MARY CONYERS-TAYLOR
Baltimore,MD
Summary
CAREER OBJECTIVE: Reliable Case Management Supervisor balancing clinical and financial interests with community member needs. Identifies treatment plans that serve family needs and strive towards creating higher qualities of life. Trains subordinate managers to be effective team leaders. Identifies effective, qualified candidates for promotion.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Case Management Supervisor
Centene
New York, NY
07.2020 - 09.2023
- Responsible for performing care management within the scope of licensure for members with complex and chronic care needs by assessing, developing, implementing, coordinating monitoring, and evaluating care plans designed to optimize member health care across the care continuum
- Performs duties telephonically or on-site such as at hospitals for discharge planning
- Primary duties may include, but are not limited to:
- Ensures member access to services appropriate to their health needs
- Conducts assessments to identify individual needs and a specific care management plan to address objectives and goals as identified during assessment
- Implements care plan by facilitating authorizations/referrals as appropriate within benefits structure or through extra-contractual arrangements
- Coordinates internal and external resources to meet identified needs
- Monitors and evaluates effectiveness of the care management plan and modifies as necessary
- Interfaces with Medical Directors and Physician Advisors on the development of care management treatment plans
- Negotiates rates of reimbursement, as applicable
- Assists in problem solving with providers, claims or service issues
- Provided leadership during emergency situations ensuring high standards of patient safety are met.
- Resolved conflicts between staff members in a timely manner while maintaining morale.
- Created individualized patient plans based on assessment findings.
- Conducted regular performance reviews to ensure quality patient care.
- Provided guidance and direction to subordinates regarding job duties and responsibilities.
- Directed and supervised team of 15 employees in daily operations.
- Resolved customer complaints in a timely manner while ensuring customer satisfaction.
- Maintained accurate records of employee performance, attendance, leave requests, and disciplinary actions.
- Coordinated employee schedules according to shift changes and availability.
- Maintained operating schedules to provide effective coverage for key areas and achieve objectives.
- Recruited, hired, trained, mentored, coached, evaluated, and terminated staff as necessary.
- Collaborated with other departments to coordinate workflow processes between teams.
- Evaluated employee performance through periodic reviews and documented results accordingly.
- Conducted weekly meetings with team members to discuss upcoming tasks and project deadlines.
- Demonstrated expertise in creating accountable teams which closely followed corporate healthcare strategies.
- Streamlined discharge planning to create efficient, patient-oriented care strategies.
- Collaborated with multidisciplinary team to establish record of comprehensive patient care plans.
- Planned and directed nursing services in high-specialized patient care areas in accordance with state and federal guidelines.
- Managed the daily operations of the case management department including developing policies and procedures.
- Provided leadership, guidance, and supervision for a team of caseworkers responsible for managing complex cases.
- Defined and applied utilization review methods to guarantee conformance with medical coverage plans.
RN Case Manager Occupational Health /Telephone Triage Nurse
Corvel
Duluth, GA
01.2013 - 04.2020
- Managed Accounts: National accounts including multiple airline carriers and Fortune 100 employer Groups, Responsible for providing telephonic and onsite case management for a variety of insurance carriers
- Demonstrated compliance with facility-wide Utilization Management policies and procedure, specific to the responsibilities held by the Case Management Department
- Reviewed inpatient admission with the use of InterQual and Milliman Care criteria
- Assured department is identifying and negotiating the fullest possible reimbursement to maximize insurance benefit coverage for the patient
- Collaborated with other health care givers in reviewing actual and proposed medical care and services against established CMS Coverage Guidelines review criteria
- Manage network participation, care with specialty networks, coordinate with DME providers, and transfers to alternative levels of care using knowledge of benefit plan design
- Identify potentially unnecessary services and care delivery settings and recommend alternatives if appropriate by analyzing clinical protocols
- Facilitate peer-to-peer process, interaction with payor, and external physician advisors
- Travel onsite to hospitals to complete utilization review and discharge planning in collaboration with hospital Utilization review and Case Management departments
- Provided case management services including intake, assessment, crisis intervention, advocacy, referral and monitoring of families.
- Monitored client progress through regular follow-up contacts.
- Maintained accurate case records and documentation according to agency guidelines.
- Assessed clients' needs, developed service plans and monitored progress towards goals.
- Counseled clients on available resources within the community that could help meet their needs.
- Compiled reports on cases and submitted them to supervisors as required.
- Participated in interdisciplinary team meetings to discuss treatment options.
- Assisted with applications for government benefits such as Medicaid or Social Security Disability Insurance.
- Collaborated with healthcare team to improve care quality, reduce costs and gauge patient progress.
- Collaborated with healthcare providers, lawyers, employers and other stakeholders involved in a client's case.
- Assisted in the coordination of services needed after hospitalization such as home health care, durable medical equipment, transportation.
- Participated in multidisciplinary team meetings when determining appropriate levels of care prior to discharge.
- Conducted assessments to assess patient's level of functioning and identify appropriate resources upon discharge.
- Maintained timely communication with physicians regarding patient's progress during the course of treatment prior to discharge.
- Created a safe environment for discharged patients by providing information about safety precautions at home and in the community.
- Assessed patient's physical, mental, and psychosocial health status to develop individualized care plans.
- Provided emotional support and counseling to patients dealing with chronic illness or end-of-life issues.
- Facilitated transitions between levels of care through effective coordination of resources within a managed care environment.
- Identified high-risk cases requiring intensive monitoring or specialized interventions.
- Reviewed clinical data including lab results, radiology reports and vital signs to assess appropriateness of treatments.
- Monitored and evaluated effectiveness of treatment plans and interventions.
Medical Case Manager SR /Occupational Health
Georgia Power/Southern Company
Atlanta, GA
09.2010 - 01.2013
- Responsible for providing telephonic and onsite medical and disability case management to employees to implement an expedited return to work for employees out of work related to FMLA, STD, LTD or other medical disability
- Worked independently in a home office environment
- Travel onsite to hospitals to complete utilization review and discharge planning for catastrophic cases
- Evaluates and authorizes the medical necessity of inpatient and outpatient services as assigned by application of approved criteria and established policies and guidelines
- Actively participates in identification of opportunities for improvement and assists with action plan development and problem resolution
- Administered immunizations, first aide
Education
Associate of Science - Registered Nursing
Union Memorial School of Nursing
Baltimore, MD05.1988
Bachelor of Science - Nursing
Notre Dame University of Maryland
Baltimore, MDSkills
- Catastrophic Case management (10 Years)
- Trauma and ICU nursing experience (3 Years)
- Volunteer for multiple charitable organizations (10 Years)
- Utilization Review (10 years)
- Team Management
- Client Advocacy
- Records Management
- Regulatory Compliance
- Care Coordination
- Performance Tracking
- Referral Coordination
- Chronic Disease Management
- Case Management
- Documentation Proficiency
- Quality Assurance Controls
- Utilization Management
- Discharge Planning
- Insurance Knowledge
- Quality Improvement
- Needs Assessment
Certification
- Registered Nurse /Certification GA#118060
- Certified Nurse Case Manager # 41752
- Compact RN Licensure #118060
- BLS Certified/ ALS Certified
References
References available upon request
Timeline
Case Management Supervisor
Centene
07.2020 - 09.2023
RN Case Manager Occupational Health /Telephone Triage Nurse
Corvel
01.2013 - 04.2020
Medical Case Manager SR /Occupational Health
Georgia Power/Southern Company
09.2010 - 01.2013
Associate of Science - Registered Nursing
Union Memorial School of Nursing
Bachelor of Science - Nursing
Notre Dame University of Maryland