Experience

Anthem

• United States
• Insurance
• 700 & Above Employee

• Senior Clinical Trainer Specialist

  • Oct 2013 - Present

  Learning and Development Department under Government Business Division for Anthem, Amerigroup* Responsible for Training and Development of New Hires and Upskill training of existing associates under multiple Current HCMS programs for Anthem/Amerigroup eg UM, CM, LTSS Nurse Managers, Coordinators and Social Service Associates; covering all clinical and non clinical programs associated with Healthplan functionality (eg, NextGen Facets, Care Compass, MACESS, Member 360, PEGA 7); current implementation projects and demonstrations (eg NJ Choice program; NY FIDA program; TX Star Kids, CA Pega/ACMP)* Covering Amerigroup Markets including but not limited to New York, New Jersey, Virginia,Florida, Texas, Indiana, California* Certified InterQual Instructor* Certified Performance Solutions Consultant (Langevin)* Certified Mental Health First Aid Instructor* proficient in delivering instruction in both VILT (Virtual Instructor Led Training) format,via Adobe Connect,Microsoft Lync and Camtasia and ILT( Instructor Led Training/Live) format and combinations of both



Regal Medical Group

• ACO Nurse Case Manager

  • May 2013 - Oct 2013

  *ACO {Accountable Care Organization) Care Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk ACO Beneficiaries under Medicare division. *Assses and develops plan of care, coordinates care between Primary care Physician, consulting Physicians and all health practitioners involved in care .*Responsible for managing members in Outpatient basis, focusing on preventative care. *ACO {Accountable Care Organization) Care Case Manager is responsible for the assessment, treatment planning, intervention, monitoring, evaluation and documentation on identified High Risk ACO Beneficiaries under Medicare division. *Assses and develops plan of care, coordinates care between Primary care Physician, consulting Physicians and all health practitioners involved in care .*Responsible for managing members in Outpatient basis, focusing on preventative care.



CareMore Health

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Nurse Case Manager

  • Jun 2010 - Mar 2013

  Out of Network Case Manager for CA, NY, VA Markets CareMore Health plan & Empire Blue Cross Blue Shield 03/12 – 03/13• Inpatient care management including facilitating transfer of members to in-network facilities, discharge planning and coordination of services upon discharge• Responsible for approvals and denials of referrals for inpatient services• Responsible for concurrent reviews for continuing inpatient stay of members in non-contracted facilitiesHigh Risk Case Manager and Advance Care Team for CareMore Health Plan, Cerritos, CA 07/11 – 03/12• Coordinate care services for palliative patients and high risk patients using critical thinking skills• Communicate with hospitalists, providers and social workers to provide a holistic approach to patient care• Meet with patients in clinical settings to introduce the member to the plans resourcesCareMore Intervention Team Case Manager Los Angeles and Orange county, CareMore health plan, Cerritos, CA 06/10 – 07/11• Coordinate care services for patients identified under the Crisis Intervention Team • Communicate and coordinate care within the high risk team including LCSW’s, House call physicians and nurse practitioners• Meets patients and their families to establish rapport and trust, introducing and facilitating member’s use of preventative care benefits and resources within the community



Park Regency Care Center

• NURSE CASE MANAGER

  • Mar 2008 - Jun 2010