Case Management Development Specialist

Cynthia McDonald

**** *. ***** *******, ** ***** (Cook County, IL)

Summary:

Cynthia is an experienced and compassionate Case Manager with over 5 years of expertise working with different healthcare and managed care settings.

Expertise in conducting case management, worked with ageing/disabilities members, LTSS, developed and implemented individualized care plans, care coordination and collaborated effectively with multidisciplinary teams to ensure optimal patient outcomes.

Skilled in handling 60-70 cases per month, 2-3 assessments per day helps members actively and knowledgably participate with their provider in healthcare decision-making, monitoring, evaluation and documentation of Care.

Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate and familiar with HIPPA and state/federal regulations and guidelines.

Proficient with Microsoft office and maintained thorough case notes and ensured compliance with policies and procedures.

Education:

Millikin University - Decatur, IL, BA of Science in Organizational Leadership and Management May 2006

Malcolm X College – Chicago, IL Certification in Community Health May 2019

Skills:

Case Management

Assessment

Adobe Products

Medical Terminology

Kantar

Customer Service Relationship Management Software

Ad Data Express

Crisis Training

Social Media

Microsoft Outlook

Microsoft Word

Salesforce

Medical Record Training (EPIC)

Internet

Microsoft Excel

Google Docs

Microsoft PowerPoint

Coordination Skills

Motivational Interview Training

Resource Researcher

Epic

Social work

Empathy

HIV/AIDS care

Hospital experience

Hospice care

Case management

Patient assessment

Managed care

Medical records

Patient care

Intake

Patient service

Quality Management

Crisis Intervention

Professional Experience:

CVS-Chicago, IL Feb 2023 to Jan 2025

Case Manager Analyst

Handle 60-70 caseloads, work with LTSS/Long term care, disabilities and aging members.

Utilizes critical thinking and judgment to collaborate and inform the case management process, to facilitate appropriate healthcare outcomes for members by providing care coordination, support and education for members through the use of care management tools and resources.

Using care management tools and information/data review, conducts comprehensive evaluation of referred member’s needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member’s benefit plan and available internal and external programs/services

Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referral to clinical case management or crisis intervention as appropriate.

Coordinates and implements assigned care plan activities and monitors care plan progress.

Enhancement of Medical Appropriateness and Quality of Care:

Using holistic approach consults with case managers, supervisors, Medical Directors and/or other health programs to overcome barriers to meeting goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.

Identifies and escalates quality of care issues through established channels.

Utilizes negotiation skills to secure appropriate options and services necessary to meet the member’s benefits and/or healthcare needs.

Utilizes influencing/motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health.

Provides coaching, information, and support to empower the member to make ongoing independent medical and/or healthy lifestyle choices.

Helps members actively and knowledgably participate with their provider in healthcare decision-making Monitoring, Evaluation and Documentation of Care.

Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures.

Howard Brown Health-Chicago, IL Nov 2020 to Jan 2023

Ryan White Part D Medical Case Manager

Explain the range of Howard Brown Health’s medical and psychosocial services to eligible patients who are referred for services.

Provide information, education, and emotional support to patients in a compassionate, culturally sensitive, and appropriate manner.

Maintain, at minimum, monthly contact with every client on assigned caseload; upwards to 60 clients.

Complete initial assessments and care plans with all RWC clients assigned to the case manager’s individual caseload and conduct subsequent required reassessments every six months.

Evaluate all clients’ ability to understand health plans; provide treatment education, and adherence counseling to clients to improve health outcomes; consult with medical providers regarding assessment and counseling sessions.

Coordinate medical care with providers, schedule patient follow-up (internal and external) appointments; facilitate appointments with collaborative medical partners for provider recommended follow-up screenings and treatment.

Consult and collaborate with a multi-disciplinary team including primary care providers, behavioral health staff, nursing, MA’s, other members of patient care teams, partner services staff, and other Howard Brown staff involved in client/patient care, in addition to those across different institutions and agencies.

Assess financial needs of clients and facilitate patient financial and employment support; complete applications with clients, especially as it relates to public benefits programs, rental/utility assistance, health insurance (Medicaid/ACA Marketplace), and ADAP, resumes, cover letters and prescription assistance programs.

Provide referrals on an ongoing basis of relevant services, such as LINK, ADAP, and housing, vision, DHS, SSI, unemployment, insurance, rental, and prescription assistance.

Develop and maintain required records, reports, and statistical data. This includes maintenance of an active and inactive caseload, completing day sheets, progress notes, resource receipts, and tracking health maintenance of each client.

Follow appropriate standards of care and support clients with tracking and completing necessary health and wellness screenings including, but not limited to, standard HIV.

Howard Brown Health-Chicago, IL Feb 2019 to Nov 2020

Patient Navigator

Complete brief, immediate needs assessments with Howard Brown Health patients of who may benefit from accessing other relevant medical and social services provided by Howard Brown Health and other community organizations, providing necessary referrals (both internal and external) when appropriate.

Explain the range of Howard Brown Health’s medical and psychosocial services to eligible patients who are referred for services.

Provide information, education, and emotional support to patients in a compassionate, culturally sensitive, and appropriate manner.

Evaluate patients’ ability to understand health plans; provide relevant treatment education and adherence counseling to patients to improve health outcomes; consult with medical providers regarding patient needs.

Take lead on implementing NowPow referral system, training staff on using the system and troubleshooting as necessary.

Regularly update the electronic and physical copies of the referral binders ensuring that referrals are relevant and still active.

Consult and collaborate with a multi-disciplinary team including primary care providers, behavioral health staff, nursing, MA’s, other members of patient care teams, partner services staff, and other Howard Brown staff involved in client/patient care, in addition to those across different institutions and agencies.

Provide education, information, and referrals (LINK, ADAP, housing, DHS, SSI, health insurance, etc.) to patients on an ongoing basis; locate, identify, and utilize new social services and resources including employment.

The National Center for Complex Health and Social Needs-Chicago, IL Dec 2018 to Dec 2018

Assistant Facilitators Intern

Responsible for greeting and seating guest.

Served as mediator between panelist and guest.

Responsible for creating conference packages and filing unused materials.

Lurie’s Children Hospital-Chicago, IL Sept 2018 to Dec 2018

Community Health Care Worker Internship

Attended and participated in healthcare training sessions and seminars focusing on mental illness, chronic disease and patient interaction.

Attended and participated in patient appointments with care coordinators, social workers, nurses, and doctors.

Coordinated with community resource members to secure various assistance for patients and their families.

Updated and maintained documents in community healthcare resource database (community programs).

Secured food for families in the community who participated with Medicaid.

Documented Doctor patient interaction during patient appointments.

Workshop Instructor Independent Contractor-Chicago, IL June 2018 to June 2018

Planned, set up, and clean up creative workshop sessions.

Engaged in a group of students and working professionally in active, hands-on learning.

Wellness, Gender Neutrality, and Mindfulness Jan 2017 to Apr 2018

Designed Curriculums on Health

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