Experience

Fenway Community Development Corporation

• United States
• Civic and Social Organizations
• 1 - 100 Employee

• Resident Engagement Coordinator

  • Dec 2022 - Present



Tufts Health Plan

• United States
• Insurance
• 700 & Above Employee

• Behavioral Health Utilization Management Clinician

  • Feb 2021 - Jul 2022

  • Conducted clinical precertification, concurrent and discharge reviews for behavioral health treatment request. • Evaluated clinical information to screen for medical necessity of behavioral health services and ensure members received the most appropriate treatment based on their clinical presentation and needs. • Consulted with internal managers and physician advisors when it appeared requests for services did not medical necessity criteria and proposed alternative plans of treatment. • Conducted clinical precertification, concurrent and discharge reviews for behavioral health treatment request. • Evaluated clinical information to screen for medical necessity of behavioral health services and ensure members received the most appropriate treatment based on their clinical presentation and needs. • Consulted with internal managers and physician advisors when it appeared requests for services did not medical necessity criteria and proposed alternative plans of treatment.



Blue Cross Blue Shield of Massachusetts

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Behavioral Health Utilization Manager

  • Dec 2008 - Nov 2019

  ● Conducted pre-admission, concurrent, and discharge reviews for a caseload of approximately 60 members, complying with regulatory standards, contract requirements, and medical necessity.● Managed outpatient authorizations for Applied Behavioral Analysis (ABA), out-of-network treatment, and urine drug screens as outlined in member’s policy benefit summary, and as medically required.● Revised and streamlined workflows as Outpatient Workflow Lead that increased the efficiency of requests and reviews.Aligned workflows of utilization managers and psychiatrist to increase consistencies in review process and determination



Cambridge Health Alliance

• United States
• Hospitals and Health Care
• 700 & Above Employee

• Licensed Clinical Social Worker

  • Jun 1999 - Jun 2008

  ● Provided medication insurance coverage leading to improved continuity of care for patients diagnosed with HIV/AIDS.● Collaborated with medical providers and nursing staff resulting in a multi-disciplinary approach to patient care.● Enhanced patient stability, sense of wellbeing, and self-awareness, by conducting relevant psychosocial assessment.● Provided psychoeducation, psychotherapy, and case management that improved patient quality of life. ● Provided medication insurance coverage leading to improved continuity of care for patients diagnosed with HIV/AIDS.● Collaborated with medical providers and nursing staff resulting in a multi-disciplinary approach to patient care.● Enhanced patient stability, sense of wellbeing, and self-awareness, by conducting relevant psychosocial assessment.● Provided psychoeducation, psychotherapy, and case management that improved patient quality of life.



North Suffolk Community Services

• United States
• Mental Health Care
• 200 - 300 Employee

• Clinical Supervisor

  • Jul 1997 - Jun 1999

  ● Provided clients with substance use/dependence and dual diagnosis with individual and group counseling that encouraged them to explore and navigate their recovery.● Collaborated with East Boston District Court and provided courthouse based psychosocial-educational groups that met court requirements for mandated DYS and DSS youth.● Led agency as HIV/AIDS liaison to local community health center resulting in education opportunities, community awareness, and cross referrals.● Oversaw Federal Probation contract with referral evaluations, and appropriate mental health services. Met with probation officers and provided reports that allowed for insightful, informed feedback about clients’ progress in treatment.



Family Couseling Center

• Licensed Clinical Social Worker

  • Mar 1996 - Feb 1997



Heritage Hospice

• Licensed Clinical Social Worker

  • Jan 1994 - Mar 1996



Pathways Inc. - Kentucky

• United States
• Mental Health Care
• 1 - 100 Employee

• Family Therapist

  • Apr 1992 - Dec 1993



Bluegrass East Comprehensive Care Center

• Mental Health Specialist

  • Jan 1986 - Aug 1991

  Forensic Services Unit Forensic Services Unit