Julie Wiley-Castillo

Results oriented professional with 20 years of experience in the insurance and healthcare industry. Proven ability to motivate and lead team members with managing and implement state compliance projects. NCQA audit reviews.

Key strengths: problem solving and customer service and support. Case management/ care coordination of IL Waiver population. Successfully acquired Licensure and certification as a Direct Child Welfare Worker from IL DCFS/ Foster Family Homes.

Certified Care

Coordinator- IL Department on Agin. Provide client resources on managing chronic conditions

Case Manager-Traumatic Brain Injury Waiver - Aabcor, Inc. - Westmont, IL

(2025-09)

• Develop Person-Centered Care Plans
• Review comprehensive assessments
• Monthly telephonic outreach to provide advocacy and support
• Act as a liaison between patients, families and caregivers to ensure services are meeting the needs of members.

Care Coordinator 3 - Senior Services Associates - Aurora IL

(2025-03 - 2025-09)

• Conduct in-home needs assessments for eligibility of support services
• Developed individualized person-centered Plans of Care.
• Referred clients to internal and external/ community resources.
• Managed annual eligibility reviews for Medicaid, SNAP, and other programs.
• Assisted with benefits applications to ensure access to services.
• Conduct monthly in-service trainings. Submit monthly billing for approved services.

Case Management Coordinator - Aetna Better Health (IL)

(2022-12 - 2025-01)

• Complete Initial/Annual Health Risk Assessments and Develop Care Plans for IL Waiver Programs
• Conduct in-home visits, set up waiver services, provider and community services
• Approve authorizations for approved in home, transportation and medical services.
• Collaborate with Community Care programs, IL Dept. on Aging, and IL DRS to ensure eligibility of Home and Community Based Services.

Program Specialist 1 / Service Coordinator II - Children with Special Needs (SNC Team) - Centene Corporation

(2011-03 - 2021-09)

• Manage an active caseload of 75 to 100 members within the Northern Illinois counties and regions.
• Administer Initial/Annual Health Risk Assessments and Develop Care Plans for medium and high acuity members.
• Discharge Planning and Post Hospitalization review to minimize repeat utilization of inpatient hospitalizations.
• Conduct Inter-Disciplinary Care Team (IDCT) presentations to foster an increased understanding of successful care coordination from a team-based approach.
• Monthly medication review with members.

Contract Implementation Analyst - Centene Corporation

(2011-03 - 2021-09)

• Manage health plan workflow for timely and accurate submission and implementation of provider contracts utilizing IL HFS and MEDI websites.
• Research claims and provider contract issues to determine root cause of systems/payment limitations.
• Ensure timely configuration of identified claims and provider set-up issues.
• Submit systems change requests to correct contracting, pricing, and benefit changes.

Program Coordinator, Core ICT Team - Centene Corporation

(2011-03 - 2021-09)

• Assist members with completing health risk screening. Educate members on HEDIS measurements. Send Krames educational materials. Maintain integrity of Protected Health Information (PHI).
• Verify member eligibility and benefits, assign primary care physicians, provide informational resources on community-based programs and organizations.
• Initiate authorization requests for inpatient and outpatient services, update member discharge planning notes, send inpatient notification correspondence.
• Preceptor trainer/mentor for newly hired Program Coordinators.
• Participate in special team projects to promote quality improvement of care coordination.

Member and Provider Services Representative II - Centene Corporation

(2011-03 - 2021-09)

• Assist IL Managed Care Health Plan Recipients with the coordination of medical benefits and eligibility.
• Review and resolve medical claims inquiries, pharmacy review status.
• Utilize state MEDI database to verify member health plan eligibility.
• Support medical practitioners with health benefits information and credentialing status.
• Initiate and submit requests for Appeals and Grievances.

Licensing Representative-Foster Care - Lutheran Child and Family Services - Joliet IL

(2022-08 - 2022-12)

• Recruit, assess, and licensure of prospective foster care family applicants in accordance with DCFS Rule 402.
• Assess family home environment, financial readiness, family relationships of prospective foster families.
• Educate foster families on CARC responsibilities. Ensure safety and welfare of children placed in Foster Care Homes.
• Complete written home study /documentation for licensure.
• Maintain licensing files/ Foster Parent Records for annual compliance visits.
• Maintain communication with DCFS licensing office on licensing process, procedural updates and compliance regulations.
• Assist DCFS Case Managers with locating emergency shelter for foster children.
• Attend DCFS Licensing training sessions.
• Coordinating and document training activities for foster parents.

B.S. - Criminal Justice Sciences - Illinois State University

Graduate Certification - Public Services - DePaul University