Sade C. Vantrease

• Responsible for conducting over 250+ audits independently on an annual basis
• Monitoring ongoing quality improvement activities within the Medical Management Program;
• Analyzing compliance with departmental policies, regulatory and accrediting requirements, and preparing reports for management presentation to internal ancillary departments and committees;
• Serving as a resource to internal ancillary departments on quality and utilization issues and contributing to Accreditation Survey processes
• Reviewed medical records for completeness and filed records in alphabetic and numeric order

Responsible for performing daily Audits of medical records received

• Support HEDIS team and facilitate, medical record abstractions, audits of medical records and outreach to IPA's supporting documentation
• Consults with MG/IPA's physicians, providers
• Upload all supporting documents related to abstracted medical records
• Averaged 200+ medical records/reviews weekly

• Performed telephonic health assessments
• Responsible for abstracting data from Census report and inputting into EMR
• Reviewed/Scanned medical health assessments
• Conducted outbound calls to members to verify completion of assessments
• Received fax requests via provider's office
• Contacted provider's offices to obtain additional information regarding members

• Contacts members within required time frames and conducts assessments
• Follows policies on contacting members that are unable to be reached
• Prioritizes members according to intensity, need, and required follow-up
• Schedules visits/contacts using the most efficient routing and time efficiency as possible
• Conducts comprehensive assessments utilizing ECM tools and incorporates other required Health Plan and/or State/Federal required assessments
• Collaborates with member to develop member-centric plans of care that incorporates a service plan, back-up plan, and identification of problems, goals, and intervention
• Makes appropriate referrals to other programs to address the member's needs in keeping with State cost maximums and/or utilizing plan benefits, incorporates natural supports and community resources as appropriate
• Ensures that all care coordination activities and all communications are documented accurately and timely in ECM and all required Health Plan or State reporting required format to ensure that information will be available for report production, data collection, and data entry for care plan management
• Initiates and collaborates with the interdisciplinary care team (ICT) and facilitates case reviews as necessary
• Participates in regular team meetings and on-going education and training
• Works in conjunction with others on the team and promotes collaborative teamwork
• Adheres to organizational policies and procedures
• Maintains a working knowledge of, and adheres to applicable federal/state regulations including but not limited to, laws related to patient confidentiality, release of information, and HIPAA
• Maintains appropriate professional boundaries
• Interacts in a manner which is professional, respectful, positive, helpful, and promotes trust
• Uses safe work practices
• Promptly reports workplace and safety issues to supervisor
• Serves as an advocate for their members, alert to any possibility of abuse, neglect and/or exploitation and any situation where fraud and abuse may occur; follows reporting guidelines
• Facilitates transitions of care from hospital to home/LTC ensuring appropriate discharge planning and interventions to lessen risk of readmissions.

• Performed chart reviews and abstraction
• Responsible for management and maintenance of Medication administration
• Provided clinical in-service education to patients and family
• Provided and monitor geriatric clients with all medical necessities
• Assisted in compliance reviews for survey readiness
• Medication privileges
• G-tube, Trach, Vent experience
• Ability to asses and document patient's responses findings properly
• Ability to perform with no supervision
• Excellent listening and communication skills
• Ability to maintain a consistent level of patient service
• Great organization and time management and leadership skills
• Ability to ensure a safe and clean environment for patient's and coworkers
• Hospice /Home care experience
• Extensive experience working with Alzheimer's and Dementia patients
• Experience in home care, long term care, and assisted living settings

• Responsible for assisting patients with all activities of daily living, including bathing, dressing, feeding, grooming, walking, etc
• Collected information about patients conditions and treatment plans from caregivers, nurses and doctors
• Examined patients for bruises, blood in urine or other injury wounds
• Performed basic vital signs, reported any changes to nurse appropriately