ROSIE STOXSTELL
Park Forest,IL
Summary
Detail-oriented team player with strong organizational skills and the ability to handle multiple projects simultaneously with a high degree of accuracy.
Overview
12
12
years of professional experience
1
1
Certification
Work History
Medical Management Specialist
Health Care Service Corporation, BCBSIL
01.2018 - 12.2022
- Conducted initial health, socio-economic, behavioral, self-management and risk status assessments with low, moderate, and high risk members.
- Provided education, support, and care coordination for members to encourage proper management of health conditions
- Coordinated and acted as a primary member of Interdisciplinary Care teams for all members by communicating and collaborating with members, providers, and family members involved in member’s care
- Created member driven service plans and manages waivers through Illinois Department of Aging and Division of Rehabilitation Services
- Provided ongoing care coordination services for high/moderate risk waiver and non-waiver members
- Worked with members to assess needs and develop and follow an appropriate individualized care plan
- Participated in assessing and co-facilitating discharge needs while members are hospitalized
- Assessed post discharge needs ensuring that members had appropriate medical equipment and proper follow up with providers post discharge
- Completed scrubbing of cases in preparation for state HSAG audits.
- Utilized electronic medical record systems to store, retrieve and process patient data.
Care Manager
LaRabida Children’s Hospital
02.2016 - 01.2018
- Provided care coordination for members ages 0-21 who were enrolled in managed care organizations
- Utilized clinical data systems such as Medi, I-Care, insurance provider portals, and primary care provider EMR systems in order to review utilization and determine possible needs of the members
- Conducted thorough health, socio-economic, behavioral, self-management and risk status assessments with families
- Worked with enrollees to establish and execute care plans according to needs
- Communicated with primary care providers, specialists, school staff, behavioral health providers, etc., in order to promote collaboration and coordinate the care of members enrolled in the program
- Attended PCP/Specialist appointments, IEP meetings, and other appointments with families in order to provide support and advocacy, as needed
- Participated in discharge planning and continuously provided after-care coordination for members when hospitalized
- Also, continuously worked with families to ensure follow up appointments are completed, as necessary
- Supervised and provided daily support and oversight to several care coordinators
- Assigned tasks, created weekly plans for the team, conducted team meetings, completed performance reviews, approved timesheets, and provided clinical guidance on a regular basis
- Participated HSAG/NCQA audits, including preparing and presenting cases to MCO and State auditors.
Social Worker Case Manager
Lurie Children’s Health Partners CCE
07.2014 - 01.2016
- Participated in the initial roll out of Lurie Children’s Health Partners Care Coordination (Managed Care Organization) and clinically integrated network programs
- Provided Care Coordination Services for pediatric members ages 0-21 enrolled in the health care plan, such as completing psychosocial assessments, creating shared action plans for members, advocating, collaborating with physicians and specialists, and locating local resources for families
- Supervisor for Resource Navigators performing duties such as assigning tasks, approving time sheets and time off requests, as well as providing guidance on a regular basis.
- Coordinated individual referrals to obtain community services, advocate for client needs and resolve roadblocks.
Engagement Specialist
Edgewater Systems
09.2011 - 01.2012
- Engaged mental health clients in individual sessions on a weekly basis
- Collaborated directly with physicians regarding treatment plans and medical compliance
- Connected clients with community services and resources based on their individual needs
- Created and updated treatment plans for clients when needed
- Completed discharge planning and case closing
- Created a community resource handbook to assist clients with identifying appropriate resources.
Intern
Department Of Children And Family Services
05.2011 - 08.2011
- Completed Child Abuse and Neglect investigations, as well as intact home visits
- Worked directly with hospitals, schools, foster care facilities, and other community agencies in relation to clients
- Completed multiple Statistical Data Projects for the Regional Administrator of Cook-South
- Participated in workshops and presentations related to projects to gain knowledge.
- Completed research, compiled data, updated spreadsheets, and produced timely reports.
Education
M.S.W -
Governors State University
05.2014
Bachelor of Science - Family and Child Studies (F.S
Northern Illinois University
DeKalb, IL08.2011
Skills
Excellent Typing Skills/ Proficient with Microsoft Office and several electronic medical record systems
Care Coordination
Case Management
Utilization Management
Electronic Health Record Applications
Multi-Tasking
Supervisory experience in managed care settings
Discharge Planning
Aftercare planning and connecting clients with community resources
Care Plan development
Experience facilitating individual and group therapeutic sessions
Strong interpersonal, communication, and problem solving, skills
Certification
Certified Case Manager (CCM) 2020 - present
Licensed Master Social Worker (LMSW) 2015 - present
Timeline
Medical Management Specialist
Health Care Service Corporation, BCBSIL
01.2018 - 12.2022
Care Manager
LaRabida Children’s Hospital
02.2016 - 01.2018
Social Worker Case Manager
Lurie Children’s Health Partners CCE
07.2014 - 01.2016
Engagement Specialist
Edgewater Systems
09.2011 - 01.2012
Intern
Department Of Children And Family Services
05.2011 - 08.2011
M.S.W -
Governors State University
Bachelor of Science - Family and Child Studies (F.S
Northern Illinois University
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