Zuzette Robles Email and Phone Number

Care Management is a service model whereby all of an individual's caregivers communicate and interface so that the patient's needs are addressed in a comprehensive manner. This is done primarily through a "care manager" who oversees and provides access to all of the services an individual needs to assure that they receive everything necessary to prevent hospitalizations, stay healthy, and maintain stability.The Care Manager is ultimately responsible for the overall provision and coordination of services to assigned caseload. The Care Manager guides program enrollees and their caretakers (legal guardians) through the health care system by assisting with access issues, developing relationships with service providers, and tracking interventions and outcomes.

-Assist with various aspects of the HEDIS process-Performed medical chart reviews to look for gaps in care such as missing mammograms, colon cancer screenings, diabetic screenings, etc.-Tracked open quality gaps-Coordinate with clinical staff to inform them of missing screenings and HEDIS gaps-Download patient records and upload them to insurance portals to close quality gaps.-Track inpatient and emergency room discharges and collect medical records from the corresponding healthcare facilities-Faxed release of information requests to necessary healthcare facilities-Worked with an automated system to upload records to patient charts-Kept a log of inpatient and emergency room discharges-Coordinated with clinical staff to inform them of patient hospital and emergency room utilization so proper follow-up steps can be taken by the clinic.

-Supporting provider quality review process by reviewing and maintaining clinical data. -Identifying and evaluating the highest quality care for patients.-Manage screening of clinical data sets from providers, including but not limited to verifying receipt of requested data, removing Protected Health Information (PHI) and sending data to internal and external parties.-Identifying and assisting in resolution of data processing issues.-Developing an understanding of radiology imaging data and transmission.-Becoming familiar with radiology image and medical report data and be able to triage and analyze for various project objectives. -Managing multiple projects on a daily basis.-

•Responsible for Medical Record retrieval projects; provides clerical support to the department; targets member and provider outreach. • Utilizing departmental tracking tools to request and retrieve Medical Records; transcribe, format, input, edit, retrieve, copy, and transmit text and data. • Store and retrieve files in accordance with established procedures to ensure the timely access of information and records • Distribute files as determined by project needs in accordance with the Supervisor and Team Lead. • Outreach to members and Providers via telephone or other method of correspondence to assure care needs are being met and all applicable data is received by Fidelis Care New York. • Medical Record retrieval projects; providing clerical support to the department; targets member and provider outreach. • Knowledge of various quality programs, including measures associated with QARR and HEDIS. • lead or coordinate projects within own department.

-Contacting members by phone after they have completed the Advance Care Planning process to help them understand and execute their documents.-Becoming an expert in the state-specific documents and the signature/witnessing requirements needed to execute them.-Expected to balance daily workload and work efficiently with minimal supervision to provide a quality member experience to the populations we serve.

Responsible for scheduling and meeting patients; schedule patient’s medical appointments.• Coordination Care Plans for patients and helping them follow through.• Provide outreach, enrollment, and case management services to eligible patients to includepsycho-social and functional assessment, development of a case management service/care planand self-management goals.• Conduct case conferences with patients PCP and internal and external caregivers, escort toexternal agencies and home visits as needed.• Coordinate with the lead Health Home agency and subcontractors to assure the required trackingand quality logs are submitted in a timely manner and participates in the tracking and continuousimprovement of health home services.• Provide case management services following an emergency room visit or hospitalization; follow-up with the agency to assure patients’ successful transition from hospital to home.

• Entered, updated, and reviewed account data to ensure accurate data information.• Enrolled patients who qualified for the Health Home Program.• Conducted extensive outreach to provide information about the Health Home Program topotential patients.• Provided health assessments to patients during enrollment process.• Provided home visits as needed.

• Welcome customers and determine their coffee interests and needs• Educate customers by presenting and explaining the coffee drink, menu; answering questions• Generate revenue by attracting new customers; defining new and expanded services and products• Update job knowledge by participating in educational opportunities; reading coffee, retail trade, and food service publications• Prepare and sell coffee drinks by following the preparation techniques such as latte art