Geminesse Williams Email & Phone Number

This position is responsible for the coordination and oversight of Clinical projects in the Clincal Department. The Sr. Clinical Project Coordinator assumes the role of internal expert for assigned projects and communicates with interdepartmental staff and external contacts to monitor the progress of various assignments, determine that requirements are met to conclude projects at stated deadlines. Additionally, this position is responsible for developing and implementing data collection and tracking tools for quality improvement projects and data analysis projects. This position is also responsible for compiling data and providing analysis reports, auditing the data integrity of department projects and making recommendations for changes or improvements. SPECIFIC DUTIES:•Assist with the development and implementation of data collection and tracking tools for Clinical Department projects•Compiles and performs in-depth analysis of data collections•Audits and monitors the effectiveness of tools created to maintain compliance standards and makes recommendations for tool improvements as needed to the Sr. Director of Utilization Management and Clinical Informatics•Assists in supporting the UM/CM Acuity System •Assists with the preparation of various in-service programs, orientation, and training of department staff and contract staff on the use of department specific databases.•Participates and supports various committee meetings, Utilization Management Committee, Clinical Operations, and UR Taskforce•Updates leadership staff to status of activities related to assigned projects.•Serves as a technical resource for the Clinical Department staff.•Assists with the design of power point departmental presentations.•Participates in the review of demo CM/UR software designed to collect, monitor and evaluate the effectiveness of CM/UR operational activities. •Assists in ensuring that the UM/Case Management Assistant Staff comply with quality assurance standards.

Tarrytown, New York

This position is responsible for interacting with health care professionals, under the guidance of a Case Manager, to supply authorizations for designated medically necessary services and to identify through established criteria, members who may be candidates for case management intervention. Additionally, this position provides telephonic outreach to members to ensure that coordinated health care services are in place and that the patient’s established health care needs are being met. This position also strongly supports the utilization management and case management programs by assisting with all case management clerical functions that include case tracking, record keeping, the coordination of special member mailings, and the generation of department reports. The prompt answering of the ACD line to provide high quality service is also required.Specific Duties:•Interacts (under guidance of a Nurse Case Manager), with Providers and other health care professionals to provide computer generated authorizations for designated medically necessary services.•Recieves requests via ACD call center•Provides telephonic patient outreach to ensure that coordinated health care services have been appropriately implemented and that the patient’s needs are being met •Prepares daily reports and maintain department-reporting database•Participates in the completion of projects as required•Assists with the identification of high-risk patients, through the use of established criteria, who may require case management intervention or special assistance•Assists healthcare professionals track non-compliant members in need of preventative services•Provides anticipatory guidance to families enrolled in special case management programs •Participates in all special patient outreach projects •Provides language assistance when necessary (Spanish translation)•Ensures regulatory timeframes are maintained for service requests, appeals and denials