Donna J Washington
Phoenix
Summary
Methodical Program Coordinator offers internal document creation, program management, and project implementation expertise paired with outstanding time management and multitasking abilities. Resourceful and versatile professional with many years of experience developing and coordinating programs.
Overview
12
12
years of professional experience
Work History
Program Specialist
AHCCCS
01.2025 - Current
- Receive, research, document, and resolve quality of care issues utilizing standardized processes and centralized databases.
- Track, trend, and monitor status of cases to ensure thorough and timely completion as well as appropriate referrals.
- Primary emphasis will be placed on special populations such as those utilizing behavioral health services.
- Ensure research and resolution of quality-of-care issues in a timely manner as assigned and identify systemic issues for AHCCCS to address.
- Participate in operational reviews, technical assistance, and focused studies/reviews, including the behavioral health delivery system, to ensure compliance with contractual and policy requirements for all lines of business.
- Follow-up on written reports, corrective action plans, notices to cure and sanctions as appropriate.
- Ensure quality of care to AHCCCS members, including ensuring member health and safety as well as dignity and respect.
- Focus on unique aspects of each case, individual care needs, timely correspondence with members, and timely acknowledgment of concerns as well as resolution of the issue.
- Use appropriate judgment regarding data to research, regulatory referrals, status level, interventions, and appropriate resolution.
- Provide technical assistance to Contractors, as appropriate, regarding contractual and/or policy requirements to improve quality of care and service delivery to AHCCCS members.
- Participate in special projects and reviews as assigned and assure completion within the designated timelines.
- Provide ongoing updates to CQM Management.
- Coordinate and complete tracking, evaluation, and response to Contractor deliverables.
- Participate in the development of improved processes and procedures to improve efficiency of the CQM Unit.
- Participate in on-site visits to conduct QM investigations and reviews regarding possible health and safety concerns, immediate jeopardy situations and other situations supporting AHCCCS initiatives and ventures.
- Onsite visits may also occur outside of normal business hours and weekends.
Field Care Coordinator-ALTCS
United Health Group
11.2022 - 12.2024
- Engage members face-to-face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs.
- Conduct community visit to home, nursing home and assisted living facilities.
- Coordinate services with member, family members, and community partners.
- Identify and initiate referrals for medical services: Home Health Nursing, Home Health, Medical Equipment.
- Develop care plan throughout the continuum of care as a single point of contact: 90 days, 180 day in requires setting.
- Communicate with internal and external community partners for care coordination and coordinate Long Term Care.
- Communication to ensures needs met.
- Develop and implement person centered care plans to address member needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines.
- Provide education and coaching to support member self-management of care needs and lifestyle changes to promote health.
- Complex problem-solving member issues, concerns and follow up in community and via hone.
- Support proactive discharge planning and manage/coordinate Care Transition following ER visit, inpatient or Skilled Nursing Facility (SNF) admission.
- Identity Housing resources within Maricopa and Yavapai County, Maintain database for housing contact resources.
- Assess assigned and new members for housing needs(low income, section e, HUD, Homeless, substance abuse and mental health).
- Advocate for members and families as needed to ensure the member’s needs and choices are fully represented and supported by the health care team.
- Complete case notes within time specified time frames.
Case Manager Coordinator
Mountain Valley Regional Rehab
05.2022 - 11.2022
- Demonstrates an understanding of treatment costs and financial support as they relate to quality and efficiency.
- Using logic and reasoning to identify members strengths and weaknesses of alternative solutions, conclusions or approaches to problems.
- Utilizes the appropriate leadership skills in delegating, organizing, and educating coworkers and staff.
- Knowledge of community resources to meet post-discharge clinical and social needs.
- Knowledge of clinical operations and procedures.
- Ability to establish and maintain pro-active relationships with internal interdisciplinary team members, local payer, physicians, community service organizations and health care facilities.
- Coordinates all activities associated intake procedures, assessment and treatment assignment of agency clients.
Program Manager
Apogee Mental Health
07.2021 - 12.2021
- Provide direction and support to employees in all phases of developing policies, objectives, procedures, and program goals for Mental health services.
