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Top Patient Care Manager Skills

Below we've compiled a list of the most important skills for a patient care manager. We ranked the top skills based on the percentage of patient care manager resumes they appeared on. For example, 18.9% of patient care manager resumes contained patient care as a skill. Let's find out what skills a patient care manager actually needs in order to be successful in the workplace.

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The six most common skills found on Patient Care Manager resumes in 2020. Read below to see the full list.

1. Patient Care

high Demand

Patient care entails the diagnosis, recovery, and control of sickness as well as the maintenance of physical and emotional well-being through the use of healthcare providers' services. Patient care is described as services provided to patients by health practitioners or non-professionals under guidance.

Here's how Patient Care is used in Patient Care Manager jobs:
  • Interacted with multiple vendors and community representatives to improve and streamline patient care and costs associated with delivery.
  • Managed outpatient and inpatient care programs for Connecticut, including authorizing continuing care based on medical necessity.
  • Maintain patient admissions and care manager statistics creating monthly reports on specified indicators of renal inpatient care.
  • Care Manager-responsibilities include coordination of patient care through multiple disciplines, from admission to discharge.
  • Participated in daily morning meeting to discuss overall patient care and suggestions for improvement.
  • Provided direct patient care to patients experiencing medical-surgical, pulmonary, and post-operative conditions.
  • Recognized for providing exceptional patient care and pacifying difficult personalities which improved patient retention.
  • Integrated and collaboratively developed nursing daily flow-sheets to enhance documentation of patient care.
  • Communicated with medical practitioners to ensure proper maintenance of up-to-date patient care plans.
  • Staff development for individuals involved in patient care through self-improvement in education and experience
  • Authorize all patient care expenditures, subject to established Company approval authority levels.
  • Collaborate with multiple professionals to support, coordinate the provision/management of patient care.
  • Provided performance evaluations for registered nurses, patient care technicians and unit secretaries.
  • Monitored and analyzed the results of quality measurements and recommended patient care resolutions
  • Assumed direct-line responsibility for patient care delivery, ancillary and support services.
  • Supervised patient care management teams and ensured optimal quality of care.
  • Managed patient care and office organization at a busy dermatology practice.
  • Addressed all complaints regarding patient care in accordance with policy/procedure.
  • Have received recognition for exemplary documentation and patient care.
  • Coordinated patient care with numerous insurance companies.

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2. RN

high Demand

RN means a registered nurse -- a person who has fulfilled the criteria set by the government or a regulatory body to obtain a nursing license. A registered nurse requires graduating from a nursing program and/or completing a bachelor's degree. The rules and regulations set to become a registered nurse vary across the country.

Here's how RN is used in Patient Care Manager jobs:
  • Floated to the positions of the Pact RN Care Manager, Mental Health nurse and performed LVN duties when needed.
  • Participated in development of Oncology Technician role as an expanded option for nursing assistants within an all RN staff model.
  • Assisted in building and supporting team of 5 RN Embedded Care Managers within Mosaic Life Care clinics within Kansas City.
  • Manage an Interdisciplinary team of 35 including RN's, LPN's, MSW, Spiritual Care and Bereavement coordinators.
  • Serve as RN Care Manager to pregnant Medicaid recipients determined to be at high risk for poor birth outcomes.
  • Documented all care, services, and products given to clients and meetings with the RN about the clients.
  • Collaborate with other RN's, Physicians, or ASO any and all changes in client's health.
  • Assist in implementation of comprehensive screening and service model in conjunction with agency RN's and nursing homes.
  • Completed RN Reviews and follow up assessments as indicated by the stratification guidelines set by the program.
  • PACE program RN responsible for care management and primary care for caseload of up to 80+ patients.
  • Guided RN's in case management skills for a case load of approximately 15 to 20 patients.
  • Review situations or concerns with RN and/or Supervisor on a regular basis and when conditions change.
  • Supervised 3 RN's, 6 CNA's, 1 each Social Worker/Spiritual Counselor.
  • Interviewed potential employees (RN, CNA, Chaplains and Medical Social Workers).
  • Home Health RN caring for pediatric and or adults requiring in home nursing care.
  • Completed the schedule for RN's, Unit Secretaries and Unit assistants.
  • Recorded medical information in residents' charts and reported to RN.
  • Worked with HR recruiters traveling to college campuses seeking RN's.
  • Sole RN for metropolitan Minneapolis office reaching clients in 10 cities/towns.
  • Supported with manager to maintain no RN vacancy since 2008.

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3. Health Care

high Demand

Healthcare means an organized service provided to people when they are diagnosed with a medical illness or suffer an injury. Basic health care would ensure to improve the health of the patient. Health care is provided by designated and certified specialists who can be doctors, registered nurses, therapists, etc. The healthcare of the people is the responsibility of the state as they set up hospitals and clinics for the public and arrange certified professionals in them for the health care of the people.

