Detail-oriented professional with expertise in chronic disease management, documentation accuracy, and effective communication. Proven ability to implement referrals and maintain high standards of care, ensuring optimal member support and outcomes.
Overview
9
9
years of professional experience
1
1
Certification
Work History
New Member Clinical Coordinator
Community Health Choice
Houston, TX
09.2024 - Current
Implement initial contact with members, review program benefits.
Perform required LTSS assessments to determine members' level of function, additional needs and or resources.
Creation LTSS authorizations
Implement referrals as needed to Behavioral Health, Case Management and SDOH services.
Maintain accurate documentation in members' chart, audit tools and interdisciplinary records.
Educate and train new employees related to LTSS processes, regulations and internal documentation.
LTSS Service Coordinator
Elevance
Houston, TX
06.2017 - 06.2024
Assessments and authorization processing
Chart reviews
Medication Reconciliation
Referrals to Behavior Health, CCM, SDOH needs
Extensive experience with chronic disease and comorbidity management
Collaborated with RN and other interdisciplinary team members both internal and external
Participated in UMR audits with resolution of members' needs
Decision making with nursing judgement and program guidelines to ensure members' needs are met