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Click here or scroll down to respond to this candidateCandidate's Name
PHONE NUMBER AVAILABLEEMAIL AVAILABLEStreet Address
Phone is preferred method of contactEXPERIENCEEDUCATION02/2022 to 06/2022 New DirectionsCare Manager-Make and receive member and provider phone calls toEnsure members receive all necessary healthcare services.-Follow up with members following Emergency Department visitsTo schedule with appropriate follow up services.-Laid off following merger with new organization.10/2017 to 02/2022 Magellan Health ServicesSr Care ManagerTake inbound calls for Behavioral Health services from consumers with Commercial or Medicare/Medicaid plans, assess need, and refer to appropriate services.Provide crisis intervention services as to members in need.Initial authorization and concurrent review for various levels of care for mental health and substance abuse services for commercial and Medicare/Medicaid consumers.Review requests for Transcranial Magnetic Imaging and authorize as appropriate.Work weekends as authorization entry for after hours.Occasional coverage for afterhours care managers.05/2016 to 08/2017Manager Care Coordination Pop HealthcareOversight of Care Coordination department which provided administrative support to Nurse Practitioners who saw patients for Medicare home wellness visits.07/2021 to 05/2014Crisis System Manager Magellan Health Services of ArizonaResponsible for management and oversight of the Maricopa County Crisis System which included over 30 provider/contractors and over 300,000 consumers.Coordinated with and provided training inter-departmental workgroups, CEO, CFO, Clinical Directors and Provider executive staff to address issues related to behavioral health crisis system needs.Identified, implemented and monitored activities to enhance the quality and efficiency of the crisis service delivery system, while serving as Subject Matter Expert.Responsible for receipt and distribution of data and deliverables.Supervised Crisis Coordination staff to ensure accuracy of data and performance.Laid off when company lost contract to State.LaSalle UniversityPhiladelphia, PAMA in Clinical Counseling PsychologyUniversity of PhoenixMBA in Healthcare AdministrationPennsylvania State UniversityBS in PsychologyREFERENCES-AVAILABLE UPON REQUESTEXPERIENCE02/2007 to 06/2012Senior Care Manager Magellan Health ServicesWorked remotely for behavioral health managed care company conducting telephonic concurrent and precertification review and authorization of behavioral health care services based on need of member and benefit eligibility.Managed all levels of behavioral health benefits, including Outpatient, IOP, PHP, and all levels of inpatient care for Mental Health and Substance Abuse in conjunction with Medical Director.Managed behavioral health benefits for multiple commercial and public sector insurance plans and EAP customers.Represented Care Management Staff in monthly Executive Committee meetings to improve process flow and continuous quality improvement.Chosen as the only non-Manager level employee to participate in national Leadership Foundations program.Left for promotion within organization.01/2003 to 08/2006Senior Care Manager Magellan Health ServicesWorked in behavioral health managed care environment to provide telephonic review of health care benefits, authorization of services and treatment planning.Collaborated with all levels of staff, from entry level to Executive to ensure customer satisfaction, positive outcomes and continuous quality improvement.Gathered, analyzed and reported on utilization data to Executive staff and County Contractors.Met weekly with local County Government officials and Network Providers to review data, patient treatment plans and develop new program initiatives.Developed, built and maintained positive relationships with both contractors and providers, ensuring excellent customer service and outcomes.Responsible for resolving escalated customer complaints and follow up to ensure satisfaction.Assigned to new program called "Partners in Care" to work with County and Providers closely through frequent site visits for on-site reviews, treatment planning, discharge planning, all done collaboratively.Worked with a specific provider with contract trouble- went weekly to provider for on-site IP MH review of charts to shape performance of provider, establish positive relationship with staff and decrease length of stay while increasing positive outcomes for members. |