Here's how Health Care is used in Patient Care Manager jobs:
  • Establish effective collaboration, communication and coordination among all responsible parties of an individual's multidisciplinary health care team.
  • Conducted neonatal utilization reviews, developed care plans, and monitored and evaluated effectiveness of health care treatments.
  • Provide behavioral health care management services through prospective, concurrent and retrospective evaluation and review of treatment.
  • Collected accurately and timely health care data and adequately documented patients' related issues.
  • Facilitated empowerment of the patient and family in self-management and a health care decision-making.
  • Promote effective education, self-management support, and timely health care delivery.
  • Coordinated patient care through ongoing collaboration with PCP, patient/family, community, and other members of the health care team.
  • Evaluated, directed the coordination patient care between skilled nurses and other health care professionals to provide holistic health care services.
  • Reviewed clinical information about mental health clients in order to arrange appropriate levels of behavioral health care for insurance plan members.
  • Coordinated and integrated services with other areas, medical staff and their support staff, other health care facilities and vendors.
  • Assess and evaluate patient's needs, and interact with health care providers to coordinate transition of care utilizing plan criteria.
  • Close out referral once consult notes has been received by using Composite Health Care System (CHCS) operating system.
  • Coordinated day-to-day utilization of human and material resources to achieve the goals, objectives and standards of health care providers.
  • Provided assessment, diagnosis, treatment, and follow-up management of health care needs for a panel of 1,025 patients.
  • Implemented and trained staff in Interactive Patient Care methodology to help veterans take an active role in their health care.
  • Coordinate care through collaboration with members, caregivers, and health care providers ensuring effective and timely delivery of services.
  • Coordinated care with health care team which included doctors, therapists, home health aides, & social workers.
  • Manage all aspects of complex medical care needs of the members in conjunction with other disciplines of health care.
  • Coordinate and assist with activities in a home like setting, such as basic home and health care needs.
  • Care manager completes all PE and Medicaid documentation with the family to assure health care coverage for the youth.

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4. Medication Administration

high Demand

Here's how Medication Administration is used in Patient Care Manager jobs:
  • Perform random auditing of Medication Administration Records with focus on improving nursing documentation and maintaining accurate records.
  • Educated patients on his/her disease management, medication administration, and home safety.
  • Job responsibility/achievement: Assist residents with activities of daily living, medication administration.
  • Maintain accurate records of residents' medication administration and vital statistics.
  • Implemented Admin RX system for medication administration to reduce medication errors.
  • Maintained accurate documentation of care given and medication administration records.
  • Counseled clients on medication administration & nutrition.
  • Obtained certification in Medication Administration.
  • Head to toe assessments, feeding tubes, insulin injections, vitals, medication administration, documentation, hygiene assistance.
  • Provided patient teaching in regard to disease process, medication administration/purpose/side effects, wound care, and plan of treatment.
  • Supply their meals; provided social and personal care, including help with bathing, dressing and medication administration.
  • Assisted seniors with their activity of the daily living and medication administrations.
  • Assist in daily living cares including bathing, toileting, dressing and feeding Laundry Medication administration
  • Assisted in bathing, eating, oral cares, and dressing Medication administration Meal prep Assisted with off campus activities
  • Worked with memory care clients - Prepare and serve meals - Medication administration - Assist with activities of daily living

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5. Community Resources

high Demand

Community resources are a set of resources that are used in the day to day life of people which improves their lifestyle in some way. People, sites or houses, and population assistance can come under the services offered by community resources.

Here's how Community Resources is used in Patient Care Manager jobs:
  • Supply telephonic post-hospitalization care coordination to patients, including explanation and reinforcement of discharge instructions and availability of community resources.
  • Conducted telephonic assessments to identify appropriate community resources, make referrals and coordinate social services for Medicare and Medicaid recipients.
  • Provided care management services to older adults by facilitating and promoting collaborative teamwork among community resources and primary care physicians.
  • Maintained relationships with local schools, businesses and social organizations implementing an active network of volunteers and community resources.
  • Provide individual counseling sessions and recommend treatment within the program and referral and linage to community resources as indicated.
  • Emphasized and empowered youth and families to utilize informal supports and successfully transition towards independence utilizing sustainable community resources.
  • Provided referrals and/or community resources as appropriate for life-work, psychiatric and/or chemical dependency issues 5.
  • Provided seniors and their families with information regarding community resources and assist with emergency basic needs.
  • Analyze and review the eligibility of clients for referral to community resources and other organizations.
  • Assisted with making appointment with physician for follow up care Connected patients with available community resources
  • Provided health education and information on community resources to participants, family members and caregivers.
  • Provide information to senior citizens regarding other Community Resources not provided by this agency.
  • Provide patient teaching and initiate referrals to community resources and outpatient services.
  • Empower youth and families, emphasizing informal support development and community resources.
  • Expanded knowledge of community resources; refer to local collaborative/system of care.
  • Identified and effectively utilizes community resources to meet family's needs.
  • Assisted in identification of community resources for support outside Kaiser system.
  • Coordinated community resources including long term and sub acute placement.
  • Provided treatment consultation to other agency programs and community resources.
  • Monitor quality outcomes and assist member with community resources.

