Case Manager Long-Term Care
Resume:
Jose Pagan
Coffeyville, KS *****
407-***-**** *********@*****.***
Experience
Horne – 02/2021 – 01/2024-Remote
Senior Associate QA-QC-Bilingual Health Case Manager
• Bilingual Spanish and English professional always working in maintaining high level of flexibility for Government Services/Health as roles/duties pivot between departments for CMS, Care Act Pandemic Federal Program and Treasury Department allocation like Medicaid and Low-Income Subsidy Members.
• Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services.
• Reviewing members applications, communicating with applicants to secure data & documentation, creating budget for eligibility determination.
• Determining application eligibility based on program policies following program guidelines.
• Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
• Advocate for patients and families as needed to ensure the patient’s needs and choices are fully represented and supported by the health care team.
• Visiting assign members in their homes or in long-term care facilities including being flexible, adaptable with all patients for all types of situations.
• Experience in serving individuals with co-occurring disorders (both mental health and substance use disorders)
• Experience in long-term care, home health, hospice, public health, or assisted living coordination.
• Experience with local behavioral health providers and community support organizations addressing SDOH (e.g., food banks, non-emergent transportation, utility assistance, housing/rapid re-housing assistance, etc.)
• Background in managing populations with complex medical or behavioral needs. Florida Blue – 08/2017 - 12/2018-Remote
Medicare Advantage Licensed Broker Coordinator Dual Case Manager Orlando, FL
• Maintaining an extensive knowledge of Medicaid and CMS Guidelines.
• Building comprehensive full benefits packages through consultative, needs-based sales approach.
• Representing company's goals guided by federal CMS government regulations to provide the best product or services to current and prospective members, during the open enrollment period.
• Designing strategies to achieve and exceed established company's goals.
• Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care.
• Visiting assign members in their homes or in long-term care facilities including being flexible, adaptable with all patients for all types of situations.
• Manage the care plan throughout the continuum of care as a single point of contact. CarePlus Health Plans – 10/2016 - 07/2018
Benefits Senior Case Manager Orlando, FL
• Providing excellent service to members; address member’s questions pertaining to benefits, claims, appeals, DME, medications, dental, vision, and eligibility.
• Documenting all interaction and activities for quality and metrics reporting
• Obtaining prior authorizations for service and/or procedures
• Providing member assistance to members and/or providers regarding website registration and navigation
• Coordinating member transportation and made referrals to other departments.
• Maintained performance and quality standards based on established call center metrics Researching, identifying, and processing any processing inaccuracies in claim payments.
• Dual Social Services Plan Coordinator.
JP Morgan Chase – 06/2006 - 02/2011
Financial Advisor Lake Mary, FL
• Successfully building portfolios that include stocks, bonds, mutual funds, and insurance products for clients.
• Analyzing portfolios and investment strategies for prospective clients and provided a comprehensive analysis of the strengths and weaknesses of their current portfolio positions.
• Identified and quantified clients’ needs-based risk tolerance, age, and financial goals.
• Working with Marketing Department to learn & test new products and services to the bank customers.
• Providing essential banking and financial services by producing daily operations reports, managing overdrawn account reports, and tracking significant changes in balances for large business and government accounts.
Federal Emergency Management Agency (FEMA)
Disaster Relief Manager/Coordinator Puerto Rico Financial Advisor Lake Mary, FL
• Working as liaison between federal and local government, coordinating and mitigating federal emergency aid to hurricane disaster victims
• Answering inbound calls to support, provide step by step instructions to resolve issues.
• Reviewing account information, processes and performed queries in multiple databases.
• Quality and volume statistics were above average. Education
1999 University Central of Bayamon – MA. Business Administration Bayamon, Puerto Rico
1990 University of Sacred Heart – BA. Communications & Journalism Santurce, Puerto Rico
Skills
Strong Communication skills Fluent in Spanish Bilingual Case Manager Organizational skills Adaptability/Works well under pressure Initiator Computer Literate – Microsoft Office Products Computer Literate – Microsoft Office Certificates & Licenses
Health Insurance License 240
Life Insurance License 214
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