MARY CLOUTIER
Xenia,OH
Summary
Engaging, multi-faceted professional driven by team building and shared success. Problem solving individual determined to exceed metrics through dedication, determination, and diligence. Customer focused with trustworthy dedication to solutions and problem solving.
Knowledgeable [Desired Position] with robust background in community health initiatives. Skilled at developing and implementing health education programs that promote wellness and prevent disease within diverse populations. Demonstrated ability to build strong relationships and effectively communicate health information to community members.
Overview
25
25
years of professional experience
1
1
Certification
Work History
Transition of Care Community Health Worker
United Health Care
07.2020 - Current
- Engage members either or face over the phone to assist with closing gaps in care linking to necessary services providing education about their health.
- Conduct member health assessment that bio-psychological functional and behavioral health needs.
- Work with members to develop goals and identify potential barriers to achieving healthcare goals.
- Utilize interviewing techniques and active listening techniques to collect and retain member information incorporating responses as they are presented to complete assessment.
- Review plan benefits and appropriate programs and services based on healthcare needs and benefits.
- Experience in Managed Care
DSNP STARS Member Navigator
UnitedHealth Group
04.2015 - 11.2019
- Conducting community-based outreach to identify and engage DSNP plan's most vulnerable and hard to reach members to understand and eliminate specific barriers to care which directly impacted DSNP Stars rating and HEDIS measures.
- Contacting and working with medical providers and partners to assist DSNP plan members with making appropriate appointments to address personalized healthcare needs while adhering to HIPAA/PHI regulation guidelines.
- Connecting members with service providers and coordinating member's care needs with physicians, clinics, and pharmacies to assist in achieving 4 Stars or high on CMS contract.
- Ensuring that members have completed recommended services based on specific medical conditions while reducing reoccurring emergency medical engagement.
- Sole Northeast Ohio Navigator servicing five counties contiguous to Cuyahoga, as well as thirteen expansion counties. Demonstrating familiarity with county-specific resources and community-based assistance programs.
Service Coordinator
National Church Residences
01.2013 - 05.2015
- Developed a Resource Directory that included a listing of state and/or local service providers that resident could contact for assistance.
- Sponsored educational events that included subjects relating to health care, agency support, life skills, referral sources, and others.
- Facilitated the formation of resident associations within the property if the residents were interested. The formation of these groups assisted the residents in planning social events, organizing activities, and discussing daily life issues.
- Monitored the ongoing provision of services from community agencies and kept the case management plan current with the progress of the individual.
- Served as a liaison to community agencies, networked with community providers, and sought out new services available to the residents.
Intensive Case Manager
Catholic Social Services
12.1999 - 09.2009
- Worked independently and consistently exercised discretion and sound judgment in the area of case management. Recognized problems and provided best practice solutions, with supervisory consultation, as needed.
- Provided comprehensive risk assessments and medical case management services to approximately 60 high risk pregnant women and post-partum women in compliance with program plan and contractual agreements with funder. Conducted all services in clients' home.
- Engaged the client in formulating care plans by mutually identifying target problems, goals and tasks.
- As a mandated reporter, reported to the supervisor/director and the Department of Children and Family Services (DCFS) of any suspicions and findings of abuse or neglect.
- Identified and coordinated medical and social services to ensure best- possible outcomes for each pregnancy. Provided linkage and advocacy for social services as indicated by the client assessment as well as coordination of service care with client's primary care physician, obstetrical care, and any other appropriate specialty care.
Education
Bachelors of Arts - Sociology
Wright State University
Fairborn, OHSkills
- Benefits
- Customer Care
- Instructing and coaching
- Active Listening
- Medical terminology
- Quality Assurance
- Self-motivated
- Motivational interviewing
- Service coordination
- Health promotion
- Multitasking
- Active listening
Certification
- Certified Peer Support Specialist 2024-present
Timeline
Transition of Care Community Health Worker
United Health Care
07.2020 - Current
DSNP STARS Member Navigator
UnitedHealth Group
04.2015 - 11.2019
Service Coordinator
National Church Residences
01.2013 - 05.2015
Intensive Case Manager
Catholic Social Services
12.1999 - 09.2009
Bachelors of Arts - Sociology
Wright State University
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