Christine Fairchild

• Consistently exceeded enrollment goals by building meaningful relationships with members in SNP and Post-Discharge programs.
• Completed initial member assessment to determine and address member's home care needs.
• Responsible for health care management for members with complex acute and chronic care needs by assessing, developing, implementing, coordinating, monitoring, and evaluating care plans designed to optimize member health care across the care continuum.

• Delivered care, support and advocacy to many of the most chronically ill members, not equipped to navigate our overwhelming healthcare system alone.
• Assisted members and families in establishing patient-specific goals, identifying gaps in care, removing barriers, improving resource utilization while promoting cost containment and the health of the member.
• Created and implemented care plan that addressed the identified needs, removed barriers and improved the health of the patient.
• Completed initial member comprehensive assessment to determine and address member's post-discharge and home care needs, in collaboration with IDT team.
• Directed and participated in the establishment & maintenance of effective working relationship with outside agencies at discharge.
• Coordinated care by serving as a resource for the patient, their family and their physician.

• Communicated and collaborated with Member’s IPA/MG as needed.programs support clinical disease management improvement efforts.

• Developed and implemented individualized care plan for each hospice patient while following company protocols.
• Educated family members and caregivers in various ways to manage patients' pain, how to check for vital signs and proper methods for dressing changes.
• Established and maintained successful relationships with patients, family members and physicians by utilizing exemplary communication and active listening skills.
• Offered listening ear to both patients and loved ones to meet emotional and mental, as well as physical needs.

• Welcomed new patients and actively built relationships by assisting patients through continuum of care in collaboration with patient's interdisciplinary health care team.
• Performed a holistic and comprehensive admission and concurrent review of the medical record for the medical necessity, intensity of service and severity of illness.
• Assisted with coordination of discharge planning process in conjunction with related departments to facilitate patient’s continuity of care.
• Completed patient needs assessment utilizing proprietary post-acute care planning tools to improve patient’s functional recovery.
• Assured that patients and families proceeded efficiently through the course of hospitalization.
• Participated in the maintenance of effective working relationship with outside agencies in collaboration with discharge planner.
• Developed optimal discharge plan to most appropriate PAC setting, at most cost-effective level of care needed to meet patient's needs.
• Coordinated program referrals for community-based resources.
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• Utilized CalOptima’s medical criteria, policies, and procedures to authorize referral requests from medical professionals, clinical facilities, and ancillary providers.
• Verified and processed specialty referrals, diagnostic testing, outpatient procedures, home health care services, durable medical equipment and supplies via telephone or utilizing established clinical protocols to determine medical appropriateness.
• Screened requests for the Medical Director review, gathered pertinent medical information prior to submission to the Medical Director; followed up with the requester by communicating the Medical Director’s decision; documented follow-up in the utilization management system; composed and mailed documents per protocol.
• Refers cases of possible over/under utilization to the Medical Director for proper reporting.
• Directly interacted with provider callers and served as a resource for their needs.
• Participated in weekly IDT meetings in person and telephonically.
• Reported the progress of all open cases to the Medical Director, Director of Healthcare Services and Manager of Utilization Management.