Naomi J
@naomij
Results-driven case manager with expertise in Medicaid and HEDIS.
What I'm looking for
I am a results-driven Case Manager with over 18 years of experience in Medicaid and Medicare programs, specializing in HEDIS quality improvement and long-term support services. My proven track record includes enhancing care coordination, increasing HEDIS scores, and implementing effective case resolution strategies. I excel in motivational interviewing, regulatory compliance, and client advocacy, ensuring that diverse populations receive the support they need.
Throughout my career, I have successfully delivered case management for aging populations, conducted biopsychosocial assessments, and created compliant care plans. My experience spans various roles, including Case Management Analyst at Aetna CVS and Older Youth Case Manager at Geminus Corporation, where I provided mentorship and resources to foster youth. I am passionate about community health outreach and have led initiatives to improve HEDIS metrics through direct member engagement and collaboration with quality management teams.
Experience
Work history, roles, and key accomplishments
Case Management Analyst – Medicaid LTSS
Aetna CVS
Aug 2022 - Present (2 years 11 months)
Delivered case management for aging populations (29+) with emphasis on long-term care, waiver services, and holistic care coordination. Evaluated eligibility, conducted biopsychosocial assessments, and created care plans compliant with regulatory guidelines.
Older Youth Case Manager / Family Advocate
Geminus Corporation
Feb 2020 - Present (5 years 5 months)
Supported foster youth in transition to independence post-DCS involvement through tailored case plans and resource connections. Provided mentorship, community engagement, and life skills education to promote employment and post-secondary success.
Case Manager
Seeds of Life
Aug 2019 - Present (5 years 11 months)
Delivered intensive case management for families and youth in foster care. Coordinated behavioral health services, conducted assessments, and tracked developmental progress.
HEDIS Outreach Specialist
Harbor Health Plan
Sep 2017 - Present (7 years 10 months)
Led outreach efforts to improve HEDIS metrics through community events and direct member engagement. Collaborated with quality management to execute data collection strategies and regulatory reporting.
HEDIS Specialist
Molina Healthcare
Aug 2016 - Present (8 years 11 months)
Supported HEDIS and quality improvement programs by analyzing gaps in care and engaging members in preventive services. Coordinated telephonic outreach and scheduled appointments to close care gaps.
Health Outreach Coordinator
Family Health Network
Oct 2014 - Present (10 years 9 months)
Organized disease prevention fairs and led outreach calls to drive HEDIS compliance. Facilitated referrals, authorizations, and managed care coordination across provider networks.
Community Health Advisor / CHW
Buckeye Community Health Plan
Jun 2013 - Present (12 years 1 month)
Conducted home visits to educate members on health benefits, improve HEDIS scores, and reduce ER re-admissions. Organized educational and promotional events to strengthen member engagement.
MRDD/Patient Care Advisor
Consumer Support Services
Jan 2001 - Present (24 years 6 months)
Managed group home operations and coordinated care for at-risk youth and adults with developmental disabilities. Oversaw ISP development, behavior plans, staff supervision, and regulatory compliance.
Education
Degrees, certifications, and relevant coursework
Ashford University
Bachelor of Arts, Psychology
Obtained a Bachelor of Arts in Psychology, focusing on foundational psychological principles and theories. Developed a comprehensive understanding of human behavior and mental processes.
University of Phoenix
Associate of Arts, Psychology
Completed an Associate of Arts in Psychology, building a strong base in psychological concepts. Gained initial insights into the field of psychology and its applications.
Tech stack
Software and tools used professionally
Availability
Location
Authorized to work in
Job categories
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