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Regional/Market/Division Director of Case Management/Utilization Management Resume
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| Desired Industry: Healthcare |
SpiderID: 84713 |
| Desired Job Location: Allen, Texas |
Date Posted: 8/14/2024 |
| Type of Position: Full-Time Permanent |
Availability Date: Immediately |
| Desired Wage: 175,000 |
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U.S. Work Authorization: Yes |
| Job Level: Executive (President, VP, CEO) |
Willing to Travel: Yes, Less Than 25% |
| Highest Degree Attained: Masters |
Willing to Relocate: Yes |
Objective:
Expert at leading interdisciplinary teams, implementing innovative strategies, and ensuring compliance with regulatory standards. Equipped with strong communication and interpersonal skills in collaborating with colleagues and other healthcare providers. Known for spearheading innovative initiatives that consistently contribute toward the achievement of organizational goals and objectives. Excels in guiding and mentoring future leaders in case management.
Experience:
MEDICAL CITY DALLAS HOSPITAL | Dallas, TX
Director of Case Management 03/2023–07/2024
o Oversaw a team of 75 healthcare professionals comprised of registered nurses, social workers, and case management assistants across three locations.
o Created and executed comprehensive protocols and procedures for case management.
o Enforced adherence to regulatory standards and guidelines.
o Provided constructive feedback to personnel based on performance appraisal.
o Worked closely with interdisciplinary teams for effective coordination of patient care.
o Evaluated data and trends to define areas for improvement in case management processes.
Key Accomplishments:
Decreased overall length of stay (LOS) by 15% through the implementation of effective strategies, along with execution of initiatives to boost patient throughput.
Increased employee engagement by 10% through the implementation of monthly one-on-one meetings, addressing staff concerns, and demonstrating transparency.
CHRISTUS SPOHN SHORELINE HOSPITAL | Corpus Christi, TX
Director of Case Management 07/2022–02/2023
o Spearheaded efforts to streamline case management processes and enhance patient outcomes.
Key Accomplishments:
Achieved the hospital's lowest ratio on record and a reduction in observation rate to below 20% by executing LOS reduction strategies.
Improved associate engagement scores by emphasizing the “why” or rationale behind initiatives.
Partnered with IT and department leaders to create turnaround time reports that boosted operational efficiency and decreased length of stay.
REDLANDS COMMUNITY HOSPITAL | Redlands, CA
Director of Case Management 05/2016–06/2022
o Formulated case management strategies aimed at maximizing patient care and achieving better outcomes.
o Supervised a team in charge of utilization review for a large group of capitated lives.
o Initiated efforts to improve patient throughput and reduce denials by creating and enforcing protocols.
o Optimized discontinuing cardiac monitoring procedure in coordination with other healthcare providers.
o Built and maintained delegated payer relationships with major health plans for more than 200,000 capitated lives.
Key Accomplishment:
Demonstrated expertise in case management, resulting in top 5% readmission rate attainment and record-breaking net revenue for the hospital.
DOCTORS HOSPITAL AT RENAISSANCE | Edinburg, TX
Director of Case Management 12/2013–04/2016
o Led case management operations for over 500 beds across three campuses on a day-to-day basis.
o Introduced unit-based daily stoplight rounds to prioritize discharges, decrease length of stay, and enhance patient throughput.
o Devised and executed strategies to improve patient care coordination and maximize resource utilization.
o Directed a team of case managers, offering assistance to ensure streamlined and efficient operations.
EARLIER POSITIONS HELD:
RN Case Manager 01/2010–12/2013
Float Pool Licensed Vocational Nurse 10/2009–01/2010
║EARLIER CAREER
DEPENDABLE MEDICAL STAFFING | San Antonio, TX
President/CEO 01/2000–10/2009
CARESTAFF AGENCY | San Antonio, TX
LVN Staff Nurse 10/1998–01/2000
RETAMA NURSING CENTER | San Antonio, TX
LVN Charge Nurse 07/1997–10/1998
UNITED STATES ARMY | San Antonio, TX
91 Whiskey Vocational Nurse 09/1991–07/1997
Education:
Master of Healthcare Administration West Coast University | Anaheim, CA, 08/2023
Bachelor of Science in Nursing University of Texas | Arlington, TX, 01/2017
Associate’s Degree in Nursing University of Texas | Brownsville, TX, 01/2011
Licensed Vocational Nurse Saint Philip's College | San Antonio, TX, 01/1997
Skills:
Operations Management | Readmission and LOS Reduction | Quality Improvement | Problem and Conflict Resolution
Resource Utilization | Performance Evaluation | Leadership and Development | Protocols Creation and Implementation Employee Engagement | Federal and State Regulations | Admission and Level of Care Criteria
Additional Information:
License:
Registered Nurse, State of Texas, Valid Until:10/2024
Registered Nurse, State of California, Valid Until:11/2024
Certification:
Accredited Case Manager, Valid Until: 08/2026
American Case Management Association
Candidate Contact Information:
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