
Healthcare professional with focus on case management and patient care coordination. Adept at developing and implementing comprehensive care plans tailored to individual patient needs. Recognized for strong team collaboration and adaptability in dynamic healthcare environments.
Experienced with patient assessment, care coordination, and case management. Utilizes clinical knowledge to develop and implement effective care plans. Track record of enhancing patient outcomes through meticulous care planning and follow-up.
• Developed and implemented strategies to improve HEDIS scores, resulting in a XX% increase in overall performance.
• Collaborated with interdisciplinary teams including physicians, nurses, pharmacists, and case managers to coordinate care plans aligned with HEDIS measures.
• Ensured compliance with regulatory standards by conducting regular internal audits of clinical processes related to HEDIS measures.
Collaborated with physicians, pharmacists, and other healthcare professionals to develop comprehensive treatment plans for patients •
Monitored patient outcomes and made necessary adjustments to care plans in order to achieve desired results
• Verifying that physician orders for all disciplines are complete, accurate and cover the care and visits provided.
• Verified patient eligibility and benefits package information via phone or online services.
• Obtained insurance information necessary for various clinical services. • Obtained needed information from PCP and HMO payers' to initiate manage care authorizations allowing no more than 48 hours for completion.
• Worked closely with clinic managers and/or designated person regarding issues with scheduling or insurance.
• Obtain the initial prior authorizations/pre-certifications as required by patients' insurance/plan
Evaluated patient care needs, prioritized treatment, and maintained patient flow. Accurately documented all elements of nursing assessment, treatments, medications, discharge instructions, and follow-up care.
• Verifying that physician orders for all disciplines are complete, accurate and cover the care and visits provided.
• Verified patient eligibility and benefits package information via phone or online services.
• Obtained insurance information necessary for various clinical services. • Obtained needed information from PCP and HMO payers' to initiate manage care authorizations allowing no more than 48 hours for completion.
• Worked closely with clinic managers and/or designated person regarding issues with scheduling or insurance.
• Obtain the initial prior authorizations/pre-certifications as required by patients' insurance/plan.
• Verifying that physician orders for all disciplines are complete, accurate and cover the care and visits provided.
• Verified patient eligibility and benefits package information via phone or online services.
• Obtained insurance information necessary for various clinical services.
• Obtained needed information from PCP and HMO payers' to initiate manage care authorizations allowing no more than 48 hours for completion.
• Worked closely with clinic managers and/or designated person regarding issues with scheduling or insurance. • Obtain the initial prior authorizations/pre-certifications as required by patients' insurance/plan,