Opal C. Owens
Riverside
Summary
Healthcare professional with strong background in care coordination. Skilled in patient advocacy, healthcare planning, and resource management. Known for effective team collaboration and achieving measurable results. Adaptable to changing needs with robust communication and organizational skills. Reliable and focused on delivering high-quality care outcomes.
Strong background in media communications. Ability to connect with diverse communities while applying Television and Radio experience for Bay Area radio stations. Expertise in audience engagement, event support, and technical setup including sound and lighting engineering for Live 105 and 102.9 KBLX in the San Francisco Bay Area.
Overview
16
16
years of professional experience
Work History
Inpatient/Post Acute Care Coordinator II - Inpatient & Outpatient Care Management
Altais Health Solutions / Brown & Toland Physicians
08.2018 - Current
- Experienced Care Coordinator with expertise in inpatient authorization processing, census management, and care coordination across multiple facilities, and health plans.
- Communicates regularly with contracted Health Plans, Behavioral Health organizations, Altais Health Solutions medical director, and care management team and any other provider when appropriate, e.g., readmitted members, California children’s services or health plan audits.
- Skilled in obtaining and entering data into EMR systems, reconciling daily census reports, and facilitating timely (TAT) communication between hospitals, providers, and care management teams.
- Proficient in scheduling and confirming post-discharge appointments, generating member notices and denial letters per regulatory standards, and ensuring compliance with Division of Financial Responsibility (DOFR), delegation agreements, and eligibility requirements.
- Adept at researching and resolving information gaps, supporting appeals processes, and coordinating with referral services, analytics, claims, and quality teams.
- Strong background in administrative support, including authorizations for home health, DME, SNF, and specialty referrals, while maintaining tim response times for urgent and routine care management needs.
Chronic Conditions Management - Program Assistant
Kaiser Permanente Medical Office
12.2016 - 06.2018
- Supported CCM Manager and Supervisor in daily operations of Chronic Conditions Management (CCM) programs for the Mission Bay and Geary locations.
- Conducted patient outreach and scheduled overdue preventive services, including mammograms, pap smears, colorectal screenings, and annual health checkups.
- Managed department voicemail and patient requests, ensuring timely follow-up and coordination of care.
- Utilized population management reporting systems to provide resources and coordinate patient-specific prevention activities.
- Assisted care managers with patient education and supported departmental projects, meetings, and inventory of emergency preparedness “Grab and Go” kits.
Team Lead –Member Care Specialists
Care Counsel, LLC
09.2014 - 10.2015
- Department transition with Care Counsel, LLC to resume the responsibilities (referenced below) for Affinity Medical Solutions (HMO).
- Affinity Medical Solutions-University Healthcare Alliance (UHA) Care Counsel, LLC Partnership with Stanford Healthcare in January 2014.
- Resolved customer inquiries, grievances, and appeals, ensuring timely issue resolution and quality service.
- Verified prior authorizations, processed appeals, and prepared supporting documentation per compliance standards.
- Collaborated with physicians and management to remove barriers and improve patient care coordination.
- Analyzed compliance and process data, identified trends, and recommended operational improvements.
- Developed and maintained policies, procedures, and documentation to ensure regulatory compliance.
Team Lead- Member Service Representative, Provider Relations
Stanford Healthcare –A Division of University Healthcare Alliance, (Affinity Medical Group)
02.2010 - 09.2014
- Transitioned from Provider Relations Representative and promoted to Team Lead in 2013.
- Provided professional customer service via inbound/outbound calls, resolving patient complaints, grievances, and appeals efficiently.
- Documented case summaries and prepared Copay and Out-of-Pocket Max reports for health plans and member requests.
- Managed provider relations, including claim and authorization resolutions, and facilitated provider portal training and education.
- Served as first-level escalation contact and supported team associates, including training new hires and assisting with troubleshooting.
- Assessed, coordinated, and prioritized departmental projects and workflows to ensure operational efficiency.
Education
Bachelor of Science - Business Healthcare Management
Capella University
Minneapolis, MN10.2017
No Degree - Radio And Television Broadcasting
San Bernardino Valley College
San Bernardino, CA06.1997
High School - undefined
Ramona High School
Riverside, CA06.1990
Skills
- Effective case management strategies
- Technical documentation
- Health education delivery
- Effective organizational skills
Affiliations
- April 2019 American Public Health Association-Member Washington, DC
- California Public Health Association- Affiliate
Timeline
Inpatient/Post Acute Care Coordinator II - Inpatient & Outpatient Care Management
Altais Health Solutions / Brown & Toland Physicians
08.2018 - Current
Chronic Conditions Management - Program Assistant
Kaiser Permanente Medical Office
12.2016 - 06.2018
Team Lead –Member Care Specialists
Care Counsel, LLC
09.2014 - 10.2015
Team Lead- Member Service Representative, Provider Relations
Stanford Healthcare –A Division of University Healthcare Alliance, (Affinity Medical Group)
02.2010 - 09.2014
High School - undefined
Ramona High School
Bachelor of Science - Business Healthcare Management
Capella University
No Degree - Radio And Television Broadcasting
San Bernardino Valley College