Maria Devisme Email & Phone Number

United States

Tampa, Florida

Achievements-*Grew and developed a team of 20 case managers to support member Long Term Care services* Acted as interim manager for 6 months*Created departmental team training that included: Sensitivity Training, Emergency Preparedness, Cross-*Established Molina’s Long Term Care Member Enrollment Verification process. This included validation of member data received from the State file. The process ensured accurate case load assignments, cost effective staff assignments and ability to create long term relationships between the health plan, provider and member*Designed Molina’s Case Transfer Process. Ensured efficient and cohesive transfer of all details related to member’s services*Instituted monthly authorization renewal process allowing authorizations to be proactively updated, avoiding missed services or claim issues*Facilitated monthly meetings with internal teams (Provider Services, Provider Contracting, and Claims) to review best performing providers and discuss the need for any new services/providers.*Created departmental monthly analytical reports to be used by the team to monitor services, over utilization, cost effectiveness of services and complex authorizations that may impact claims,Responsibilities-*Continually meet with processors responsible for interpreting and adding authorizations into the system, review questions, concerns and best and consistent practices*Monitored staffs job assignments to ensure they did not exceed state requirements*Coach and mentor team members as a team and individually*Completed audits internally and state required*Utilized community resources prior to spending company dollars for services*Identified trends and developed processes for quality improvement based on audit results*Ability to understand and operationalize provider contracts*Promote staff to work collaboratively with internal and external partners*Served as departmental resource to assist with clinical issues for guidance

Plant City Florida

Achievements-*Recruited prestigious primary care physician group of 5 physicians to service nursing home membersResponsibilities-*Completed evaluations of possible residents into the skilled nursing facility*Created a referral network to include: hospitals, assisted livings, physicians and community agencies*Completed medication, financial and background checks for admissions*Coordinated with insurance companies the coverage of services needed*Participated in community events to market services provide by facility*Member of the Agency Area on Aging Task Group & Plant City Chamber of Commerce*Reviewed Clinical Information to assess needs of resident and appropriateness for admission

Achievements-*Introduced Meals on Wheel relationship to nursing home to assist with transition of members back homeResponsibilities-*Completed evaluations of possible residents into the skilled nursing facility*Created a referral network to include: hospitals, assisted livings, physicians and community agencies*Completed medication, financial and background checks for admissions*Coordinated with insurance companies the coverage of services needed*Organized training for outside staff*Participated in community events to market services provide by facility*Member of Continuity of Care & Plainfield Chamber of commerce*Supervised admissions coordinator*Delivered Meals on Wheels to seniors in the community*Reviewed Clinical Information to assess needs of resident and appropriateness for admission

Responsibilities-*Assessed patients and family needs for discharge*Reviewed medical needs and established an understanding of clinical information to plan appropriate discharge plans*Coordinated services (i.e. medical supplies/equipment, home health services, hospice care, nursing home placement, assisted living, follow-up care, transportation)*Identified needs in collaboration with interdisciplinary team*Worked with insurance companies including: Medicare, Medicaid, commercial and managed care*Assisted patients/family with applying for benefits as needed*Population served was predominantly low income*Participated in patient rounds and family meetings*Served as a member of the Task Advisory Group, Patient/Family Education Committee, Continuum of Care Committee*Participated in pilot program for utilization management*Clinical understanding specializing in Wound Care, Oncology, Dialysis and HIV/AIDs