Experience

Seven Counties Services

• Mental Health Care
• 700 & Above Employee

• Utilization Management Clinician

  • Oct 2019 - Present

  • Collaborates with Utilization Management (UM) counterparts at Managed Care Organizations (MCO) on all aspects of their UM program. • Utilizes clinical skills to coordinate, communicate, & document all aspects of the utilization management process. • Completes intakes and concurrent reviews in order to obtain authorization for services such as Detox, Residential Treatment, Intensive Outpatient, & Assertive Community Treatment.• Performs internal chart audits to confirm that documentation supports medical necessity, that assessments support diagnoses, and that guarantor expectations are met.• Provides ongoing education to clinicians in order to decrease denials, paybacks, & other barriers to service reimbursement and continuity of care.• Participates in transition team for major guarantor changes and assists with the development of new processes to adapt current protocols • Works as part of team to conduct in-house investigations regarding potential fraud and related compliance concerns.



Family Health Centers Louisville

• United States
• Medical Practices
• 1 - 100 Employee

• Licensed Clinical Social Worker

  • Dec 2017 - Oct 2019

  • Served a diverse population of medically underserved patients, predominantly composed of immigrants, refugees, and non-English speakers.• Provided clinical & support services to adults, children, and families who had behavioral health and medical care needs by conducting brief, targeted biopsychosocial assessments and follow-up counseling and/or health behavior coaching.• Supported behavioral health integration into health services by working with medical staff to enhance their behavioral health skillset.• Worked collaboratively with the medical team and patient to improve patient wellness and adherence to treatment recommendations, and to increase patient satisfaction with care.• Assisted patients in overcoming barriers to health & wellness by addressing social determinants of health, & through advocacy, case management, and care coordination. • Worked collaboratively with various agencies, specialists, and systems to decrease gaps in care in order to improve outcomes and prevent the need for higher levels of care.



Seven Counties Services

• Mental Health Care
• 700 & Above Employee

• Senior Social Worker

  • Jan 2014 - Dec 2017

  • Provided individual and group therapy, as well as intake services in a psychiatric rehabilitation program for adults with severe mental illness.• Completed functional assessments to determine level of need in order to identify and connect clients to applicable services.• Customized interventions to provide individualized skill development.• Collaborated to create evidence-based rehabilitation plans and treatment plans.• Completed authorizations for services and work collaboratively with Utilization Management to ensure that all services were appropriate & efficacious, and that they met medical necessity in order to decrease denials, increase reimbursement rates, and reduce waste. • Provided crisis intervention in order to restore psychological equilibrium and prevent further physical and/or emotional deterioration.• Piloted a Cognitive Enhancement Therapy program to treat the cognitive and psychosocial impairments that characterize chronic psychotic disorders in order to improve social cognition and increase vocational capabilities.• Acted as liaison to Central State Hospital to promote continuity of care upon discharge to lower level of care in order to decrease re-hospitalization.