Case Manager

Healthcare Case Manager — Beacon Health Network

Atlanta, GA | November 2023 – Present

• Coordinated daily discharge planning and post-acute transitions for an average caseload of 22 patients, reducing discharge delays by 26% and increasing patient disposition satisfaction scores by 18%.
• Conducted comprehensive utilization reviews using MCG CareWeb and InterQual criteria for 120+ weekly admissions, securing initial insurance authorizations and reducing deniable days by 32%.
• Collaborated with a multidisciplinary care team of 15 physicians, therapists, and nurses to streamline patient care pathways, which decreased the average inpatient length of stay from 5.4 to 4.3 days.
• Facilitated daily transition huddles and coordinated with 8 regional skilled nursing facilities (SNFs) to expedite placement times, shortening the average post-acute transfer window by 4.5 hours.

Associate Case Manager — Pinnacle Care System

Savannah, GA | June 2021 – October 2023

• Managed care transition plans and psychosocial assessments for a pediatric caseload of 18 patients daily, reducing readmission rates by 15% through customized post-discharge caregiver education.
• Liaised with 12 insurance providers to advocate for coverage of specialized medical equipment and home health services, achieving a 93% success rate on first-time prior authorization submissions.
• Identified and resolved social determinants of health (SDOH) barriers for 300+ patients annually by coordinating community resources, which decreased discharge delays due to logistics by 24%.
• Utilized Epic EHR and CarePort to document care pathways and send referrals, reducing administrative errors by 28% and ensuring compliance with CMS Conditions of Participation.

Discharge planning, Care transitions, Utilization review, CarePort, Epic EHR, MCG CareWeb, McKesson InterQual, HIPAA compliance, Patient advocacy, Psychosocial assessment, Medicare and Medicaid guidelines, Prior authorization, Case management, Interdisciplinary collaboration

Readmission Reduction Initiative

Role: Lead Case Manager

Tools: Epic EHR, CarePort, Excel

Designed and implemented a post-discharge phone call program for high-risk patients, reducing 30-day readmissions by 22% over 6 months.

Electronic Referral Integration

Role: Case Manager Representative

Tools: CarePort, Epic, Microsoft Teams

Standardized the referral workflow to post-acute providers within CarePort, reducing average referral response times from 8 hours to 3 hours.

• Accredited Case Manager (ACM-RN) (2023)
• Certified Case Manager (CCM) (2024)

• Languages: English (Native), Spanish (Professional working proficiency)
• Affiliations: Member, American Case Management Association (ACMA)
• Availability: 2 weeks notice