Cindy Fraley
Big Stone Gap,VA
Summary
I have extensive experience at Mountain Empire PACE, excelling in Medicaid eligibility and care plan development. Proven track record in increasing participant enrollment through effective communication and innovative marketing strategies. Adept at interdisciplinary collaboration and problem-solving, ensuring high-quality care and compliance with regulatory standards.
Overview
44
44
years of professional experience
1
1
Certification
Work History
RN Intake/Enrollment Coordinator/LTSS Screener
Mountain Empire PACE
Big Stone Gap, VA
08.2020 - Current
- Hold the primary responsibility as an RN for performing Medicaid Long-Term Services and Supports (LTSS) to determine an individual's eligibility for long-term care Medicaid.
- Adhere to all state, federal, and regulatory bodies' policies, in addition to company policies.
- Responsible for enrollment to support the growth of PACE.
- Participate in Quality Assurance and Performance Improvement program.
- Perform marketing events for the promotion of PACE.
- Communicate the PACE program to participants and caregivers.
- Coordinate with other departments and attend IDT meetings.
- Compile reports on enrollment trends using various software programs.
- Develop and implemented strategies to increase participant enrollment.
- Conduct interviews with applicants, explaining the benefits process, and which programs and resources are available to meet their needs.
- Complete and process applications for enrollment.
Utilization Management RN
United Health Care Group
Richmond, VA
02.2019 - 02.2020
- Review of requests to determine if the required documents are submitted per MCO, which justifies the need for the services being requested per the DMAS 98R, DMAS 97 A/B, and DMAS 99.
- Verification of medical eligibility.
- Communicated with MCOs for submission of correct documents.
- Submit request for service to MD Review per request criteria.
RN Care Manager
United Health Care
Richmond, VA
02.2017 - 02.2019
- The current case load was 145.
- Case Load: 175 Nursing Facility Residents.
- Perform assessments initially, quarterly, and as needed.
- Development of Care Plan.
- Facilitate discharge from NF to the community.
- Responsible for updating DMAS documents.
- Schedule and attend ICT meetings.
- Establish a line of communication with the nursing facility staff and the member's family.
- Assist with transportation scheduling.
- Utilization Management RN.
- Responsible for daily assigned requests.
- Review request to determine if the required documents are submitted per MCO that justify the need for the services being requested per the DMAS 98R, DMAS 97AB, and DMAS 99.
- Verification of Medicaid eligibility in the DMAS Portal.
- Communicates with MCO for the submission of corrected documents or documents not submitted via fax within a 5-day turnaround time per DMAS.
- Submit the completed request for service to MD Review, per the request criteria.
- Utilizes ICUE for the direct entry of requests.
- Responsible for personal email and team email.
Home Care Supervisor, RN
Mountain Empire Older Citizens
Big Stone Gap, VA
02.2008 - 02.2017
- Case Load 50+ Participants
- Supervises 50+ Personal Care Aides
- Initial In-Home Assessments to determine if client meets criteria for Long Term Care Eligibility per, Medicaid, Veterans Affairs, PACE and Private Pay guidelines.
- Provides required documentation for opening of services to Departments of Social Services, Medicaid, DMAS, and Veterans Affairs.
- In-Home assessments monthly to determine continuum of care.
- Develops, monitors, and maintains Plan of Care for each client.
- DMAS documentation and authorization per Policy and Procedure Manual and Medicaid regulations.
- Ensures program compliance and standards per DMAS.
- Coordinates and communicates with providers outside of the agency.
- Utilizes Referral Sources
- Interdepartmental managed care and utilization review.
- Performs HR tasks; recruiting, employing, and training per DMAS guidelines.
- Maintains visit schedule for aides to ensure maximum efficiency and effectiveness.
RN Case Manager II
Frontier Behavioral Health
Big Stone Gap, VA
06.2007 - 06.2008
- Conducted Interviews
- Provided Assessments, Service Planning, Crisis Assistance, and Linkage/Referral
- Maintained Positive Internal and External Customer Service Relationships
- Surpassed Productivity Requirements
Registered Nurse
Wise County Schools
Wise, VA
01.2005 - 01.2007
- Powell Valley Middle School Nurse- 2005-2006
- Pound High School Nurse-2006-2007
Registered Nurse
Wellmont Lonesome Pine Hospital
Big Stone Gap, VA
01.1981 - 01.1987
- OB/GYN staff nurse
- Medical Surgical Unit Staff Nurse
- Gastroenterology Nurse.
Education
Registered Nurse -
Mountain Empire Community College
Big Stone Gap, VA05.1982
Skills
- Microsoft Word
- Microsoft Excel
- Windows
- Adobe
- Outlook
- Coding
- CCC Plus
- Medicaid eligibility
- Care plan development
- Effective communication
- Client assessments
- Marketing events
- Interdisciplinary collaboration
- Problem solving
- Documentation
- Heart Saver First Aid (First Aid)
- LTSS Screener
Certification
- VA RN License with Multi-State Privilege
- AHA-BCLS
- AHA First Aide
- Crisis Management Certification
- CSB Pre-Admissions Screener
- Train the Trainer Certification (CPA Classes)
References
- Lisa Chandler, Quality Improvement Manager- Mountain Empire Older Citizens, 276-393-7343
- Layne Walker, Mountain Empire Medicaid Special 276-870-5765
- Sherry Goode Mountain Empire FNP 276-523-0599
References
References available upon request.
Timeline
RN Intake/Enrollment Coordinator/LTSS Screener
Mountain Empire PACE
08.2020 - Current
Utilization Management RN
United Health Care Group
02.2019 - 02.2020
RN Care Manager
United Health Care
02.2017 - 02.2019
Home Care Supervisor, RN
Mountain Empire Older Citizens
02.2008 - 02.2017
RN Case Manager II
Frontier Behavioral Health
06.2007 - 06.2008
Registered Nurse
Wise County Schools
01.2005 - 01.2007
Registered Nurse
Wellmont Lonesome Pine Hospital
01.1981 - 01.1987
Registered Nurse -
Mountain Empire Community College
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