Mental Health Case Manager resume examples

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Professional Summary
Highly analytical healthcare professional, combining more than 10 years of work in Health Care with proficiency in problem solving, operations, analyzing, compiling and validating medical data.  Providing direct and indirect healthcare through case management and data analysis. 
Skills
  • Healthcare processing
  • Claims Processing
  • Insurance and collections procedures
  • Medical Device Management 
  • Medicare Management 
  • Analyze healthcare treatment 
  • Compliance with Healthcare regulations 
  • Sales force, Oracle,  MS systems , Power MHS, Care Radius, Facets
  • Planning and development
  • Facilitation 
  • Problem Solving 
  • Assertiveness
  • Time Management 
Work History
Resolution Coordinator , 02/2018 to Current
 Blue Cross and Blue Shield of North Carolina/Manpower – Durham, NC
  • Analyzes and coordinates all aspects of the appeals process to ensure compliance with our medical necessity criteria for member and provider appeals. 
  • Determines the validity of incoming appeals and make critical decisions to provide rationale for the valid and  non-valid decision
  • Provide written response member education regarding appropriate submission of inquiries
  • Ensures the compliance with medical necessity criteria, Corporate Medical Policy, contract provisions, NC DOI, legislative and NCQA requirements
  • System knowledge  includes usability of Care Radius, Power MHS, Facets, Macess,  Magic, Doc Request, and accessing Corporate Medical Policy
  • Coordinates and assigns dispositions of Level 1 Member and Provider appeals
Medical Communication Specialist, 04/2016 to 08/2017
 PPD – Morrisville, NC
  • Updated and maintained adverse events and product complaint in case report systems  daily
  • Processed and managed case reports per clinical case through clinical systems database.
  • Reviewed clinical files for accuracy prior to reporting and sending to Client.
  • Identified, analyzed, and interpreted medical trends through Salesforce database systems.
  • Generated medical and technical reports via FDA and SOP protocol.
  • Developed spreadsheets and reports that included trends for adverse events and products complaints through Trackwise systems .
  • Compiled and analyzed clientele data through Salesforce database.
  • Provided clinical support to Medical professionals and Client teams.
  • Worked closely with internal and external client contacts to resolve complex customer and HCP issues.
Benefits/Financial Associate, 09/2011 to 09/2015
 Fidelity Investments – Durham, NC
  • Processed and monitored benefit enrollments in the Oracle database.
  • Determined patient's eligibility for annual and life changing event statuses.
  • Assessed and collected data through customers for accurate enrollments.
  • Assisted with technical issues through online planning and enrollments.
  • Analyzed operational performance of mutual funds through financial planning.
  • Measured performance and compared overall rate of return for funds within a client's portfolio.
  • Completed financial research and transitional budgeting of multi-million-dollar accounts.
  • Consulted with business unit for investment analysis of present and future changes.
  • Provided project management and conducted formal training sessions to new staff.
  • Resolved benefits claims with third party vendors.
Mental Health Case Manager, 05/2007 to 08/2010
 Fellowship Health Resources – Raleigh, NC
  • Developed a treatment plan, taught modules, monitored treatment, and planned intervention in accordance with the Person-Centered Plan.
  • Facilitated groups, taught social skills training classes, and actively organized improvement initiatives.
  • Maintained clinical records, transported clients, and sustained client relationships.
  • Lead meetings concerning consumer growth and observation.
06/2005 to 06/2007
 Caring Family Network Mental Health Community Professional – Raleigh, NC
  • Provided counseling services to behaviorally and emotionally challenged youths,.
  • Developed behavioral plans, monitored youths quarterly through NC TOPPS assessment, documented service delivery, and organized in monthly child and family team meetings.
Education
MBA: April 2010
 University of Phoenix - Raleigh NC
Bachelor of Science: Criminal Justice, December 2002
 East Carolina University - Greenville NC
Criminal Justice
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Professional Summary
Individual who thrives under pressure and successfully works with diverse teams. I have 9 years of experience working in the field of psychology, and I have a passion for creating an impact in our community. I am enthusiastic, goal oriented, and an apt learner.
Skills
  • Efficient multi-tasker
  • Bilingual English/Spanish
  • Counseling Abilities
  • Interpersonal Skills
  • Writing Skills
  • Typing speed 78 WPM
  • Editing and proofreading
  • Spreadsheets
  • Document management
Work History
Vocational Provider/Tutor, 06/2016 to Current
 Elite Community Services – 1790 S. 3rd Ave. Yuma, AZ 85364
Provide Vocational Training including the following:
  • Resume building
  • Interview skill building
  • Communication training
  • Job Searching
  • Tutoring English & Math
Mental Health Vocational Counselor, 02/2014 to 04/2015
 Vocational Rehabilitation Administration/DES – 1185 S. Redondo Center Dr. Yuma, AZ 85365
  •  Worked with clients who suffer from disability. Primary focus mental health population.
  • Directed strengths-based, culturally competent and individualized intakes and assessments to determine eligibility.
  • Connected clients with community service and resource agencies.
  • Displayed sensitivity to the cultural and linguistic needs of the clients and families served.
  • Worked with mental health agencies to maintain coordination according to ADBHS standards.
  • Conducted community based presentations for Vocational Services. 
  • Developed and implemented treatment plans and modified when needed.
Legal Secretary, 04/2012 to 01/2014
 City of San Luis – 1090 E. Union St. San Luis, AZ
  • Transcribed legal documents and phone conversations.
  • Obtained signatures from attorneys for legal documents.
  • Filed legal documents with different courts in a timely manner.
  • Drafting city council agenda items from legal department
  • General Office Organization
  • Participated as interview panel for police department
Clinician and T36 Coordinator, 06/2010 to 04/2012
 Mountain Health & Wellness – 3180 E. 40th St. Yuma, AZ
  • Work with Yuma County Superior Court to coordinate mental health inpatient legal procedures.
  • Provide Community Training on ARS § Title 36
  • Coordination among psychiatric facilities inpatient and outpatient.
  • Community Outreach
  • Complete biopsychosocial assessments
  • Case Management
  • Planned and coordinated logistics and materials for RBHA meetings, staff meetings and clinical meetings.
  • Maintained statistical reports for RBHA compliance
  • Coordinated admissions and discharges into and out of inpatient facilities.
Inpatient Behavioral Health Technician-BHT, 05/2013 to 06/2015
 Mountain Health & Wellness – 3180 E. 40th St. Yuma, AZ
  • Worked on psychiatric hospital floor
  • Maintain calm and safe environment
  • Assist with vitals 
  • Facilitate therapeutic and wellness groups
  • Conduct drug and pregnancy testing
  • Complete admission and discharge procedure
  • Translation from English to Spanish when needed
Tutor, 06/2015 to 02/2016
 Upswing – Online
  •  Tutoring to college students primarily in different levels of English. 
Mental Health Case Manager, 04/2008 to 04/2010
 Chicanos Por La Causa – 1020 S. 4th Ave. Yuma, AZ
  • Coordination of care for mental health clientele
  • Referred clients to community resources
  • Worked with adults and children 
  • Worked with Seriously Mentally Ill population (SMI).
  • Update and maintain paperwork according to ADBHS standards
  • Some counseling services
  • Skill building activities
Education
Ph.D.: Performance Psychology, Current
 Grand Canyon University - Phoenix, AZ
Master of Science: Psychology, 2015
 Grand Canyon University - Phoenix, AZ
Bachelor of Science: Criminal Justice Administration, 2012
 University of Phoenix - Yuma, AZ
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Professional Overview

