Lisa-Marie Blakney
Las Vegas,Nevada
Summary
A dedicated and results driven professional seeking a role where my extensive experience in strategic planning, medical administration and organizational leadership can foster room for growth. Dedicated candidate eager to leverage knowledge in social services and program development. Skilled in running social services initiatives and developing policies and procedures. Collaborative and committed to addressing social issues to improve quality of life in marginalized communities.
Overview
12
12
years of professional experience
Work History
Supervising Case Manager
Chicanos Por La Causa
07.2023 - 01.2024
- Coordinate and supervised a team of 10 Case Managers, 20 Navigators and 8 Engagement Specialist; providing guidance, support and mentorship
- Conduct regular meetings and training to ensure the delivery of effective and consistent case management services
- Monitor and evaluate the performance of Case Managers, providing feed back and implementing new work flows as needed
- Conduct comprehensive assessments Client’s needs, goals and barriers to housing stability
- Develop individualized care plans in collaboration with Client’s setting objectives and identifying appropriate resources along with interventions
- Assist on the development and implementation of program policies, procedures and best practices
- Maintaining the social service directory listings
- Coordinate and facilitate access to community resources including: housing assistance, healthcare, employment and other supportive services.
Customer Service Advocate
OptumRx under UHC
04.2022 - 07.2023
- Provide phone support for all lines of business caller questions and any unresolved issues
- Identify processing issues with Retail Pharmacy Claims and resolving issues on the first call
- Assist Members and Beneficiaries with explanation of benefits, also going over all accumulators
- Specialty Care calls with National Medicaid Programs and Medicare part D
- Additional education with Members with the following plans MediCaid/Medicare part D and Commercial Health Plans
- Filing grievances on members behalf
- Completion of medication overrides and filing prior authorizations on Member behalf when medically necessary.
Social Services Director
Pacific Post Acute Care Center
09.2020 - 09.2021
- Complete all required social services charting, including Minimum Data Set (MDS), psychosocial evaluations, social histories, assessments, quarterlies, update Patient Care Plan (PCP) entries to meet federal/state licensing requirements
- Complete all services as follows smooth Discharges w/HH, specialty provider appointment scheduling and transportation services for residents
- Scheduling and coordinating all Ancillary services with Staff and residents
- Participate as a member of the Interdisciplinary Team (IDT)
- Compiling and maintaining directory for all ancillary services, home health agencies, specialty care providers and transportation service, referrals etc.
- Assisting the QA Committee in appropriate plans of correction if warranted for residents and staff
- Responsible for Gradual Dose Reduction (GDR) and maintaining all pertinent documentation
- Following Infection and Control policies and Safety and Sanitation procedures
- Reporting any occupational exposures to blood, body fluids, or other hazardous materials immediately
- Protecting each residents file and data with confidentially per HIPAA standards.
Pharmacy Care Coordinator
AppleCare Medical Group
06.2016 - 06.2020
- Adheres to and maintains required levels of performance in both coding accuracy and productivity
- Ensures that details to program for SUPD/SPC adherence levels are maintained on a monthly basis for both past and newly acquired patients
- Runs weekly reports for prescribing pharmacists to insure that Medication Adherence is being met
- Assist in making appointments with specialist and ensuring medication adherence
- Ensure that Medication Reconciliation Targets are being met with MedicareAdvantange Patients along with High Risk Medicaid Patients that have been recently discharged from hospitals
- Ensure that all targets and outcome measures are being met and assisting Pharmacists with contacting Patients in order to reconcile medication lists as soon as possible
- Currently working on assisting patients with any barriers that they may have when obtaining a 90day supply of proper medication
- Coordinate with Social Service, Case Management and DME to insure that senior patient are receiving all necessary services that they require.
Benefits Specialist Supervisor/Front Office Coordinator
Los Angeles LGBT Center
06.2013 - 01.2015
- Supervises the benefits screening staff to ensure that all patients have been appropriately financially screened and qualify to receive benefits/services
- Under the direction of the Operations Coordinator, I recruited, hired and trained new staff to ensure they acquired necessary certifications in the first 30 days of employment
- Trained team to teach our patient’s how to maximize their health plan benefits
- Assisted with intakes and promoted mental health services
- Care Coordination with the crisis team when immediate need for newly diagnosed HIV patient’s
- Advocated for Patients continuously during the Covered California rollout with lengthy, complicated benefits issues including but not limited to; appeals, exception medication request, individual verifications, redeterminations etc.
- Assisted patients with obtaining and completing appropriate application forms for various benefits and services
- Assisted with benefits for non-disabled/disabled individuals (i.e., families, General Relief, food stamps, etc.)
- Assisted Patient Services Manger during local, State and Federal audits pertaining to program eligibility
- Participates in all required management and staff meetings including HMHS Team, HMHS Managers, HMHS All Staff.
Education
Certified Community Health Worker
05.2024
General Education -
College of Southern Nevada
01.2022
SNHD Certified HIV Rapid Results Tester
Las Vegas11.2021
Social Services Designee for Long Term Care Certification -
Career Smart Learning
10.2020
Skills
- Problem-Solving
- Case Management
- Case Documentation
- Organization and Multitasking
- Documentation And Reporting
- Decision-Making
- Conflict Resolution
- Email and Telephone Etiquette
- Client Advocacy
- Care Coordination
- Community Resources
- Case Planning
- Data Entry and Analysis
- Crisis Intervention
- Treatment Planning
- MS Office
- Referral Coordination
- Resource Management
- Case Management Tracking
- Patient support
- Case Needs Assessment
- Interdisciplinary Collaboration
- Home Visits and Inspections
- Annual Case Reviews
- Discharge Planning
- Intervention Plans
- Medical Records Management
- Staff education and training
- Program Development
- Court Mandated Reporter
- Recruitment
- EMR / EHR
- Staff Management
Timeline
Supervising Case Manager
Chicanos Por La Causa
07.2023 - 01.2024
Customer Service Advocate
OptumRx under UHC
04.2022 - 07.2023
Social Services Director
Pacific Post Acute Care Center
09.2020 - 09.2021
Pharmacy Care Coordinator
AppleCare Medical Group
06.2016 - 06.2020
Benefits Specialist Supervisor/Front Office Coordinator
Los Angeles LGBT Center
06.2013 - 01.2015
Certified Community Health Worker
General Education -
College of Southern Nevada
SNHD Certified HIV Rapid Results Tester
Social Services Designee for Long Term Care Certification -
Career Smart Learning