Care Coordinator - Aetna CVS
(2024-03)
- Evaluation of Members: -Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Enhancement of Medical Appropriateness and Quality of Care: - Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Identifies and escalates quality of care issues through established channels.
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the member's benefits and/or healthcare needs.
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.
- Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- Monitoring, Evaluation and Documentation of Care: - Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.
Administrative Assistant - Fresenius Medical Care, Austell, GA - Austell, GA
(2018-07)
- Assist in auditing medical records compliance standards.
- Maintain accurate hospital records via EPIC.
- Maintain patient admissions and travel data.
- Perform patient intake.
- Assist Social Worker with conducting Surveys, assessments, and referrals.
- Provide a broad range of administrative support to management, staff, and patients.
- Greet patients and guests while maintaining confidentiality.
- Administrative duties, include screening telephone calls, opening mail, scheduling appointments, maintaining the monthly calendar; and coordinating meetings (internal/external).
- Monitor and assist with payroll and work schedules.
- Ensure weekly completion of data entry for Crown Web
Patient Intake Coordinator - Fresenius Medical Care, Kennesaw, GA - Kennesaw, GA
(2016-05 - 2018-07)
- I interviewed referral sources, patients, and/or patient's representatives to obtain personal and financial data eligible for admissions.
- Coordinated patient referral requests.
- Coordinated patient admission process to establish placement at the appropriate facilities according to vacancies.
- Verified demographic(s), medical records, insurance, and registration information in accordance with established policies and procedures.
- Facilitated patient appointment schedules, cancellations, and approval data for admissions.
