Amine Mikou
Astoria,USA
Summary
Dynamic professional dedicated to advancing the healthcare industry through innovative strategies that enhance member quality outcomes, engagement, growth, and retention. Recognized for a solution-driven mindset and adaptability, with a strong commitment to supporting organizations at the forefront of government programs and vulnerable population health management. Proven expertise in community outreach and engagement emphasizes the importance of building robust relationships and fostering collaboration. A successful track record of driving participation and support for initiatives has resulted in increased community involvement and the achievement of organizational objectives.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Director of Community Engagement
Molina Healthcare
07.2021 - 07.2025
- Oversees operational areas involving member impact and engagement including Appeals and Grievances, Member Problem Research and Resolution.
- Ensures access and availability for all Molina Members to voice concerns, request for Member information and benefit interpretation. Represents Member issues on the Plan’s Senior Leadership Team.
- Liaisons with Contact Center- reviews call metrics and root cause analyses of common member complaints; ensures communication and collaboration to address process and training opportunities.
- Ensures that employees and management are knowledgeable of, and participate in identifying and implementing, opportunities for improvement to support member retention.
Liaison Community Outreach
Prime Home Health services
08.2019 - 07.2021
- Outreach hospital discharge department, home infusion, Primary Doctors, Specialists and other Clinicians participating in Patients Care
- Develop Community relation with hospital/facility/liaison team, discharge planners and CM department
- Working to Coordinate patients care to transition from hospital or nursing home to Community
- Assess and evaluate Patients in needs of LTCC/ HCBS and refer to MLTC or MMP programs
Director of Member Care Division
Integra Care MLTC, New Hyde Park
08.2017 - 06.2019
- Monitor enrollment and disenrollment numbers and patterns
- Work with the authorization team to assure members authorizations are realigned to referral source
- Point of contact of vendors to resolve claims, authorizations issues and grievances
- Worked collaboratively with departments, care managements, provider relations, vendors relation, marketing, finance and compliance
Director of Complex Care/Director of Enrollment
Fidelis Care, Queens, NY
10.2014 - 07.2017
- Participating in the statewide expansion for Members enrollment in MLTC/DSNP/MMP/MA
- Oversaw the SNP MA Dual MLTC Members to meet both Medicare and Medicaid regulatory guidelines
- Responsible for Statewide recruitment and Retention of all MLTC/ FIDA/ DUAL-MAP/ MMC
- Provides grass roots, Community-Based Training for frail population care including self-care techniques and prevention strategies
Education
Masters in Business Health Administration and Informatics - MHA/MS
Saint Joseph’s College
Brooklyn, NY06.2022
Bachelor of Science - Nursing
Saint Joseph’s College
Brooklyn, NY12.2016
Skills
- BLS, ACLS, System (Facets, Salesforce, Tri-Zetto -Clinical Care Advance), Care compass, McKesson
Accomplishments
- Supervised team of 180 staff members.
- Resolved Growth issue through effective retention.
- Documented and resolved Member's concerns which led to better retention.
Affiliations
- International Council of Nurses
- American Marketing Association
Certification
- NY State Registered Professional Nurse
- NY State Health and Accident
FOREIGN LANGUAGE
Spanish, French, Arabic, Moroccan, understand Bengali/Greek
Interests
- Youth mentor, providing guidance and support to empower the next generation of leaders
- Volunteer Work
- I participate in various sports activities for physical activity, camaraderie, and personal growth
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Timeline
Director of Community Engagement
Molina Healthcare
07.2021 - 07.2025
Liaison Community Outreach
Prime Home Health services
08.2019 - 07.2021
Director of Member Care Division
Integra Care MLTC, New Hyde Park
08.2017 - 06.2019
Director of Complex Care/Director of Enrollment
Fidelis Care, Queens, NY
10.2014 - 07.2017
Bachelor of Science - Nursing
Saint Joseph’s College
Masters in Business Health Administration and Informatics - MHA/MS
Saint Joseph’s College
President's Award for Excellence And Exemplary Dedication
In 2024 Molina Healthcare rewarded me with the President's Award for Excellent And Exemplary Dedication based of the outstanding achievement for engaging 4 times the amount of budgeted membership.