Jayson Bates
Beaver Dam,WI
Summary
Dynamic Community Support Specialist with Molina Healthcare, skilled in metrics reporting and policy implementation. Proven track record in enhancing self-directed support coordination and leading teams in fraud detection. Adept at fostering relationships and driving successful outcomes for individuals with disabilities through innovative strategies and effective communication.
Overview
17
17
years of professional experience
Work History
Community Support Specialist
Molina Healthcare
Beaver Dam, WI
03.2017 - Current
- Provide a variety of training, education, consultation and coaching to care management, in accordance with contractual requirements, best practice guidelines, and DHS/CW shared initiatives specific to SDS and member Employment. Encourage care teams to support member's enhanced opportunities in Self-direction and employment.
- Analyze data to identify strengths and opportunities for improvement in the implementation of Self-Determination strategies. Identify new strategies to address opportunities for improvement in processes, member education, care team support and training, and external collaboration.
- Develop relationships and maintain ongoing collaborations with external agencies who support member's SDS plans.
- Work closely with other departments to promote creative services and support that encourage greater self-determination of the people we support
- Facilitated communication and collaboration to achieve performance initiative benchmarks.
- Developed and maintained policies, procedures, and tools to enhance SDS and member employment functions.
- Maintained current knowledge and understanding of SDS, including an understanding of national and international trends and activities that build self-determination opportunities in people with disabilities. Maintain in-depth knowledge of the contractual requirements and federal/stated guidance as related to SDS and member supported employment.
- Monitor the accuracy and appropriateness of SDS through periodic auditing.
- Created data reports and provided essential information to departments such as Quality Improvement, Compliance, Finance, Provider Services, and IT to support metric monitoring.
- Review of all Caregiver Background Checks that have any charges or convictions listed, then provide next steps to Care Teams based on the final results.
- Identified potential opportunities to eliminate fraud, abuse, and waste through collaborative investigations. to eliminate fraud, abuse and waste through collaborative investigations and reporting.
- Collaborate with Provider Services to identify and develop a wider network of in-network providers.
Care Manager
Community Care Inc.
West Bend, WI
01.2012 - 03.2017
- Complete Long-Term Care Functional Screens for members after all changes of condition and/or their periodic reviews.
- Conducted assessments and developed member-centered care plans.
- Collaborated effectively with team members to ensure seamless care coordination; to secure ongoing care coordination.
- Resolved conflicts within members' cases through effective communication and problem-solving.
- Conducted quality assurance and monitored services for program members, including frail elders and individuals with developmental or physical disabilities.
- Managed Medicare and Medicaid funds to ensure accurate and appropriate usage.
- Constant financial oversight and review of members' expenses, to ensure top cost effectiveness while continuing to meet members' needs.
- Serving as team SDS budget Champion for the past 4 years. The Champion provides the Washington County teams (Family Care and PACE/Partnership) guidance on the development of financial budgets of self-directed services for members.
- Championed technology initiatives by providing insight and testing for new systems or programs prior to company-wide implementation.
- Communicated and collaborated with outside agencies to meet member and program goals.
Program Manager
Bethesda Lutheran Communities
Brandon, WI
11.2009 - 01.2012
- Managed personnel through interviewing, hiring, evaluating, training, and supervising, fostering staff development to enhance success in assigned roles.
- Managed, and implemented program budgets; provides input for budget development; ensures programs stay within allocated budget
- Coordinated communication with service agencies to align support and achieve individual outcomes.
- Facilitated the planning, development and implementation of person-centered plans for the individuals residing in the facility.
- Coordinated and actively participated in individual plan meetings to ensure comprehensive care. in individual plan meetings.
- Developed individuals' goals and outcomes with people supported.
- Monitored, documented, and reported progress toward meeting individual outcomes, ensuring accountability and continuous improvement.
- Ensured current state licensing and certification rules and regulations, accreditation requirements and agency policies and procedures are followed by each facility.
- Resolved conflicts between staff members to maintain a positive work environment.
- Conduct investigations when incidents involving the residents or staff arise.
- Assisted each individual in creating and maintaining their natural support networks (family/friends).
- Monitored physical upkeep of the service site, vehicles and personal property; took action to correct any concerns.
- Performed additional duties to support overall operational effectiveness.
Education
Bachelor of Science - Business Administration, Accounting
Marian University
Fond du Lac, WI01-2009
Computer Information Systems
Herzing University
Madison, WI01-2004
Skills
- Policy implementation
- Fraud detection leadership
- Fraud investigation
- Reporting metrics
- Support coordination
- Job placement support
- Project oversight
- Caregiver background checks
Timeline
Community Support Specialist
Molina Healthcare
03.2017 - Current
Care Manager
Community Care Inc.
01.2012 - 03.2017
Program Manager
Bethesda Lutheran Communities
11.2009 - 01.2012
Bachelor of Science - Business Administration, Accounting
Marian University
Computer Information Systems
Herzing University