Francis B Stuart Jr
Plainfield,IL
Summary
Practiced Care Plan Coordinator dedicated to timely and accurate completion of patient assessments, supporting development of comprehensive care plans. Collaborates with interdisciplinary team in monitoring progress and adjusting plans to achieve target results. Observes resident care, recommending opportunities for improvements.
Overview
11
11
years of professional experience
Work History
Member Care Coordinator
BlueCross Blue Shield IL
01.2018 - Current
- Contacting identified members to inform and educate them on health care programs
- Responding to inquiries from members and supporting the clinicians in the Medical Management department with their provider and member activities
- Utilizing Guiding care and MPUI
- Completing Heath risk screening, and Health risk assessment with members in home and telephonic
- Engage client in program services according to established protocols and procedures
- Utilize ECCIPSS and Webcm to aid in locating unable to reach members
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement
- Updated policies and procedures, leading continuous improvement of resident assessments and care.
- Determined need for special assessment activities for complex cases, effectively handling care plans.
Care Manager Coordinator
Aetna
10.2016 - 12.2017
- Aetna Better health
- Identifies high risk factors and service needs that may impact member
- Coordinates and implements assigned care plan activities and monitors care plan progress
- Identifies and escalates quality of care issues through established channels
- Utilizes negotiation skills to secure appropriate options and services necessary to meet the members benefits and/or healthcare needs
- Utilizes influencing/ motivational interviewing skills to ensure maximum member engagement
- Identifies and escalates quality of care issues through established channels
- Utilizes case management and quality management processes in compliance with regulatory and accreditation guidelines and company policies and procedures
- Conduct in home assessment to review member services
- Handled waiver services for eligible members on behalf of the Illinois
- Assisted clients with daily living needs to maintain self-esteem and general wellness.
- Consulted with supervisors to assess cases and plan strategies for enhancing care.
Care Coordinator
La Rabida Children Hospital
01.2016 - 10.2016
- Integrate PCP specialist and therapy treatment plans
- Address barriers to care, education needs
- Include personal and wellness goals
- Appointment reminders
- Extra support for families
- Home visits
- Resolution of barriers to care
- Assistance with school 504 plan/IEPs
- Educations, problem-solving and encouragement
- Extra support for providers
- Brief, pre-appointment updates of child’s status and current family concerns
- Assistance with specialist and other referrals, coordination and reports
- Resolution of barriers impacting treatment plan
- Facilitation of health plan support
- Updated policies and procedures, leading continuous improvement of resident assessments and care.
- Determined need for special assessment activities for complex cases, effectively handling care plans.
Registration/Scheduling Coordinator
La Rabida Children Hospital
03.2015 - 01.2016
- Accurately and efficiently completes patient registration, all other Meditech routines and other system processes, as defined by job assignment (Admitting, Outpatient Registration, Emergency Department) in a timely manner, in person or by phone
- Explains consent forms thoroughly
- Uses interpretive services when appropriate
- Obtains signatures
- Completes and distributes all paperwork
- Demonstrated knowledge of insurance payer rules and regulations
- Strong organization and coordination skill
- Demonstrated qualities including professional verbal, written communication skills, problem solving and decision making
- Greets and assists all patients, visitors, physicians and employees promptly and in a friendly, courteous and professional manner
- Directs or escorts patients and visitors to appropriate room, department, or location
- Developed strong working relationships with management and executive team through effective scheduling and communication skills.
- Gathered employee data to develop monthly work schedules, enabling proper staffing for departments for each shift.
Benefit Advisor
Go Health, Blue Cross Blue Shield
09.2013 - 11.2014
- In IL, MI
- Added optional supplemental benefits to plans, assisted with Anthem Extras enrollments
- Efficiently used data entry software
- Enrolled applicants in HMO, PPO, and Medicare Supplement plans
- Assisted clients with selection and enrollment into health plans
- Efficiently enrolled eligible citizens into Medicare
- Licensed in life/health to recommend benefit
- Checked employees' benefits enrollment for accuracy and inputted all data into [Software].
- Explained benefits to plan participants in easy to understand terms in order to educate each on available options.
Education
Bachelor of Arts - Psychology
East West University
Chicago, IL06.2013
Skills
- Personal and professional integrity
- Relationship and team building
- Motivation techniques specialist and critical thinking proficiency
- Cultural awareness and sensitivity
- Proficient in Microsoft office
- Excellent communication skills
- Proven patience and self-discipline
- Operating Plans Development
- Service Utilization Improvements
- Financial Reporting Coordination
Timeline
Member Care Coordinator
BlueCross Blue Shield IL
01.2018 - Current
Care Manager Coordinator
Aetna
10.2016 - 12.2017
Care Coordinator
La Rabida Children Hospital
01.2016 - 10.2016
Registration/Scheduling Coordinator
La Rabida Children Hospital
03.2015 - 01.2016
Benefit Advisor
Go Health, Blue Cross Blue Shield
09.2013 - 11.2014
Bachelor of Arts - Psychology
East West University
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