Experience

Hospital for Behavioral Medicine

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Director of Utilization Management

  • Jan 2019 - Present

  • Interacts with Medical, Nursing, and Executive leadership to facilitate quality based, cost effective, patient care in the most appropriate setting • Collaboration, design and execution for policies and procedures for the opening of a startup behavioral health hospital. • Responsible for development and implementation of the utilization management program to ensure compliance with State and Federal regulations. • Successfully navigated initial Joint Commission, CMS and Department… Show more • Interacts with Medical, Nursing, and Executive leadership to facilitate quality based, cost effective, patient care in the most appropriate setting • Collaboration, design and execution for policies and procedures for the opening of a startup behavioral health hospital. • Responsible for development and implementation of the utilization management program to ensure compliance with State and Federal regulations. • Successfully navigated initial Joint Commission, CMS and Department of Mental Health surveys with the CEO. • Assure patients are receiving effective, person centered treatment designed to mitigate risk and facilitate safe discharge planning. • Oversee the daily functions of healthcare management services inclusive of prior authorizations, concurrent reviews, step downs and appeals. • Designed and developed the medical appeal workflow. • Complete continuous quality review of all clinical documentation for quality and clinical appropriateness. • Collect and analyze data for physician/provider or unit trends and develop corrective action plans. • Effectively manages insurance denials with a rate of 0.05% or less. Show less • Interacts with Medical, Nursing, and Executive leadership to facilitate quality based, cost effective, patient care in the most appropriate setting • Collaboration, design and execution for policies and procedures for the opening of a startup behavioral health hospital. • Responsible for development and implementation of the utilization management program to ensure compliance with State and Federal regulations. • Successfully navigated initial Joint Commission, CMS and Department… Show more • Interacts with Medical, Nursing, and Executive leadership to facilitate quality based, cost effective, patient care in the most appropriate setting • Collaboration, design and execution for policies and procedures for the opening of a startup behavioral health hospital. • Responsible for development and implementation of the utilization management program to ensure compliance with State and Federal regulations. • Successfully navigated initial Joint Commission, CMS and Department of Mental Health surveys with the CEO. • Assure patients are receiving effective, person centered treatment designed to mitigate risk and facilitate safe discharge planning. • Oversee the daily functions of healthcare management services inclusive of prior authorizations, concurrent reviews, step downs and appeals. • Designed and developed the medical appeal workflow. • Complete continuous quality review of all clinical documentation for quality and clinical appropriateness. • Collect and analyze data for physician/provider or unit trends and develop corrective action plans. • Effectively manages insurance denials with a rate of 0.05% or less. Show less



Riverside Community Care

• United States
• Mental Health Care
• 700 & Above Employee

• Assistant Program Director for Community Crisis Stabilization & Respite Program

  • 2016 - Jan 2019

  • Responsible for developing relationships with community stake holders and referral sources to insure smooth delivery of Crisis Stabilization Services and DMH Respite services. • Led transitional upgrade from one DMH respite program serving 3 site based clients and 5 mobile clients to a two location program serving 12 site based clients and 14 mobile clients and expanding Crisis Stabilization Services to a second location. • Manage 1.5 million dollar budget and oversee fund… Show more • Responsible for developing relationships with community stake holders and referral sources to insure smooth delivery of Crisis Stabilization Services and DMH Respite services. • Led transitional upgrade from one DMH respite program serving 3 site based clients and 5 mobile clients to a two location program serving 12 site based clients and 14 mobile clients and expanding Crisis Stabilization Services to a second location. • Manage 1.5 million dollar budget and oversee fund allocation. • Manage issues related to client safety at all times. • Develop program policies, practices and oversee the program’s clinical direction and programming. • Provide clinical, coaching and administrative supervision of approximately 30 professional and paraprofessional staff. • Responsible for triage and clinical consultation for Emergency Psychiatric Service and CCS/Respite staff providing services to 27 towns. • Train and direct program clinicians and staff to provide these services. Write and oversee the quality of treatment and discharge plans. • Provision of ongoing program direction in evaluation, planning and implementation. • Participated in the development of a successful Request for Proposal to the Department of Mental Health. • Provide active oversight and management of facility structure and expenses.

• Senior Emergency Services Clinician

  • 2016 - 2016

  • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Maintain excellent working relationships with Emergency Department staff, referral sources and community agencies. • Monitor quality and appropriateness of services delivered. • Perform emergency department and med floor evaluations and level of… Show more • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Maintain excellent working relationships with Emergency Department staff, referral sources and community agencies. • Monitor quality and appropriateness of services delivered. • Perform emergency department and med floor evaluations and level of care determinations. • Report abuse or neglect of a child or elder • Assist in diverting individuals from more intensive levels of care and maintaining them in their home communities.



