LOVINE MCREA ASWAD

• Support the Director in promoting teamwork, accountability, collaboration, and positivity across the Care Management Team.
• Assist with managing monthly billing, and policy implementation.
• Work as a collaborative partner with Director level and Executive staff to ensure regulations and best
practices are understood and adhered to.

• Participate in quality and process improvement initiatives to identify opportunities for continued
improvement, supporting the Director to ensure the Department continues to operate efficiently.
• Interact with internal and external contacts (e.g., vendors/service providers, State and government
agencies, and various other stakeholders). Ensure appropriate communications with Health Homes,
Waiver Providers, Managed Care Plans and DOH, as instructed by Director.

• Assist with care manager retraining on program policies as needed, in collaboration with Staff Trainer.
• Review and process Child and Adolescent Needs and Strengths (CANS) assessments in UAS.

• Guide Care Management staff in effective support of families in accessing Nursing, Home Care, DME,
Supplies, Home and Vehicle Accessibility, Transportation, Respite, Habilitation, Palliative Care, Therapies, parent/family support opportunities, grants and other services of relevance to the population.

• Manage multiple priorities amongst groups of up to 7 Care Managers, serving 15 to 25 families each.
• Ensure caseload compliance to maintain program and Medicaid eligibility.
• Conduct ongoing reviews of the physical record to ensure accuracy, compliance, and completion of the needed documentation and billing.
• Organize monthly team meetings and 1:1 supervision, offering guidance and training to direct reports.
• Supervises the development and implementation of comprehensive care plans and Assessments are completed ensuring that they are maintained in an accurate and timely manner.
• Works alongside the Program Director to ensure all HH policies and procedures are followed through and new policies are implemented.
• Accompany team members to internal and external meetings or site visits.
• Organized transfer of special needs children to OPWDD or Adult Health Homes as they approaches 21 and ages out of the Health Homes Program.

• Managing a caseload of 25 children with special needs /disabilities and conduct monthly meetings.
• Compile documentation (Consents, IEP, psych, social, medical, etc.) necessary to coordinate enrollment and secure services on behalf of clients, maintaining ongoing Medicaid, program and service eligibility.
• Identify service needs, issues and concerns of families and proactively follow-up.
• Collaborate with families, professionals and other involved parties to develop a comprehensive plan of care, completing ongoing timely reassessments.
• Conduct monthly site visit with client's and or guardian (caregiver) in their home or community.
• Acquire knowledge and recall of families being served Develop well written, comprehensive case notes, service plans and assessments.
• Act as liaison between client/family & Medicaid, LDSS, SSA, school, providers, etc.
• Attend IEP meetings in support of families and ensure that the child actively receive services mandated on the IEP.

• Reviewing and Processing M11Qs received from Physicians requesting Personal Care Service for clients.
• Assigning cases to UAS Assessment RNs and schedule cases for Assessment.
• Collaborating with Care Managers and Assessment Registered Nurse to ensure assessment are conducted.
• Liaison with Personal Care Service providers to reach members to conduct assessments.
• Advocate for chronically ill patients to remain at home verses long -term institutions.
• Assisting members in obtaining valid M11Qs and any other documents needed to assist member with obtaining necessary home care service and medical durable equipment.
• Recording and tracking assessments completed daily.
• Entering and removing data in Health Commerce System.
• Maintained accurate records of all activities conducted.

• Processing in-coming and outgoing calls, providing excellent customer service to members and providers offering satisfactory resolution.
• Generating authorizations for various services such as; PCS, Physical Therapy Speech Therapy, CHHA services.
• Verify member's eligibility and benefits utilizing ePaces system.
• Process authorization for the entire Personal Care Service Department.
• Receiving and processing services request from members and providers via fax.
• Liaison between Metroplus MLTC, HHA/PCA vendors and providers in-regards to the care and service of members.
• Addressing member's complaint and issues with HHA vendors.
• Assisting members to obtain new M11Q for reassessment for continuation of Personal Care Service.
• Notify vendors of members start date day and end date of service.

• Greeting and registering 50+ patients in fast paced multi practice medical center.
• Scheduling appointment through EPIC (EMR) programs.
• Perform administrative duties which include: monitoring high volume of telephone calls, create letters, faxing, copying.
• Generating incoming and out going referrals.
• Verifying insurance eligibility and obtaining authorization.
• Tracking of Radiology reports.
• Collecting and processing co - pay with speed and efficiency.
• Prioritizing physician’s schedules based on current patient medical history.
• Processed incoming calls and making outgoing calls to patients and providers.