Melissa Green Email and Phone Number

Through the use of care management tools and information/data review, conducts comprehensive evaluation of member’s needs/ eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/ services. Determines high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.Coordinates and implements assigned care plan activities and monitors care plan progress.Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.Identifies and escalates quality of care issues through established channels.Demonstrates negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.Provides coaching, information and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.Helps member actively and knowledgably participate with their provider in healthcare decision-making.Implements case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Worked closely collaborating with community providers such as Hospice, Palliative Care, Mobile Providers, and multiple physician groups to ensure members were offered a holistic team approach to their care. Daily provided initial assessments, post-hospital assessments, and reassessments to a mixed caseload of 80 members residing at private homes, Assisted Living Homes, Assisted Living Facilities, Behavioral facilities, and Skilled Nursing Facilities.Worked closely on a daily basis with members who have behavioral health diagnoses and assisted with creating a behavioral health care plan.Oversaw, designed, and implemented individual service plans for 80 members in order to ensure adequate services based on the members strengths and needs. Ensured the services members received were appropriate and cost effective. Referred members to the Ombudsman, Public Fiduciary, Guardianship, Crisis Team, and APS as the need arose. Gathered and provided resources on choosing Primary Care Providers for caseload of 80 members while also acting as a facilitator and advocate for members facing difficulties with primary care providers.Comprehensively assessed functioning of members and ensured members were provided with necessary durable medical equipment.Implemented and facilitated development of community resources, referrals, and authorizations to ensure adequate care for members with varied backgrounds and socioeconomic status.Timely assisted with changing or canceling medical appointments, scheduling interpreter services, and arranging transportation. Clearly explained to members their right and responsibilities, regulations, and the grievance and appeal process related to AHCCCS, Medicare, and private health insurance.

Position Purpose: Responsible for members gaining access to needed services through coordination and integration of medical and long term care services for the purpose of orientation, care plan development, assessment, and care coordination.•Complete assessments with member/caregiver/provider to obtain information regarding client status, support system, and need for services for care plan development•Monitor delivery of services and follow-up with members/caregivers/providers through member face to face•Authorize and coordinate referral for services•Ensure provider services are delivered without gaps and identifies functional deficiencies in plans of care•Assist in coordinating the development of informal or voluntary services to integrate into the member care plan•Collaborate with discharge planners, physicians, and other parties to ensure appropriate discharge plan, care plan, and coordination of acute care and long term care services.•Assists member with filing and resolution complaints and appeals

• Actively functioned as a member of a multidisciplinary collaborative care team including nurse practitioners, registered nurses, certified nursing assistants, medical directors, activities personnel, therapists, dietitians, and pharmacists.• Developed and implemented individual plans of care and appropriate interventions including home health, durable medical equipment, community program referrals, counseling services, hospice, and palliative care.• Identified risk factors by conducting initial and ongoing psychosocial assessments. • Developed, reviewed and revised Individual Plans of Care focused on disease management with input from collaborative care team, primary care provider and specialists, and family members. • Functioned as an advocate for patients and family members while assisting with both educational and motivational interviewing in order to decrease hospitalizations and hospital readmissions.• Collaborated with the patient’s primary care physician to deliver and coordinate necessary services.• Successfully managed the “Connect 4 Healthcare” pilot program.• Initiated and completed discharge planning for patients including palliative care, hospice, home health, durable medical equipment, skilled nursing facility rehabilitation placement, and funeral coordination.• Assisted with informing individuals of resources and programs both on state and federal levels including Medicare, Medicaid, and the AHCCCS Long Term Care Program within Arizona.