Anita Simon
Waxahachie,TX
Summary
Goal focused individual seeking a part time employment opportunity, where I can utilize my strong organizational, analytical, and detailed oriented skills. Resourceful Associate Manager known for high productivity and efficient task completion. Specialize in team leadership, operational management, and strategic planning. Excel in communication, problem-solving, and adaptability to ensure smooth operations and team alignment towards organizational goals.
Overview
17
17
years of professional experience
Work History
Associate Manager, Case Management
Aetna
Dallas, TX
04.2020 - Current
- Responsible for the overall supervision of care management associates and any supporting staff.
- Accountable for member outreach, satisfaction, enrollment, and coordination of care with care managers, members, community resources, and providers.
- Develops, motivates, evaluates, and coaches staff on work procedures, proper call handling, and teamwork, delivering excellent customer service and enrolling members in care management.
- Assesses individual and team performance on a regular basis and provides candid and timely feedback regarding developmental and training needs, including completion of monthly and annual scorecards.
- Monitors all performance measures, such as daily metrics and schedule adherence, and allocates resources to meet volume and performance demands.
- Develops and maintains strong collaborative relationships with care managers and other internal departments.
- Acts as liaison between staff and other areas, including management, all segments, provider teams, etc., communicating workflow results, ideas, and solutions
- Proactively analyzes constituent data, identifies trends and issues
- Recognizes and acts on the needs to improve the development and delivery of products and services
- Clearly identifies what must be accomplished for successful completion of business objectives
Case Management Associate
Aetna
01.2012 - 04.2020
- Team Lead and Trainer for Care Management Associates on the Aetna Line of Business.
- Partnered in developing training aids and distributed materials, and helped to improve CM Department processes using analytical and problem-solving skills to visualize, articulate, and conceptualize all improvements.
- Monitored quality of the work for all care management associate staff and appropriately reoriented deviations, bringing them back to department processes.
- Efficiently and consistently identified issues and irregularities within the department processes, notifying supervisors of possible learning opportunities.
- Cross-trained with the Utilization Management Department. Duties included Prior Authorization review and processing.
Benefit Counselor
St Johns Caregivers’ Council on Aging
01.2011 - 11.2011
- Reviewed Benefits Summaries and Evidence of Coverage documents.
- Explained benefits, premiums, and cost sharing limits to seniors, disabled Medicare beneficiaries, and their families, partners, and caregivers.
- Offered education about Medicare/Medicaid and other health insurance coverage while evaluating health insurance needs, reviewing present health cover to maximize benefits cost on clients' behalf.
- Assisted in completing and submitting applications for health benefits programs, such as the Qualified Medicare Beneficiary (QMB) Program, the Specified Low Income Medicare Beneficiary (SLMB) Program, and the Qualifying Individual (QI) Programs.
Medicaid Eligibility Specialist III
Health Human Services Commission
03.2008 - 11.2009
- Responsible for a Medicaid eligibility determination on caseload for a designated territory.
- Investigated and verified accuracy of information provided by recipients under the Medicaid programs to determine compliance with state and federal laws, rules, and regulations.
- Determined eligibility for Medicaid-funded Medicare programs for age and disabled individuals, which included Qualified Medicare Beneficiary (QMB) programs, Specified Low-Income Medicare Beneficiary (SLMB) programs, and Qualified Individual (QI) programs.
- Interviewed clients, documented information, gathered data, determined benefits, verified case data, explained program benefits and requirements, provided information and referral services to clients, providers, agency staff, and the public.
- Review eligibility of clients for ongoing services, monitored nursing facility compliance with state and federal requirements.
- Working closely with other agencies, such as the Texas Department of Aging and Disability Services (DADS), the Texas Department of Assistive and Rehabilitative Services (DARS), and the Office of the Attorney General (OAG), to ensure accuracy of information provided.
- Conducted Home assessments with clients and determined client eligibility for State/Federal funded programs
Education
Bachelor of Arts - Social Work
University of Texas At Arlington
Arlington, TX06-2026
Skills
- Data-Driven Results Analysis
- Operational Oversight
- Strategic Coordination
- Client Relationship Management
- Effective Project Coordination
- Results Analysis
- Department Oversight
- Departmental management
- Staff Training and Development
Honorsandawards
Aetna Way Excellence Award-Integrity
Accomplishments
- Integrity Award-Aetna Excellence
Timeline
Associate Manager, Case Management
Aetna
04.2020 - Current
Case Management Associate
Aetna
01.2012 - 04.2020
Benefit Counselor
St Johns Caregivers’ Council on Aging
01.2011 - 11.2011
Medicaid Eligibility Specialist III
Health Human Services Commission
03.2008 - 11.2009
Bachelor of Arts - Social Work
University of Texas At Arlington