Sharon Lujan Email and Phone Number

Working in different Skilled Nursing facilities per diemAdministering medications via oral, G-tube, and injectablesMonitoring vitals, charting, knowledge of PCC system and feeding pumps.

Responsible for serving as a resource for IEHP Members and Providers for care management and care coordination.Responsible for screening Members for appropriate care management needs and documenting findings.Uses approved screening tools which contribute to the assessment (i.e. Health Risk Assessment or other designed tool).Contribute to the development and modification of the Individualized Care Plan (ICP).Acts as a Member advocate at all times.Assist and facilitate… Show more Responsible for serving as a resource for IEHP Members and Providers for care management and care coordination.Responsible for screening Members for appropriate care management needs and documenting findings.Uses approved screening tools which contribute to the assessment (i.e. Health Risk Assessment or other designed tool).Contribute to the development and modification of the Individualized Care Plan (ICP).Acts as a Member advocate at all times.Assist and facilitate referrals for IEHP Members that are eligible for carve-out programsAssist members with immediate needs with regard to access, referrals and authorizations.Facilitates referrals to resources such as LTSS, Independent Living and Diversity Services, Behavioral Health, and community resources.Model the highest ethical behavior in relationships with co-workers, supervisors, Members, Providers, and colleagues in the community.Knowledge of regulatory standards of BHCM policies and procedures.Knowledge of Medicare, CM, DHCS, DMHC and NCQAResponsible for any other duties as required to ensure successful care management processes and Member outcomes. Show less

Care Coordination for Member’s needs including doctor’s visits, specialist visits. Home Health, and DME.Knowledge of Utilization Management processes and care coordination using MedHok and CRM systems.Knowledge of Medicare, Medi-Cal, and Cal Medi Connect.Excellent written and verbal communication including interpersonal skills.Strong organizational skills.Knowledge of HRA’s.

Home health visits to patients home including vital checks, wound care, education on disease process, safety/fall precautions, and medication management.

Graduated with honors LVN Nursing Program. Clinicals done at Heritage Park Nursing Center, Inland Valley Care, Providence Nursing Home, and Pacific Grove Mental Health.

Worked with IPA’s to assure Member’s satisfaction. Process disenrollment, divorces, deceased, transportation, and interpreter requests.Answered phones and data entry.

Communicate effectively and interact with the provider groups, physicians, patients and health plans. Process requests that were approved, denied, or deferred and brought to resolution. Maintained confidentiality, followed HIPAA compliance.Knowledge of EZ-CAP software and MS office, ICD-9, CPT, LOA, Third Party Leins and HCPCS codes, medical terminology, and data entry.

Complete home care including bathing, dressing, feeding, medication management, wound care, and hospice care.

Patient liaison/ Customer Service. Verified benefits, wrote, authorized referrals, data entry, MS Word, answered multi-phone lines, participated in weekly UR meetings, third party liens, Grievance and appeals, and extensive training within the Managed Care dept.

Eligibility desk supervisor, patient liaison/ Customer Service, authorized and input outside referrals, trained new employees, HMO billing, third party liens, Grievance and Appeals, pulled, ran, and filed medical charts, and answered multi-phone lines.