EDWINA FLAGG
Westland
Summary
Dynamic healthcare professional with over 20 years of comprehensive experience in managed care, hospitals, and primary care environments. Proven expertise in care management, HEDIS data abstraction, and member engagement, complemented by a strong background in patient access operations, including scheduling, insurance verification, and registration. Recognized for exceptional organizational skills and analytical thinking, with a deep understanding of Medicaid and Medicare regulations. Seeking opportunities that align with professional strengths while accommodating family priorities.
Overview
13
13
years of professional experience
Work History
Care Management Specialist
Aetna Better Health of Michigan
02.2024 - 08.2025
- Assessed client wellness and developed individualized care plans
- Participated in integrated care team meetings and adjusted care plans accordingly
- Conducted risk stratification and validated member eligibility for specialized programs
- Coordinated services across providers, social workers, and community resources
- Documented interventions and outcomes in MedCompass and ensured compliance with NCQA standards
- Identified barriers to care and initiated problem-solving strategies to improve access
Care Coordinator
Aetna Better Health of Michigan
01.2021 - 02.2024
- Conducted health risk assessments and coordinated referrals for medical and behavioral health services
- Scheduled appointments, verified eligibility, and tracked member engagement
- Educated members on preventive care and chronic condition management
- Collaborated with interdisciplinary teams to ensure continuity of care
- Maintained accurate documentation and supported quality improvement initiatives
HEDIS Outreach Coordinator
Aetna Better Health of Michigan
11.2019 - 01.2021
- Performed outreach to close gaps in care and improve HEDIS Star measures
- Requested and abstracted medical records for compliance and reporting
- Used motivational interviewing techniques to engage members in preventive health behaviors
- Coordinated transportation and appointment scheduling for screenings and follow-ups
- Documented outreach activities and supported audit readiness
Care Manager Associate
Aetna Better Health of Michigan
02.2017 - 11.2019
- Supported case managers with member assessments, eligibility reports, and care plan updates
- Processed communications from members, providers, and vendors
- Assisted with data entry, documentation, and reporting for utilization management
- Verified insurance and coordinated benefits across Medicaid and Medicare platforms
- Maintained confidentiality and compliance with HIPAA regulations
Care Coordinator Assistant (HAP)
Henry Ford Health System
04.2016 - 02.2017
- Scheduled health risk assessments and coordinated care team meetings
- Verified member eligibility and updated contact information in EPIC
- Assisted with referrals, appointment reminders, and documentation tracking
- Supported transitions of care and follow-up scheduling
Customer Service Representative
Henry Ford Health System
01.2015 - 04.2016
- Scheduled and registered patients; verified insurance and collected co-pays
- Resolved billing inquiries and guided patients through benefits and coverage
- Provided empathetic service during high-volume interactions
- Maintained patient confidentiality and adhered to HIPAA standards
Unit Secretary
Henry Ford Health System
11.2012 - 01.2015
- Managed patient charts, scheduled procedures, and verified insurance
- Answered phones, relayed messages, and coordinated communication between departments
- Maintained inventory of supplies and ensured an organized work environment
- Supported clinical staff with administrative tasks and documentation
Education
Bachelor of Science -
Davenport University
Livonia, MI01.2014
Associate of Arts - undefined
Wayne County Community College
Detroit, MI01.2007
Skills
- Medicaid & Medicare Regulations
- HEDIS Measures & Outreach
- SNP & Long-Term Care Management
- NCQA Care Management Standards
- EPIC Systems (Super-User)
- Patient Access & Scheduling
- Insurance Verification & Registration
- Microsoft Office Suite Proficiency
- Appeals & Grievance Support
- Strong Organizational & Analytical Skills
- Patient communication
- Case assessment
- Follow-up care coordination
Timeline
Care Management Specialist
Aetna Better Health of Michigan
02.2024 - 08.2025
Care Coordinator
Aetna Better Health of Michigan
01.2021 - 02.2024
HEDIS Outreach Coordinator
Aetna Better Health of Michigan
11.2019 - 01.2021
Care Manager Associate
Aetna Better Health of Michigan
02.2017 - 11.2019
Care Coordinator Assistant (HAP)
Henry Ford Health System
04.2016 - 02.2017
Customer Service Representative
Henry Ford Health System
01.2015 - 04.2016
Unit Secretary
Henry Ford Health System
11.2012 - 01.2015
Associate of Arts - undefined
Wayne County Community College
Bachelor of Science -
Davenport University
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