Brittney Avila
Member Care Coordinator
Albuquerque,NM
Summary
Find a great opportunity that will allow myself to grow with experience and challenge myself, so that I may advance myself, grow in knowledge and skill set. Caring and empathetic Care Coordinator with over 10 years of experience in healthcare, providing therapeutic support for adults with disabilities. Competent planner, developer and implementer of complex individual program plans. Practiced Care Plan Coordinator dedicated to timely and accurate completion of member assessments, supporting development of comprehensive care plans. Collaborates with interdisciplinary team in monitoring progress and adjusting plans to achieve target results. Observes member care, recommending opportunities for improvements.
Overview
8
8
years of professional experience
2
2
years of post-secondary education
Work History
CC-Care Coordinator
Blue Cross Blue Shield
Albuquerque, NM
05.2022 - Current
- As of May 23, 2022, this CC is still completing full HC duties as well as maintaining caseload of 25 on Specialty Team (the Self-Directed Team)
- This CC completes Annual Comprehensive Needs Assessment on members and all Annual documents
- CC goes over with members/Employer of Record duties and responsibilities to ensure the person in charge of member’s program is coherent and capable of completing tasks and responsibilities inherent with the EOR title
- This CC assesses member for needs related to Activities of Daily Living and In Activities of Daily Living regarding member’s caregivers which include the assistance of time that is needed and that is given to member’s care providers
- When leadership runs Acuity report, it is this CC’s job to maintain this CC’s metrics against the percentage of this CC’s caseload weight ratio
- When Unit manager sends out the Bi-Monthly Compliance Report every week this CC must ensure all Quarterly Touchpoints are complete and being met on time which includes running a spending report and reviewing these finding with the member during our (TP) to ensure member will maintain allocated funds for remainder of budget plan year
- This will also require this CC to complete member’s Comprehensive Care Plan and ensuring that it gets sent to member’s provider afterwards with updated goals included
- New HC started on August 3, 2022; New hire went through New hire training
- This CC began to train the new hire on August 26, 2022, along with this CC’s caseload increasing to 32
- All duties currently remain the same until the new HC is fully trained and can replace this writer
- With new caseload that has increased to 32 this CC continues to maintain caseload with compliance level of 85%-100% every week, meeting an achievement of goals which include maintaining touchpoints on time, completing multiple budgets within the given timeframes (no submissions late) dealing with member facing issues daily and solving those issues quickly and efficiently
- CC continues task of training new hire, providing training materials such as updated Job Aides, Standard Operating Procedures (SOPs), PowerPoint slides, and any other needed materials, answering instant messages with questions throughout the day and being available for new hire when possible, to complete one on one trainings to further HC's understanding of SDCB program and completing Health Care Coordinator position accurately and timely
- This writer is reviewing processes, rules and procedures with new hire.
