Licensed Mental Health Counselor - White Sands Treatment Center - Tampa/Kissimmee, FL
(2021-02)
- Manage a large patient caseload, providing group, individual, and family therapy for adult and pediatric patients
- Conduct bio-psychosocial assessments
- Collaborate with the treatment team to formulate the master treatment plan and assist in coordinating discharge planning
- Conduct urine screens and process results with patients
- Implement behavioral contract when necessary
- Provide referrals to other providers as needed as well as, act as a liaison with the UR Department on all aspects of patient care
- Assist in monitoring and improving retention of patients for outcomes that support long-term recovery from addiction
- Communicated with patients for follow up, and invitation for community events
Behavioral Health Utilization Review Manager - Wellcare - Tampa, FL
(2019-04 - 2021-02)
- Conducted initial, concurrent, retrospective chart review for clinical financial resource utilization
- Coordinated with healthcare team for optimal/efficient patient outcomes, while decreasing length of stay (LOS) and avoid delays and denied days
- Maintained patient caseload and provide intervention, coordination to decrease avoidable delays, denial of reimbursement
- Screened pre-admission, admission process using established criteria for all points of entry
- Utilized CareCentral, MCG, InterQual, EQHealth
- Facilitated communication between payers, review agencies, healthcare team
- Identified delays in treatment or inappropriate utilization and serve as a resource
- Facilitated peer-to-peer review between physicians, help patient process appeals and grievance issues
- Worked with SMI patients, therapeutic foster care, foster care, DJJ substance abuse
- Coordinated communication with physicians
- Identified opportunities for expedited appeals and collaborates resolve payer issues
- Ensured and maintained effective communication with Revenue Cycle Departments
Behavioral Health Specialist/UR Clinical Coordinator - Lakeland Regional Medical Center - Lakeland, FL
(2014-06 - 2019-04)
- Experienced with initial, concurrent and retrospective review of patient hospitalization and status to determine medical necessity against payer criteria and hospital protocol/policies
- Utilized InterQual and Cerner care manager tools
- Reviewed an average of 30 cases per 8-hour shift
- Delivered determination letters of benefits to patients with hospital policy and procedure
- Collaborated with the physician advisor to identify opportunities to improve physician documentation to best describe the patient's condition, acuity, and intensity of services, Implements physician advisor directives
- Coordinated with physician and payer peer to peer consultations, discuss with patient the outcome of the peer-to-peer consultation and provide patient with the right to an expedited appeal
- Attended monthly meetings with case managers, physicians, payers, and medical director to discuss case denials, appeals, department budget, patient safety standard work operations identify ways to improve the department
- Communicated and worked collaboratively with payer social workers, physicians and staff to meet expected patient and program outcomes to secure authorized length of stay and approval of post discharge services
- Provided timely referral and work with social workers/ continuity of care coordinators to identify patient socioeconomic and care needs, coordinate delivery of post discharge services such as home health
- Documented in medical records and hospital information system to adequately reflect the utilization and documentation review process, maintain patient confidentiality and privacy adhere to HIPPA standards
Mental Health Intake Specialist - Central Florida Behavioral Hospital - Orlando, FL
(2010-05 - 2014-06)
- Performed all aspects of Central Florida Behavioral Hospital's intake and admission process, including efficient and effective handling of inquiry calls, knowledge of and communication with referral sources
- Provided hospital and program information to individuals, agencies, facilities, and professionals
- Made outside referrals, when appropriate
- Assessed and triaging an individual's mental health status for both pediatric and adult patient populations
- Made patient safety and level of care recommendations to the CFBH physician
- Identified insurance benefits and pre-certification of patient care
- Completed all admission requirements communicating patient safety concerns and pertinent patient information to unit nursing staff and documenting all necessary information in Med Series 4
- Met with patient conduct biopsychosocial assessment, determine patient dianoia's using DSM criteria, and make recommendations to SW regarding treatment and level of care inpatient, outpatient or partial hospitalization program
- De-escalated any violent and aggressive patients while in the intake area
- Worked as a team to coordinate care for patient
Mental Health Counselor/Case Manager - Human Service Associates - Kissimmee, FL
(2006-03 - 2010-05)
- Performed complex counseling sessions within the correctional recovery program; responsible for planning, coordinating and implementing substance abuse counseling activities
- Coordinated with other departments to ensure maximum utilization of resources available for chemical dependency treatment and rehabilitation in compliance with Kissimmee Department of Criminal Justice directives
- Experienced with both adult and pediatric patient populations
- Attended bi-weekly court hearings as client advocator and collaborating with judge, lawyer and team members to determine client program requirements
- Made appropriate recommendations to members regarding client's sanctions, community service hours, work release program, and residential treatment based on clients conduct and random urinalysis
- Determined treatment level of care either basic or intensive treatment or referred client to appropriate treatment provider, following up with treatment provider for clients progress
- When appropriate conduct graduation ceremony and provide client with null process paperwork
- Responsible for conducting onsite one-on-one counseling session with inmates at jail facilities to determine whether client is appropriate to enter the drug court program, rule out mental health disorders using DSM IV and providing referrals for treatment and medications with follow up care
- Performed thorough bio-psychosocial assessments within specific time frames consistent with program philosophy, preparing clients individualized treatment plans and providing guidance regarding implementation of treatment strategies
- Documented client's progress in treatment and identified mental health issues in accordance with DSM IV
Mental Health Counselor - Seminole Community Mental Health Center - Sanford, FL
(2005-03 - 2006-03)
Optimized the functioning of individuals and maximizing their self-sufficiency and to create strategies to reduce or eliminate the tendency to foster dependency among individuals with a mental illness, assist individuals with complex needs by coordinating the provision of quality treatment and support services.
- Provided support services based on each specific individual and their particular treatment needs
- Responsible for identifying treatment needs through an intake and assessment period and developing outlines to address these needs
- Responsible for providing support services including linkage to entitlement programs, assistance with obtaining or maintaining stable housing, ongoing monitoring of medication compliance illness, mental health status checks and assistance with accessing community resources
- Admission to this program was based on individual needs and length of participation in the program depending on the needs of the individual
Substance Abuse Mental Health Counselor - Mid-Florida Metro Treatment Center - Kissimmee, FL
(2003-01 - 2005-12)
Case Manager - The Salvation Army - Sanford, FL
(2001-01 - 2003-12)
Alcohol and Drug Counselor - Phoenix East Residential Home - Haverhill, MA
(1997-01 - 1998-12)
Suicide and Depression Counselor - Samaritans - Haverhill, MA
(1996-01 - 1997-12)
