Health Care Quality Manager of the Central region.

Independent Consultant

Personal Health Coach, TelephonicDesignated as SME (Subject Matter Expert) for excellent management of members and meeting / exceeding call metrics with quality daily. Provided coverage for other teammates while out of office. As lead SME for team prioritize calls based on need and distribute calls to others as needed. ● Built quality within team and met daily metrics with appointment to Team Lead by assisting direct manager with staff needs, training new staff, coverage for staff, and policy clarification. ● Improved member health and wellness by providing personal one-on-one telephonic care management to 700 members educating, guiding, and supporting members in managing chronic health conditions, and developing self-management techniques. ● Increased quality of life by providing educational information and treatment options, assisting on setting health goals, and connecting members with community resources.● Enhanced overall health by assisting members with using motivational interviewing skills for setting attainable health care goals and developing care plan for meeting goals.● Enriched member overall well-being and health management, reduced time in hospital, and increased days spent at home by coordinating and collaborating services with interdisciplinary team to identify gaps in care and health goals. ● Acted as member advocate and resolved billing and cost of service issues by providing support to members with concerns in regards to benefits, prescription assistance and overall healthcare needs. ● Attained compliance by completing appropriate case management notes in tracking system that Humana used and met Center for Medicare & Medicaid Services (CMS) guidelines. ● Recognized with STAR Award for providing excellent quality service to members.● Met CMS established HEDIS and STARS Requirements by encouraging and assisting members with scheduling preventative health screenings and annual blood work.

MALACHI, INC., Middletown, OH Quality Assurance Coordinator 2010 – 2013Completed enrollment assessment of youth ages 16-21, identified barrier and established individual serviced plan to assist youth in becoming self-sufficient. ● Ensured compliance with Workforce Investment Act (WIA) Case Management and monitored goal attainment by reviewing files, identifying gaps in care, and appropriate documentation ● Enhanced accuracy by maintaining ACCESS Database and State monitoring systems reviewing and verifying accurate information for use in grant reports completed and submitted to local county. Improved youth in meeting goals by providing youth services required by Service Plan, interviewing, establishing appropriate services, and enrolling youth for identifying barriers, developing plans for assisting youth in becoming self-sufficient, completing education, and attaining gainful employment.Program Coordinator / Community Relations Liaison 2002 – 2010Planned, directed, or coordinated activities of social service program or community outreach organization. Established and maintained relationships with other agencies and organizations in community to meet community needs.Increased capacity of MALACHI and enhanced public image by developing printed materials highlighting agency goals and accomplishments, planning and implementing fundraising activities. Sustained and continued funding to support agency mission, vision, and youth services in community by assisting Executive Director in writing grant requests.Side-By-Side Mentoring Program Director Oversaw program or organization's budget and policies on participant involvement, program requirements, and benefits. Assisted in the development of the mentor training manual, identified appropriate mentee matches and monitored mentor-mentee relationships. Evaluated and trained staff and volunteer work to meet appropriate quality and resources are used effectively.