Marlen Reyes
Miami,FL
Summary
Objectives To become part of a company where the acquired experiences can be utilized and grow with the industry to become the best at providing health services nationwide. Dynamic Bilingual Customer Service Representative with 15 years of experience handling incoming calls, resolving customer issues, inputting orders and processing shipments. Native English speaker and fluent in Spanish. Enterprising Long Term Medicaid Care Manager successful in leading every facet of new and ongoing business operations. Strategic thinker and tactical decision-maker with passion for serving customers and exceeding expectations. Creative problem solver skilled at de-escalating situations and driving positive change.
Overview
28
28
years of professional experience
Work History
Bilingual Care Coach
Humana Medicaid Long Term Care Services
12.2017 - Current
- Accomplishments and Related Skills:
- Care Coach Responsibilities to assess and evaluates member's needs and requirements in order to establish a member specific Plan of Care in order to be able to coordinates services
- Care coach ensures members are receiving services in the least restrictive environment, in order, to achieve and/or maintain optimal well-being by assessing their care needs
- Care coach continuously monitoring patient care through the use of monthly and annual visits, assessment, data, and conversations with member, providers, doctors, caregiver and family
- Care coach coordinates services, monitors and evaluates the Plan of Care against the member's personal goals
- Guides members, caregiver, providers, and families towards resources appropriate for their care
- Member services are driven by facilitating interactions with other payer sources
- Medicare and Medicaid Long Term Care Services, doctors, providers, such as Home
- Health, Day Care Facilities, Assisting Living Facilities, Skill Nursing, Rehabilitation
- Center and Durable Medical Equipment providers, interdisciplinary teams and others involved in the member’s care as appropriate and required by our comprehensive contract
- Care coach visit Medicaid Long Term Care members in their homes, Day Care
- Facilities, Assisted Living Facilities, Skill Nursing and Rehabilitation Center every
- Initial/Orientation, Quarterly and Annual visits
- Coordinate services with Providers, such as Home health, Day Care, Durable Medical Equipment, Assisting Living Facilities,
- Skill Nursing and Rehabilitation Center
- Communicate and submit Plan of Care and
- Summary of Services to member’s doctor office, Skill Nursing, Assisting Living Facilities and member representative or caregiver
- 2
- Care coach maintains as per contract requirements on Quarterly visits, Annual visit the renewal of Freedom of Choice, Release of Information, Plan of Care and Summary of
- Services form
- Care coach also establish Initial/Orientation upon first visit to member and create Plan of Care , Summary of Services, Freedom of Choice and Release of
- Information and 701B assessment to comply with Agency for Health Care
- Administration (AHCA)
- Care coach also maintains and renews as per Agency of Health
- Care Administration (AHCA) requirements the Level of Care for member.
Case Manager
Guardianship Program of Dade County
10.2003 - 12.2016
- Accomplishments and Related Skills:
- Acts as legal guardian for incapacitated clients/wards with physical and mental impairment, by determining if the care is appropriate based upon the resources available to each of the wards
- Secures information such as medical, psychological, and social factors contributing to client's situation
- Provided supportive counseling, as well as reality testing in order to determine if the clients/wards social functioning can improve
- Refers clients to community resources and other organizations
- Assisted in making medical, financial and social decision, which will most benefit the client/ward
- Review service plans and performs follow-up to determine if the care being provided to the client/ward is appropriate
- Write progress notes that are pertinent regarding each of the client/ward when activity is performed
- Ensures the monthly face to face visits of the wards
- Prepared various reports as required by the Probate Court or governmental agencies
- Understanding government benefits, such as social security,
- Medicare and Medicaid and disability benefits
- Provided annual reports to the Probate
- Court for each client/ward
- Request and attend restauration hearing on behalf of the client/ward to have a Probate Court judge restore client/ward rights.
Administrative Assistant
Telefonica Media
08.1999 - 10.2003
- Provided administrative support for the departments of Finance, Security and
- Engineering
- Coordinated services requested by Telefonica's division (B2B, Telefonica
- Media, Terra Networks and Cable)
- Audited and created expense reports for employees
- Served as support to the accounts payable and human resources department
- Back-up for the reception area.
Teacher Position
Village Green Christian School
06.1998 - 07.1999
- Related Skills:
- Responsible for teaching the subjects of Language Arts and Math to the 5th, 6th and 7th grade students
- Created lesson plans according to the Beka Curriculum Program
- Created a safe environment where the students could express and interact with each other
- Taught students to work with Microsoft Word and the Internet
- Responsible for planning and organizing student’s field trips
- Served as counselor and tutor students.
Member Service Representative
AvMed Heath Plan
09.1994 - 07.1999
- Accomplishments and Related Skills:
- Responsible for maintaining a professional customer service for the members and the providers
- Main duty was to help members with questions in regard to their policies, claim issues and grievances
- Follow-up duties as to complaints and request of policies material for the members and the providers
- Contacted providers to resolved complaint issues placed by the members
- 4
Education
Bachelor's Degree - Psychology, Special Education
Nova Southeastern University
05.1997
Associate's Degree - Child Development
Miami-Dade Community College
05.1993
Skills
Courteous with Strong Service Mindset
- Quality Assurance Evaluation
- Conflict Mediation Abilities
- Upbeat and Positive Personality
- Corporate Standards
- Training Junior Team Members
- Document and Records Management
- Dependable and Responsible
- First Aid/CPR
- Flexible and Adaptable
- Problem-Solving
- Employee Coaching and Motivation
- Managing Operations and Efficiency
Accomplishments
- Name Employer Title Phone Email
- Teresa
- Quevedo (
- Miami Dade Risk
- Management
- Supervisor305-2057968
- Shabrikel@gmail.com
- Caren Lesser(
- Guardianship Program of
- Dade County, 11th
- Judicial
- Court
- Attorney at Law305-3057990caren@gpdc.org, Navarro (
- Humana Medicaid LTSS
- Region 11
- Supervisor of Case
- Management305-796-9627diniquintino@hotmail.com
- Diann
- Raymond(
- Humana Medicaid LTSS
- Region 11
- Care management
- Support Professional305-776-2943draymond@humana.com(
- Indicates professional reference
Languages
Spanish
Full Professional
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Every problem is a gift—without problems we would not grow.
Tony Robbins
Timeline
Bilingual Care Coach
Humana Medicaid Long Term Care Services
12.2017 - Current
Case Manager
Guardianship Program of Dade County
10.2003 - 12.2016
Administrative Assistant
Telefonica Media
08.1999 - 10.2003
Teacher Position
Village Green Christian School
06.1998 - 07.1999
Member Service Representative
AvMed Heath Plan
09.1994 - 07.1999
Bachelor's Degree - Psychology, Special Education
Nova Southeastern University
Associate's Degree - Child Development
Miami-Dade Community College
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