Medical Management

MARILYN VARGAS

** ****** **., *******, ** ***** Telephone (C) 203-***-****

OBJECTIVE:

To obtain an administrative position where I can employ my educational background,

networking knowledge, skills and work experiences in which I can expand both

professionally and personally.

EDUCATION:

5/92 - 3/93 Career Advancement Program, NYS

Clerk/Typist Curriculum - Graduate

6/90 - 5/92 Baruch College, NYS

Business Mayor

EMPLOYMENT HISTORY:

4/08 to Present Aetna-Patient Management Care Management Associate

• Work closely with individual nurses to maintain availability of

work. Keeps a running log of cases created for each plan sponsor

and nurse.

• Care Management Intake

• Responsible for initial review and triage of Care Team tasks

• Identifies principle reason for admission, facility, and member product

to correctly apply intervention assessment tools I

• Screens patients using targeted intervention business rules and

processes to identify needed medical services, make appropriate

referrals to medical services staff and coordinate the required services

in accordance with the benefit plan

• Monitors non-targeted cases for entry of appropriate discharge

date and disposition

• Identifies and refers outlier cases (e.g., Length of Stay) to

clinical staff

• Identifies triggers for referral into Aetna's Case Management,

Disease Management, Mixed Services, and other Specialty Programs

• Utilizes eTUMS and other Aetna systems to build, research and

enter member information, as needed

• Support the Development and Implementation of Care Plans

• Coordinates and arranges for health care service delivery under

the direction of nurse or medical director in the most appropriate setting

at the most appropriate expense by identifying opportunities for the

patient to utilize participating providers and services

• Promotes communication, both internally and externally to enhance

effectiveness of medical management services (e.g.,health care

providers, and health care team members respectively)

• Performs non-medical research pertinent to the establishment,

maintenance and closure of open cases

• Provides support services to team members by answering telephone

calls, taking messages, researching information and assisting in solving

problems

05/05 to 04/08 Aetna-Disease Management/Care Management Associate

• Assist the RN’s and LPN’s in the development of effective

and efficient care coordination and self care of members

• Responsible for making outreach calls to members for

program

• Call Intake, initial review if tasks and other administrative

type activities that support the unit

• Bilingual/interpreter

• Subject matter expert for handling of CMA assignments

12/03 to 05/05 Aetna - Credentialing Department

•Review practitioners applications for completeness and collect

data within defined timeframes

•Review and document findings of practitioners performance and

credentials

•Prepare investigative summaries for peer review and prepare

final committee-ready credentialing provider files for clients

•Adhere to strict confidentiality guidelines and Code of Conduct

standards

•Conform to defined processes in compliance with quality

standards and regulatory requirements

7/01 to 10/01 Community Health Center, OB/GYN Clinic

Medical Receptionist

•Provide interpretation services for physicians and patients.

•Special assignments as necessary for supporting staff which

consists of nurses, social workers and physicians.

•Schedule appointments for patients.

•Review insurance data and assure compliance of the same for

patients.

4/00 to 7/01 Mid State Medical Center, OB/GYN Clinic

Clinical Information Associate

•Daily contact with incoming patients.

•Registration and discharge of new patients.

•Communication with ancillary departments such as Radiology

and Laboratory to schedule appointments for patients and

request medical records.

•Telephone follow-up with patients regarding incoming test

results.

•Bilingual translator/interpreter for other departments such as

Mediquick, Infectious Disease and Diabetes Center.

•Special assignments as necessary for supporting staff which

consists of nurses, social workers and physicians.

•Responsible for data input of HealthyStart program.

•Prepare monthly reports and statistics.

•Daily use of SMS and Patient Record Repository.

4/97 to 4/00 RM Services – Yankee Gas, Meriden, CT

Account Associate II, Credit & Collection Serv. Dept.

•Bilingual representative for department.

•Received inbound and made outbound calls to customers regarding

residential and commercial accounts.

•Setup new accounts and close-out terminated accounts.

•Verification and process of check and credit card payments.

•Determine payment arrangements and referrals to state agencies such as

CAMM and Casa Boricua.

•Process gas leak and meter issue reports.

4/94 - 9/94 WestVaco Corp, NY

Secretary - Human Resources/Benefits/Compensation

•Responsible for typing of all correspondence for three Benefits

Assistants.

•Screened calls, handled benefits forms, filing, ordering supplies and

processing all personnel action forms.

11/93 - 2/94 General Instruments, Co., PR

Bilingual Secretary - Human Resource Dept.

•Position consisted of data entry, switchboard, greeting visitors, keeping

logs of all department expenses and purchase orders.

•Interviewed new employees, prepared time cards and photo Ids for new

hire’s and distributed the same.

SKILLS:

•Bilingual - Fluent in both English and Spanish

•Computer - Microsoft Windows, Rumba, Microsoft Excel, FSMB, CAQH,M-table

•e-Tums,ATV and ASD

Contact this candidate