Dionne Miller
Odessa
Summary
Dedicated healthcare professional with extensive experience in Care Management and Utilization Management. Successfully engages Medicare members by coordinating care, conducting health assessments, and collaborating with interdisciplinary teams to enhance member outcomes while ensuring adherence to regulatory standards.
Overview
1
1
Certification
20
20
years of professional experience
Work History
Care Management Support Assistant III
Humana
09.2025 - Current
- Support Medicare members by engaging them through inbound and outbound calls to encourage participation in Care Management programs.
- Complete comprehensive health assessments and identify healthcare risks requiring clinical intervention.
- Document member concerns, barriers to care, and health risks for Nurse Care Managers to develop individualized care plans.
- Coordinated physician appointments and linked members to healthcare resources and community services to facilitate care continuity.
- Guided members in understanding and utilizing healthcare benefits to enhance access to necessary services.
- Collaborated with interdisciplinary healthcare teams to enhance member outcomes and address gaps in care delivery.
- Maintain accurate documentation while ensuring HIPAA compliance and adherence to organizational policies.
- Demonstrate empathy, professionalism, active listening, and sound judgment while assisting members with complex healthcare needs.
Medicare Sales Agent
Humana
05.2023 - 10.2024
- Educated Medicare beneficiaries on plan options and healthcare benefits, ensuring CMS compliance and informed decision-making.
- Assessed member healthcare needs to recommend tailored Medicare plans that align with individual circumstances.
- Built trusted customer relationships through consultative sales and exceptional customer service.
- Maintained accurate documentation of customer interactions in CRM systems to support effective follow-up and service continuity.
- Participated in ongoing professional development to remain current on Medicare regulations and products.
Utilization Management Coordinator II
Humana
05.2019 - 05.2023
- Coordinated with physicians, providers, and healthcare facilities to secure clinical documentation for timely medical reviews.
- Coordinated physician reviews and facilitated timely case completion.
- Managed multiple cases, ensuring adherence to quality, productivity, and compliance standards.
- Reviewed medical documentation to support utilization management decisions.
- Maintained accurate case documentation while adhering to HIPAA and organizational policies.
- Collaborated with internal departments to enhance quality of healthcare outcomes.
Care Manager
Humana
01.2011 - 05.2019
- Facilitated chronic disease management, preventive healthcare, and care coordination for members, enhancing their overall health.
- Partnered with Nurse Care Managers to implement strategies that led to improved health outcomes for members.
- Addressed complex member concerns through effective communication and problem-solving, ensuring member satisfaction and continuity of care.
- Educated members regarding healthcare benefits, preventive screenings, and available community resources.
- Maintained confidential healthcare documentation while complying with HIPAA requirements.
Utilization Management Coordinator
WellCare Health Plans
08.2006 - 01.2011
- Facilitated provider communication and documentation review to enhance utilization management and clinical operations.
- Coordinated admissions, discharges, and medical record requests.
- Generated reports and correspondence to strengthen healthcare operations.
- Contributed to utilization management projects, ensuring adherence to healthcare regulations.
- Collaborated with providers and interdisciplinary teams to improve workflow efficiency.
Education
Florida 2-40 Health Insurance License -
ExamFX
High School Diploma -
Clearwater High School
Skills
- Care Management
- Utilization Management
- Grievances & Appeals Support
- Member Advocacy
- Clinical Documentation Review
- Medical Documentation
- Care Coordination
- Medicare
- Health Insurance Operations
- Provider Relations
- HIPAA Compliance
- Healthcare Compliance
- Case Documentation
- Microsoft Office Suite
- Microsoft Excel
- Microsoft Word
- CRM Systems
- Critical Thinking
- Problem Resolution
- Time Management
- Team Collaboration
- Customer Service Excellence
- Microsoft Outlook
- Microsoft Teams
- CGX
- HCAT
- Healthcare Documentation Systems
Certification
Florida 2-40 Health Insurance License, Active
Professional Achievements
- Recognized as a Top Performer, 09/01/18, for consistently delivering exceptional member service and exceeding performance expectations.
- Consistently met or exceeded 90% of company performance metrics, while maintaining high-quality member interactions and documentation standards.
- Selected to test CGX and HCAT applications prior to implementation, providing valuable feedback and sharing best practices that improved team efficiency and successful member engagement.
- Recognized as a trusted team resource, by mentoring new and existing associates, facilitating team meetings, and supporting leadership with system implementations and operational initiatives.
- Nearly 20 years of progressive healthcare experience, supporting members, providers, and interdisciplinary healthcare teams.
Timeline
Care Management Support Assistant III
Humana
09.2025 - Current
Medicare Sales Agent
Humana
05.2023 - 10.2024
Utilization Management Coordinator II
Humana
05.2019 - 05.2023
Care Manager
Humana
01.2011 - 05.2019
Utilization Management Coordinator
WellCare Health Plans
08.2006 - 01.2011
Florida 2-40 Health Insurance License -
ExamFX
High School Diploma -
Clearwater High School