Pamela Lewis
Scottsdale,AZ
Summary
Highly dedicated and compassionate care coordinator with significant comprehensive experience in healthcare management, specializing in outreach, patient care, claims processing, and nurturing strong patient and provider relationships across diverse healthcare environments. Proficient in addressing the unique needs of special populations, including individuals with serious mental illnesses (SMI) and chronic health conditions. Seeking opportunities to promote patient well-being and address the behavioral, medical, and socioeconomic needs of diverse communities.
Overview
13
13
years of professional experience
Work History
Health Outreach Coordinator
Optima Family Care
04.2020 - Current
- Strategically create opportunities to showcase multiple programs and services for Medicaid/Medicare beneficiaries, advocates, and community leaders.
- Initiate and spearhead community activities to drive membership growth and retention, targeting Medicaid, Medicare, D-SNP, Optima Family Care, OHCC, and LTSS members.
- Expertly manage Medicaid/Medicare tracking and coordination for incentive programs, with a specialization in high-risk, gap-in-care, pregnant, C-SNP and other special needs members.
Senior Network Contract Manager
Optum- United Healthcare
01.2018 - 01.2020
- Coordinated development and expansion of the autism network in 14 states, collaborating with Implementation, Audit, Credentialing, and BH Network teams. Effectively managing East Coast staff
- Conducted provider orientation presentations for VA/ABA/CCC Plus implementation, ensuring an efficient onboarding process.
- Provided specialized network education and support to newly credentialed ABA providers, while fostering ongoing provider relations for Network Partnerships in NY, NJ, and CT.
Clinical Care Coordinator
Anthem/Beacon Health Options
01.2017 - 01.2018
- Offered education, crisis management, monthly follow-ups, and transitional services, ensuring comprehensive person-centered clinical care coordination to Medicaid/Medicare members.
- Identified members who would benefit from alternative levels of care or waiver programs such as EDCD/DD waivers.
- Ensured the fulfillment of program requirements as outlined by the Department of Medical Assistance Services (DMAS).
Contract Service Coordinator
US Coast Guard Support Division (Part-time)
03.2011 - 12.2017
- Developed a CISM peer registry.
- Conducted training needs assessments for CISM peers and recommended training curriculum.
- Provided essential sexual assault resource information to the USCG Support EAP website and maintained EAP service linkage.
- Skillfully managing 21 Coast Guard EAPC representatives to negotiate SCA's rates.
- Maintained files for six national databases of potential network providers.
Provider Relations Rep II
ValueOptions/Beacon Health
03.2011 - 12.2017
- Primarily responsible for plans in NM and other states, overseeing the review and processing of members' and providers' QIO; expediting appeals for Medicare Part C and D.
- Prepared additional Maximus federal reviews for non-par providers-to-non-par providers referrals and no prior authorization for Part C members.
- Implemented the Behavioral Health Department's project management knowledge-sharing system.
Education
Bachelor of Science - Business Administration And Management
Indiana University Bloomington
Bloomington, IN05.1986
Skills
- State Accreditation and Regulatory Standards
- LIC CCHW
- HEAL
- EPIC
- Workforce Management
- Salesforce
- WebTrax
- Sure Reports
- NDB
- CMS
Timeline
Health Outreach Coordinator
Optima Family Care
04.2020 - Current
Senior Network Contract Manager
Optum- United Healthcare
01.2018 - 01.2020
Clinical Care Coordinator
Anthem/Beacon Health Options
01.2017 - 01.2018
Contract Service Coordinator
US Coast Guard Support Division (Part-time)
03.2011 - 12.2017
Provider Relations Rep II
ValueOptions/Beacon Health
03.2011 - 12.2017
Bachelor of Science - Business Administration And Management
Indiana University Bloomington
Similar Profiles
Charlotte HopeCharlotte Hope
Referral/Contract Coordinator at Optima Family ServicesReferral/Contract Coordinator at Optima Family Services
Destiny RamirezDestiny Ramirez
Infant Specialist at Optima Family ServicesInfant Specialist at Optima Family Services
Elysia Mangold OTR/LElysia Mangold OTR/L
Regional Director of Rehabilitation at Optima CareRegional Director of Rehabilitation at Optima Care