Johnathan Melvin
San Antonio,TX
Summary
Skilled professional ready to excel in a Management role with focus on results-driven performance. Proven ability to streamline operations and foster team collaboration to achieve organizational goals. Known for reliability and adaptability in meeting changing demands while maintaining high standards.
Overview
8
8
years of professional experience
Work History
Supervisor, LTSS Care Management
Superior Health Plan Inc
07.2024 - Current
- Effectively Leads a Staff of 18 Service Coordinators both Clinical and Non-Clinical through Coaching, Call Monitoring and Auditing, Documentation reviews, 1x1s, After hour Trainings, Performance Development, and Career Development.
- Collaborates cross functionally with Internal and External Stakeholders to develop and implement work processes for SK and SH staff, to ensure the alignment of State contract language and to best support Field Staff. Analyzes any existing workflows to identify process gaps and implemented process improvements to increase efficiency and productivity.
- Contributes to the monthly BRD reporting and conduct/attend monthly touch base meetings with internal stakeholders on monthly performance metrics, achievements, and possible areas of improvement.
- Extensive Knowledge in Medicare, Medicaid (STAR+Plus, STAR Kids and STAR Health Program Support Units) and Market Place plans. Vast knowledge in all LTSS benefits, including but not limited to: PAS, DAHS, DME, and Waiver benefits. Knowledge in Contract Language, RFP Implementation, Provider Benefit Hierarchy, Medicaid Benefit Allowable, Clinical Review and Documentation guidelines, Coordination of Care. Well informed on DME and other LTSS Provider Manuals. Proficiency in Excel, Pivots, Reporting, and SharePoint Creation.
Supervisor, Service Coordination
Superior Health Plan Inc
03.2020 - 07.2024
- Effectively Led a Staff of 18-25 Service Coordinators both Clinical and Non-Clinical through Coaching, Call Monitoring and Auditing, Documentation reviews, 1x1s, After hour Trainings, Performance Development, and Career Development.
- Collaborated cross functionally with Internal and External Stakeholders to develop and implement work processes for SK and SH staff, to ensure the alignment of State contract language and to best support Field Staff. Analyzes any existing workflows to identify process gaps and implemented process improvements to increase efficiency and productivity.
- Contributed to the monthly BRD reporting and conduct/attend monthly touch base meetings with internal stakeholders on monthly performance metrics, achievements, and possible areas of improvement.
- Extensive Knowledge in Medicare, Medicaid (STAR+Plus, STAR Kids and STAR Health Program Support Units) and Market Place plans. Vast knowledge in all LTSS benefits, including but not limited to: PAS, DAHS, DME, and Waiver benefits. Knowledge in Contract Language, RFP Implementation, Provider Benefit Hierarchy, Medicaid Benefit Allowable, Clinical Review and Documentation guidelines, Coordination of Care. Well informed on DME and other LTSS Provider Manuals. Proficiency in Excel, Pivots, Reporting, and SharePoint Creation.
Senior Service Coordinator
Superior HealthPlan
09.2019 - 02.2024
- Maintained up-to-date knowledge of Team trends, enabling the implementation of best practices in service coordination processes.
- Evaluated team performance against set targets, providing constructive feedback through coaching for continuous improvement efforts, as appropriate.
- Served as primary point of contact for non-clinical personnel and department liaison when People Leaders were unavailable
Care Support Representative
Envolve PeopleCare
10.2016 - 07.2017
- Responsible for inputting and locating participant information in member management system. May contact participants for scheduling and enrollment information.
- Utilized Policy and Procedures for locating participant demographics when participants have been identified as unable to locate or no response.
- Input direct referral participant information to member management system, including eligibility and diagnosis
- Contacted participants for initial Health Coaching assessments to identify program intervention level
- Delivered excellent customer service with a friendly and professional demeanor.
Education
Bachelor of Science - Healthcare Management
Colorado Technical University
Colorado Springs, COAssociate of Science - Health Administration
Colorado Technical University
Colorado Springs, CO08-2016
Skills
- Customer Service
- Policy enforcement
- Process monitoring and improvement
- Excel experience
- SharePoint Knowledge
- Employee development
- Workflow management
- Teamwork and collaboration
- Effective communication
- Adaptability and flexibility
Timeline
Supervisor, LTSS Care Management
Superior Health Plan Inc
07.2024 - Current
Supervisor, Service Coordination
Superior Health Plan Inc
03.2020 - 07.2024
Senior Service Coordinator
Superior HealthPlan
09.2019 - 02.2024
Care Support Representative
Envolve PeopleCare
10.2016 - 07.2017
Bachelor of Science - Healthcare Management
Colorado Technical University
Associate of Science - Health Administration
Colorado Technical University
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