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6. Substance Abuse

high Demand

Here's how Substance Abuse is used in Patient Care Manager jobs:
  • Managed and reviewed utilization of mental health and substance abuse services provided in inpatient and intermediate care settings.
  • Provided telephonic clinical assessment referrals and certification of care for mental health and substance abuse authorizations.
  • Conducted training on substance abuse, crisis management and motivational interviewing techniques to a multidisciplinary team.
  • Provided detailed information to members and providers regarding mental health and substance abuse treatment insurance benefits.
  • Conducted mental health/substance abuse utilization reviews for intensive service levels of care with providers.
  • Administer substance abuse assessments and referral.
  • Assess, oversee and coordinate a client's needs including medical, behavioral health, substance abuse, and social services.
  • Reviewed, authorized, and monitored treatments for inpatient and outpatient mental health and substance abuse consumers for a call center.
  • Provide member assistance with mental health and substance abuse issues as well as crisis intervention and participate in special QI projects.
  • Assist with discharge planning and ambulatory follow up activity; provide member assistance with mental health and substance abuse issues.
  • Determine appropriate level of care related to mental health and/or substance abuse treatment for members based on medical necessity criteria.
  • Assist patients in crisis situations ex: discharge from hospitalizations and admission into substance abuse treatment to name a few.
  • Work effectively with interdisciplinary team of providers including PCP, Substance Abuse treatment programs, residential, hospital discharge planners.
  • Conducted Utilization Review of mental health and substance abuse treatment plans with outpatient providers, programs, and facilities.
  • Completed telephonic concurrent review of inpatient, partial hospital, and intensive outpatient mental health and substance abuse cases.
  • Provided behavioral health services to clients involved in criminal justice system who have mental health and/or substance abuse issues.
  • Refer clients to services including but not limited to mental health and substance abuse treatment, entitlements and housing.
  • Work with probation and parole department in referring people in this program to substance abuse and mental health services.
  • Provision of assessment, referral, and authorization for appropriate level of care for mental health and substance abuse patients
  • Experience in conflict resolution with the elderly population and those residents suffering from mental illness and substance abuse issues.

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7. Customer Service

high Demand

Customer service is the process of offering assistance to all the current and potential customers -- answering questions, fixing problems, and providing excellent service. The main goal of customer service is to build a strong relationship with the customers so that they keep coming back for more business.

Here's how Customer Service is used in Patient Care Manager jobs:
  • Completed Rockefeller customer service training: Complaint Resolution; Realizing Customer Expectations; Customers Loyalty; Cultural Competency and Awareness
  • Provide consultation and customer service to individuals receiving developmental disability services, service providers, and other stakeholders.
  • Provided outstanding customer service through actively initiating assistance and providing fair conflict resolution.
  • Worked directly with nursing departments to achieve positive client customer service experiences.
  • Committed to providing excellent customer service in a fast-paced, detail-oriented environment.
  • Provided excellent customer service during contact with professional and non-professional contacts.
  • Maintain superior customer service standards with all internal and external customers.
  • Developed and implemented unit goals to improve customer service and quality.
  • Managed online customer service department of business-to-business online gaming company.
  • Provide excellent customer service and consultation with providers and contractors.
  • Collaborated with various department leaders to ensure excellent customer service.
  • Maintained quality control of clinical and customer service functions.
  • Provided excellent customer service and ensured customer satisfaction.
  • Provided excellent customer service to residents and families.
  • Strive to maintain exemplary internal/external customer service.
  • Performed all levels of Customer Service interactions.
  • Participate in customer service assessment activities.
  • Developed procedures and policy manual and successfully improved relationships between front and back office staff, as well as customer service.
  • Take care of all animals in the building and to also be a strong leader to show high customer service standards.
  • Schedule veterinary appointments, Train new team members, pet/customer service, inventory/stocked/faced displays, feed and take care of animals.

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8. Hospice

high Demand

Here's how Hospice is used in Patient Care Manager jobs:
  • Assured regulatory compliance with other members of the hospice administration team including achieving and maintaining hospice Medicare certification.
  • Assessed potential clients who were seeking hospice services and provided educational information related to the Hospice benefits.
  • Meet Quality Assurance Program expectations including daily compliance reporting Community education and awareness of hospice services.
  • Coordinated services among referring facilities to include hospice in-services and relationship building and effective problem resolutions.
  • Participated in development and initiation of the Quality Assurance/Performance Improvement initiatives for Harbor Light Hospice.
  • Assured State regulatory compliance, including achieving and maintaining Hospice Medicare certification.
  • Hired, oriented, directed and evaluated 12 qualified Hospice interdisciplinary members.
  • Coordinated all hospice care with attending physician and Hospice medical director.
  • Operated within the Medicare Certificates of Participation for Hospice eligibility.
  • Monitor patient charts for accuracy, consistency and hospice eligibility.
  • Authored and implemented Hospice of DuPage Pain Management Protocols.
  • Consult with family Dr.s case managers about hospice eligibility.
  • Perform patient assessments and determine qualification for hospice services.
  • Managed 30-bed inpatient hospice facility.
  • Assisted nurse and hospice staff with all aspects of daily care, including bathing, feeding and dressing and monitored fluid intake
  • Maintain knowledge of service systems in the community served by the agency and insuring services provided are approved by the hospice.
  • Work as part of interdisciplinary team providing hospice care to patients and families with a variety of physical and behavioral conditions.
  • Prepare and monitor Infection Control Reports for Hospice and Home Health Quarterly and administer TB skin test to employees as needed.
  • Ensured successful operation of the hospice agency by selecting, developing and directing staff to ensure a competent, well-motivated workforce.
  • Planned and supervised the activities of the interdisciplinary team members to provide comprehensive care and continuity of services to hospice patients.

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9. Clinical Staff

high Demand

The clinical staff consists of people who work under a healthcare professional like a physician. Their job is to assist in healthcare professional services but not to report them directly. The clinical staff has direct contact with patients for diagnosis, treatment, and further care.