- HC-Health Care Coordinator did not receive access to start completing work immediately, which meant this CC completed additional 2 weeks of the HC observing this CC working on HC duties and tasks
- CC walked HC through step-by-step training once HC received access to all systems needed to complete necessary work of the position of an HC
- This writer continues to assist HC with duties and responsibilities of the position
- HC has continued to need assistance with his newly found position since starting and this CC has seen improvement with the new hire’s daily tasks and responsibilities since first starting, new hire has taken on more responsibilities which in turn means this CC can focus more on one assigned role
- CC blocks out anywhere between 2-8 hours at a time for training sessions with new HC, 1-2 times per week every week or as needed, in the beginning when CC was training HC number of times were increased to 3-4 times per week
- CC’s caseload has increased by 3 more to include total of 37 as of September 1st, 2022
- This CC creates/develops members budget after the member has provided necessary invoices and needed medical providers letters
- CC has formula that is followed depending on which type of budget is identified (Basic,
- Grandfathered, Respite) calculations are followed through from the formula, this CC then adds up requested amounts from each requested item and provides a total
- This writer will then submit this proposed budget to our (MCO) Utilization Management (UM) reviewers
- After this budget has been submitted (in a task) to our nurse reviewers in our major reporting system Guiding Care (G.C)
- This SDCC will create note within FOCoS online which will notify the Support Broker
- But this writer will also send email to the SB and notify that this proposed budget has been sent to UM for review, after this email has been sent this CC will document in reporting system G.C that this email was sent out to Support Broker for documentation purposes
- CC goes through the Budget approval process through UM department, once budget plan is approved this
- CC will enter approved amount into FOCoS online, this writer will create note within FOCoS that this CC has requested the SB to align member’s goals to match new approved budget amount
- This CC will send email to the SB informing them approved amount has been entered into FOCoS, and this CC is requesting that Consultant align goals to match new approved budget amount, this CC includes budget breakdown which includes approved budget amounts broken down into each approved service that is being requested
- After Support Broker aligns the member’s goals and notifies this CC that budget plan is ready for final submission of UM review
- This CC will check that member’s hours are completely and properly being utilized, CC will compare the member’s hours on FOCoS to Allocation tool
- If member is not utilizing all hours on the allocation tool compared to what is showing on FOCoS
- This writer will need to find out why member is not utilizing all their hours and complete Member Risk Agreement to ensure the member’s safety and care
- After that CC will enter the monetary amount within FOCoS, this writer must ensure this amount is entered correctly this is the finalization process in the budget plan
- After this step, this CC will enter final note into FOCoS and notify the SB this has been completed
- This CC can work on up to 15-18 budgets at a time so far and has been doing so proficiently
- CC multi-tasks throughout the day and uses time management skills to complete needed daily tasks.
- Used company software and databases to maintain records of services performed and patient conditions
HC-Health Care Coordinator
Blue Cross Blue Shield
Albuquerque, NM
11.2017 - 05.2022
- Collect, monitor, validate, and analyze Care Coordinators’ Self-Directed documents to reduce issues and improve operational performances
- Review all final Assessment forms to ensure accuracy before faxing out to Support Broker agencies
- Document CNA invites that were sent by SD Care Coordinators to Support Brokers/Responses from SBs’
- Communicate with agency-based care coordinators to determine if member would be successful on SDCB program during referral calls
- Advise SDCCs’ of this communication that took place between HC and ABCC (staffing referral call)
- Assist Self-Directed Care Coordinators in completing Referral calls and explaining Self-Directed Community-Based program to member/employer of record and/or caregiver, whoever else might be involved in member’s immediate success to the Self-Directed program
- When members come into the SD work Queue by their already assigned Agency Based Care Coordinators (ABCCs’) it means the member has stated an interest in Self-Directed Community Based Program (SDCB), at that point this writer would assign one of the Self-Directed Care Coordinators (as secondary CC until member Transitions) demographically via email to all parties involved, this HC will also assign CC in main operating system which is Guiding Care (G.C.)