Community Healthlink Inc

• United States
• Hospitals and Health Care
• 200 - 300 Employee

• Emergency Services Clinician

  • 2014 - 2016

  • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Provide short term clinical crisis intervention services in the community as a mobile service or walk in clinic services. • Identifying, assessing, stabilizing and treating the individual with the goal of reducing imminent risk and increasing coping… Show more • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Provide short term clinical crisis intervention services in the community as a mobile service or walk in clinic services. • Identifying, assessing, stabilizing and treating the individual with the goal of reducing imminent risk and increasing coping skills and functioning. • Report abuse or neglect of a child or elder • Write clinical formulations and present for insurance companies for authorization of level of care. • Coordinate service referrals and referrals to levels of care. • Assist in diverting individuals from more intensive levels of care and maintaining them in their home communities. Show less • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Provide short term clinical crisis intervention services in the community as a mobile service or walk in clinic services. • Identifying, assessing, stabilizing and treating the individual with the goal of reducing imminent risk and increasing coping… Show more • Evaluate clients who are currently in crisis and formulate a clinical assessment based on current presentation, information gathered from clients, collaterals, and historical data and determine a disposition of appropriate level of care. • Provide short term clinical crisis intervention services in the community as a mobile service or walk in clinic services. • Identifying, assessing, stabilizing and treating the individual with the goal of reducing imminent risk and increasing coping skills and functioning. • Report abuse or neglect of a child or elder • Write clinical formulations and present for insurance companies for authorization of level of care. • Coordinate service referrals and referrals to levels of care. • Assist in diverting individuals from more intensive levels of care and maintaining them in their home communities. Show less



Marlborough Hospital

• United States
• Hospitals and Health Care
• 1 - 100 Employee

• Utilization Review and Quality Improvement Coordinator

  • 2012 - 2014

  • Provided oversight of the UR process, worked with the physicians and treatment team to reduce the length of stay from 10.3 to 5.7 days in a 6 month time frame. • Returned the unit to a Tier 3 status for Massachusetts Behavioral Health Partnership (Managed Medicaid) contract, increasing initial authorizations from 3 to 5 days and decreasing staff time spent in obtaining authorizations. • Supervised UR staff throughout the concurrent review and appeals process. • Member of the… Show more • Provided oversight of the UR process, worked with the physicians and treatment team to reduce the length of stay from 10.3 to 5.7 days in a 6 month time frame. • Returned the unit to a Tier 3 status for Massachusetts Behavioral Health Partnership (Managed Medicaid) contract, increasing initial authorizations from 3 to 5 days and decreasing staff time spent in obtaining authorizations. • Supervised UR staff throughout the concurrent review and appeals process. • Member of the Performance Improvement Steering Committee, Restraint Analysis Team and the Environment of Care Committee. • Responsible for performing quality audits of open/closed charts, for physician documentation, patient safety and compliance with regulations and guidelines of The Joint Commission, CMS and DMH Show less • Provided oversight of the UR process, worked with the physicians and treatment team to reduce the length of stay from 10.3 to 5.7 days in a 6 month time frame. • Returned the unit to a Tier 3 status for Massachusetts Behavioral Health Partnership (Managed Medicaid) contract, increasing initial authorizations from 3 to 5 days and decreasing staff time spent in obtaining authorizations. • Supervised UR staff throughout the concurrent review and appeals process. • Member of the… Show more • Provided oversight of the UR process, worked with the physicians and treatment team to reduce the length of stay from 10.3 to 5.7 days in a 6 month time frame. • Returned the unit to a Tier 3 status for Massachusetts Behavioral Health Partnership (Managed Medicaid) contract, increasing initial authorizations from 3 to 5 days and decreasing staff time spent in obtaining authorizations. • Supervised UR staff throughout the concurrent review and appeals process. • Member of the Performance Improvement Steering Committee, Restraint Analysis Team and the Environment of Care Committee. • Responsible for performing quality audits of open/closed charts, for physician documentation, patient safety and compliance with regulations and guidelines of The Joint Commission, CMS and DMH Show less