Resourceful Mental/Medical Health Care Professional with 14 years' experience. Self-directed and organized with well-developed abilities in managing a wide range of administrative needs.

Skill Highlights
  • Fund raising and marketing
  • Customer service mindset
  • Analytical abilities
  • Strong problem solving
  • Collaborative team player
  • Self-directed
  • Multi-tasking
  • Administrative support
Education
Master of Arts, Health Care Administration University of Phoenix - Palm Coast, FL

Completed first year.
Bachelor of Arts, Psychology 1996 University of Central Florida - Orlando, FL
Experience
Medical Case Manager Feb 2013 to Sep 2013
 Outreach Community Care Network - Daytona Beach, FL
  • Developed patient care plans, including assessments, evaluations, and nursing diagnoses.
  • Supported patients with customized patient teaching tools and intervention advocacy.
  • Provided treatment within scope of practice as defined by state law.
  • Coordinated with doctors and registered nurses to develop care plans for patients.
Program Manager Sep 2008 to Oct 2012
 Gulf Coast Jewish Family - Daytona Beach, FL
  • Supervised a staff of 15 adult foster caregivers.
  • Developed patient care plans, including assessments, evaluations, and nursing diagnoses.
  • Supported patients with customized patient teaching tools and intervention advocacy.
  • Ensured efficacy of treatments through monitoring of treatment regimens.
  • Maintained all confidential personnel files, licensing and CPR compliance records.
Family Coach Jan 2007 to Sep 2008
 The House Next Door - Daytona Beach, FL
  • Conducted 10 crisis counseling sessions each week.
  • Interviewed and assessed 20 new clients each week.
  • Selected and compiled relevant information and resources for clients to support them in overcoming mental and emotional problems.
  • Assessed and wrote treatment plans and weekly progress notes for each client assigned to caseload.
Children's Mental Health Case Manager Sep 2003 to Aug 2006
 ACT Corporation - Daytona Beach, FL
  • Assessed and wrote treatment plans and weekly progress notes for each client and their family.
  • Worked with clinical psychiatrist to draft treatment plans for a caseload of 20 patients.
  • Referred clients to outside social service providers to address psychiatric and personal issues.
  • Designed and implemented a community fund raising program.

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