Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Sandra McWilliams

Long Beach,CA

Summary

Dedicated healthcare professional with over 10 years of experience in patient-centered medical offices. Proven expertise in care coordination, patient advocacy, operations, and customer service. Skilled at managing high caseloads, enhancing care outcomes, and fostering collaboration between patients and healthcare teams. Known for compassionate service, effective communication, and deep understanding of healthcare systems including Medicare/Medicaid.

Overview

12
12
years of professional experience
1
1
Certification

Work History

Lead Care Manager

Cardin Healthcare
11.2023 - Current
  • Manage a caseload of up to 50 members with complex health and behavioral needs
  • Conduct in-home assessments and develop individualized care plans
  • Coordinate referrals to specialists, hospitals, ERs, and ancillary services
  • Provide education and advocacy for navigating healthcare systems and accessing resources
  • Maintain accurate records while adhering to privacy regulations
  • Assisted in developing individualized care plans for clients based on needs and preferences.
  • Educated and evaluated clinical and support staff regarding care quality management regulations and standards of care.
  • Coordinated referrals to specialists, hospitalizations, ER visits, ancillary testing, and other enabling services for patients.

Lead Care Manager

St. John's Community Health
12.2022 - 11.2023
  • Supervised clinical staff and ensured compliance with quality care standards
  • Developed and implemented individualized care plans for residents
  • Managed discharge planning and follow-up coordination
  • Handled crisis situations with professionalism and empathy
  • Connected patients to social services and community benefits

Care Coordinator

Central Neighborhood Health Foundation
10.2020 - 09.2021
  • Oversaw a caseload of 60 patients, ensuring timely interventions
  • Facilitated communication between patients and healthcare providers
  • Provided health education and helped patients overcome barriers to care
  • Collaborated with families and care teams to evaluate and adjust care plans

Sr. Member Services Representative III

Molina Healthcare
03.2013 - 07.2020
  • Resolved member inquiries efficiently, enhancing customer satisfaction and loyalty.
  • Managed account updates and changes, ensuring data accuracy and compliance with regulations.
  • Trained new team members on best practices for member assistance and service delivery.
  • Collaborated with cross-functional teams to resolve complex membership issues effectively.
  • Conducted regular audits of member accounts to identify discrepancies and implement corrective actions.
  • Achieved consistent high performance ratings based on key performance indicators such as call quality, resolution time, and member satisfaction scores.


Education

No Degree - General Studies

Long Beach City College
Long Beach, CA

High School Diploma -

Escuela Americana Bilingue
El Salvador, San Salvador.
06-1998

Skills

  • Quality control standards
  • Service planning
  • Training skills
  • Care Coordination & Discharge Planning
  • Insurance Verification & Eligibility
  • EMR Systems Microsoft Word, Excel, Outlook
  • Strong Communication & Interpersonal Skills
  • Critical Thinking & Crisis Management
  • Bilingual: English & Spanish (assumed based on education)
  • HIPAA Compliance Documentation Accuracy
  • 60 WPM Typing 10-Key Proficiency

Certification

Medical Terminology – Torrance Adult School, Torrance, CA

Medical Insurance Billing & CNA – ROP, Long Beach, CA

Timeline

Lead Care Manager

Cardin Healthcare
11.2023 - Current

Lead Care Manager

St. John's Community Health
12.2022 - 11.2023

Care Coordinator

Central Neighborhood Health Foundation
10.2020 - 09.2021

Sr. Member Services Representative III

Molina Healthcare
03.2013 - 07.2020

No Degree - General Studies

Long Beach City College

High School Diploma -

Escuela Americana Bilingue

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Sandra McWilliams