Abigail Clark
Saint Francis,WI
Summary
Knowledgeable Case Manager experienced in coordinating care for frail elders, and adults with disabilities. Proactive and resourceful with strong knowledge of community resources. Strong communicator with passion for helping others. Experienced with auditing, claims reviews, and compliance.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medicare Case Manager
Molina Healthcare
07.2018 - Current
- Assist Medicare Members with coordinating and maintaining their healthcare by scheduling medical appointments, providing education on condition management, and reinforcing preventative care measures
- Outreach to members for completion of their annual Health Risk Assessment (HRA) with care plan creation as well as Disease Specific Assessments, Emergency Room and Transitions of Care Assessments.
- Review case management level stratification with members to ensure outreaches are completed to best meet member's needs.
- Develop and implement comprehensive case management plans to address client needs and goals.
- Identify care needs of individual patients and coordinate responses based on physician advice, insurance limitations, and procedural costs.
- Review supplemental benefits with members to ensure all health and safety needs are met.
- Assist with durable medical equipment and/or service coordination.
- Collaborate as needed with internal Molina Teams including the Medicare Escalation Team, Pharmacy Team, Vendor Support Team, Utilization Team & Medicare Product Team.
Care Management Supervisor
My Choice Family Care, Unison Care Management Unit
11.2017 - 07.2018
- Plan, implement and direct Care Management Unit (CMU) services for members with disabilities and frail elders, in compliance with program requirements as defined by the Managed Care Organization (MCO) and outlined within CMU Lead Supervisor (LS) contractual agreement
- Recruit, orient, train, supervise and evaluate Interdisciplinary Team (IDT) members including registered nurses (RN) and care managers (CM) in the CMU program
- Conduct regularly scheduled meetings with IDT to review program requirements and member service delivery
- Coordinate training on Family Care core competencies
- Direct, monitor and audit documentation by IDT to ensure timely, accurate and documentation including but not limited to case noting, work sheets, Member Centered Plans (MCP) and any and all contractual documentation and reporting
- Monitor high risk situations of members with IDT for needed follow up as well as oversee and coordinate member health and safety services including required reporting and critical incidents.
Case Manager III
My Choice Family Care, Unison Care Management Unit
04.2017 - 10.2017
- Coordinate and monitor services for members of Milwaukee County's Long Term Care Program in the most effective way possible
- Long Term Care clients include frail elders, those who are physically disabled and developmentally disabled
- Complete bi-annual assessments of member's needs and services as well as assess and monitor member's behavioral/mental health, employment, finances, and natural/social support to ensure that they are living in the most fulfilling way possible
- Utilize the Resource Allocation Decision making methodology (RAD) to help members identify preferred outcomes
- Provide ongoing evaluation of member's safety and risk concerns
- Responsible for making direct contact with over 40 clients per month to check on their wellbeing, health, and service needs to meet their goals, as well as completing monthly home visits
- Assisting members in completing Medicaid/Title 19 applications annually
Case Manager
My Choice Family Care, Goodwill Industries
08.2015 - 04.2017
- Coordinate and monitor services for members of Milwaukee County's Long Term Care Program in the most effective way possible
- Long Term Care clients include frail elders, those who are physically disabled and developmentally disabled
- Complete bi-annual assessments of member's needs and services as well as assess and monitor member's behavioral/mental health, employment, finances, and natural/social support to ensure that they are living in the most fulfilling way possible
- Utilize the Resource Allocation Decision making methodology (RAD) to help members identify preferred outcomes
- Provide ongoing evaluation of member's safety and risk concerns
- Responsible for making direct contact with over 40 clients per month to check on their wellbeing, health, and service needs to meet their goals, as well as completing monthly home visits
- Assisting members in completing Medicaid/Title 19 applications annually
Day Camp Site Leader
Easter Seals of Southeast Wisconsin
05.2015 - 08.2015
- Responsible for managing all staff (10 people) and making sure 65 participants are engaged and safe
- Developed activity schedule and calendar
- Responsible for assisting participants with personal cares, conducting group activities and maintaining a safe and supportive environment
- Interacts with participants in a respectful and age-appropriate way by honoring behavioral plans and care information
- Reports suspected abuse, neglect and exploitation of participants immediately
- Ensures the safety of all participants by monitoring activities and creating a clutter free environment
- Maintained records and logs of work performed and materials and equipment used.
- Trained new team members on site policies and procedures.
Classroom Assistant
Downtown Montessori Academy
08.2014 - 08.2015
- Assisted the Montessori Directress in implementing the Montessori Approach in the classroom, playground and enrichment programs
- Created a warm, nurturing, safe environment for children in which individuality is respected and independence is encouraged
- Helped with student drop-off and pick-up and facilitated transition into the classroom daily
- Supported childcare staff members in daily activities such as naptime, snacks, and lunch
- Assisted with development of daily activities
- Provided one-on-one assistance for children who need additional help reaching their academic goals
Manager
YMCA of Milwaukee
09.2009 - 07.2014
- Monitored the building to be positive that all safety rules and YMCA policies are being followed and enforced at all times
- Responded to any emergency innocents and provided medical assistance if needed
- CPR, AED and First Aid Certified
Line Therapist
Autism Treatment for Children
07.2013 - 12.2013
- Assisted client with educational programs and making sure they are progressing though assigned material affectively
- Required to attend all team meetings to discuss clients therapy plan
- Conducted structured play activities with the client
- Had the ability to maintain confidentiality pertaining to child, family and staff
- Communicated clearly and effectively both verbally and in writing
- Recorded all client program data
Education
Bachelor of Science - Psychology
Carroll University
05.2014
Bachelor of Science - Sociology
Carroll University
05.2014
Skills
- Case Management Leadership
- Utilization Review
- Performance Tracking
- Member Support
- Care Coordination
- Member Assessments
- Chronic Disease Management
- Behavioral Health Management
- Cross-Functional Collaboration
- Discharge Planning
- Auditing and Compliance Experience
- Skilled in Patient Ping, QNXT, UMK2, Clinical Care Advance (CCA), EPIC, CVS Caremark, Microsoft Suite, Skype for Business, and Zoom
- Interdisciplinary Collaboration
Certification
Mental Health Ally Certification, Psych Hub - 11/2023
Timeline
Medicare Case Manager
Molina Healthcare
07.2018 - Current
Care Management Supervisor
My Choice Family Care, Unison Care Management Unit
11.2017 - 07.2018
Case Manager III
My Choice Family Care, Unison Care Management Unit
04.2017 - 10.2017
Case Manager
My Choice Family Care, Goodwill Industries
08.2015 - 04.2017
Day Camp Site Leader
Easter Seals of Southeast Wisconsin
05.2015 - 08.2015
Classroom Assistant
Downtown Montessori Academy
08.2014 - 08.2015
Line Therapist
Autism Treatment for Children
07.2013 - 12.2013
Manager
YMCA of Milwaukee
09.2009 - 07.2014
Bachelor of Science - Psychology
Carroll University
Bachelor of Science - Sociology
Carroll University