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Case Manager

Location:
Revere, MA
Salary:
65,000
Posted:
February 25, 2020

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Resume:

Grace Gomez

** ******* ****** ******, **

adbzlq@r.postjobfree.com

617-***-****

LinkedIn: www.linkedin.com/in/gracegomez11

EDUCATION

M.S. in Human Services/Concentration in Leadership

Northeastern University - Boston, MA 2015 - 2017

B.A. in Political Science/ Minor in Latin American and Latino Studies

College of the Holy Cross - Worcester, MA 2007 - 2011

WORK EXPERIENCE

Patient Support Specialist

Vertex Pharmaceuticals – Boston, MA 2019 – 2019

·Provide extraordinary service and build meaningful connections with patients and external partners.

·Solve problems with urgency to help patients/caregivers gain access to therapy and maintain adherence.

·Partner with reimbursement vendors to obtain information needed for reimbursement.

·Support compliance through product education.

·Use reimbursement knowledge to counsel patient/caregiver on options and assess financial assistance eligibility.

·Demonstrate adaptability and flexibility to seek out opportunities to support your teammates.

·Navigate CRM system with ease and rapidly learn internal team processes.

·Maintain confidentiality of patient health information and act in compliance with all laws, regulations and Vertex Company policies.

Team Lead - Case Management Associate

Boston Children's Hospital - Boston, MA 2014 –2019

· Supervise and lead a group of seven Case Management Associates.

·In conjunction with nurse case managers, communicate and coordinate with multidisciplinary team members around specific needs to implement patient and family-centered discharge plans.

·Initiate, process, and finalize referrals for discharge planning including, but not limited to, rehabilitation and psychiatric placement, skilled and private duty nursing, infusion and enteral therapy services, respiratory services, home equipment and supplies, and transportation when needed for pre-and post-discharge needs.

· Communicate with patients and/or family members as necessary to assist with collecting information to provide information and/or literature related to on community resources.

· Develop relations as needed with relevant clinical groups (both inpatient and outpatient) and act as a liaison to facilitate discharge coordination needs and activities.

· Review and compute clinical information into the hospital’s electronic medical record system.

· Collaborate with insurances to obtain information about benefits, prior authorizations, and medication overrides and appeals.

· Coordinate special projects as needed by the case management department and clinical teams in the hospital.

Practice Assistant II

Brigham and Women's Hospital - Boston, MA 2012 - 2014

·Answer phone calls from patients regarding scheduling and billing inquiries and conduct necessary follow up.

·Manage the schedule for twenty doctors in the group practice.

·Coordinate with other medical offices regarding requests for medical records and patient information.

·Verify health insurance coverage prior to the appointment.

·Work closely with group triage nurses and doctors to schedule appointments.

·Request slides, medical records and pathology reports as required and process appropriately upon arrival.

·Entering billing codes and information into Partners’ data base.

·Schedule appointments in other clinics and imaging centers as needed.

·Reschedule patients when doctors cancelled clinic sessions.

Constituent Services Intern

Office of Governor Deval L. Patrick, Boston, MA

2010 - 2010

·Represented Governor Deval Patrick by speaking to constituents and relaying his policies, such as budgetary decisions and legislative changes.

·Served as a liaison between the Governor’s office, constituents, and other government offices by providing information to help constituents better understand state offices and resources.

·Prepared response letters and recognition certificates for the staff’s review.

Human Resources Assistant

Goodwin Procter LLP - Boston, MA 2006 – 2008

·Helped to identify and assess qualified applicants by reviewing job descriptions, developing and implementing recruitment strategies, drafting recruitment materials, creating and submitting postings.

·Prepared personnel files for new, temporary, and outgoing employees.

·Assisted trainers/consultants by setting up training room, equipment, and other supplies needed to conduct training.

·Helped in the preparation and execution of new hire orientation.

·Assisted employees with PowerPoint and Excel projects.

SKILLS

·Fluent in Spanish

·Microsoft Word, Outlook, Excel, and Powerpoint

·Epic

·Powerchart (Cerner)



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