Dan He Email & Phone Number

Greater New York City Area

• Regularly audits care teams’ job performance to ensure high quality, cost-effective care is consistently delivered to increase member satisfaction and improve patient outcomes.• Meet daily with care teams to review pending issues; assist and guide care managers and non-clinical staff on member-related problems, goals and interventions.• Provide support and guidance to care teams on dual eligible members, including coordination of benefits between Medicare & Medicaid to make sure members have full access to seamless high quality health care.• Works closely with the Care Management (CM) and Utilization Management (UM) teams on member requests to ensure appropriate services are provided as needed.• Manages continuity of care while ensuring safe and effective transitions for dual eligible members.• Promotes a positive and team-oriented work environment to increase job efficiency and effectiveness.• Established and managed Member Welcome team; holding staff accountable for meeting high performance goals and member satisfaction. • Developed and implemented disenrollment, UM and Notice of Action workflows. Periodically review, update and provide training as business operational processes evolve. • Interact with Quality Assurance Department on Grievances and Appeals filed, providing documentation and input so that a resolution that meets both member and plan objectives is achieved.• Collaborate effectively with other operational areas to facilitate resolution of day-to-day member and provider issues.• Involved in various projects across all plans (FIDA, MLTC, SNP & PACE) to meet organizational goals, such as ICD9 to ICD10 mapping; Electronic Health Records system upgrade and pended claims resolution.

Greater New York City Area

• Assess member’s condition to identify needs so that a comprehensive care plan with input from the member, family and providers can be developed.• Assist members to identify the goals that are most important for them to achieve and provide education and support on disease and self-management skills.• Assist members to navigate through the complexities of the healthcare system along with guidance on how to access community resources as needed.• Communicate effectively and clearly with members, family and providers to achieve defined goals.• Ensure members receive the best possible care in the most cost-effective way.• Experience working with following:o CareEnhance Clinical Management Software (CCMS)o Citrixo RightFaxo Virtual work platforms (VPN)

Greater New York City Area

• Prepared patients for examination by performing preliminary physical tests and documenting results.• Secured and maintained patient information and confidentiality by following HIPAA regulations.• Provided Antepartum and postpartum education such as:o Signs and Symptom of impending laboro Dieto Medicationso Breastfeeding.

• Provided translation services between Doctors and patients to make sure that accurate information was delivered so that the desired outcome(s) were achieved. • Followed all established operational protocols for procedural preparation along with the care and treatment of patients.

Bachelor’S Degree, Registered Nursing/Registered Nurse

Associate’S Degree, Registered Nursing/Registered Nurse

Bachelor, Business And Management