April Bushre

MAT/CAT-At Risk Team

• Use of CMMT and CMOR tools to identify members at risk of noncompliance due to upcoming initial or annual THRA.
• Perform a chart review to determine why outreaches or documentation has not met standards for completion.
• Making outreaches or documenting corrections to make in compliance.
• Identifying trends for further education of MAT/CAT employees.

Care Plan Remediation

• Reviewing eligibility, assessments, pharmacy data, medical history, claims, utilization MMP Medicare/Medicaid dual enrolled
• Computer programs used: CCN, QNEX, Member 360, Share Point,
• Contacted Member to complete required assessments and update medical data
• Created and Updated Care Plans based on most recent information available. Made Goals, Interventions, Outcomes and Barriers in S.M.A.R.T format.
• Made member care plans up to CMS standards.

• Determined and coordinated appropriate level of care to meet individual patient needs, factoring in medical advice, insurance and procedure costs
• Helped patients navigate healthcare system and care options by educating on relevant subject areas and answering questions throughout treatment process
• Collaborated with physicians on patient medications, medical needs and performance

• Oriented, assessed and mentored staff on correct procedures and clinical skills
  
• Reviewed and assessed staff processes, reducing hazards posed for residents and staff while promoting
  regulatory compliance
  
• Communicated with patients with compassion while keeping medical information private

• Developed patient care plans, including overall patient health assessments and evaluations
  
• Updated and maintained discharge plan of care with physician, members of healthcare team, patients, and
  families
  
• Determined and coordinated appropriate level of care to meet individual patient needs, factoring in medical
  advice, insurance and procedure costs
  10/1998 to 08

• Communicated with supervisors and managers about suspicious or unruly behavior from patrons, enabling issues to be promptly handled
• Maintained enjoyable environment by entertaining and engaging players at tables
• Performed functional game duties quickly by efficiently handling money and chips