Experience

Regions Hospital

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

• Utilization Management Program Manager

  • Jul 2015 - Present



Gillette Children's

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

• Outpatient Prior Authorization Nurse

  • Apr 2012 - Dec 2013

  - Conduct prospective review of authorization requests including selected specialty medications, medical treatments and services ensuring coverage and medical necessity. - Perform prior authorization process by performing clinical review of requests, submitting request to benefit manager and entering authorizations into the system, coordinating authorization requests with medical team and providers to ensure needs of the patient are being met. - Assist with coordination of care delivery processes for the purposes of enhancing the patient’s health and wellness safety and quality of life and providing the most beneficial, cost effective health care.



UCare

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

• Complex Care Manager

  • Jan 2009 - Apr 2012

  Provide telephonic Complex Medical Case Management to government program recipients including pediatric and adult special needs members, coordinating services to ensure safe, effective and thorough health care services. Proactively identify and evaluate member’s need for case management from a variety of sources such as referrals and medical claims; completing comprehensive assessment identifying needs including preventive medical care and significant changes in condition which may warrant early intervention for medical problems. Ensure coordination of care delivery processes, to include alternate health care settings and the home environment for the purposes of enhancing the patient’s health and wellness safety, productivity and quality of life and for providing the most beneficial, cost effective health care.



Gentle Shepherd Ministries

• United States
• Religious Institutions
• 200 - 300 Employee

• Mental Health Practitioner

  • Jan 2007 - Jan 2009

  Provide client centered ARMHS services to adults and children with severe persistent mental health illness and/or behavior disorders. Assess clients needs for mental health services; counsels or provides psychotherapeutic and rehabilitation services for individuals, assisting them in achieving productive social adjustments, reducing the impact of disabling disorders, and facilitating their achievement of living, vocational, recreational, and interpersonal goals. Document clinical activity, clinical evaluations, and recommendations; review diagnosis and treatment plans; act as a case manager by coordinating services for clients to assure continuity of care and to assure that clients receive appropriate types of service.



Provide Care, Inc.

• Mental Health Case Manager

  • Nov 2005 - Jan 2007

  Provide Adult and Children’s Mental Health Case Management to individuals with persistent mental health illness and behavior disorders. Perform personal assessment of client's characteristics and needs through interviews with family, friends, advocates, and service professionals as well as meeting the disabled person in several environments. Provide crisis intervention in situations where client might be in danger of imminent eviction from home, arrest, suffering bodily harm, inflicting injury on someone else, a psychotic episode, or being a missing person.