Case Management Service Coordinator
Resume:
Relevant Experience:
Brings ** years of experience in field and community-based support to pediatric and young adult patient populations in the Dallas and Ft. Worth area as a Service Coordinator
Experience with several Texas Waiver programs:
oMDCP, YES, CBA, HCBS Program
oCLASS, STAR, STAR PLUS, DBMD
oTexas Home Living
Knowledge
Business Application Systems- Dashboards, Job-aids, Desktops, SOP’s, Sharepoint
Dynamo- (Service Coordination System)- Access demographic, enrollment information, rate codes, PHI, Case Management documentation, Authorizations, service dates and service plans
Outlook (email, calendars and work schedule), QNXT (Utilization Management, Member Services, Claims system)
TMHP Portal- Tx Medicaid Health Plan, CareUnify, Contact Sharing Data- in Salesforce
Recent training: Analytics and Behavior Change: Pharmacy Data Introduction, Prescription drug Benefit Manuel PDBM, Disease Management - Diabetes
Skills
Oral and written communication skills
Organizational skills
Outreach and Enrollment
Screenings and Assessments
Manage multiple priorities
Attention to details
Multi-task to accomplish workload efficiently
Navigate systems efficiently
Administer Comprehensive Assessment Tools
Effective decision-making skills for problem-solving
Service Planning and Interventions
Proficient in Microsoft Office, Word, Excel, Outlook
Professional Experience:
Aetna Better Healthcare, Arlington, TX
October 2016 to present
Analyst, Case Management
Provide STAR Kids Members ages 0- 21 years old with a member-centric, collaborative process that is designated to assess, plan, facilitate and advocate health needs through communication, education, and motivation
Develop internal and external relationships that promote ongoing assistance by identifying, obtaining, coordinating, and using Covered Services and other supports to enhance the Member's well-being
Conduct comprehensive screening and assessments; educate member with information about the purpose and goals of the program to maximize health outcomes
Manage multiple priorities including creating and monitoring Individual Service Plans (ISP’S) to covered and uncovered services, including acute care services, while assisting member in carrying out personal goals listed in service plan, and service authorizations in QNXT
Conduct member engagement through annual face to face visits and quarterly telephone contacts to meet contract term of the program
Document in member files, upload confidential health information in a timely manner
Dallas Behavioral Healthcare Hospital, Desoto, TX
April 2016 to August 2016
Utilization Review Case Manager
Reviewed medical records of children and adolescent patients who are under treatment for emotional or mental illness to ensure proper utilization of treatment resources
Reviewed patients’ records for internal auditing for proper case documentation, and medical compliance
Advocated for required patient treatment with behavior health providers such North Star, Cenpatico and Commercial Insurances such as Blue Cross Blue Shield, United Healthcare and Aetna
Collaborated with the Department of Family and Protective Services regarding case allegations
Performed various administrative duties to input patient information and authorization request into database
Dallas Metro Care Services, Dallas, TX
May 2015 to September 2015
Enrollment Service Coordinator, Texas Home Living (TxHmL) Program
Provided essential services and supports to individuals with intellectual disabilities and assist with maintaining their independence and quality of care
Provided Behavioral and Community Support services
Assisted clients with the enrollment process and coordinating a service plan that best supports a quality of life
Maintained accurate documentation and completed in a timely manner
Denton County MHMR Center, Denton, TX
September 2011 to May 2015
*Transitioned between roles listed below based on employer needs
Service Coordinator, Texas Home Living (TxHmL) Program
Developed and coordinated client’s plan of care according to service needs
Maintained positive relationships with individuals, service providers and other community partners
Educated new clients with program components and provide telephonic support
Completed documentation and maintained compliance on all assigned clients
Care Coordinator, Home and Community-Based
Coordinated a system of care to ensure client safety, health, and continuity
Monitored, documented, and delivered eligible services to assigned caseload
Created and maintained positive relationships with clients, family members, internal and external resources
Service Coordinator, Home and Community-Based
Developed Service Coordination assessments on all assigned consumers
Conducted internal audits, managed, and completed required documentation on a high caseload of persons with multiple, complex needs
Maintained positive relationships with clients, family members, providers, and community agencies
Case Manager, Child & Adolescent
Behavioral management of children and adolescents with mild to severe clinical mental health diagnoses
Facilitated skills training, routine, and intensive case management services
Documented progress and measurable outcomes in program’s database
Little Servant Christian Academy, Lewisville, TX
November 2008 to February 2009
Teacher Assistant
Assisted director with gathering and imputing information into the program’s database and various administrative support duties
Instructed children ages two to four years old with classroom curriculum and constructive social activities
City of Dallas - Project Exodus II, Dallas, TX
May 2006 to January 2008
Outreach Case Management
Performed outreach and case management services to Hurricanes Katrina and Rita survivors with a focus on managed care for the senior population
Collaborated with social service organizations and faith-based initiatives to meet basic needs
Developed assessment plans and maintained charts through internal audits and documentation
Denton County Federation of Families, Denton, TX
November 2005 to May 2006
Administrative Assistant
Performed routine administrative support, customer services, and various related program responsibilities
Helped with data entry, answering phone calls and maintaining records of all accounts
Created advertising material using Microsoft Publisher for Advocacy meetings
Spindle top MHMR Services, Port Arthur, TX
August 1997 to October 2005
Therapist Technician
Worked with Community Enrichment Program and CLS Program/Adult Skills Training
Developed individual activity plans to meet specific needs of individuals with mental and or related conditions as determined in their Uniform Assessment
Provided rehabilitative services in the community and documented progress
Implemented occupational, social, and vocational skills training to clients with Intellectual Developmental Disabilities
Maintained clinical documentation and various office administrative duties
Education:
Master’s in Business Administration, Texas Woman’s University, Dallas, TX
Bachelor of Science in Sociology, Texas Woman’s University, Dallas, TX
Associates of Arts in Human Services Management, University of Phoenix, Phoenix, AZ (Distance Learning)
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