Elaine Morgan BSPH
Population Health
Yonkers,NY
Summary
Passionate and analytical Mid-level Healthcare Professional with extensive knowledge in Medical Terminology, Medicaid, and Medicare with a clear understanding of HEDIS and QARR measures. Distinguished as an effective communicator. Committed to a proactive, advocacy-driven, and holistic approach to quality care coordination.
Successfully supervised and trained new hires advancing proficiencies. Consistently meet and exceed performance-based metrics goals. Proven to think and work independently, effectively, and efficiently.
Overview
18
18
years of professional experience
7
7
years of post-secondary education
Work History
Clinical Care Coordinator Sr/Care Navigator
United HealthCare/ Optum at Home
02.2023 - Current
- Empower new hires and continue coaching resulting in increased performance and metrics.
- Deliver guidance and subject matter expert experience to team on best practice of new processes.
- Proficiently manage high-volume of Staple, Emerging, High-Risk, and Rising members.
- Effectively complete assessments for Risk Stratification (RSA), Health Risk (HRA), Social Determinants of Health (SDOH), Clinical Indicator (CI), Health Maintenance (HM), Emergency Room Discharge (ED), Post Hospital Visit Follow-ups (PHV).
- Championed patient advocacy, ensuring that unique needs and preferences of each individual were respected and addressed throughout care process.
- Provide advice and assistance members in navigating their Medicare and Medicaid benefits as well as coordinate care with Medicaid Managed Care plans.
- Streamlined communication between multidisciplinary healthcare teams for improved patient outcomes and satisfaction with Case Managers and Behavioral Health Care Managers.
- Promoted patient-centered care by actively involving patients and their families in treatment decisions and goal-setting processes.
- Facilitated timely access to appropriate healthcare services by assessing patient needs and coordinating with outreach, referrals and follow-ups.
- Maintained thorough documentation of all non-clinical interventions, ensuring accurate records for continuity of care and regulatory compliance.
Senior Utilization Management Analyst-In Office to Remote
Montefiore-CMO
05.2015 - 03.2022
- Increased communication between multiple vendors and department teams that resulted in decrease in over-utilization of Home Health Aide services by 10% and increase in Provider engagement of 12%.
- Exceeded in supervising and training new hires elevating their skills on departmental operations and practices contributing to improved department retention rate.
- Achieved cost reduction of over-utilization of Durable Medical Equipment by 20%.
- Executed authorization of services for caseloads of 100+ members a month for Durable Medical Equipment, Home Health Aide Services, RN visits, Physical Therapy, etc.
- Ranked first in 60-line phone queue.
- Managed and prioritized inbound and outbound calls to members, provider, and vendors with focus on member-centric communication.
- Directed and triaged calls achieving successful issue resolution through effective communication with challenging issues.
- Resolved claims issues with timeframe analysis for cost effectiveness
- Initiated out of network processes and negotiation of rate contracts.
Senior Utilization Management Analyst-Telehealth/Community
Montefiore-CMO
04.2009 - 05.2015
- Supervised all aspects of training for new hires, creating a highly effective team.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Educated staff on organizational mission and goals to help employees achieve success.
- Managed authorizing for Diabetic and Durable Medical Equipment.
- Proficient in assessments for Baseline, Flu Shot, Chronic Kidney Disease, Hypertension and Diabetes.
- Managed daily health risk outcome reports for 6 coordinators and 12 RN Certified Diabetes Educators.
- Provided reporting for forecast analysis and ad-hoc reporting in support of decision-making.
- Increased enrollment by 70% in Chronic Kidney Disease program and 60% in Hypertension program.
- Organized and contributed in preventive care classes with 3 Certified Diabetes Educators in 3 locations.
- Enhanced enrollment from 8% -10% participants per location to approximately 20%-25% within first quarter.
- Worked effectively in fast-paced environments.
Utilization Management Analyst
Montefiore-CMO
02.2006 - 04.2009
- Authorized services for HIP, Healthnet and Oxford Health Plans.
- Processed medical director review and assisted case managers with retro reviews for negotiating rates of out of network services.
- Completed daily member assessments to ensure member compliance.
- Referred member to various programs via referrals.
- Achieved cost reductions by utilizing medical information to manage admission and concurrent review process.
- Ensured regulatory compliance and maintained delegated status with health plans by processing of denials within appropriate time frames.
Education
Bachelor of Science - Public Health
Southern New Hampshire University
08.2016 - 02.2021
Associate of Applied Science - Healthcare Administration
Monroe College
08.2013 - 06.2016
Skills
- Integrity
- Self-Directed
- Problem-Solving
- Empathy
- Organizational Skills
- Analytical Skills
- Critical Thinking
- Positive Attitude
- Time Management
- Issue Resolution
- Team Building
- Communication
- Healthcare operations
- Interdepartmental Collaboration
- Supervision
- Training and mentoring
Systems Programs
- Health Information Systems
- Electronic Medical Records
- ICUE
- EPIC
- Nerve Center
- Salesforce
- Scripter
- Pathway
- Spark
- Nice
- DMVES
- Microsoft Office
- Care Memo
- GPS
- Maestro
- CCMS
- Interactive Scripter
- IEX
Community Involvement
Point/Ravine Community Coalition 2021-2024
Community Advocate
The City of Yonkers Mayor's African American Advisory Board 2018-2021
Vice-Chairperson
Community Outreach Coordinator
Timeline
Clinical Care Coordinator Sr/Care Navigator
United HealthCare/ Optum at Home
02.2023 - Current
Bachelor of Science - Public Health
Southern New Hampshire University
08.2016 - 02.2021
Senior Utilization Management Analyst-In Office to Remote
Montefiore-CMO
05.2015 - 03.2022
Associate of Applied Science - Healthcare Administration
Monroe College
08.2013 - 06.2016
Senior Utilization Management Analyst-Telehealth/Community
Montefiore-CMO
04.2009 - 05.2015
Utilization Management Analyst
Montefiore-CMO
02.2006 - 04.2009
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