Here's how Clinical Staff is used in Patient Care Manager jobs:
  • Supported administrators by compiling and analyzing financial, operational and clinical information and develops analyses, projections, reports and presentations.
  • Ensured a patient-centered, recovery-focused format through provision of psycho-educational groups and pharmacological treatment; directed 40+ clinical staff members.
  • Presented clinical information and consulted with medical director to facilitate denial of services when medical acuity not met.
  • Assessed, evaluated and communicated clinical information daily to provider such as lab values and patient/parent reported information.
  • Educated, validated and assisted clinical staff on any new policies/procedures and medical equipment per hospital standards.
  • Project facilitator for BHSF System initiative: Committee chair for the Cancer Collaborative Project: Clerical/Clinical Staffing
  • Participated in clinical staff rounds and gathered and evaluated data to ensure compliance with accreditation agencies.
  • Collected appropriate clinical information to make a determination of medical necessity for reviewed service.
  • Improved financial accountability as required by Medicare guidelines through clinical staff in services.
  • Review documentation of clinical staff to evaluate for appropriateness and timely submission.
  • Supervised clinical staff to evaluate performance and compliance with all regulations.
  • Collaborate with clinical and non-clinical staff to ensure appropriate intervention implementation.
  • Provided patient clinical information under strict time constraints.
  • Direct supervision of clinical and non-clinical staff.
  • Review of clinical information for services requested.
  • Provided in-servicing programs for clinical staff.
  • Provide continuing education for clinical staff.
  • Assist Director of Nursing as liaison between administration, clinical staff, patients and their families, and the community.
  • Handled inquiries and concerns from patients and clinical staff, providing timely responses and solutions to all issues.
  • Review clinical information provided by facilities for acute, residential, IOP and lower levels of care.

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10. Mental Health

high Demand

Mental health is the state of wellbeing in which an individual can cope with the regular stresses and tensions of life, and can work productively without having any emotional or psychological breakdown. Mental health is essential for a person of any age and helps them make the right decisions in their life.

Here's how Mental Health is used in Patient Care Manager jobs:
  • Case management of clients with mental health concerns Create and implement individualized treatment plans Create comprehensive assessments Connect clientele with various providers/services
  • Incorporated management system approach to environmental health, safety, security and communication activities, including third-party audits.
  • Maintained detailed records and documentation of inpatient mental health hospitalizations with caseloads that often exceeded 100 active hospitalizations.
  • Served as consultant for managed disability program, overseeing mental health treatment of patients on psychiatric disability.
  • Communicate with Team Leader, Quality Assurance Manager and/or Mental Health Consultant regarding difficult-to-serve or at-risk cases.
  • Manage psychiatric and chemical dependency facility-based and outpatient mental health treatment through telephonic or written review.
  • Focused primarily on care coordination and facilitating communication with medical and mental health providers.
  • Manage interaction between Primary Care and Mental Health Physicians coordinating services and information flow.
  • Worked with multidisciplinary mental health team and external agencies/Departments in providing 24/7 crisis intervention.
  • Facilitate Motivational Interviewing training for multidisciplinary team of mental health professionals and nurses.
  • Conducted telephone assessments and provided mental health referrals for participating health plan members.
  • Case management and utilization review for clients using mental health insurance benefits.
  • Created manual utilization authorizations for mental health services and other covered benefits.
  • Administered bio/psycho/social assessments and communicated findings to psychiatrist and mental health team.
  • Completed and submitted documentation according to City/Department of Mental Health's regulations.
  • Coach individuals with medical conditions to decrease co-occurring mental health symptoms.
  • Provided community-based outpatient mental health and addiction services for adults.
  • Reduced benefit and member spending utilizing mental health acumen.
  • Authorized inpatient and outpatient mental health services.
  • Worked with youth with mental health and behavioral challenges in the community to facilitate the effective coordination of assessments and services.

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11. Medical Records

high Demand

Here's how Medical Records is used in Patient Care Manager jobs:
  • Completed retrospective review of medical records to determine medical necessity for admission and length of stay.
  • Drafted assessments based on patient information, physician recommendations and medical records review.
  • Prepared administrative folders and ensured that all medical records were prepared correctly.
  • Audit medical records for proper documentation.
  • Gained proficiency in electronic medical records.
  • Complete care for non-ambulatory elderly patient with Dementia, Manage and Administer Medications, Medical Records, appointments, Coordinate Care.
  • Organized external provider s medical records necessary for the continuation of care and forwarded pertinent information to the Pact provider.
  • Provided oversight of medical records management ensuring accurate records maintained in the electronic health record and in hard copy files.
  • Reviewed client medical records, and worked closely with client's family and service providers involved with client care.
  • Review of medical records and benefit eligibility assessments to further evaluate ongoing care needs and level of care required.
  • Maintained 100% accountability of 235 medical records ensuring they were all verified and filed correctly.
  • Performed on-site medical records audits of network providers with high volumes of health plan members/participants.
  • Maintained accurate and timely client files, including the documentation of progress notes and medical records
  • Assisted the residents and interns with improving documentation skills for accurate medical records.
  • Verified orders, charting, medical records management, HIPAA and JCAHO regulations.
  • Maintained, updated, and organized all current patient medical records.
  • Point person for all Electronic Medical Records (EMR) implementations.
  • Requested and reviewed medical records, and visiting nurse assessment referrals.
  • Fax paper work to doctors and maintain medical records
  • Planned, trained, and administered new records retention initiative Trained incoming administrative personnel on family medicine/medical records process

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12. Phone Calls

high Demand

Phone calls are a wireless or wired connection made over a telephone or a mobile phone between two people. Two parties are involved in a phone call, the caller and the receiver. A caller dials the number of the one he wants to call, and the recipient hears a bell or a tune to which he picks up the call. The call establishes a connection between them through which they can communicate. The voice is converted into signals and is transmitted through wired or wireless technology.

