Maegen Klein-Momber

Experience

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  Holland Home/Grayling Nursing & Rehab/Hilltop Manor

  Jan 2008 - Aug 2013

  Certified Nursing Assistant

  -Years of working on many floors of skilled nursing, subacute rehabilitation, dementia units and hospice. -Duties include performing all activities of daily living, medication administration, vitals and more. Daily use of medical terminology, Electronic Medical Records, patient care and safety. -Compliant with HIPAA regulations, privacy policies, patient advocacy and support.

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  Corewell Health

  Aug 2013 - Mar 2017

  Certified Medical Assistant & Care Coordination

  Group Visit Facilitator, Shared Medical Appointments, Advanced Medical Home2016-2017 -Piloted SMAs. Shared medical appointments (SMA) are joint doctor’s visits with about 10 other patients. Typically visit lasts about 90 minutes. Teach patients about goal setting, self-care, preventive care and everyday wellness. Developed workflows, standard work, educational tools for staff/providers/patients, trained multiple team members, cold calls to patients and lead shared medical appointments and co-led pilot experiments. Operations Core Member, Transitions of Care/Navigation, Advanced Medical Home2015-2017 -Being a part of the Advanced Medical Home, a leading site to drive this work, the steering committee for SHMG and Advanced Medical Home chose Core team members and Leads for the 7 areas of work identified that needed to improve to sustain the redesign of Primary Care from our Value Stream event that was held in February 2015.Transitions of Care/Care Coordination, Primary Care2014-2017-Working with Spectrum Health to develop a new position to provide better care after being discharged for the emergency department. Cold calling patients post discharge from the ER for telephonic follow up. Reconciling medications, educated patients, scheduling follow up appointments and triaging new symptoms back to primary care physician. Working directly with patients, providers and care management. Patient Navigator, Care Team Visits, Advanced Medical Home2016-2017 -The MA Navigators role is to facilitate the Care Team Visits and provide administrative support for the Allied Health Team members. Work with Allied Health team members to determine what patients to contact from Risk list. Coordinate and collaborate on Care Team visits. Participate and lead as needed the weekly huddles and Care Conferences, as well as scribing. Show less

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  Priority Health

  Mar 2017 - now

  -Working in product innovation for the DSNP line of business. Designing plan benefits, assisting with yearly CMS bid and managing multiple vendor relationships for our supplemental vendors. -Updating annual enrollment and plan documents, webpages and knowledge articles. Designing and presenting annual training related to new plan year benefits to various departments across the organization. -Onboarding new vendors and assisting with contracting, pricing negotiation, eligibility files, reporting, marketing materials and compliance. Seeking out new benefits, vendors and plan designs while improving the lives of our members. -Key partner in updating D-SNP's Model of Care, Compliance and CMS audits. Show less -Managed and supported many DSNP Vendors and member pilots/programs in all business aspects; contracting, created billing documents, training for Model of Care and workflows, audited staff on compliance in relation to NCQA, MOC and CMS standards. -Led regularly scheduled meetings with all organizations. Communicated & reported all updates, issues and changes to Vendor Organizations as well as upper DSNP Leadership. Created reports and manually tracked all aspects of each organizations work. Guiding Care SME for DSNP team and Vendors. -Assist staff with daily EMR issues, submitting defect tickets and testing resolution. Submit, prioritize and present for approval on all LOB change requests. Work with MBO team to create BRDs, test and validate all changes across all 4 Guiding Care Platforms. Create documents & trained all staff on product enhancements and changes to EMR. -Prepared for, presented and participated in multiple mock program audits in preparation for CMS audit. Created & led project plans after audits to improve compliance. Assisted in developing compliance, productivity & other ADHOC reports. -Continually working to improve staff & member satisfaction, while keeping compliance first & foremost. Show less Care Management Program Development -Supported Leadership develop, implement and “go live” of new line of business, DSNP. Provided advice on roles and workflows for each role on the team. Tested all our functionalities within the EMR and made improvement changes. Functioned in a supervisory role in interim with Care Management Director, until new management team was implemented. Trained and supported staff members while resolving daily issues/questions from staff, members and leadership. Wrote, trained and implemented SOW (standard of work) documents for Priority Health staff. Aided in establishing relationships with multiple Community Care Agencies. Developed, wrote and tested SOWs for those agencies and then led in person training for one agency on brand new platform within EMR for external care providers that Priority Health had not utilized yet.Complex Care Management-Engaged high complexity members in Priority Health Care Management. Completed various assessments with members to determine needs and barriers of members. Reconciled medications, provided care coordination with healthcare providers, assisted members to complete goals, created care plans to improve health outcomes and reduce cost of care. Engaged and followed members for transitions of care after inpatient hospital admissions. Coordinated with hospital staff and Priority Health Utilization Management RNs while high risk members were inpatient to ensure appropriate discharge plan is in place before member leaves the hospital. Worked to reduce unnecessary ER visits and educate members on appropriate usage. Advocate for underserved members and assist with improving independence, education, careers, housing for near/current homelessness, connecting members to community agencies and insuring member get the care they need and deserve. Multiple success stories have been published on a care management journal showing various interventions initiated and highlighting outcomes for members. Show less Complex Care Management-Engaged high complexity members in Priority Health Care Management. Completed various assessments with members to determine needs and barriers of members. Reconciled medications, provided care coordination with healthcare providers, assisted members to complete goals, created care plans to improve health outcomes and reduce cost of care. Engaged and followed members for transitions of care after inpatient hospital admissions. Coordinated with hospital staff and Priority Health UM RNs while high risk members were inpatient to ensure appropriate discharge plan is in place before members leave the hospital. Worked to reduce unnecessary ER visits and educate members on appropriate usage. Advocate for underserved members and assist with improving independence, education, careers, housing for near/current homelessness, connecting members to community agencies and insuring member get the care they need and deserve. Multiple success stories have been published on a care management journal showing various interventions initiated and highlighting outcomes for members. Benefits Monitoring Program (BMP), MDHHS/SOM Program-Revamped how Priority Health uses the program, brought compliance from 12% to 100%, which made which made Priority Health a top performing health plan. Recognized across Priority for hard work, dedication and exceeding expectations for the program/turnaround time. Presented BMP work and answered series of questions during 2019 Focus Study with the State and also with the OIG. Worked with the OIG & SOM to reduce fraud, waste and abuse throughout our Medicaid service area.Disease Specific Outreach-Solley worked two separate programs for targeted proactive disease outreach, CKD Outreach & Opioid Outreach. Completed cold calls to members for engagement in care management. Provided member education, resources, referrals, transportation, disease management and self-care, while reducing barriers and improving health outcomes. Show less

  • Medicare Product Specialist, DSNP

    Mar 2022 - now

  • Senior Clinical Program Specialist, DSNP

    Jun 2020 - Mar 2022

  • Medical Care Coordinator, DSNP

    Oct 2019 - Jun 2020

  • Care Management Navigator, Medicaid

    Mar 2017 - Oct 2019