Natline S. Bland
Saint Louis
Summary
Results-driven Analyst in Care Management with extensive experience in managed care organizations (MCO) across Medicare, Medicaid, and commercial lines of business. Recognized for exceptional communication skills and a strong ability to resolve member issues while effectively coordinating care. A dedicated team player known for high energy and commitment, consistently achieving positive outcomes and enhancing customer-provider relations. Expertise in leveraging resources to drive company goals and improve revenues, with keen sensitivity to the cultural needs of diverse clients.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Analyst, Care Management (Care Coordinator- D-SNP)
CVS HEALTH/Aetna
09.2022 - Current
- Coordinates access to care and services that are appropriate to members’ health conditions and health care needs.
- Completing outbound calls to members to complete assessments – Health Risk Assessments and addressing Annual Face-to-Face encounters with doctors
- Coordinates services with members’ second line of coverage under Medicaid to ensure members’ needs and care are addressed
- Addressing members’ and doctors’ inquiries regarding medication reconciliation for medications that were rejected or are not covered
- Answering members’ questions and providing information on why claims were not paid and how to address and form questions regarding unpaid claims with their doctors
- Educating members on benefits related to transportation, vision, dental, and Healthy Rewards program; also assisting with attesting to those rewards
- Submits referrals to doctors for durable medical equipment (DME) needs
- Documents case notes appropriately in the system for accurate reporting.
Special Needs Representative
CVS HEALTH/Aetna
02.2020 - 09.2022
- Provided assistance to members in obtaining necessary services to avoid delay in treatment.
- Interacted with providers and members to improve healthcare by bringing awareness to preventative care options and compliance and addressed any coordination of care needs, while members are in transition to health plan.
- Back-up coordinator to the Medicaid Restrictions Program to assist with coordination of care to include assigned doctors and assigned pharmacies, to help member obtain health services or medications
- Continued to be notetaker for Physical Health/Behavioral Health Integrated Care Plan rounds with other community Behavioral Health MCO’s
- Resolved issues with medications or authorizations for medications and medical services, by researching the reasons for claims being denied or rejected
- Coordinator for project – Maternal Substance Use Disorder Programs initiative Utilizing current resources and services made available by health plan to assist members in obtaining and achieving their healthcare goals - Monitored progress of member’s care through utilization of processes, completing assessments, initiating and updating chart reviews Held a case load of over 200 members to include mothers and their children
- Coordinator for project – COVID-19 Outreach and initiative by health plan (Feb 2020 – Jun 2021) Outreached and assessed for confirmed and potential exposure to COVID-19 and assess those needs and refer for case management services and/or provide referrals to services to treat or test for diagnosis
Case Management Coordinator
CVS HEALTH/Aetna
01.2019 - 02.2020
- Implemented the initial Integrated Care Plan coordination for members who have been identified to participate in the Integrated Care Program, a fee-for-service program under Behavioral Health MCO’s for Aetna Better Health of Pennsylvania plan – also, for the Maternal Substance Use Disorder population
- Coordinated and shared information with the BH MCO, via correspondence or by phone.
- Notetaker coordinator for all physical health (PH)/BH for Integrated Care Plan rounds with BH MCO’s to improve health outcomes of members with serious mental illness, chronic health issues and/or substance abuse; minutes of meeting were emailed to all BH MCO participants.
- Handled case assignments under the Integrated Care Program/PH BH Program, drafted care plans, reviewed case progress and determined case closures.
- Provided necessary care coordination and service coordination management services to all clients including intake assessments.
- Developed effective working relations and cooperate with medical team and BH MCO’s throughout case management process to include rounds meetings.
Program Coordinator
HEALTHCARE USA, an Aetna Company
10.2014 - 05.2018
- Utilized critical thinking and knowledge of program requirements, network and community resources, and Medicaid benefits to facilitate appropriate physical, behavioral healthcare, and social services for members
- Care coordination duties related to complex patient populations and collaboration of services with community programs and providers including mental and medical services.
- Educated members on benefits and coordinate plan benefits and resources to promote cost-effective healthcare outcomes.
- Acted as liaison for community providers and care management, including State, County, and community providers, provided information on physical and mental health, substance abuse programs, resources, and care program referrals.
- Collaborated with Providers Services in monitoring the network to ensure compliance with state/contractual requirements and to identify service gaps in the network.
Education
Bachelor of Science - Health Management
Lindenwood University
St. Charles, MOCertification Program - Medical Billing and Coding
DeVry University Online
04-2026
Skills
- Problem Solving
- Flexibility
- Researching
- Collaboration
- Attention to detail
- Responsible
- Strong work ethic
- Effective Communication skills
- Teamwork
- Interpersonal skills
- Dependable
- Critical Thinking
Certification
Aetna Clinical Services Certified Preceptor, 2024
CVS Health/Aetna
Timeline
Analyst, Care Management (Care Coordinator- D-SNP)
CVS HEALTH/Aetna
09.2022 - Current
Special Needs Representative
CVS HEALTH/Aetna
02.2020 - 09.2022
Case Management Coordinator
CVS HEALTH/Aetna
01.2019 - 02.2020
Program Coordinator
HEALTHCARE USA, an Aetna Company
10.2014 - 05.2018
Bachelor of Science - Health Management
Lindenwood University
Certification Program - Medical Billing and Coding
DeVry University Online
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