Ashley Sealy
Kewland Bagatelle,St Thomas
Summary
Enthusiastic and energetic professional with highly successful ten year background in excellent scope of healthcare, customer service and administration. Fostering analytical and excellent problem-solving and time management skills. Organized, efficient, and always willing to go extra mile to meet expectations. Eager to work in a fast-paced diversified environment that provides new challenges experience, while gaining knowledge and experience through working relationships and progressive professional environment.
Overview
14
14
years of professional experience
Work History
Case manager (remote/hybrid)
New York Health and Hospitals Corporation
06.2022 - 02.2024
- Complete community visits to investigate allegations of abuse and/or neglect
- Engage in a strength based approach with families in order to assess their individual and collective strengths and needs
- Interview family members and others who interact with the family to assess child safety and well-being
- Assess the risk of future abuse or neglect of children in the family
- Coordinate a team of family members, staff and service providers to evaluate safety and identify interventions that can reduce risks to children
- Remove child(ren) into protective custody or foster care, when children are found to be in imminent danger
- Enter and maintain accurate and timely computerized records of all case information
- Help families navigate government agencies and access entitlement benefits
- Orients high-risk members being care managed to MetroplusHealth’s suite of services available to them
- Performs case management activities including care coordination, planning for transition of care, out patient follow-up, and ancillary service review throughout the continuum of care to ensure optimum health outcomes
- Troubleshoots member issues related to transportation, appointments, DME, medication, SDoH
- Ensure members have appointments with their providers Formulates Care Plan with goals & interventions utilizing member preferences, and available clinical data/collateral resources, to identify and address gaps in care Communicates with the member’s primary care provider, community case manager and all other applicable providers, vendors, or agencies to facilitate the health and wellness of the member in a coordinated and comprehensive manner
- Documents in a comprehensive manner to ensure that all goals, interventions, and care coordination activities for each member in the DCMS system and other applicable software programs are in compliance with professional standards and regulatory guidelines
- As needed, participates in Interdisciplinary Care Team (ICT) phone meetings to coordinate member’s care Provides care coordination that reduces avoidable utilization, increases member satisfaction and retention, and reduces gaps in care.
- Ensures compliance with Federal, State, and City regulations, and is consistent with the Mission, Vision and Values of the organization Managing over 50-100 high risk medicaid members.
Medical Customer Service Representative (Remote)
MetroPlusHealth
11.2020 - 01.2022
- Managing Medicaid and Chip line of business for first call resolution, working to resolve member and provider issues at the point of contact Utilize dual monitors and leverage computer-based resources to find answers to customer questions Research and respond accurately to all customer inquiries related to eligibility, benefits/ services, claims and authorizations
- Classify and record all customer encounters clearly and concisely
- Identify and escalate complex issues and provide follow-up/ closure
- Identify and intake customer complaints capturing all pertinent information
- Assist members with PCP selection, as well as, locating providers and vendors within Plan’s network
- Verify and update member demographic information
- Process requests for member materials, such as ID cards, member guide, provider directory, etc.
- Handle enrollment inquiries and generate sales leads
- Handle disenrollment requests and pro-actively conduct retention efforts
- Perform outreach related to New Member Orientation and PCP Term/ Resign projects
- Managing 30-60 calls daily.
Medical Office administrator
Care dental P.C
01.2018 - 09.2018
- Registered patients and scheduled appointments
- Gathered patient records for provider
- Organized and maintained records by updating and obtaining both personal and financial information from patients
- Provided comprehensive administrative and clerical support, including organizing files, creating spreadsheets and imaging documents via dentrix programming.
Graduate Nurse (High dependency unit)
Queen Elizabeth Hospital
01.2010 - 01.2012
- Document and report the daily plan of care given to patients
- Administer medications intravenously, by injection, orally, through gastric tubes, or by other methods
- Prioritize nursing care for assigned critically ill patients, based on assessment data or identified needs
- Evaluate patients' vital signs or laboratory data to determine emergency intervention needs
- Explain procedures to patients, family members, staff members or others.
Education
Bachelor's - Health Science
CUNY York College
Jamaica, NY01.2022
Associate in Applied Science - Nursing
Barbados Community College
Barbados01.2010
Skills
- Problem-Solving
- Case Documentation
- Organization and Multitasking
- Community Resources
- Case Planning
- Interdisciplinary Collaboration
- Social Work
- Patient Assessments
- Family Education Programs
- EMR / EHR
- Written and verbal communication
- Multitasking
Timeline
Case manager (remote/hybrid)
New York Health and Hospitals Corporation
06.2022 - 02.2024
Medical Customer Service Representative (Remote)
MetroPlusHealth
11.2020 - 01.2022
Medical Office administrator
Care dental P.C
01.2018 - 09.2018
Graduate Nurse (High dependency unit)
Queen Elizabeth Hospital
01.2010 - 01.2012
Bachelor's - Health Science
CUNY York College
Associate in Applied Science - Nursing
Barbados Community College
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