Here's how Phone Calls is used in Patient Care Manager jobs:
  • Assessed, planned, coordinated, and monitored the provision of services to program members via home visits and phone calls.
  • Clean, help residents, take vitals, answer phones, communicate with family members, fill out papers and reports.
  • File, fax, answer large volume phone calls, coordinate meetings, and relevant office duties as required.
  • Answer and resolve crisis phone calls involving at-risk youth in their current placement with foster families.
  • Schedule patient home visits and make follow up phone calls for monthly monitoring for Nurse practitioner.
  • Care Manager/Counselor *Answering Multiple phone calls with a high call volume on a daily basis.
  • Assign community based outreach activities such as home visits, telephone calls and correspondence.
  • Monitored consumer's progress through phone calls, site visits and case management appointments.
  • Coordinated home visits to clients and completed 30-day update phone calls.
  • Answer phones and direct calls to the appropriate person or department.
  • Work independently from home communicating primarily through email and phone calls.
  • Provide support through telephone calls, home visits and Provider clinic/specialty visits
  • Follow up with the older adult with necessary telephone calls.
  • Conducted phone calls to Patient relatives pertaining status updates.
  • Handled all phone calls from parents and corporate office.
  • Answer phone calls and provide information on the facility.
  • Handle incoming phone calls, set client appointments.
  • Answer phones, schedule appointments, process payments.
  • Respond to inbound phone calls for medical emergencies.
  • Answer phone, relay messages when needed.

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13. Communication

high Demand

Communication is the ability to express one's ideas and thoughts to other people using expressions, words, or actions. Communication is to receive or send any kind of information. People need to be able to communicate and convey their message to the customers to run a successful business.

Here's how Communication is used in Patient Care Manager jobs:
  • Facilitated patient wellness and autonomy through advocacy, assessment, planning, communication, education, resource management and service facilitation.
  • Resolved communication issues; provided trouble-shooting during emergency situations and disseminated immediate communication or instructions to other issues within the team.
  • Handled all performance factors associated with multiple clients including quality of service to patients and communication to client representatives.
  • Standardized and streamlined a patient-flow process which facilitated standard communication throughout diverse care units to provide quality service.
  • Coordinated the care coordination and transition planning process for consumers through effective communication with the interdisciplinary team.
  • Provided therapeutic activities to address anger management, communication, self-esteem, parent training and family rules.
  • Maintained frequent communication with multiple agencies, organizations and individuals via telephone, email and written correspondence.
  • Maintain oversight and communication with members and providers during inpatient acute, sub-acute and/or long-term admissions.
  • Established accountability and improved communication among operations management team through implementation of communication log book.
  • Developed comprehensive model five-year communication plan adopted as a template for US manufacturing facility implementation.
  • Documented clinical assessment findings and subsequent communication with patient, families, and other professionals.
  • Manage calls with professional communication from providers and members and provided required information to same.
  • Improved quality, safety, service and value by promoting collaboration and communication among caregivers.
  • Case Manager participates in telephonic communication with parents to initiate/ schedule face to face visits.
  • Encouraged and facilitated resident communication, self-motivation, physical awareness, and positive thinking.
  • Provided continuous monitoring, evaluation and follow-up through home visits and phone communication.
  • Expedited communication with family members to discuss critical behavioral changes and immediate concerns.
  • Communicate using written and verbal skills increasing effective communication and level of understanding.
  • Maintain communication with patients to educate and encourage progress toward optimal health.
  • Close communication with physicians regarding above stated issues and orders followed accordingly.

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14. Utilization Review

high Demand

Another name for utilization review is utilization management. It is the process of ensuring that healthcare services are used in a suitable manner. Utilization review is a critical component of adding value to the health care system. Mostly, UR is carried out by healthcare insurance companies, but hospitals and other healthcare providers also perform the process. Utilization review has three types of assessment namely: concurrent, prospective, and retrospective.

