Summary
Work History
Skills
Timeline
Generic

Carmen Segoviano

LaBelle,FL

Summary

Compassionate Senior, Patient Care Advocate with background in providing high-quality support to members in diverse healthcare insurance settings. Skilled at advocating for patient rights, coordinating health needs such as providers changes, appointment scheduling and assisting members to meet their preventative measures.Case management referrals as needed. Strengths include strong communication skills, empathy, and ability to handle stressful situations with grace. Notable for creating positive members and staff experiences through consistent dedication and commitment to meeting individual needs. Participante of leadership meetings responsible professional enthusiastic about supporting best practices and operations, quality compliance and healthcare member management various programs such as event appointments scheduling and follow up call confirmation. White Glove Program services recovery survey to provide member satisfaction. Demonstrated strengths in multi-area leadership , quality assurance, and service. Resourceful professional and collaborative team player. Successful at overseeing ongoing internal programs process changes and coaching staff to enhance the skills of future company quality measure goals. Organized , proactive and flexible to handle different conditions and company requirements. EMR HEDIS record retrieval to meet company compliance end of year

Work History

Senior, Patient Care Advocate

Centene Management Company LLC
Fort Myers, FL
06/16/20 - Current
  • Conducts telephonic member outreach and gap education education, while assigned to Family Health Centers of SW FL providers' offices, to members who are identified as needing preventive services in support of quality initiatives support quality improvement and regulatory/contractual requirements
  • Schedules doctor appointments on behalf of the practitioner and assists member
  • Acts as a liaison and member advocate between the member/family, physician and clinics
  • assist with campaign confirmations attendance calls
  • assist with new onboarding and existing employee training as needed

Patient Care Advocate

Centene Management Company LLC
Fort Myers, FL
01.2017 - 2020
  • Provides education to members regarding the care gaps they have when in the providers office for medical appointments. Schedules doctor appointments on behalf of the practitioner
    • Acts as a liaison and member advocate between the member/family, physician and clinics
    • Schedules doctor appointments for members with care gaps to access needed preventive care services and close gaps in care in the provider’s office.
    • Conducts telephonic outreach to members to support quality improvement, regulatory and contractual requirements.
    • Documents all actions taken regarding contact related to member.
    • Interacts with other departments including customer service to resolve member issues.
    • Refers to case management as appropriate.
    • Completes special assignments and projects

Community Health Worker

WELLCARE/Centene Management Company LLC
Fort Myers , FL
05.2014 - 2017
  • Provides members with known community resources and supports the care team to identify member community support and provide health education as appropriate
  • Supported the coordination of community outreach resources available to members and promotes awareness of care/services
  • Served as support for members on community and care resource inquiries and opportunities available to members
  • Provided assistance to the clinical team of nurses and social workers
  • Activities include, but are not limited to outreach, community education, informal guidance and member support, managed cases as assigned.
  • Conducted non-clinical general health assessments in order to refer members to appropriate care/services, resolve concerns on member’s behalf, and gather information for medical providers and staff working within the organization
  • Conducted telephonic and/or in-person outreach to locate individuals and families in the community who are hard to reach

Skills

  • Documentation
  • Compassionate client care
  • Duties as Assigned
  • Coaching Process Improvements
  • Works Well with Others
  • Appointment Scheduling
  • Database coordination
  • Healthcare Knowledge
  • Knowledge of Medicare/Medicaid State and Federal Programs such as SSI, Medicaid, ALTCS and Medicare Advantage HMO’s and s and Medicare PDP’s and MAPD”s
  • Leadership
  • Strong listening talents
  • Deadline Adherence
  • Collaboration and Teamwork
  • Deadline-oriented
  • Microsoft Office expertise
  • Task Prioritization
  • Problem-solving abilities
  • Quality Control
  • Active Listening
  • Multitasking

Timeline

Patient Care Advocate

Centene Management Company LLC
01.2017 - 2020

Community Health Worker

WELLCARE/Centene Management Company LLC
05.2014 - 2017

Senior, Patient Care Advocate

Centene Management Company LLC
06/16/20 - Current
Carmen Segoviano