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Utilization Management Social Worker Res...
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Title Utilization Management/Social Worker
Target Location US-NC-Charlotte
Email Available with paid plan
Phone Available with paid plan
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Candidate's Name , MSW, LCSW, LCASStreet Address  Prosperity Church RoadCharlotte, NC Street Address
Phone: PHONE NUMBER AVAILABLEEmail: EMAIL AVAILABLEEducation Masters of Social Work August Street Address -May 2013Winthrop University, Rock Hill, SCBachelor of Science in Sociology August 2005-May 2010College of Charleston, Charleston, SCLicenses/Certifications LCSW Certification (North Carolina) October 2015-October 2023LCAS Certification (North Carolina) June 2018-May 2024Relevant ExperiencePartners Behavioral Health Management, Gastonia, NC October 2021-PresentMH/SU Utilization Management Child Services Team LeadActs as a liaison between Care Managers and Peer ReviewersProcesses authorization requests for all levels of care to support fellow Care Managers as leadership during periods of high volume and to ensure coverageProvide clinical guidance to Care Managers in cases where medical necessity is questionable and UM leadership is unavailableParticipates in all rounds sessions with Chief Medical Officer to promote consistencyAssist with developing and presenting UM Specific trainings both internally and externallyAssists providers with technical issues, questions, and concerns with regarding the UM Process,Completes QA Data/Reporting for Utilization Management Review TeamComplete audits and identifies training needs within the MHSU Utilization Management TeamServes as the go-between person when providers submit Enhance Rate Requests for services, ensuring all documents are correct and completed prior to sending to UM Manager for review.MH/SU Utilization Management ClinicianPerforms prior authorization review, continued stay and benchmark reviews for children and adults who have been diagnosed with Intellectual/Developmental Disability, Mental Health and Substance Abuse Disorders.Consulting with Partners BHM physician regarding request in which there is a question of medical necessity, health and safety issues, medications, and needing for Peer Review when Utilization Reviewer cannot approve request.Provide linkage, authorizations and level of care determinations to core services agencies and providers, assisting providers with creative problem solving to suggest alternative approaches to care.Performs care management to ensure continuity for care and that consumers receive the right service, at the right time, at the right frequency.Provide back-up coverage for after-hours triage of behavioral health crisis call line.Member of the Peer Review Task Force (reviewing procedures and implementing changes to the Peer Review process)ThriveWorks Counseling, Charlotte, NC March 2021-October 2021Remote TherapistDiagnoses and treats mental health disorders.Creates individualized treatment plans according to patient needs and circumstances.Meets with patients regularly to provide counseling, treatment and adjust treatment plans as necessary.Conducts ongoing assessments of patient progress.Cardinal Innovations, Charlotte, NC April 2020-October 2021Utilization Management ClinicianPerforms prior authorization review, continued stay and discharge reviews for children and adults who have been diagnosed with Intellectual/Developmental Disability, Mental Health and Substance Abuse Disorders.Conduct chart reviews of instances of care authorized for utilization purposes, case reviews for individuals that are identified as either over or under-utilizers of servicesProvide linkage, authorizations and level of care determinations to core services agencies and providers, assisting providers with creative problem solving to suggest alternative approaches to care.Performs care management to ensure continuity for care and that consumers receive the right service, at the right time, at the right frequency.Anuvia Prevention and Recovery, Charlotte, NC March 2016- March 2020Assessment CounselorFacilitate Comprehensive Clinical Assessments to clients dealing with substance use and mental health concernsMaking appropriate recommendations for different types of level of care for clientsProvides case management servicesAssist in making referrals to other providersProvide clinical supervision for MSW interns and LCSW-AInterim Assessment Team Supervisor (February 2019-May 2019) Managed the Assessment Team Managed Assessment Calendar (how many clients could be seen in one day Complete SUDDS-5 on clients who were working with Department of Social Services to receive Food Stamp or WorkFirst Benefits Coordinated services for clients who were working Youth and Family ServicesClinical Support SpecialistProviding clinical support to the first shift staff.Assist in substance abuse counseling for consumers with substance abuse/mental health issues who are admitted to the Samuel Billings Center (SBC).Assist floor staff with admissionsComplete diagnosis for incoming clients during the admissions process.Facilitate Psychoeducational GroupsSalvation Army: Center of Hope, Charlotte, NC October 2014- March 2016Veterans Program CoordinatorCompleting daily tasks that are geared to the consumers related to housing, employment, medical concerns, vocational skills.Learned the ethical and proper ways to work with consumers in these vulnerable populationsComplete the intake process of new clients (PCP (Person Centered Plans), NC-Topps, etc.), discharge summaries, database training, medication assessments, etc.Clinical Social Worker/ Case Manager September 2013-September 2014Provide weekly case management services to help residents successfully transition and maintain housing and addressing therapeutic issues.Assess need for supportive services and link residents to internal and external resources, including medical care, mainstream benefits, mental/behavioral health, and substance abuse recovery services.Maintain clients weekly progress notes and implement individual service plans with clientsCharlotte Rescue Mission: Doves Nest, Charlotte, NC August 2012- August 2013Medical TechnicianAdministers prescribed medications to residents and maintains related medical records under supervision of the nurseRecords name of drug, dosage, and time of administration on specified forms or records identified to each resident.Advanced Placement InternAssisted in developing children-based activities that addressed common cultural barriers (ex. race, sexual abuse, bullying, etc)Assisted in developing a Policies and Procedures Manual for the Childrens Program.Contacted and developed relationships with current and potential volunteers at Doves Nest.Co-facilitated and lead individual counseling session, groups, and psycho-educational classes.Engaged in the Disciplinary Process with residents (ensuring that disciplinary actions for each resident are within the NASW Code of Ethics and Doves Nest Structured Guidelines.Winthrop University, Rock Hill, SC August 2012- April 2013Admissions Specialist & Teaching Assistant (Graduate Assistantship)Developed and maintained a database for MSW program applicantsProvided administrative supports to the MSW admissions committeeInitiated regular admissions-related communications with prospective MSW program applicantsMet with professors to discuss students' grades, and assisted in correcting and grading students assignmentsHope Haven, Inc. Charlotte, NC January 2012-August 2012Contract WorkerWorked alongside the Clinical Director and Substance Abuse Counselors with the daily tasks that are geared to the consumersCompleted intake, Person-Centered Plans, progress and discharge summary notes for single women consumersProvided case management to those individuals working along with the court system including updates to probation officers and courts/urinalysis/service plans.Generalist Practice Placement InternWork alongside the MSW Clinical Supervisor and a Substance Abuse Counselor with the daily tasks that are geared to the consumers.Learned the ethical and proper ways to work with consumers in these vulnerable populationsLearned the intake process of new clients (PCP (Person Centered Plans), NC-Topps, etc.), discharge summaries, database training, medication assessments, etc.References Available Upon Request

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