CAROLYN TONEY
TOLEDO
Summary
Hardworking healthcare professional successful at managing training, gathering paperwork and assisting with different
community-based programs. Good communicator and planner with excellent organizational skills and a strong attention to
detail. Caring Community Health Worker looking to bring over 10 years' experience in the field to a challenging new role.
Focused on assisting community members with close support and vital education. Skilled at delivering training classes and
informational materials to community members in order to promote health improvements and reduce problems with chronic
diseases. Proficient in related programs and capable of helping people locate, enroll and take advantage of resources.
Compassionate and positive with good interpersonal and conflict management abilities.
Overview
6
6
years of professional experience
Work History
Care Coordinator II
Centene Inc
07.2024 - Current
- Determined need for special assessment activities for complex cases, effectively handling care plans.
- Assessed members needs and connected them with appropriate resources to ensure optimal health outcomes.
- Managed members caseloads effectively, ensuring timely follow-up and appropriate interventions.
- Monitored progress towards members goals, adjusting care plans as needed to achieve desired results.
- Advocated for members'' rights within the healthcare system, working diligently to address concerns or barriers to care.
Program Coordinator I
Centene Inc.
08.2022 - 07.2024
- Initiate authorization requests for output or input services in keeping with the prior authorization list
- Maintain integrity of PHI
- Maintain working relationships with other departments
- Research claims inquiry specific to the department and responsibility
- Attend ongoing training and in services as directed
- Perform tasks necessary to promote member compliance such as completing all required assessment with directing members to correct resources for any barriers
- Assess and monitor inpatient census
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Answers phone queues and faxes within established standards
- Screen members by priority for CM assessment
- Coordinates services with community based organizations
- Attends marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Helps develop marketing and outreach meetings as directed to represent the health plan
Provider Services Coordinator
Centene Inc.
05.2022 - 08.2022
- Answered all inbound calls
- Primary role is to support the provider network
- Research and dispute any monies redeemable to provide
Community Health Worker
Buckeye Health Plan
04.2019 - 05.2022
- Created and oversaw training courses focused on team and community education
- Answered calls and interacted with community members to provide information on advocacy services
- Helped people enroll in programs, arrange transportation and coordinate paperwork
- Delivered healthy living and disease management information to specific population groups
- Returned calls, emails and faxes according to departmental policy
- Applied concise time-management to meet deadlines
- Acquired and maintained knowledge of with all Buckeye policies and procedures
- Created new programs that resulted in increasing productivity and customer satisfaction
- Improved operations by working with team members and customers to find workable solutions
- Recognized by management for providing exceptional customer service
Education
Associate of Applied Science - Medical Assisting
Lincoln College of Technology
Toledo, OH01.2011
Skills
- Infant mortality reduction
- Organized and detail-oriented
- Chronic disease rates
- HIPAA guidelines
- Lesson planning
- Strong clinical judgment
- Team management
- Relationship development
- Managing deadlines
- Communications
Timeline
Care Coordinator II
Centene Inc
07.2024 - Current
Program Coordinator I
Centene Inc.
08.2022 - 07.2024
Provider Services Coordinator
Centene Inc.
05.2022 - 08.2022
Community Health Worker
Buckeye Health Plan
04.2019 - 05.2022
Associate of Applied Science - Medical Assisting
Lincoln College of Technology
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