinated services with financial agencies, community-based organizations, and healthcare professionals to provide useful and valuable benefits and resources to patients and families.
- Facilitated timely access to healthcare services for patients by navigating insurance coverage and advocating on their behalf. Coordinated authorizations with Blue Cross of South Carolina
- Served as a liaison between patients, families, healthcare providers, insurers.
- Primarily managed SC Blue Cross complex cases but also maintained requirements for multiple state licenses to manage complex cases for other health plans across the US with out of state travel proficiency.
- All enrollments completed with home/inpatient visits for comprehensive assessment and developing individualized care plans.
Education
Bachelor of Science - Nursing
Medical University of South Carolina
Charleston, SCSkills
Goal driven to multi-task and work independently remotely.
Compassionate and able to build trusting relationships with patients and families.
Advocate for patients and team building.
Community resources for education and financial needs.
Accomplishments
Certified Case Manager
Certification
Case management certification (CCM)
Timeline
Senior Case Manager
Absolute Total Care
2016.08 - 2023.01
Case Manager II
Absolute Total Care
2015.08 - 2016.08
Complex Case Manager
Optum
2005.06 - 2015.06
Bachelor of Science - Nursing
Medical University of South Carolina
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