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Melinda Smith
Member Advocate II
Plumas Lake,CA
Summary
Accomplished Member Advocate offering experience implementing new and innovative programs aimed at meeting the needs of the community. Skilled at building lasting relationships with members, staff and healthcare professionals. Committed and motivated with exceptional conflict resolution and decision-making skills. Exhibits strong work ethic and professional demeanor. Diligent, focused with ability to develop strong connections within a targeted population to maximize outreach and services. Effective at multi-tasking while maintaining a sharp focus on the end objective.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Member Advocate II-UC Davis ER: Full-time 40hrs
Health Net, Centene
02.2019 - Current
- Implement and streamline program development from conception through successful execution. Enhance program efficiency utilizing creative processes and implementing innovative solutions.
- Establish strategic partnerships with external organizations, expanding program reach and impact.
- Collaborate with healthcare staff regarding member progress and health outcomes.
- Outreach to health plan members connecting them to their primary care provider for follow-up care after emergency room visit.
- Support care team with reducing fragmentation of patient care to improve compliance and access to care issues, and reduce or remove treatment barriers.
- Manage patients in navigating their path through the continuum of care with the goal of improved care coordination, reduce hospitalizations, readmissions, and ER visits.
- Guide members with social needs link to community resources.
- Provide Care Coordination for specialty appointments, tests, Case management and Behavioral Health referrals.
California Children Svc Prog Coord Full-time 40hrs
California Health And Wellness, Centene
09.2013 - 02.2019
- Managed and coordinated care for health plan members in San Diego, Imperial County, 21 and under eligible for CCS County approved services .
- Collaborated and established strategic partnerships with external organizations, expanding program reach and impact.
- Submit SAR-Service Authorization requests to appropriate Counties for consideration.
- Research and requests all clinical records and medical documentation necessary to aid in the determination of a case.
- Interact with providers and members as appropriate to communicate approval outcomes.
Case Manager Assistant
Health Net, Inc. of California
Rancho Cordova
10.2012 - 09.2013
- Assisted in the development of comprehensive care plans to address individual client needs effectively.
- Collaborated with multidisciplinary teams to ensure optimal outcomes for clients and families.
- Facilitated successful client transitions between services and programs by maintaining open lines of communication with all stakeholders.
- Conducted thorough assessments to identify client needs, strengths, and areas for improvement, contributing to customized intervention strategies.
- Supported Case Managers in coordinating appropriate services for clients, enhancing overall quality of care.
- Streamlined internal processes by implementing efficient organizational systems for case files and records.
SME-Enrollment Rep III
Health Net Federal Service
05.2009 - 10.2012
- Provided exceptional customer service to Retiree's Active duty, and spouses of service members, addressing concerns and answering questions about medical benefit programs offered.
- Managed a high volume of inbound inquiries from Retiree's and service members providing timely and accurate information on medical benefits program and enrollment requirements.
- Supported members during annual enrollment periods by promptly addressing questions and concerns about retirement benefit options.
- Manages and reviews issues/service requests from initiation to closure/resolution while applying best practices, policies, procedures and general knowledge of applicable laws, regulations, and business processes.
- Collaborates with both internal and external resources to review complex issues to identify and strategize solutions, to prevent issue from occurring in the future.
- Served as a subject matter expert on enrolling Retiree's and all members into retirement plans assisting members with technical issues or inquiries with online website enrollment process
Education
Earned Units - Family Consumer Science
Sacramento City College
Sacramento, CA05.2001
Earned Units - Computer And Information Sciences
Cosumnes River College
Sacramento, CA08.2000
Earned Units - Nursing
Yuba Community College
Clearlake, CA05.1993
Skills
- Care Coordination
- Case Management
- Discharge Planning
- Health Plan Benefits expert
- Critical thinking
- Problem solving
- Decision-making
- Demonstrated ability to work effectively with limited supervision
- Excellent oral, written, presentation and interpersonal communication skills
Software Applications
- Workday
- Salesforce
- Outlook
- Teams
- SharePoint
- Oracle
- Concur
- Citrix
- EPIC
- OMNI
- Microsoft 365
Certification
- RQI-BLS-Certified Provider 01/08/2024
Work Preference
Work Type
Full TimeWork Location
On-SiteRemoteHybridImportant To Me
Company CultureWork-life balanceCareer advancementWork from home optionPersonal development programs401k matchPaid sick leaveHealthcare benefitsFlexible work hoursSoftware
Work Availability
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
The way to get started is to quit talking and begin doing.
Walt Disney
Interests
Community Involvement
Career Development
Volunteering
Travel
Leadership
Even Planning
Interior design
Timeline
Member Advocate II-UC Davis ER: Full-time 40hrs
Health Net, Centene
02.2019 - Current
California Children Svc Prog Coord Full-time 40hrs
California Health And Wellness, Centene
09.2013 - 02.2019
Case Manager Assistant
Health Net, Inc. of California
10.2012 - 09.2013
SME-Enrollment Rep III
Health Net Federal Service
05.2009 - 10.2012
Earned Units - Family Consumer Science
Sacramento City College
Earned Units - Computer And Information Sciences
Cosumnes River College
Earned Units - Nursing
Yuba Community College
- RQI-BLS-Certified Provider 01/08/2024
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