Utilization Management Coordinator

• Jul 2022 - Present

UM Care Manager

• Dec 2018 - Jul 2022

Utilization Reviewer Specialist

• Jun 2016 - Dec 2019

Lakeshore Regional Entity (LRE) is one of Michigan’s ten Prepaid Inpatient Health Plans (PIHPs), responsible for Medicaid benefits management across seven counties – Allegan, Kent, Lake, Mason, Muskegon, Oceana and Ottawa - in partnership with five Community Mental Health Services Programs - Allegan County Community Mental Health, HealthWest Community Mental Health, Network180, Ottawa County Community Mental Health and West Michigan Community Mental Health.* 2 + years of experience at the Lakeshore Regional Entity/PIHP (Prepaid Inpatient Health Plan) has allowed me to gain experience of utilization management from a regional perspective for 5 CMHSPs that cover 7 counties in West Michigan. I have a solid understanding of Michigan medical criteria to determine eligibility of behavioral health services and level of care authorizations. This includes eligibility of acute services for inpatient hospitalization, partial hospitalization and crisis residential services. Experience conducting continued stay reviews, retrospective reviews for emergent and non emergent services. -Lakeshore Regional Entity's lead representative for the Parity Project. This has allowed me to gain understanding of the Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and be involved in a state wide work group to help the state of Michigan move forward with compliance of MHPAEA.

Transition Specialist

• Dec 2007 - Jun 2016

8 continuous years as a Transition Specialist at the Area Agency on Aging of West Michigan (AAAWM) where I was a member of the Nursing Facility Transition team. My experience at AAAWM allowed me to stretch my wings as a social worker and dive into working one on one with the elderly and younger disabled population. Here, I was able to build my knowledge and gain understanding of the importance of proper care coordination and discharge planning, nursing home level of care criteria, long term care (LTC) facilities/nursing homes, subsidized housing, assisted living homes, adult foster care homes, Medicaid eligibility and the MI Choice Waiver Program. I developed case management skills and knowledge of service authorizations and program eligibility. Service authorizations include: targeted case management, personal care services, CLS, ADLs, IADLs and medical equipment.