- After members have been assigned to a Self-Directed Care Coordinator (SDCC) this HC will keep track on Excel sheet, which is in SharePoint site, the report is regarding our potential members transitioning into the SDCB program from our referrals
- Report also reflects pending referrals needing to be addressed
- Currently Unit Manager and this HC are only ones with access to this report, we have seen a significant number of improvements in CC response time in completing SD referrals timely
- There have been no “Over 30 days” which means CCs have not gone over 30 days in not contacting the member in over 6 months, which is a vast improvement compared to Self- directed referrals that were months behind, this HC aided in contacting member’s/referrals and explaining SD program to the member and their families and identifying an appropriate EOR to ensure their success into the SDCB program, after referral process was started this HC would complete a warm transfer with the CC
- Now since referrals are now caught up, we hope to continue to see these improvements and will not let CC’s get behind with their referral process again
- Aided in completing Developmentally Disabled Waiver (DDW) Quarterly Reports for Leadership
- Report included when member transitioned into the DDW program and began to utilize their state approved budgets, member’s demographics, member’s basic information
- Missing information was needed to complete this report, this HC had to research a section given to be completed
- Established and built relationships with Support Brokers, Care Coordinators and vendors that have been created throughout the years and will continue throughout this new position as Member CC
- Assisted in completing a variety of Special Projects as needed by Management/Senior Leadership at any given time, while performing/maintaining current full workload
- Tracking both payroll issues reported by members and SBs which include caregivers not getting paid timely with our vendor (PALCO/Conduent) and any EVV Authenticare issues
- Due to our vendor (Previously Conduent) now taking over (PALCO) the members experience issues at times with finding vendors to accept the PALCO checks, when this occurs the member reports it to their assigned SD CC
- CC-Care Coordinator then reports it to this HC-Health Care Coordinator and this HC must log into Excel into the SharePoint site as well as save any attachments that were sent in the email and file the email into a secured file within Microsoft Outlook
- Send out Comagine Requests every week to our outside vendor (Comagine), for the Developmentally Disabled Waiver
- CCs’, which this HC has strengthened relationships with the CCs as well as the outside vendor representative
- Completing Monthly Member Report which entails members who are deceased, who have changed MCO’s, transitioning members whether that may be members who are transitioning into Self-Directed Community Based Program (SDCB) or Developmentally Disabled Waiver Community (Mi Via DDW) it is this HC’s responsibility to research these members and record data found (members transitioning dates into their program)
- Information looking for on this report as follows; Member’s budget, (where in the process CC/SB is with budget) if budget has been entered into FOCoS, if member is no longer with SDCB program this HC looks to see where close out budget is in process of being completed by Care Coordinator/Support Broker
- This HC looks for any discrepancies or anything that might be holding up either completing or closing out budget and document in report
- This HC documents if CC has removed themselves from major reporting system in Guiding Care (G.C) and has also removed themselves and Support Broker from FOCoS Online.
- Every Month this HC is responsible for completing 6 Support Broker Monthly Reports
- Each of the Support Brokers (SB) send into the Self-Directed email box that this HC solely manages and one by one this HC tends to these reports
- Each report has its own unique set of issues from each SB, this HC has an “MCO notes” row that is created after Support Brokers send in their reports to us (MCO) this tends to members that SBs’ have identified as there being some sort of issue with whether it was late submission of a budget, or a C.NA invite was not sent timely
- It is this HC’s job to identify the issue and become the intermediary and try to find out exactly what happened
- This HC keeps all CCs’ C.NA invites in secure files within Microsoft Outlook, this writer can check these claims and document information found on report
- This HC researches all Support Brokers claims on their monthly reports, after this has been complete this writer will upload into our Share Point site this writer has created designated files for management to view, after all reports have been completed this writer reviews with Unit Manager and she will send to Senior Leadership and the EDOP team who is the Official Intermediary Management team between the Care Coordinators and Support Brokers, if changes need to be made all management parties will be informed through that team
- When Unit Manager sends out Bi-Monthly Compliance Report to all Self-Direct Care Coordinators every week to ensure the CCs are reporting on all their Touchpoints
- This HC will assist CCs with their compliance and monitoring that the budget utilization report is being ran and gone over with the member during the TPs
- If this writer sees that the CC has not yet reached out to that member, this HC will run a Utilization Accrual/Claimed report Total to Date and will copy and paste that information into an email for the SDCC and send it to them informing them that this writer has ran this report and has copied it into an activity in our reporting system into Guiding Care
- This HC will also run member’s spending report for "the total year" and attach it to email
- This will assist CC to ensure they are remaining compliant and completing their touchpoints on time and reviewing member’s budget utilization in process.
