Juan Salas
Charlotte,NC
Summary
Dynamic Care Coordinator with extensive experience at Array Behavioral Care, excelling in HEDIS and NCQA compliance. Proven track record in crisis intervention and patient advocacy demonstrates a commitment to quality care and efficient resource management. Bilingual in Spanish, dedicated to enhancing community outreach and improving patient outcomes through compassionate, organized care. Passionate about fostering strong relationships with patients and healthcare teams to drive positive change in the healthcare landscape.
Overview
11
11
years of professional experience
Work History
Care Coordinator
Array Behavioral Care
10.2024 - Current
- Reviewed reports and records for accuracy, completeness, conformance with established procedures, and other factors related to the job function.
- Documented client interactions and care plans in electronic health records (EPIC).
- Collaborated with physicians, social workers, and other healthcare providers to provide comprehensive care for patients.
- Provided crisis intervention services when needed.
- Facilitated referrals to community resources such as case management, housing, transportation, etc.
Medicare/Medicaid Member Engagement Specialist
Molina Healthcare
05.2023 - 08.2024
- Manage all things care coordination, executing DME/medication/Home Care submissions, member/provider cases via chat, email, and phone.
- Assist in training and mentorship of new coordinators and nurse coordinators
- Managing 3rd party projects that oversea 5 different state LOBs and ensure communications with healthcare services and completion of state telephonic mandated assessments.
- Identify and connect members to resources for addressing Social Determinants of (SDOH) by utilizing resources from the Health Plan and Community
Care Coordinator
Evolent Healthcare
06.2022 - 03.2023
- Manage all things care coordination, executing DME/medication/Home Care submissions, member/provider cases via chat, email, and phone.
- Assist in training and mentorship of new coordinators and nurse coordinators
- Reviewing assigned medical records to abstract clinical data elements for HEDIS reporting with nurse coordinators
- Support role within authorization dept. to document all prior authorization information including outbound provider communications, authorization dates, procedure codes and prior authorization numbers in patient profile
HEDIS Coordinator
Carolina Complete Health
05.2021 - 01.2022
- Collaborate with internal departments on rate investigation and validation activities, including maintaining all evidence, documentation, and changes
- Implement process to request and evaluate member compliance reports for each HEDIS measure, including evaluating improvement opportunities
- Perform duties to ensure HEDIS data accuracy and reporting, including investigation, auditing, and improvement opportunities
Member Service Advocate
City Block
05.2020 - 04.2021
- Respond to inquiries from members and other callers regarding our services, appointments, referrals, provider messages, and prescription refills
- Coordinate referral management with hub team and providers to ensure optimal access to primary and specialty care
- Assisted Management with oversight of enrollment/outreach of Tuft Healthcare of Massachusetts members to facilitate enrollment of new member for possible evaluation from either a PCP or BHS
Senior Customer Support Specialist
Castlight Health
Charlotte, NC
05.2019 - 12.2019
- Respond to customer service requests within established SLA's via email, phone, and live chat.
- Handle concerns and escalate if needed. Work to identify trends with customer reported issues, process issues, provide team support.
- Act as subject matter expert to other areas of the organization for strategic projects, customer-driven pilot programs and HEDIS incentive programs.
Quality Assurance Analyst
Evolent Healthcare
Doral, FL
08.2018 - 04.2019
- Assisted Quality Management with oversight of an integrated healthcare services managing 3 Medicaid contracts across the state of Florida for 180,000 members
- Provided quality assurance for 40 customer services representatives, and reported outcomes to director, manager, and supervisors as needed
- Assisted the Quality Management Department to meet state mandated accuracy of service calls, HIPAA regulations, and client required metrics with a 95% passing rate
- Responsible to manage, compile, maintain, and report risk issues, and decisions with the program team
Case Management Processor
Molina Healthcare
Doral, FL
09.2014 - 09.2017
- Assisted and managed Case Management HEDIS productivity and NCQA requirements which improved the STAR rating from 2.5 to 3.5. (2016)
- Maintained and reviewed daily departmental reports, ranging from member complaints to CMS/ AHCA updates.
- Assisted with the creating of departmental policies for both case managers and case management processors under the direction of the Manager of Case Management.
- Provided telephone, clerical, and data entry support for the Healthcare Management Dept.
Education
High School Diploma - Victoria, TX
Memorial High School
Victoria, TX01.2003
Skills
- Case management
- Organizational skills
- Patient advocacy
- Multidisciplinary team collaboration
- Healthcare operations
- Care planning
- Program oversight
- HIPAA compliance
- Crisis intervention
- Workflow management
- Discharge planning
- Treatment Planning
- Community outreach
- HIPAA guidelines
- EMR software (Athena, Ciox health, EPIC)
- Training and mentoring
- Patient education and counseling
- Leave management services
Affiliations
Miami Dade Animal Services
Timeline
Care Coordinator
Array Behavioral Care
10.2024 - Current
Medicare/Medicaid Member Engagement Specialist
Molina Healthcare
05.2023 - 08.2024
Care Coordinator
Evolent Healthcare
06.2022 - 03.2023
HEDIS Coordinator
Carolina Complete Health
05.2021 - 01.2022
Member Service Advocate
City Block
05.2020 - 04.2021
Senior Customer Support Specialist
Castlight Health
05.2019 - 12.2019
Quality Assurance Analyst
Evolent Healthcare
08.2018 - 04.2019
Case Management Processor
Molina Healthcare
09.2014 - 09.2017
High School Diploma - Victoria, TX
Memorial High School