Behavioral Health Clinician

• Jan 2020 - Present

Unit Manager, Member Care

• Mar 2019 - Sep 2019

-Manages 10 direct reports, providing coaching opportunities as well as sources for professional growth and development-Oversees quality improvement and program effectiveness for BCBS Community Health Plans-Participated in CMS Program Audit for DSNP and CCCQIPE in May 2019.-Develops audit tools based on CMS and HFS contract requirements, while integrating best practices to enhance member outcomes-Interprets data, works with DAT team to improve information universes and develop sources for tracking and reporting compliance.-Experienced in Microsoft office products (Excel, Access)-Serves as liaison between program oversight and Care Coordination leadership to educate on contractual obligations.-Facilities meetings, mock audits with other business leads to demonstrate audit methodology and standards of care-Evaluates rebuttals and remediation’s, utilizing clinical and quality judgement, to coach audit staff and care coordination teams-Assists with chart scrubbing for external audit preparation-Conducts interviews, evaluates new hire opportunities to elevate the core team

Medical Management Accreditation & Audit Coordinator

• Jun 2017 - Mar 2019

-Led the CMS mock universe project, ensuring data validation for CCQIPE membership. -Led the CMS audit readiness activity in assessing at-risk external vendor program. Provides business leaders with education regarding opportunities for improvement.-Preceptor to new staff members onboarding to the team.-Completed internal clinical audits according to monthly schedule for IL Care Coordination, including Community Based Partner Programs.-Assisted in the development of audit tools based on contractual criteria.-Completed QIP/PIP data entry and inter-rating tasks to track transition of care for both MMAI and CHP populations.-Presented at Care Coordination Clinics, Coaching Sessions, Live Audits & New Hire orientations/forums to educate staff on strategies to improve audit outcomes while enhancing quality of care.-Served as a liaison between the quality improvement department and program managers.-Calculated data derived from completed NICE audits for department presentations.

Behavioral Health Care Coordinator

• Jun 2016 - Jun 2017

-Assisted members (telephone & in-person) to access medical/behavioral health care resources.-Experienced working with Illinois Government Program’s community-based health plans.-Thoroughly completed clinical documentation compliant with contractual guidelines.-Engaged members in motivational interviewing to facilitate holistic, patient-centered care.-Implemented knowledge of behavioral health diagnoses and associated treatment interventions.-Reviewed medical records/collaborated with providers to improve clinical outcomes.-Understands medical necessity to make appropriate level of care referrals.-Ensured critical linkages via strong knowledge of community-based resources and levels of care.-Coordinated with utilization management and physical health counterparts to ensure most effective treatments.

Pediatric Social Worker

• Jul 2012 - May 2016

-I conduct individual, group and family therapy for child and adolescent clients utilizing cognitive-behavioral and family systems treatment modalities to reduce symptomatology and socio-emotional issues. -I treat wide ranging mental health concerns including: ADHD, Anxiety Disorders, Depressive Disorders, Mood Disorders, Asperger’s Syndrome, Adjustment Disorders, and other disruptive behaviors. -I complete clinical assessments and diagnostics for clients entering treatment.-I facilitate school consultation working closely with client school systems to provide teachers and school-based social workers with interventions and strategies for emotional and behavioral regulation. I have attended and contributed at 504 planning sessions.-I interact with psychiatrists and pediatricians to coordinate the most effective care and am knowledgeable on medical interventions as treatments for a variety of mental health disorders. -I facilitated Hop 2 Health, a weight management program for girls. This multidisciplinary approach to weight loss enhances client choice-making and desire to live a healthier lifestyle via goal setting, feelings identification, coping strategy development, and education on triggers to emotional eating.-I lead groups for social skill development.

ED Social Worker

• Aug 2009 - Aug 2012

-I provided case management and discharge planning services (part-time & registry) utilizing my knowledge of Chicago area resources and referral sources. -I gained substantial knowledge of physical health and associated treatments.-I Increased understanding of how hospital systems function.

Outpatient State Methadone Counselor

• Oct 2009 - Jul 2012

-I conducted outpatient-based individual and group therapy for opiate-dependent patients with psychiatric, legal, trauma, grief/loss, and relationship issues. -I addressed psychiatric symptom management and drug relapse prevention in conjunction with nurses regarding prescribed narcotics. -I utilized cognitive-behavioral therapy, solutions-focused therapy, and crisis intervention strategies.-I served as DCFS counselor working with courts, family systems, loss issues, and other service providers. -I gained in-depth understanding of dual-diagnosis.

Clinical Student Intern

• Aug 2008 - May 2009

-I served as an Individual and group therapist for low functioning, mentally ill clients. -I conducted individual therapy with children and adolescents and facilitated family therapy. -I completed intake assessments and diagnosis. -I gained increased knowledge of coding, insurance billing, etc.

Clinical Intern- Therapeutic Mentor

• Aug 2007 - May 2008

-I closely observed DCFS-contracted crisis intervention therapy, clinical case consultation, and parenting education. -I mentored pregnant/parenting wards of the state and co-facilitated a parenting class. -I gained valuable clinical knowledge and utilized community resources in this role.