Here's how Utilization Review is used in Patient Care Manager jobs:
  • Home based contract employee conducting telephonic utilization reviews in behavioral health and chemical dependency for inpatient and intermediate levels of care.
  • Conducted utilization reviews for the State hospitals in Tennessee and other private facilities utilizing medical necessity criteria for appropriateness of care.
  • Key Achievement: Analyzed market conditions, business volume/mix and researched regulatory impacts of case management and utilization review departments.
  • Handled all Utilization Review and specific Case Management functions independently for the last nine months of corporate reorganization and consolidation.
  • Provided case management services including Utilization Review and Discharge Planning to adult population within guidelines of corporate and regulatory compliance
  • Position: Case Management Coordinator Responsibilities: Utilization review and case management evaluation, continuous quality improvement management style.
  • Directed case management of inpatient and outpatient clients in addition to disease management and utilization review activities.
  • Participated in Discharge Planning, Utilization review, and Prior Authorizations and Quantity overrides for needed medications.
  • Completed retro reviews and scheduled and conducted concurrent reviews with utilization review personnel.
  • Conducted utilization reviews and completed authorizations for members admitted to acute psychiatric facilities.
  • Provided telephonic and facsimile utilization review for commercial, Medicaid/Medicare health plans.
  • Performed utilization review for outpatient and inpatient behavioral health and addiction services.
  • Provided utilization review and disease management for employees and their dependents.
  • Complete physician's authorizations for residents as well as utilization reviews.
  • Performed clinical record reviews, utilization reviews and adverse event reviews.
  • Performed utilization review and assisted with billing and insurance requirements.
  • Managed work process flow with Case management/Utilization review department.
  • Participated in Utilization Review, performed administrative on-call duties.
  • Provided utilization review of inpatient and outpatient cases.
  • Performed case management and utilization review functions.

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15. Treatment Plans

average Demand

A treatment plan is a detailed plan created by a physician or a medical expert that contains all the necessary information about a patient. It would contain the entire medical history of the patient, along with information on the patient's disease, its treatment, and how it should be executed. The treatment plan contains information about the treatment and its possible side effects. It may also contain the cost of the treatment and the necessary precautions that should be taken after it.

Here's how Treatment Plans is used in Patient Care Manager jobs:
  • Develop and Implement individual care/treatment plans Manage and supervise approximately fifty employees for all shifts.
  • Participated in development and implementation of individual treatment plans for Alzheimer client.
  • Created rehabilitation treatment plans for residents with team cooperation.
  • Developed/implemented treatment plans and modified when needed.
  • Create comprehensive treatment plans Coordinate services between agencies
  • Reviewed and approved individual treatment plans.
  • Provided comprehensive care management services, including creating goal - oriented treatment plans and connecting clients and families to appropriate resources.
  • Collect data, conduct community referrals, and implement treatment plans consistent with the youth's behavioral and emotional needs.
  • Worked with individual physicians to determine the appropriateness of the patients' level of care and updating treatment plans.
  • Developed care plans that align with the physician's treatment plans and recommends interventions that align with proposed goals.
  • Participated in integrated care efforts with all providers known to the client to monitor treatment plans and progress.
  • Established, executed and revised treatment plans for new and existing clients as specified in state regulations.
  • Authorize treatment, approve treatment plans and recommendations, review clinical information, and discharge plans.
  • Identify gaps or barriers in treatment plans and provide patient education to assist with self management.
  • Monitored client activities to ensure compliance with program rules, statues, laws and treatment plans.
  • Coordinated and monitored services, including comprehensive tracking of client progress in relation to treatment plans.
  • Coordinated both family and individual treatment plans, managing a caseload of up to 10 families.
  • Coordinated and managed Child and Family Team meetings with multiple agencies to ensure comprehensive treatment plans.
  • Collaborated with both internal psychiatrists and hospital staff in developing treatment plans for follow-up care.
  • Documented all client information including program progress notes, incident reports, and treatment plans.

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16. Medicaid

average Demand

Here's how Medicaid is used in Patient Care Manager jobs:
  • Prepared discharge summaries, including completing referrals for Medicaid applications and communicating with insurance companies to secure necessary authorizations.
  • Manage large caseload of NYS Medicaid Managed Care members certification, re-certification for PCA services working within regulatory guidelines.
  • Researched and communicated to members alternative financial and community services including assistance with applications for Medicare and Medicaid.
  • Utilized PerformCare to accurately document all services and interactions provided for each family in compliance with Medicaid regulations.
  • Assess elderly and adults with physical disabilities to determine eligibility for the Medicaid Choices For Independence program.
  • Oversee financial counseling of under-insured and uninsured patients for Medicaid eligibility, pay arrangements and charity programs.
  • Complete face-to-face community based needs assessments on Medicaid plan members in the Honolulu and surrounding area.
  • Coordinated and authorized counseling and medication monitoring for patients with Medicare, Medicaid or private insurance.
  • Collaborated with the Departments of Job and Family Service to establish and/or maintain Medicaid eligibility.
  • Applied Medicaid eligibility and community resource knowledge in connecting persons in need with assistance.
  • Provided case management for insured and uninsured patients and offered Medicaid and community outreach.
  • Educate members and providers on Medicaid services and ensure compliance with Medicaid eligibility.
  • Oversee activities involving Medicare and Medicaid Denial Reports and follow-up collection.
  • Case manage restricted Medicaid group and monitor for inappropriate utilization.
  • Maintain charting and enter documentation according to Medicaid guidelines.
  • Processed and submitted Medicaid applications to DHS for consideration.
  • Care Manager with the Medicare/ Medicaid disabled population.
  • Experience with InterQual standards and Medicaid utilization management.
  • Demonstrate knowledge of relevant Medicare and Medicaid services.
  • Managed clients with obtaining and maintaining Medicaid eligibility.

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Online Courses For Patient Care Managers

One of the best ways to acquire the skills needed to be a patient care manager is to take an online course. We've identified some online courses from Udemy and Coursera that will help you advance in your career. Since patient care managers benefit from having skills like patient care, rn, and health care, we found courses that will help you improve these skills.

