Bituin Arcinas
Canton,Michigan
Summary
To obtain a License Practical Nurse position within a reputable facility where I can expand and utilize my
nursing skills and provide the highest quality of care.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Care Connector – CSHCS & Bright Start
AmeriHealth Caritas Blue Cross Complete
Southfield, MI
03.2018 - 04.2023
- Responsible for supporting the daily operations of integrated care management and utilization management program interventions
- Operate in a contact center environment, effectively processing calls placed to members to complete surveys, providers and other areas, internal and external to the company
- Identify members with Care Gaps/HEDIS related health conditions and assists them in accessing care through Plan benefits and community resources
- Provide members with educational materials and carry out strategies in increase health care adherence and reduce barriers to care
- Deliver comprehensive, outcomes-driven care to those who need it most.
Care Connector – Children Special Healthcare Services
Mindlance (Contractor - AmeriHealth Caritas Blue Cross Complete)
Southfield, MI
12.2017 - 03.2018
- Responsible for supporting the daily operations of integrated care management and utilization management program interventions
- Performs in a contact center environment, effectively processing calls placed to members to complete mini surveys
- Identify members with Care Gaps/HEDIS related health conditions and assists them in accessing care through plan benefits and community resources
- Under the direction of clinical staff, provides members with educational materials and carry out strategies to increase health care adherence and reduce barriers to care.
Care Coordinator – Maternity and Family Health Plan
Meridian Health Plan
Detroit, MI
11.2016 - 09.2017
- Managed an assigned caseload of Meridian members while creating a relationship with the member working towards heir optimal overall health and well-being by facilitating transition of care for members through individual meetings in person and by phone
- Conducted complete, timely and accurate program specific assessments including prenatal, postnatal, health risk and comprehensive assessments while developing members plan of care including current member demographic information
- Completed all activities and interventions outlined in the members care plan and ongoing monitoring of cases to ensure routine follow up and progression in their care plan goals
- Addressed needed HEDIS with all members assigned and assisted in scheduling appointments for HEDIS measure completion
- Assembled information concerning member’s clinical background and referral needs, and per referral guidelines provided appropriate clinical information to members PCP and Specialists
- Assisted members in problem solving and potential access to care issues such as need for transportation, interpreters, cultural resources, community resources, etc.
Utilization Management Transitional Care Coordinator
Meridian Health Plan
Detroit, MI
06.2015 - 11.2016
- Completed Medicaid/Medicare authorization process in MCS system for approved authorizations and contact hospital reviewers with decision, days authorized and corporate authorization number
- Faxed processed authorizations to providers and handle provider inquiries appropriately
- Assisted with special projects or department process improvement efforts, as needed
- Performed transition of care post discharge calls to members post inpatient
- Created denial letters to hospitals as required and within established timeframes
- Coordinated with other medical management departments as needed, including making referrals to Case Management.
Business Office Assistant
St. John Providence Hospital OB/GYN Resident Clinic
Southfield, MI
10.2009 - 06.2015
- Monitored expenditures and record financial activities within the clinic
- Facilitated day-to-day administrative operations of the clinic
- Coached and advised team members to accomplish project goals, to meet established schedules, and resolve operational issues
- Responsible for the daily processing of medical records from retrieval to physician completion, to final storage
- Assisted Physicians and other clinicians in the process of record completion, as well as record review/research projects
- Received and screen visitors and telephone calls
- Performed all duties related to the registration of patients, including obtaining insurance information
- Identified the need for, and obtaining authorizations and pre-certifications from insurance carriers and physician offices
- Verified assignments of patients, benefits, co-pays, and self-responsible portion of charges
- Coded charges using ICD-9 and CPT-4 software for coding manuals, and entering data into a computerized management system.
Education
Licensed Practical Nursing
Hondros College of Nursing
Bingham Farms, MI03-2024
High School Diploma -
Kalamazoo Central High School
Kalamazoo, MI06-1999
Skills
Clinical Experience Regency At Westland, Westland, MI
- Performed head to toe assessments
- Executed simple dressing changes, foley and catheter care
- Dispensed oral, transdermal, sublingual, otic and ophthalmic medications
- Obtained finger stick blood sugar
- Administered subcutaneous injections, medications via gastrostomy tube and breathing treatments
- Maintained patient hygiene by performing bed baths, showers and oral care
Certification
Licensure
- LPN licensure pending NCLEX
- BLS certified
Volunteer
- Detroit City Lions Youth Club
- Community Clean Up for Fitzgerald Neighborhood
- Blue Cross Complete Baby Shower Event
Timeline
Care Connector – CSHCS & Bright Start
AmeriHealth Caritas Blue Cross Complete
03.2018 - 04.2023
Care Connector – Children Special Healthcare Services
Mindlance (Contractor - AmeriHealth Caritas Blue Cross Complete)
12.2017 - 03.2018
Care Coordinator – Maternity and Family Health Plan
Meridian Health Plan
11.2016 - 09.2017
Utilization Management Transitional Care Coordinator
Meridian Health Plan
06.2015 - 11.2016
Business Office Assistant
St. John Providence Hospital OB/GYN Resident Clinic
10.2009 - 06.2015
Licensed Practical Nursing
Hondros College of Nursing
High School Diploma -
Kalamazoo Central High School
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