Delonda Cooper
WALDORF,Maryland
Summary
Experienced Care Management Coordinator with expertise in eligibility verification, authorization oversight, benefits analysis, and utilization workflows. Strong background in discharge planning, case documentation, and provider communication.
Overview
19
19
years of professional experience
Work History
Care Management Coordinator I
CareFirst BCBS
Owings Mills, Maryland
12.2006 - 09.2025
- Coordinated discharge planning for patients transitioning from acute care settings to ensure seamless care continuity.
- Coordinated discharge planning support for patients transitioning from acute care settings.
- Supported member follow-up and care coordination tasks not requiring clinician intervention, including post-discharge monitoring, appointment scheduling, and service arrangement.
- Facilitated member follow-up and care coordination activities outside clinician intervention, including post-discharge monitoring, appointment scheduling, and service arrangement, enabling clinicians to concentrate on higher-level clinical tasks.
- Reviewed eligibility and benefits details to improve care coordination accuracy and support utilization review workflows.
- Reviewed eligibility and benefits with utilization details to support accurate care coordination.
- Timely escalation of complex cases routed members to care management staff per CareFirst BCBS guidelines.
- Escalated complex cases to care management staff in alignment with CareFirst BCBS guidelines.
- Screened and prioritized members using targeted intervention business rules to identify need services and routed cases to appropriate clinical resources or programs.
- Applied targeted intervention rules and screening processes to prioritize members, identify needed services, and direct cases to appropriate clinical resources or programs.
- Completed member and provider administrative support, including benefit verification, authorization management, and case documentation.
- Benefit verification, authorization management, and case documentation supported member and provider administrative needs.
- Updated case records and outreach notes to support compliance and continuity.
- Maintained case records and outreach notes to support compliance standards and continuity of care.
- Completed updates to case records to ensure accurate documentation. and outreach documentation supported compliance and continuity across care transitions.
- Provided general department support, including answering telephone calls, taking messages, drafting letters and correspondence, researching information, and helping solve problems.
- Delivered department administrative support by handling calls, messages, letters, correspondence, research requests, and problem-solving needs.
- Organized and distributed reporting data and information to enhance department workflow efficiency.
- Assisted with reporting, data tracking, information gathering, organization, and dissemination.
- Member follow-up, post-discharge monitoring, appointment scheduling, and service arrangement kept non-clinical coordination work moving while clinicians focused on higher-level care.
- Targeted screening and prioritization identified needed services and connected members to appropriate clinical resources or programs.
- Facilitated communication within the department by managing calls and messages. and research support kept calls, messages, correspondence, and problem-solving requests moving efficiently.
- Targeted screening and prioritization identified needed services and connected members with appropriate clinical resources or programs.
- Facilitated communication within the department by managing calls and messages. and research support kept calls, messages, correspondence, and problem-solving requests moving efficiently.
- Benefit verification, authorization management, and case documentation supported member and provider administrative needs.
- Reporting support improved data tracking, information organization, and dissemination across department workflows.
Education
High School Diploma -
Thomas Stone High School
Waldorf, MD06-1988
Skills
- Eligibility verification
- Authorization oversight
- Benefits analysis
- Case documentation
- Utilization management
- Utilization assessment
- Medical records review
- Provider communication
- Attention to detail
- Problem solving
- Effective communication
- Team collaboration
Timeline
Care Management Coordinator I
CareFirst BCBS
12.2006 - 09.2025
High School Diploma -
Thomas Stone High School