JOIA J. BUSH

Leverage tools to identify and educate members to better address their healthcare needs and opportunities.

• Effectively explain the opportunity and the benefits of the program for all but the most complex programs (gaps in care, basic education, disease-based, rising in clinical risk, or gaps in clinical care, high spend).
• Apply critical thinking and probing to understand member needs, and assess options for resolution.
• Act as an advocate and have a member-obsessed approach in each interaction, genuinely caring about members, and creating value for them through resolving their issues or concerns.
• Identify when and how to connect with the right internal clinical resource.
• 
  
• Maintained accurate records of all client interactions, progress reports, and medical documents.
• Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible care.
• Provided patient advocacy services to individuals and families with healthcare needs.

• Data Entry, reviewing customer accounts
• Efficiently and accurately respond to general inquiries from customers and other departments via email, or telephone.
• Maintained a high level of escalated calls to resolution
• Ability to multi-task to be able to provide customers with timely information.
• Back-office personnel, Emailing, Faxing
• Inbound and Outbound calls
• High call volume
• Web Chat
• Developed effective communication plans between clients and internal teams during an escalation situation.

• Gathers and records appropriate member information in accordance with the policies and procedures, via telephone.
• Encourages members to participate in the Care Management programs by providing information about the program, outlining program features/value and explaining available services.
• Records call details and utilize call scripts as needed based on client requirements.
• Directs member inquiries to appropriate clinical staff.
• Initiates referrals and manages consults from clinicians for participants registered in Care Management.
• Gather information from hospitals, health plans, physicians, patients, vendors, and other referral sources.
• Pre-Authorizations
• Wellness Specialist
• Handled new enrollments by entering customers' data and reviewing information.

• Provide exceptional care of patients
• Performed general and indirect patient care tasks as assigned
• Provided multi skilled direct patient care procedures and comfort measures
• Communicated effectively with patients and supervising RN, Practical nurse, or other health care professional
• Observed changes in patient's conditions and reported any abnormalities to the RN on duty.
• Safeguarded patient privacy with strict adherence to HIPAA protocols.
• Obtained patient vital signs and reported results to staff nurse or physician to identify changes from prior measurements.
• Transported specimens, laboratory items or pharmacy items, verifying proper documentation and delivery to authorized personnel.