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Service Coordinator SSI Medicare Medicaid Case management

Location:
San Antonio, TX
Posted:
September 30, 2018

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Resume:

Michalia L. D. Hall LVN

*** ********* **. *** *******, TX 78233 cell: 210-***-****

ac68kl@r.postjobfree.com

Summary of Professional Experience

Creative, resourceful, flexible, able to adapt to changing priorities, maintain a positive attitude, and strong work ethic. Professional Experience

Company Superior Health Plan, Inc San Antonio, TX

Title Service Coordinator II SSI Medicare & Medicaid Case Management Timeframe January 2015 to present

Description • Behavioral Health Case management conduct Provider Attendant Service and Day Activity Health screenings to determine approval or denial of services.

• Working knowledge of utilization review procedures, adverse determinations, behavioral health community resources, and intake scheduling.

• Conduct appropriate knowledge, education, interventions, and screening for High Risk Cases

• Conduct in-home face to face member assessments to complete HRA for ICT meetings

• Document assessments and contacts, develop and approve service plans, and ensure state forms completed with turnaround time.

• Assess member’s medical, safety needs, and coordinate adverse determinations to deliver provider attendant services.

• 80% travel to remote location rural and urban environment assessing needs of members.

• Report accurate information using Excel and Microsoft office maintaining HIPAA compliance.

• Able to make referrals for crisis interventions and report suspected abuse and neglect cases to DADS, DFPS, and local authorities.

Company Adaptive Home Health Agency San Antonio, TX Title LVN Ventilation Nurse

Timeframe July 2014 to Jan 2015

Description • Field visit to Pediatrics homes for assessment

• Highly skilled to care of vent dependent adolescents

• Strong written, oral, and interpersonal communication

• Provide education related to member’s health condition and care coordination Company Girling Healthcare Agency

Title LVN

Timeframe November 2013- Jan 2014

Description • Pediatric vent ability to effectively express ideas and views for communication with pediatrics, adolescents, adult, and geriatric recipients.

• IV therapy certified

• Wound care assessment to educate staff, members, and clients. Company Access Quality Therapy San Antonio, TX

Title Assistant Case Manager Insurance Specialist LVN Timeframe November 2008 to November 2011

Description • Manage Intake by completing authorizations through Aetna, SHP, Molina, and Bravo Health

• Provided education to CNAs via Medline

• Function independently to complete orders, supplies, and lab data

• Educate staff and review work process for ICT, MDS, HEDIS, and HRAs

• Conduct in-home face to face member assessments and telephonic outreach

• Conduct follow-up contacts or in-person visits to determine if services meet member’s needs

• Assess member’s medical, safety and support service needs and coordinate the delivery of services

• Maintain case record documents and enter information in an automated system, establishing a record for each member receiving services

• Coordinate collaboration between Complex Case management and Wavier services Company Heartland Rehabilitation

Title LVN Supervisor

Timeframe June 2007 to November 2008

Description • Provided MDS education to staff

• Completed wound care training with KCI and staff

• Person centered assessments 15-25 Medicare clients

• Oversee the day-to-day quality review function, ensuring accurate and timely review of department processes to ensure compliance with applicable state, federal and accrediting body requirements

• Coordinate with management to ensure the department output is meeting goals, expectations and requirements in alignment with the quality improvement department and program description and work plans

Company United States Army Ft. Hood, TX

Title Healthcare Specialist EMT-B

Timeframe August 2000 to December 2001

Description • Complete orders given by Commanders

• Assigned to Headquarters to manage solider and expedite forms

• Triage and provided education to other Medics and wounded soldiers Education, Licensure and Credentials

Associate Psychology, St. Phillip’s Colleges, San Antonio, 2016 Licensed Vocational Nurse, State of Texas, 2005 Associate of Science, St. Phillip’s Colleges, San Antonio, 2016 EMT-B, United States Army, San Antonio, 2000 Associate Liberal Arts, St. Phillip’s Colleges, San Antonio, 2015 Certificates

Personal Centered Certificate 2017 Medical Management Process Long term Services Cert 2018 Compliance:Fraud, Waste, and Abuse Certificate 2017 Compliance Medicare Part D Certificate 2018



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