Advocates, Inc

• United States
• Veterinary Services

• Program Coordinator-Psychiatric Emergency Services

  • Jul 2006 - Jul 2012

  • Clinical and administrative responsibility for eight Masters level clinicians providing Emergency Department assessments and Consultation/Liaison Services at Marlborough Hospital. • Developed admission protocols and insurance verification processes and tools to ensure effective bed management. • Responsible for weekly EMTALA case review with the Medical Director and the Director of Psychiatric Services to assess admissions and refusals to 22 bed unit. • Collaborated with the Director… Show more • Clinical and administrative responsibility for eight Masters level clinicians providing Emergency Department assessments and Consultation/Liaison Services at Marlborough Hospital. • Developed admission protocols and insurance verification processes and tools to ensure effective bed management. • Responsible for weekly EMTALA case review with the Medical Director and the Director of Psychiatric Services to assess admissions and refusals to 22 bed unit. • Collaborated with the Director of Psychiatric Services to increase the average daily census from 15.9 to 19.5 on a 22-bed unit. • Maintained excellent working relationships with Emergency Department staff, inpatient unit staff, referral sources and community agencies. • Monitored quality and appropriateness of services delivered. • Performed Emergency evaluations and level of care determinations. Show less • Clinical and administrative responsibility for eight Masters level clinicians providing Emergency Department assessments and Consultation/Liaison Services at Marlborough Hospital. • Developed admission protocols and insurance verification processes and tools to ensure effective bed management. • Responsible for weekly EMTALA case review with the Medical Director and the Director of Psychiatric Services to assess admissions and refusals to 22 bed unit. • Collaborated with the Director… Show more • Clinical and administrative responsibility for eight Masters level clinicians providing Emergency Department assessments and Consultation/Liaison Services at Marlborough Hospital. • Developed admission protocols and insurance verification processes and tools to ensure effective bed management. • Responsible for weekly EMTALA case review with the Medical Director and the Director of Psychiatric Services to assess admissions and refusals to 22 bed unit. • Collaborated with the Director of Psychiatric Services to increase the average daily census from 15.9 to 19.5 on a 22-bed unit. • Maintained excellent working relationships with Emergency Department staff, inpatient unit staff, referral sources and community agencies. • Monitored quality and appropriateness of services delivered. • Performed Emergency evaluations and level of care determinations. Show less

• Psychiatric Services Clinician

  • 2002 - 2006

  • Provided Emergency Department evaluations for patients with mental health and co-occurring disorders. • Responsible for screening and processing unit admissions. • Collaborated with interdisciplinary team within the Emergency Department and Hospital staff at large. • Provided Emergency Department evaluations for patients with mental health and co-occurring disorders. • Responsible for screening and processing unit admissions. • Collaborated with interdisciplinary team within the Emergency Department and Hospital staff at large.



Day Kimball Hospital

• United States
• Medical Practices

• Psychiatric Services Clinician

  • 1999 - 2001

  • Provide Emergency Department evaluations for patients with mental health and co-occurring disorders • Responsible for screening and processing unit admissions. • Collaboration with Emergency Department and Hospital staffs. • Provide Emergency Department evaluations for patients with mental health and co-occurring disorders • Responsible for screening and processing unit admissions. • Collaboration with Emergency Department and Hospital staffs.



Capstan, LLC

• United States
• Medical Practices

• Administrative Director of Geriatric Services

  • 1997 - 1999

  • Development and implementation of Geriatric Services for 32,000 Senior Plan members enrolled in Fallon Community Health Plan. • Mental Health liaison to Fallon Community Health Plan’s Disease Management and Long Term Care committees. • Creation and implementation of departmental business plans. • Budget development and fiscal accountability. • Oversight of daily operations for Outpatient and Nursing Home service teams. • Development and implementation of Geriatric Services for 32,000 Senior Plan members enrolled in Fallon Community Health Plan. • Mental Health liaison to Fallon Community Health Plan’s Disease Management and Long Term Care committees. • Creation and implementation of departmental business plans. • Budget development and fiscal accountability. • Oversight of daily operations for Outpatient and Nursing Home service teams.



Fallon Community Health Plan (FCHP)

• Coordinator of Liaison and Geriatric Mental Health Services

  • Jan 1995 - Jan 1997

  • Consultation to Primary Care physicians regarding elder substance abuse, dementia screenings, assessments and the development and implementation of patient care plans. • Integration of intake and triage to a one call system. • Development of departmental policy and procedures in compliance with DPH, CMS and contracted insurers. • Clinical consultation and staff education services to Skilled Nursing Facilities pertaining to dementia care and behavioral interventions in the… Show more • Consultation to Primary Care physicians regarding elder substance abuse, dementia screenings, assessments and the development and implementation of patient care plans. • Integration of intake and triage to a one call system. • Development of departmental policy and procedures in compliance with DPH, CMS and contracted insurers. • Clinical consultation and staff education services to Skilled Nursing Facilities pertaining to dementia care and behavioral interventions in the elderly. • Monitor compliance with all state and federal regulatory entities and provide data collection and tracking. Show less • Consultation to Primary Care physicians regarding elder substance abuse, dementia screenings, assessments and the development and implementation of patient care plans. • Integration of intake and triage to a one call system. • Development of departmental policy and procedures in compliance with DPH, CMS and contracted insurers. • Clinical consultation and staff education services to Skilled Nursing Facilities pertaining to dementia care and behavioral interventions in the… Show more • Consultation to Primary Care physicians regarding elder substance abuse, dementia screenings, assessments and the development and implementation of patient care plans. • Integration of intake and triage to a one call system. • Development of departmental policy and procedures in compliance with DPH, CMS and contracted insurers. • Clinical consultation and staff education services to Skilled Nursing Facilities pertaining to dementia care and behavioral interventions in the elderly. • Monitor compliance with all state and federal regulatory entities and provide data collection and tracking. Show less