Case Management - PNW OR Region

Case Management IP, ED and Ambulatory

• Lower ED (emergency dept.) usage by contacting Members and explaining how the Kaiser system works for them.• Determine if members should be receiving their care at KP, if not re-direct them to the correct contact.• Communicated consistently with team members of the ENCC and New Member Navigator regarding issues with KP member. • Verified Medicaid eligibility for our KP members, updated any inconsistencies such as demographics. • Reviewed and explained insurance benefits, Preventative Care Services and ADDM through KP.• Assisted and guided patients’ using the Kaiser system, along with directing them to the community resources, refer members to their different OR Medicaid dental and Mental health benefits.• Refer members with special need to Exceptional Needs Coordination Team• Project Management: PR&C Molina Medicaid, IET Addiction Medicine, High Utilizers

• Safety Committee Representative. Encourage safety awareness at Sunset Medical Office. • Communicated consistently and proactively with team members of the front desk regarding safety concerns or issues. • Addressed and communicated safety concerns during the safety committee meeting to find resolutions.• Promote safety by integrating workplace safety LMP to prevent injuries and reduce accidents• Verified, updated any inconsistencies when registering patients’ for their medical office appointment. • Collected revenue such as copayments, and partial payments on accounts• Reviewed and explained insurance benefits• Kept exceptional communication skills between, front office and back office• Created and Collected STATs for Sunset Medical Office and reported out to my supervisor• Assisted and guided patients’ using the kiosk, along with directing them to the correct module or clinic

Alternative healing modalities

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• Created an informational data entry spreadsheet for all providers’ daily intake, and reported out to the CFO.• Translated documents for our Spanish speaking patients.• Communicated changes of provider’s schedules to the phone operations, triage nurses and clinical assistants.• Prescreened patients by obtaining medical records• Verified, updated any inconsistencies when registering patients’ for their medical office appointment. • Collected revenue such as copayments, and partial payments on accounts• Reviewed and explained insurance benefits• Composed correspondence on behalf of medical staff.• Operated a telephone intake system, with a multi-line messaging system.

• Analyzed weaknesses and opportunities in a given department to determine ways to increase revenue.• Trained new team members within department by coaching, overseeing work activity, & teaming new employees with seasoned employees for training purposes.• Decreased overhead inventory by 30% the first month, continue to do so through the year.• Increased profit by $55,000 revenue sales within 3 month of decreased overhead inventory• Maintained profitability through report analysis, identifying trends, defining problems, and developing appropriate responses.• Created and implemented new system to drop SHRINK (theft) in our department by targeting items of greater value. • Assessed areas of need, organize tasks, and send projects to employees daily• Encourage and promoted VOC – Voice of the Customer 2011- Addressing concerns, “Going the extra mile”.• Managed associates’ performance through communication of goals, documentation and evaluating their performance.• Participate in weekly, monthly and quarterly meetings with Store Manager, Assistant Managers and other department supervisors

• Managed a strong cooperative relationship both internally with co-worker and externally with multiple community partners and other state agencies to achieve self-sufficiency for the client receiving benefits from the state. Case load of 350 clients.• Analyzed, developed, and executed self-sufficiency plans for each individual client, which included training, counseling, and education• As a front desk receptionist I coordinated the intake board & set up appointments for the family resource managers in the branch.• Administrative support for family resource managers. • Issued EBT cards, checks and bus passes • Sorted, prioritized a high volume of paperwork, phone calls, and heavy public contact.• Interviewed prospect for new positions

• Hispanic Liaison for the Springfield Community; represented the company at Chamber of Commerce and Latino Business Network meetings.• Effectively carry out multi-task and met deadlines. • Maintained cooperative working relationships both internally and externally with clients and businesses.• Marketed and developed strategic ways to promote the importance of State Farm Insurance in the Hispanic Community.• Cash handling, reconciled all bank transactions daily• Sorted, prioritized a high volume of paperwork, phone calls, and heavy public contact.

• Marketed, and advertised for small family businesses i.e. daycare, restaurants, cleaning services, churches• Created unique brand names by designing logos, websites, flyers, business cards• Web development and maintenance of websites for Non-Profit Organizations• Volunteer occasionally with other Graphic Design business.• Worked with editorial, product marketing, social and creative teams

• Managed and monitored 3 different computer labs on campus with PC and Apple computers.• Helped students and faculty with software and printer issues.• Fixed and troubleshoot computers and printers when required• Secured equipment rental i.e. drawing tablets and mouse for apple equipment