Jo Helen Browning
Grandview,MO
Summary
Professional with significant experience in care management. Skilled in patient advocacy, case coordination, and resource allocation. Strong focus on team collaboration and achieving results. Flexible with changing needs, reliable in diverse healthcare settings, and dedicated to improving patient outcomes.
Overview
9
9
years of professional experience
Work History
Care Management Associate
Aetna, a CVS Health
11.2018 - Current
- Completed weekly scheduling and monthly department reports for case managers.
- Reduced hospital readmissions by closely monitoring patients'' progress and adjusting care plans as needed.
- Coordinated post-discharge care by communicating with outpatient clinics, community resources, agencies and families around patients' transitional care.
- Worked with insurance carriers to obtain authorization approvals for medications, supplies and equipment.
- Provided mentorship and support to new Care Management Associates, fostering professional growth and development among team members.
- Communicated with patients and family members to assist with information, provide literature and direct to community resources.
- Ensured compliance with regulatory requirements through accurate documentation and adherence to guidelines in care management practices.
- Partnered with community resources to address social determinants of health, improving overall well-being for patients.
- Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.
- Arranged transportation and documented details of discharge transition plans.
- Answered telephone calls to offer office information, answer questions, and direct calls to staff.
- Performed various administrative tasks by filing, copying and faxing documents.
- Utilizes Aetna systems to build, research, and enter member information as needed.
- Maintained accurate and complete documentation of required information that meets risk management, regulatory, contractual, and accreditation requirements.
- Supports the administration of the hospital care, service coordination/case management, and quality management processes in compliance with various laws and regulations, URAQ and or/NCQA standards, Case Management Society of America(CMSA) standards where applicable, while adhering to contract requirements and company policy and procedures.
- Processed medical insurance claims and payments.
- Assisted with medical coding and billing tasks.
Quality Management Representative
Amerigroup/Anthem
01.2016 - 11.2018
- Improved overall product reliability with thorough testing protocols and analytical evaluations.
- Managed corrective action process, analyzing root causes of non-conformances and implementing effective solutions.
- Maintained up-to-date knowledge on regulatory requirements and industry trends to ensure alignment with evolving expectations.
- Achieved timely resolution of customer concerns through prompt investigation, root cause analysis, and corrective actions.
- Collaborated with cross-functional teams to establish best practices in quality assurance and control procedures.
- Administratively supported QM Department's HEDIS project, a yearly quality analysis audit implemented.
- ·Verified accuracy of information involving patients Personal Health Information (PHI) adhering to federal and corporate requirements regarding privacy.
- Retrieved, named, cataloged medical records received by fax and mail including maintenance of Excel spreadsheet with timeline parameters to ensure timely follow-ups.
- Reduced customer complaints by proactively addressing issues and streamlining communication channels.
- Applied coaching techniques and tools to support managers and team members in improving performance.
Education
Certified Clinical Medical Assistant - Health Care Administration
South University
Savannah, GA2025
High School Diploma -
Central Senior High School
Kansas City, MO06.1993
Skills
- Care Planning
- Quality Improvement
- Progress Monitoring
- Policy compliance
- HIPAA Compliance
- Customer Service
- Multitasking
- Problem-solving abilities
- 1 year in a Supervisory and managerial capacity specifically within a call center environment having knowledge of Medicare Part A, B, D, ICD9, ICD10-CM, HCPCS CPT codes
- Medicaid Web Portal and PROPAT)
- AS400 Claims system
- Microsoft Word, Excel,Power Point
- Scheduling
- Compass
Timeline
Care Management Associate
Aetna, a CVS Health
11.2018 - Current
Quality Management Representative
Amerigroup/Anthem
01.2016 - 11.2018
Certified Clinical Medical Assistant - Health Care Administration
South University
High School Diploma -
Central Senior High School
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