Brenda Gelinas

Worked as a Case Manager for the Passport Waiver Medicaid Program. Case load of 75 individuals. Provided services via home visits and telephonically to ensure that individuals could remain independent in their home.

Assessed and provided community resources for transportation, home delivered meals, personal care services and homemaking, durable medical equipment, and social work counseling.

Currently working as an Long Term Care Consultant. Assess individuals for the Assisted Living Passport program and Passport Waiver Medicaid Program. Determine level of care per Medicaid requirements. Complete 8 assessments a week in 9 counties. Develop care plans following NCQA guidelines. Work within PIMS, MFiles, Microsoft Word, and Excel programs.

Worked telephonically with identified Oncology patients for coordination of care.

Reviewed orders from physicians for chemotherapy, radiation, medications and surgeries and set-up pre-authorizations for approval.

Submitted all reviews within required time frames. Developed care plans per NCQA guidelines.

Provided patient education of acute and chronic disease management and course of care for current chemotherapy regimens.

Authorizations via NCCN.org and Milliman (MCG) guidelines.

Delivered Transition of Care for patients from discharge to home telephonically to ensure safe discharge. Provided education of acute and chronic disease management.

Provided benefits of the Ohio Healthy Medical Plan.

Collaborated in the development of internal care management workflows within EPIC and Sentara programs, utilizing best practice and up to date regulatory policies including NCQA accreditation processes.

Facilitate and contribute to weekly continuous process improvement with team meetings, and establishing and monitoring of KPI's (Gemba).

Monitor, analyze, compile and and report metrics to Pathways to Wellness Diabetes Program (HEDIS).

Education sessions with patients for diabetes prevention, and diabetes wellness programs including collaboration with pharmacists and medication program within benefits of health insurance plan.

Skilled telephonic case management of self-funded insurance plans.

Delivered benefit information to clients in 4 states.

Provided effective education of disease management processes with an emphases in Oncology and post-op surgical education.

Care plans within NCQA guidelines.

Empathetic nurse with reflective listening of patient's concerns.

Extensive understanding of SPD documents. with the ability to work individually as well as a team member.

Pre-authorizations for chemotherapy, radiation, infusions and surgery.

Utilization review.

Milliman (MCG), NCCN.org for chemotherapy and treatment approval.