Elizabeth Wesolek
Pardeeville,WI
Summary
Dynamic leader with extensive experience at My Choice Wisconsin by Molina, excelling in team building and critical problem-solving. Proven track record in enhancing care management operations and achieving compliance with Medicaid standards. Skilled in effective communication and training, fostering collaboration to drive quality improvements and member satisfaction.
Overview
24
24
years of professional experience
Work History
Lead Supervisor
My Choice Wisconsin by Molina
Beaver Dam, WI
05.2020 - 05.2025
- Delivered Family Care program principles via effective assessments and care planning.
- Led team of 8-15 employees, managing hiring, training, coaching, and professional development.
- Facilitated team meetings to convey organizational updates and policy changes.
- Collaborated with teams to coordinate services and resolve complex member and provider issues.
- Cultivated strong relationships with internal customers and external stakeholders.
- Participated in workgroups focused on contract compliance and quality documentation.
- Monitored monthly Medicaid recertification status for care management unit operations.
- Conducted utilization reviews to identify cost-saving strategies.
Member Rights Specialist
Care Wisconsin
Madison, WI
08.2014 - 05.2020
- Managed grievance and appeal processes, coordinating pre-hearing meetings and maintaining tracking documents.
- Advocated for members in SSI program, collaborating with medical providers and representing members in hearings.
- Ensured compliance with state and federal regulations regarding appeals and grievances.
- Liaised between care teams, advocates, and Metastar to facilitate mediation and problem solving.
- Consulted with Senior Leaders on policy interpretations, ensuring timely communication on operational risks.
- Analyzed data to identify strengths and improvement opportunities in Notice of Actions implementation.
- Maintained grievances and appeals database, generating reports to evaluate trends for continuous improvement.
- Developed policies related to Medicare, Medicaid, Member Rights, Appeals, and Grievances.
Care Manager
Care Wisconsin
Portage, WI
09.2010 - 08.2014
- Supported effective and cost-efficient long-term care outcomes for members.
- Assessed and coordinated long-term care services tailored to individual needs.
- Completed assessments, care plans, and functional screens in a timely manner.
- Collaborated with decision-makers and supports to create member-centered plans.
- Participated in team meetings and training sessions to enhance service delivery.
- Established and maintained positive relationships with community agencies and providers.
- Ensured documentation met quality standards and complied with DHS contract requirements.
Human Services Specialist
Care Wisconsin
Madison, WI
09.2007 - 09.2010
- Coordinated care plans with members, Partnership teams, families, and service providers in Adult Day Center.
- Facilitated tours of Adult Day Center for prospective enrollees.
- Completed enrollment paperwork and maintained member files per state regulations.
- Oversaw performance of CNAs and activity staff as member of Leadership Team.
Case Manager
Salvation Army
01.2002 - 05.2005
- Delivered comprehensive case management to homeless families within Dane County shelter system.
- Developed individualized weekly case plans while maintaining detailed case notes and files.
- Assessed client needs to coordinate suitable community services effectively.
- Tracked monthly statistics on clients, referrals, and available services.
- Conducted intakes to evaluate eligibility for women and families.
Support Broker
TJ’s Brokerage Firm
07.2001 - 09.2003
- Delivered systems case management to adults with disabilities under Self-Directed Services Model.
- Facilitated client service purchases within budget to achieve individual goals.
- Executed annual CIP Medicaid waiver recertification's, financial plans, and long-term care functional screens.
- Coordinated long-term care services such as residential, vocational, day programming, and personal care.
Education
Bachelor of Arts - Social Work
University of Wisconsin – Whitewater
Whitewater, WI12-1999
Skills
- Leadership and team building
- Critical thinking and problem solving
- Community collaboration
- Time management
- Training and development
- Effective communication
References
Available upon request
Professional Development
- Motivational Interviewing
- Managing Mental Health and Substance Abuse Disorders
- Root Compass Manager Development
- Dementia Training – Music & Memory
- Managing Threatening Confrontations
Timeline
Lead Supervisor
My Choice Wisconsin by Molina
05.2020 - 05.2025
Member Rights Specialist
Care Wisconsin
08.2014 - 05.2020
Care Manager
Care Wisconsin
09.2010 - 08.2014
Human Services Specialist
Care Wisconsin
09.2007 - 09.2010
Case Manager
Salvation Army
01.2002 - 05.2005
Support Broker
TJ’s Brokerage Firm
07.2001 - 09.2003
Bachelor of Arts - Social Work
University of Wisconsin – Whitewater
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