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Palliative Care Always
coursera

Palliative Care Always is a specialization for health care practitioners, patients and caregivers. We've designed this specialization to demonstrate how palliative medicine integrates with patient care, and to help you develop primary palliative care skills. Over the next five courses, you will develop skills in symptom management, goals of care and effective communication to improve the quality of life for patients and families suffering with serious illness. Our hope is that you feel increasin...

Patient Safety
coursera

Preventable patient harms, including medical errors and healthcare-associated complications, are a global public health threat. Moreover, patients frequently do not receive treatments and interventions known to improve their outcomes. These shortcomings typically result not from individual clinicians' mistakes, but from systemic problems - communication breakdowns, poor teamwork, and poorly designed care processes, to name a few. The Patient Safety & Quality Leadership Specialization covers the...

Applying Health Coaching in Patient Care
edX (Global)

For health practitioners, having knowledge of treatment protocols is not enough. They must be able to inspire behavior change in their patients. In order for the treatment to be effective patients must be empowered to implement therapeutic approaches in their lives. In this course, you will learn about health coaching, which is an effective method for helping patients change their behaviors. Health coaching uses a blend of evidence-based strategies, interventions and communication to actively...

Essentials of Palliative Care
coursera

This course starts you on your journey of integrating primary palliative care into your daily lives. You will learn what palliative care is, how to communicate with patients, show empathy, and practice difficult conversations. You will learn how to screen for distress and provide psychosocial support. You will learn about goals of care and advance care planning and how to improve your success with having these conversations with patients. Finally, you will explore important cultural consideratio...

Patient Care Technician (Voucher Included)
ed2go

Patient Care Technician (Voucher Included)...

Certificate in End of Life Care
ed2go

(19 contact hours) The Certificate in End-of-Life Care will enhance the knowledge and skills of health care professionals and individuals who work with or care for those experiencing a terminal illness...

Symptom Management in Palliative Care
coursera

This course should be taken after the Essentials of Palliative Care course and continues building your primary palliative care skills - communication, psychosocial support and goals of care. You will learn how to screen, assess, and manage both physical and psychological symptoms. You will explore common symptoms such as pain, nausea, fatigue, and distress and learn specific treatments. You will continue to follow Sarah and Tim's experience and learn cultural competencies critical for optimal sy...

What is Palliative Care?
coursera

Palliative care provides invaluable help for patients living with serious or life-limiting illness and their family caregivers. Palliative care should be part of healthcare services to improve quality of life, the ability to tolerate and benefit from treatment and improve survival. In this course, you will learn about the nature of suffering and how this concept can help you understand the experience of people living with serious illness. Next, you will learn skills to more effectively communica...

Palliative Care: It's Not Just Hospice Anymore
coursera

People living with serious, life-limiting, chronic illness experience significant suffering. Fortunately there are new and developing treatments which may cure some and improve survival for many people living with serious illness. However, seriously ill people and their loved ones still experience many distressing physical symptoms as well as spiritual, social and psychological distress. There is much we can do to support people to live well with serious and life-limiting illness by understandin...

Transitions in Care from Survivorship to Hospice
coursera

This course should be taken after the Symptom Management course and continues building your primary palliative care skills - communication, psychosocial support, goals of care and symptom management. You will explore transitions in care such as survivorship and hospice. You will learn how to create a survivorship care plan and how to best support a patient. The course also covers spiritual care and will teach you how to screen for spiritual distress. Finally, you will learn the requirements for...

Emergency Care: Pregnancy, Infants, and Children
coursera

Welcome to the final course of lectures in your quest to master EMT basics. In this course, we will cover some of the highest-stress patient populations: pregnant patients and kids, also known as pediatrics. To wrap up your EMT knowledge we will end this course with information about hazmat situations, extricating patients from tight spots and finally how you write a note about your patient care. You will learn to ensure it communicates what your assessment of the patient was, what interventions...

Value-Based Care: Managing Processes to Improve Outcomes
coursera

COURSE 3 of 7. This course is designed to introduce you to critical office-based processes that a value-based practice must manage in the drive towards improved patient outcomes. In Module 2, we'll focus on office-based and clinical patient-based supporting functions. At every level in healthcare, guidelines, processes, and functions exist to improve outcomes, and following a consistent process will return the best effect. Refine your understanding of value and learn strategies to provide real a...

Health Care Innovation
coursera

In this course, you'll learn the foundational economic theories behind health care innovation and how to optimize your own health care practice or organization. Designed to help you gain a practical understanding of the theoretical frameworks of behavioral economics and operations management in the health care setting, this course will help you apply these frameworks to assess health care practices and apply innovation while managing risk. You'll also explore the best practices for evaluating on...

Health for All Through Primary Health Care
coursera

This course explores why primary health care is central for achieving Health for All. It provides examples of how primary health care has been instrumental in approaching this goal in selected populations and how the principles of primary health care can guide future policies and actions. Two of the most inspiring, least understood, and most often derided terms in global health discourse are "Health for All" and "Primary Health Care." In this course, we will explore these terms in the context of...

