Experience

• Capella University

  Doctorate of Public Health Epidemiology (DrPH) Candidate

  Enjoli worked at Capella University as a Doctorate of Public Health Epidemiology (DrPH) Candidate

• Capella University

  Doctorate of Public Health Epidemiology (PhD) Student

  Enjoli worked at Capella University as a Doctorate of Public Health Epidemiology (PhD) Student

• Horizon Blue Cross Blue Shield of New Jersey

  Managed Care Coordinator, Disease Management Program

  Managed Care Coordinator- Medicare, Fully Insured
  Horizon Blue Cross Blue Shield NJ, Newark, NJ
  •Coordinated and responsible for leading member referrals for clinical care managers and non-clinical staff of health education and promotion decreasing the percentage of hospitalizations, readmission rates and emergency room visits. Collaborate across multi departments i.e. Complex case management, pharmacy. Responsible for providing health education among Chronic Care Program members Medicare and fully insured ensuring behavior modifications for their overall health
  Disease Management of chronic conditions; ESRD/ CKD, MS, Hepatitis C, COPD, Heart Failure, Diabetes, CAD, Asthma, Weight Management including behavior modifications. Responsible for clinical quality measures including colorectal screenings, diabetes hba1cl poor control, DRE eye exams, Hypertension control, COPD-Spriometry screenings
  •Responsible for leading data collection/abstraction and analysis of clinical quantitative data for HEDIS, STARS measures of all members in CCP. Lead and conducted medical records reviews for HEDIS of Chronic Care Program members. Daily management of disease management activities including referrals, pre-certifications, authorizations and compliance. Entered Health Risk Assessments into electronic case records CPW. Trained and educated all current and new employees
  •Conformed daily with HIPAA Policies & Procedures, Members Rights & Regulations, Healthcare fraud. Project Management

• Preferred Health Partners

  Quality Improvement Coordinator

  Provided support relative to improving overall quality of care through collection; analyze quantitative data and the development of Quality Improvement reports and studies
  Attended physician, community center and administrative meetings, as directed, to provide continuous support, education and/or guidance on Quality Improvement initiatives and standards w/ in Brooklyn NY Community Centers.
  Provided support for NYS HEDIS/QUARR Quality Care Improvement initiatives and reviews, including but not limited to asthma, mammography, glaucoma, lead screenings, pap smears, chlamydia, cervical cancer screening.
  Assisted the Quality Improvement department in ensuring completion of projects ie. Meaningful Use- Incentive Program measuring how efficiently the organization is meaningfully utilizing the NextGen Electronic Medical Record, Monthly Discharge of Emblem Health Patients reported for each Brooklyn NY Community Center, Emblem Non Incentive Inpatient report, Daily New Inpatient Admission reports, Peers for Support Group- Initiative of pairing compliant & non-compliant diabetic patients to assist with managing diabetic measures, Ascertained clinical quantitative data for Fidelis Patients missing QCMI 2011 NYS HEDIS/QUARR Measures.
  Created reports utilizing Pivot Tables within Excel collecting & analyzing patient data- New Inpatient Admissions of Emblem Health, Patient Discharges among Community Hospitals), Scorecards for HEDIS Metrics
  Conducted chart Audits for Payors (Fidelis, Emblem, Health Plus, Empire Blue Cross Blue Shield, Well Care, United Health Care) by ascertaining clinical data via NextGen Electronic Medical Records
  Utilized the Electronic Medical Records System via NextGen daily to obtain Patient Health Information ie. Viewing & flagging patient appointments to ascertain HEDIS Measures, verifying patient enrollment to payors, create encounters, verifying patient labs, referrals, prescription

• Essex County College

  Adjunct Professor of Public Health Education-Division of Social Sciences

  Providing education among the college students located within the state of New Jersey with a focus of Public Health- Disease management & prevention, quality, mental and emotional health, Infectious Diseases and many others facets of the health care system.
  
  • Develop and manage syllabus materials which inform students in writing about course requirements as to absences, tardiness, testing, assignments, and grading policies. Responsible for selecting and compiling tests, assignments and/or online discussion exercises that permit measurement of performance relative to standardized learning objectives.
  • Facilitate Class Instruction. Responsible for teaching the health class in accordance with learning objectives and session plan outlines specified by Essex County College.
  • Evaluate Student Performance at Essex County College. Responsible for administering evaluations of student performance based on course deliverables and course rubrics.
  • Teach Health courses among the students of Essex County College.
  • Inform students of their progress by promptly returning assignments, quizzes, and examinations.
  • Encourage the use of the Library, the Tutoring Center, the Counseling Center and other supportive services at Essex County College.

• UnitedHealth Care

  HEDIS Clinical Quality Manager -Quality Management & Performance| Telecommuter

  Responsible for managing the Quality & Performance of HEDIS for the Mid-Atlantic East Region MD, VA, DC & DE -Medicare M&R/ Commercial E&I lines of business. Manager prior focused in North Carolina, South Carolina Plans/Markets, assist with other markets as needed
  Responsible for leading and delegating the direction and guidance of clinical and non-clinical staff charged with ensuring that UHG and Medicare members achieve the highest quality, as measured by HEDIS and STARS ratings.
  Provide direction and leadership for data collection for HEDIS and identify opportunities for improvement based upon results. Manage multiple projects and results for improved performance in the markets hybrid HEDIS data collection and medical records review
  Collaborate and work closely with National and Regional Accreditation teams to meet goals. Educate and train staff on compliance, privacy and good documentation practices. Ensure compliance with all standards, policies, procedures and documentation requirements in accordance with HIPAA, NCQA and CMS standards. Project Management. Vendor Management

• American Public Health Association

  Review all assigned abstracts for the Public Health Education and Health Promotion Program.
  Review all assigned abstracts for the Epidemiology Program. Review all assigned Manuscript submissions