ELIZABETH CASTILLO

Provide leadership and support in establishing and directing Stars Program for specific regions

• Develop and prepare for monthly leadership market level meetings to discuss Star performance and review opportunities for improvement
• Collaborate with market executives to execute implementation of Star initiatives
• Provide expertise Star measures and tools that support collection of and communication about HEDIS/STARS
• Work in collaboration with Clinical Training team to develop required educational materials and support for increased Star acumen
• Develop HEDIS/STAR member and provider engagement strategies
• Facilitate, integrate, and/or coordinate implementation and evaluation of identified quality improvement / HEDIS / STAR activities as requested by market and/or clinical leadership
• Promote understanding, communication, and coordination of all quality initiatives
• Maintains Star program documents, reports, and meeting minutes and follows all internal privacy and confidentiality policies and procedures
• Lead the coordination and completion of projects with cross - functional teams and senior leaders across medical/nursing / clinical functional areas to achieve targeted clinical strategic performance goals
• Provide training with Risk Adjustment data and documenting expectations.
• Implemented change management initiatives, ensuring successful adoption of new processes and systems within organizations.
• Partnered with cross-functional teams to develop targeted solutions addressing identified performance gaps.
• Evaluated the effectiveness of interventions, making necessary adjustments to optimize results.
• Provided coaching and mentoring to clients, fostering a culture of continuous learning and development.
• Collaborated with stakeholders to design and implement performance management systems, streamlining organizational processes.
• Boosted client performance by conducting in-depth assessments and identifying areas for improvement.
• Evaluated diverse organizational systems to identify workflow, communication, and resource utilization issues.
• Conducted thorough reviews of operations to devise and deploy improvement strategies.
• Established strong relationships with key stakeholders, securing buy-in for proposed solutions aimed at boosting overall efficiency.

• Orchestrated comprehensive workflow analysis and process mapping initiative, pinpointing inefficiencies in procurement cycle resulting in 25% STAR Score increase
• Implement performance improvement tools to support clinic outreach activities, track data gaps, and decrease healthcare disparities
• Gather demographics, diagnosis and utilization, clinical quality, and performance data for analysis and reporting
• Initiate, track and report project outcomes
• Provide education to team coordinators/IPA office staff on how to implement best practices, and what expectations are required for group and provider outreach
• Managed process re-engineering project to improve and consolidate end-to-end service processes; restructured communication flow among 10 departments and cut down paperwork by 75%
• Identify eligible population and extract relevant data and indicators for healthcare measures
• Knowledge in Managed Care Organizations (Health Plan, IPA/Medical Group, HMO, PPO, etc.) as well as Medicaid/Medicare and related programs
• Assists with project activities related to organizational change management (e.g., development and execution of user adoption, implementation, and training plans).
• Followed up on change orders to ongoing projects, confirming necessary alternation completions occurred on time.
• Organized meetings and gathered support materials.
• Implemented change management processes to address evolving scope or shifting priorities, minimizing disruptions to the project timeline.
• Reduced project timelines through effective delegation of tasks and monitoring progress to ensure timely completion.
• Published progress reports, updating senior leadership and stakeholders on overall project development.
• Utilized industry best practices throughout all phases of the projects'' lifecycles resulting in improved outcomes.

• Train new team members
• Manage small projects or components of larger projects
• Lead work of project team members by requesting internal and/or external resources
• Complete work assignments by applying up-to-date knowledge in subject area to meet deadlines; follows procedures and policies and applies data and resources to support projects or initiatives with limited guidance
• Support management and proactive mitigation of project risks by assisting in analysis/resolution of trigger events
• Provide support by regularly communicating with project team members and working closely with key stakeholders
• Medical Record Abstraction Scheduling, coordinating, and conducting provider office visits to ensure that data is provided within accepted timeframe.
• Facilitated regular meetings with team members to discuss progress updates, address challenges, and brainstorm solutions for ongoing success.
• Established strategic partnerships with external organizations, expanding program reach and impact.
• Developed and maintained relationships with external partners to facilitate program operations.
• Kept program-related data accurate, up-to-date and easily accessible for accessibility.
• Created and delivered program training and education to keep participants knowledgeable about program and provide necessary skills to participate productively.
• Provided ongoing direction and leadership for program operations.
• Provided exceptional customer service to program participants through prompt response times and attentive assistance with inquiries or concerns.
• Determined broadcast requirements to plan event coverage and regular programming.

Work directly with the clinic staff in establishing, refining, and implementing developed policies, procedures, and protocols for use in the clinic

• Engage in process improvement and work with other departments as needed to ensure organization wide improvement
• Maintain written reports of findings and activities and manage quality measures for Provider Incentive Program Meet productivity standards and performs duties as workload necessitates Essential Duties and Responsibilities
• Sanitized, restocked, and organized exam rooms and medical equipment.
• Obtained client medical history, medication information, symptoms, and allergies.
• Performed medical records management, including filing, organizing and scanning documents.
• Called and faxed pharmacies to submit prescriptions and refills.
• Documented vital signs and health history for patients in clinic and hospital environments.
• Built strong relationships with patients through effective communication skills that foster trust in clinic's commitment to quality care.
• Enhanced clinic efficiency by assisting physicians with routine procedures and diagnostic tests.
• Coordinated patient referrals to specialists or other healthcare providers as needed for comprehensive care management plans.

• Collect patient specimens and data, including vital signs, input/output and other delegated measurements
• Change sterile dressings, administered injections, assisted with well women screenings, Tested and recorded blood glucose levels
• Respond appropriately to physical, emotional, and developmental needs of patients
• Accurately process claims submissions
• Verify insurance benefits
• Perform clerical duties, such as answering phone calls, checking in patients, scheduling appointments with minimal supervision, seamlessly
• Monitor expiration of medical supplies and medications for compliance.
• Coordinated work of junior staff to keep team performance high and effectively handle needs of 40+ patients per day.