Health Care Delivery in Healthcare Organizations
coursera

Have you ever needed health care and thought that there must be better ways to get or deliver health care? For example, have you found yourself thinking that there should be a way to get a diagnostic test or treatment at home? Or do you work in a healthcare organization and find yourself thinking that there must be better ways to deliver health care? If you have, this course is for you. Course content includes an overview of health care delivery including healthcare consumerism, the patient's pe...

Newborn Baby Care
coursera

A newborn baby is an amazing beautiful life filled with hope. Unfortunately, many babies die or experience preventable harm even in 21st century. It is imperative that babies who are born healthy get off to a healthy start in the first month of life. There are some easy tenets of care to implement that help ensure that babies and families get off to a healthy start no matter where they are in the world. In this specialization learners will acquire the skills necessary for newborn baby care to op...

Horse Care Management
ed2go

Horse Care Management...

Addiction Treatment: Clinical Skills for Healthcare Providers
coursera

This course is designed with a singular goal: to improve the care you provide to your patients with substance use disorders. By delving into a model case performed by actors, seven Yale instructors from various fields provide techniques to screen your patients for substance use disorder risk, diagnose patients to gauge the severity of their use, directly manage treatment plans, refer out to treatment services, and navigate the various conditions that may limit your patient's access to treatment...

Trauma Emergencies and Care
coursera

Welcome to Trauma Emergencies and Care. In this course, you will learn about some of the mechanics and physics of trauma on the human body, and how this can cause injury. You will continue to expand your new vocabulary with medical terminology, and learn how to describe the different injuries you may see. You will also learn about the trauma system itself- and when it is important to transport patients to a trauma center. Then we will dive into specific injuries based on what part of the body ma...

Health Care Entrepreneurship Bundle
ed2go

Health Care Entrepreneurship Bundle...

20 Most Common Skill For A Patient Care Manager

Patient Care18.9%
RN13.6%
Health Care10%
Medication Administration6.1%
Community Resources4.6%
Substance Abuse4.3%
Customer Service3.2%
Hospice3%

Typical Skill-Sets Required For A Patient Care Manager

RankascdescSkillascdescPercentage of ResumesPercentageascdesc
1
1
Patient Care
Patient Care
18.9%
18.9%
2
2
RN
RN
13.6%
13.6%
3
3
Health Care
Health Care
10%
10%
4
4
Medication Administration
Medication Administration
6.1%
6.1%
5
5
Community Resources
Community Resources
4.6%
4.6%
6
6
Substance Abuse
Substance Abuse
4.3%
4.3%
7
7
Customer Service
Customer Service
3.2%
3.2%
8
8
Hospice
Hospice
3%
3%
9
9
Clinical Staff
Clinical Staff
2.6%
2.6%
10
10
Mental Health
Mental Health
2.6%
2.6%
11
11
Medical Records
Medical Records
2.5%
2.5%
12
12
Phone Calls
Phone Calls
2.5%
2.5%
13
13
Communication
Communication
2.5%
2.5%
14
14
Utilization Review
Utilization Review
2.5%
2.5%
15
15
Treatment Plans
Treatment Plans
2.5%
2.5%
16
16
Medicaid
Medicaid
1.8%
1.8%
17
17
PCP
PCP
1.7%
1.7%
18
18
Emergency
Emergency
1.4%
1.4%
19
19
LPN
LPN
1.3%
1.3%
20
20
Social Workers
Social Workers
1%
1%
21
21
Appropriate Level
Appropriate Level
0.8%
0.8%
22
22
Care Management Services
Care Management Services
0.8%
0.8%
23
23
Staff Members
Staff Members
0.8%
0.8%
24
24
Hipaa
Hipaa
0.8%
0.8%
25
25
Crisis Intervention
Crisis Intervention
0.7%
0.7%
26
26
Personal Care
Personal Care
0.7%
0.7%
27
27
Community Services
Community Services
0.6%
0.6%
28
28
Dementia
Dementia
0.6%
0.6%
29
29
Meaningful Relationships
Meaningful Relationships
0.5%
0.5%
30
30
Service Plans
Service Plans
0.5%
0.5%
31
31
Appropriate Referrals
Appropriate Referrals
0.4%
0.4%
32
32
Community Agencies
Community Agencies
0.4%
0.4%
33
33
Interqual
Interqual
0.4%
0.4%
34
34
IV
IV
0.3%
0.3%
35
35
Vital Signs
Vital Signs
0.3%
0.3%
36
36
Memory Care
Memory Care
0.3%
0.3%
37
37
ISP
ISP
0.3%
0.3%
38
38
ADL
ADL
0.2%
0.2%
39
39
DME
DME
0.2%
0.2%
40
40
Daily Living Activities
Daily Living Activities
0.2%
0.2%
41
41
CNA
CNA
0.2%
0.2%
42
42
Alzheimer
Alzheimer
0.2%
0.2%
43
43
Jcaho
Jcaho
0.2%
0.2%
44
44
Physical Safety
Physical Safety
0.2%
0.2%
45
45
Individual Care
Individual Care
0.2%
0.2%
46
46
Safe Environment
Safe Environment
0.1%
0.1%
47
47
Blood Pressure
Blood Pressure
0.1%
0.1%
48
48
Insurance Companies
Insurance Companies
0.1%
0.1%
49
49
Psychosocial Assessments
Psychosocial Assessments
0.1%
0.1%
50
50
Emotional Support
Emotional Support
0.1%
0.1%

46,329 Patient Care Manager Jobs

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