- Coordinate Clinical staff to develop employees, to include performance management, training in accordance with policy and procedures.
- Oversee transitional housing program and staff.
- Review intake documentation and complete renewal documents to maintain housing for tribal clients.
- Developing and coordinating health care programs.
- Communicating between staff, patients and family.
- Handling patient case management and education.
- Recruiting and training staff and creating schedules.
- Evaluate assigned duties for employee to improve efficiency.
- Identify through clinical and administrative supervision, serve as a mentor, coach and teacher for staff and create a climate which promotes quality treatment for each member.
- Develop and collaborate with other components of the organization and outside agencies involved with the program.
- Fosters strong community relations; maintains productive working relationships with staff, clients and community providers to ensure services received in timely manner.
- Review packet for client intakes for Behavioral health program, education and outpatient services.
- Conduct new hire orientation and scheduling.
- Review and coordinate community resource to patients enrolled in mental health education and clinical services.
Management Coordinator
Aetna-Mercy Care
01.2017 - 07.2021
- Utilizes skills to coordinate, document and communicate all aspects of the utilization/benefit management program.
- Applies critical thinking and knowledge in clinically appropriate treatment, evidence-based care and medical necessity criteria for members by providing care coordination, support and education for members through the use of care management tools and resources.
- Evaluation of Members; Through the use of care management tools and information/data review, conducts comprehensive evaluation of referred member's needs/eligibility and recommends an approach to case resolution and/or meeting needs by evaluating member's benefit plan and available internal and external programs/services.
- Identifies high risk factors and service needs that may impact member outcomes and care planning components with appropriate referrals.
- Weekly supervision with staff to determine member referrals can be made as part of an individual service plan, based on medical necessity.
- Partner with community house resource to provide stable house for current members.
- Review application for section 8, low income housing, senior placement, skilled nursing placement and assisted living placement.
- Monthly tracking and reporting to senior management for status of current placement and providing updates on status of placement options.
- Coordinates and implements assigned care plan activities and monitors care plan progress.
- Enhancement of Medical Appropriateness and Quality of Care.
- Uses a holistic approach to overcome barriers to meet goals and objectives; presents cases at case conferences to obtain multidisciplinary review in order to achieve optimal outcomes.
- Helps member actively and knowledgably participate with their provider in healthcare decision-making.
- Guidelines and company policies and procedures.
Clinical Coordinator/Case Manager
Partners In Recovery/Southwest Network
05.2013 - 12.2016
- Oversee the clinical team’s day-to-day functioning to ensure compliance with all program requirements.
- Participate in the hiring, training, coaching, mentoring and supervising of team members, facilitate daily team meetings, to ensure all member needs are coordinated and addressed.
- Ensure clinical quality and productivity standards are met by the team by providing clinical oversight of services provided, assessments conducted, and service plans implemented for all members assigned to your team.
- Additional duties will include daily communication and coordination that is required for continuity of care across team principles.
- Follow up and coordinate member in hospital, community setting.
- Provide testimony in mental health court and develop treatment plans.
- Enters timely and accurate case notes and assessments per agency expectations for each client while maintaining client confidentiality and following program guidelines for charting.
- Utilizes evidence-based practices in service provision, including but not limited to, Motivational Interviewing and Trauma Informed Care.
- Thoroughly assesses client need while identifying and strategizing around barriers to long-term success.
Education
Bachelor of Arts -
Northern Arizona University
Skills
- Quality assurance
- Case management
- Data analysis
- Policy compliance
- Care coordination
- Healthcare regulations
- Health services delivery
Timeline
Program Specialist
AHCCCS
01.2025 - Current
Field Care Coordinator-ALTCS
United Health Group
11.2022 - 12.2024
Case Manager Coordinator
Mountain Valley Regional Rehab
05.2022 - 11.2022
Program Manager
Apogee Mental Health
07.2021 - 12.2021
Management Coordinator
Aetna-Mercy Care
01.2017 - 07.2021
Clinical Coordinator/Case Manager
Partners In Recovery/Southwest Network
05.2013 - 12.2016
Bachelor of Arts -
Northern Arizona University