Taranum Pandhi
Mississauga,Ontario
Summary
Proven Case Worker with experience over 3 years and a track record of developing holistic care strategies and reducing hospital readmissions, notably at Medi Assist. Skilled in Case Documentation and Relationship Building, Multidisciplinary approach and problem-solving abilities have consistently enhanced patient care. Achieved significant cost savings by optimizing care settings, demonstrating exceptional multitasking and interpersonal communication skills. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
6
6
years of professional experience
Work History
Case Worker
Achieva Health
01.2022 - Current
- Collaborated with multidisciplinary teams to develop holistic care strategies for complex medical cases.
- Managed 25+ assigned cases per day with adherence to general company processes.
- Maintained accurate records, ensuring compliance with regulatory requirements and facilitating seamless transitions between care providers.
- Managed approximately 30 incoming calls, emails and FAQs per day from clients.
- Monitored case progress for timely completion and compliance with applicable regulations.
- Assessed needs of each client and recommended appropriate services and resources.
- Administer and adhere to case-management protocols, including clinical monitoring, data collection, on-going patient follow-up, compliance, therapy disruption/discontinuation monitoring, adverse event reporting and liaison with primary healthcare providers;
- Implemented pharmaceutical and biotechnology related market research initiatives with physicians, patients, pharmacists or other allied health professionals;
- Participated and attended on-going refresher training and in specialized training courses for specific products or programs as deemed appropriate by manager.
- Clear communication to manager and program trained colleagues regarding management of cases during foreseen absences.
Case Invenstigator
Optum Global Solutions
04.2020 - 10.2021
- Maintained accuracy 95% and evaluated claims error free.
- Collected, analyzed and interpreted information, documentation, and physical evidence associated with investigations.
- Prevent the payment of potentially fraudulent and/or abusive claims utilizing medical expertise referring to client specific guidelines and member policies.
- Provided call-centre programs, providing support to patients, healthcare professionals, and funding bodies on issues related to funding, access, compliance programs, and special access.
- Reduced case resolution times by implementing strategic investigative approaches and leveraging technology.
- Solved numerous cases, applying innovative investigative methods and relentless pursuit.
Medical Case Worker
Medi Assist
11.2018 - 04.2020
- Collaborated with multidisciplinary teams to develop holistic care strategies for complex medical cases.
- Maintained accurate records, ensuring compliance with regulatory requirements and facilitating seamless transitions between care providers.
- Facilitated successful treatment plans by working closely with healthcare providers, patients, and families to address their needs.
- Reduced hospital readmissions by effectively managing high-risk cases and implementing preventive measures.
- Monitored patient progress throughout treatment plans, adjusting interventions or coordinating additional services as required.
- Contributed to cost savings by identifying opportunities for alternative care settings or service providers when appropriate.
- Maintained patient confidentiality in accordance with HIPAA regulations and ethical guidelines, protecting sensitive personal information at all times.
- Participated in ongoing professional development activities to maintain knowledge of current best practices related to medical case management.
- Managed 15+ complex caseloads while maintaining a high degree of organization and attention to detail, ensuring consistent delivery of high-quality care.
- Organized clinical documentation, treatment plans, and referrals.
Education
Bachelor of Science - Health Sciences
Amity University
IndiaPG Diploma -
Conestoga College
OntarioPG Diploma -
Mohawk College
CanadaSkills
- Case Documentation
- Problem-Solving
- Administrative Management
- Attention to Detail
- Time Management
- Teamwork and Collaboration
- Interpersonal Communication
- Multitasking Abilities
- Problem-solving abilities
- Customer Service
- Customer Relations
- Call center experience
- Conflict Resolution
- MS Office
- Referral Coordination
Timeline
Case Worker
Achieva Health
01.2022 - Current
Case Invenstigator
Optum Global Solutions
04.2020 - 10.2021
Medical Case Worker
Medi Assist
11.2018 - 04.2020
Bachelor of Science - Health Sciences
Amity University
PG Diploma -
Conestoga College
PG Diploma -
Mohawk College
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