- Resolved problems, improved operations and provided exceptional service
CNA - Certified Nursing Assistant
Genesis HealthCare
Albuquerque, NM
11.2017 - 01.2019
- Worked in the rehabilitation wing and the long-term patient wing
- Completed after care and assisted in removal process of deceased
- Used Sit-to stand machine to assist patients’ incapable of fully being able to stand on their own and that needed that extra support
- Throughout this writer's career as C.NA using a Total lift when proven necessary and patient was documented as Total needs patient and was unable to follow commands and/or their body was physically unable to aid when attempting to get up from a laying down position into a sitting upright position
- Assisted patients with them In Activities of Daily Living and Activities of Daily Living (IADL’s & ADL’s)
- Assist patients with exercise regimens as prescribed by their surgeon/PT/OT
- Fed patients that required assistance (according to their prescribed diet), whether it was stand by assistance or total assistance
- Chart on patients, take Vitals, transfer patients
- Evaluated patients to identify and address wounds, behavioral concerns and medically relevant symptoms
CNA - Certified Nursing Assistant
The Medical Resort, Fiesta Park
Albuquerque, NM
06.2017 - 09.2017
- This is a Rehabilitation Facility
- Assisted patients with their Activities of Daily Living & In Activities of Daily Living (ADL’s & IADL’s)
- Assist patients with exercise regimens as prescribed by their surgeon/PT/OT
- Chart on patients, take Vitals, transfer patients
- Assist nurses with completing tasks that patients were needing such as; nurse duties (Stand-by assist, assisting with wound care, during nurse shortage at facility)
- Changing/emptying Ostomy bags on patients, empty/clean Foley bag on patients
- Obtained biological specimens for ordered tests and prepared for laboratory transport
Home Health Care Aide
We Care Agency
Albuquerque, NM
11.2015 - 03.2017
- Home Healthcare Provider
- Provide patients with help moving in and out of beds, baths, wheelchairs, or automobiles and with
- Dressing, and grooming
- Plan, purchase, prepare, or serve meals to patients or other family members, according to prescribed diets
- Perform variety of duties as requested by client, such as obtaining household supplies or running errands
- Cleaning clients home; completing dishes & laundry for client as needed
- Accompany clients to doctors' offices or on other trips outside home, providing transportation,
- Assistance, and companionship.
- Cooked tasty, nourishing meals for patients to promote better nutrition
- Encouraged patients to participate in safe physical activity to help boost mood and improve overall wellness
Caregiver
Homes With A Heart Assisted Living
Albuquerque, NM
04.2015 - 09.2015
- Administer bedside or personal care; perform housekeeping duties, such as cooking, cleaning,
- Washing clothes or dishes and running errands
- Would assist house manager in planning and preparing nutritious meals
- Would provide Companionship and long-term connections to home member
- Managed over 16 home members at a time, with just myself to manage cooking dinner and next meal for next day.
- Maintained clean personal areas and prepared healthy meals to support client nutritional needs
- Transported individuals to events and activities, medical appointments and shopping trips
- Recognized and reported abnormalities or changes in patients' health status to case manager
- Assisted patients with self-administered medications
- Turned and positioned bedbound patients to prevent bedsores and maintain comfort levels
Education
Master - Barber Certification
Albuquerque Barber College
06.2017 - 06.2019
Certificate in Certified nursing assistant -
On Pointe
Medical Resort 04.2017 - 04.2017
CNA First Aid CPR AED - First Aid CPR AED
On Point
Medical Resort 01.2013 - 01.2013
Skills
Software Proficiency
Timeline
CC-Care Coordinator
Blue Cross Blue Shield
05.2022 - Current
HC-Health Care Coordinator
Blue Cross Blue Shield
11.2017 - 05.2022
CNA - Certified Nursing Assistant
Genesis HealthCare
11.2017 - 01.2019
CNA - Certified Nursing Assistant
The Medical Resort, Fiesta Park
06.2017 - 09.2017
Master - Barber Certification
Albuquerque Barber College
06.2017 - 06.2019
Certificate in Certified nursing assistant -
On Pointe
04.2017 - 04.2017
Home Health Care Aide
We Care Agency
11.2015 - 03.2017
Caregiver
Homes With A Heart Assisted Living
04.2015 - 09.2015
CNA First Aid CPR AED - First Aid CPR AED
On Point
01.2013 - 01.2013
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