Martinez Evans Email & Phone Number

Durham, North Carolina, United States

Make direct outreach contact to targeted members utilizing effective engagement strategies and motivational interviewing techniques. Utilize soft sales techniques to respectfully encourage members to engage in Case Management services. Coach, educate and guide members in case management and health program participation. Identify trends based on forecasted information in order to achieve optimum Fulfillment accuracy, efficiency and customer satisfaction. Act as the first level of escalation for more complex and urgent inquiries from providers or members.

Durham, Nc

Coordinates the planning and implementation of the time line for credentialing activities which includes the initial credentialing and re-credentialing of all professional, facility and ancillary providers, and verification of communication with external agencies. Thoroughly examine applications and supporting documentation prior to the review by the Credentialing Committee. Focus on business process analysis, design and optimization of the credentialing process. Work closely with each all levels of management to ensure that all commitments and departmental expectations are met or exceeded.

Durham, Nc

Coordinated the process of integrating review and case management of services. Optimized the appropriate placement of patients to receive accurate services and supplies. Collected, stored and retrieved patient data. Maintained and ordered medical records. Conducted physician interviews to elicit clinical information. Designed, implemented and measured Workflow processes. Served as the sole facilitator of Provider-Link to the entire department. Served as Lead Auditor for identifying errors and generating correction requests on the Department's main database.

Durham, Nc

Processed admission notifications based on corporate medical policy. Determined medical necessity for hospitalization. Reviewed and processed the Prior Plan requests made by healthcare providers. Maintained and updated member information on the company database.

Master In Health Administration, Health/Health Care Administration/Management

Bachelor Of Science (Bs), Public Health Education And Promotion

Activities and Societies: Community Health