Jessica Claire
  • Montgomery Street, San Francisco, CA 94105
  • Home: (555) 432-1000
  • Cell:
Professional Summary
Marriage and Family Therapy Trainee eager to collaborate with other mental health professionals to provided individual, group, and/or couple psychotherapy to clients experiencing symptoms associated with mental illness. Foundational coursework and training in Assisted Suicide Intervention Skills Training and various therapeutic modalities including Cognitive-Behavioral Therapy and Family Systems Therapy, experience providing psychotherapy interventions to clients and the families of clients who suffer from pervasive disorders, mood disorders, psychotic disorders, etc. Demonstrates excellent verbal and written communications skills, problem-solving skills and documentation skills. Demonstrates skills in performing initial assessments and creating and implementing effective treatment plans. Knowledge of legal and ethical responsibilities, crisis and behavior management.
Skill Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Authorization Coordinator, 11/2012 to Present
Encompass Health Corp.Ocean Springs, MS,
  • Supports the UM Specialist (RN) by handling all administrative and technical functions of the authorization processes including intake, logging, tracking and status follow-up.
  • Collects information required by clinical staff to render decisions.
  • Assists Manager and Director of Department in meeting regulatory timelines by maintaining and preparing accurate authorizations and expediently and accurately troubleshooting CBAS issues as they arise in a timely manner.
  • Gathers information needed to resolve provider disputes, member's grievances, and claims issues.
  • Performs data entry and processing of referrals/authorizations in the database, authorizes request consistent with auto criteria, maintains confidentiality when communicating member information, and preparing template letters for members and providers.
  • Assists with training of new staff and developing and implementing policies and procedures.
  • Works with Provider Network Operations, Claims, and Member Services Departments, Community-Based Adult Services Centers, and L.A.
  • Care members regarding the education of Community-Based Adult Services policies and procedures and problem resolution.
Marriage and Family Therapist, Trainee, 01/2015 to 08/2015
Bethany Christian ServicesMeadville, PA,
  • Performed Adult Initial Assessments, screen clients for substance use/abuse and provide provisional diagnoses to clients with symptoms associated with mental illness.
  • Developed treatment plans and provided individual psychotherapy using various interventions with clients diagnosed with a variety of mental illnesses including Schizophrenia, Bipolar Disorder, Post Traumatic Stress Disorder, Anxiety Disorder, etc.
  • Maintained progress notes to ensure proper documentation of session content and interventions.
  • Worked closely with the psychiatrist, clinical supervisor, case managers and provided referrals and linkages to outside agencies to ensure clients were receiving comprehensive and holistic treatment.
Case Manager, 01/2011 to 06/2012
Lehigh Valley Hospital & HealthLehighton, PA,
  • Assessed potential client(s) needs, completed initial assessments, and developed detail plan of action to meet each client's individual needs while implementing Individual Service Plans.
  • Maintained thorough records of client's cases with complete and accurate documentation.
  • Facilitated information - sharing and presenting information via PowerPoint and case coordination with peers and supervisors.
  • Assisted clients with accessing community resources by acting as an advocate between social service agencies /programs and recipients.
Referral Specialist, 07/2008 to 04/2010
Cci Health & Wellness ServicesSilver Spring, MD,
  • Supported the UM Specialist (RN) by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.
  • Assisted with the implementation of departmental workflows and coaching of new hires.
  • Provided computer entries of authorization requests via provider inquiries by phone, mail, or fax and verified member eligibility and benefits.
  • Conducted training courses with new employees regarding Utilization Management policies, procedures, guidelines, and timelines.
Utilization Management/CCS Coordinator, 05/2007 to 02/2008
DentaquestMilwaukee, WI,
  • Delegated work assignments, assisted with interviewing/screening applicants, departmental and Health Plan audits and addressed internal team issues.
  • Supported the UM Specialist (RN) by handling all administrative and technical functions of the authorization process including intake, logging, tracking and status follow-up.
  • Facilitated group meetings and provided continuous training with employees regarding departmental policies and procedures.
  • Contacted physician offices according to Department guidelines to request missing information from authorization requests or for additional information as requested by the Medical Director and notified UM Nurses and Medical Director of potential CCS cases as well as logged, tracked, and followed-up on CCS cases.
Lead Utilization Management Coordinator, 04/2005 to 04/2007
La Vida Medical Group & IPACity, STATE,
  • Assisted with supervisory duties for a 9 person team of authorization coordinators including: payroll processing, PTO requests, employee reviews, interviewed/screened applicants, departmental audits and addressed internal team issues.
  • Provided continuous training with employees regarding departmental policies and procedures.
  • Received and entered authorization requests while efficiently managing intake activities, requested clinical records to process authorizations, referred requests/notifications to the appropriate licensed health professional for review, conducted eligibility and benefit verification, ensured proper coding of procedures & diagnoses, maintained accurate documentation of authorizations, and outbound calls when necessary.
  • Maintained confidentiality of all Patients Health Information (PHI), performed required clerical support duties, professionally interacted with patient's while acting as a liaison between the Provider Relations, Claims, and Member Services.
Provider Relations Representative, 06/2003 to 04/2005
Santa Monica Bay PhysiciansCity, STATE,
  • Maintained provider relationships via provider contacts.
  • Conducted provider education on policies and procedures, operational workflows, and contracting requirements.
  • Assisted with internal and external audits.
  • Assisted providers with escalated service issue resolution and fee dispute resolution while working closely with Utilization Management, Claims, and Member Services department.
  • Tracked provider issue outcomes, developed solutions for escalated issues, and proactive problem resolution.
Career Chronology
, to
Education and Training
Master of Arts Degree: Psychology, Expected in October 2015
Brandman University - Irvine, CA
administrative, benefits, clerical, coaching, content, client, clients, data entry, database, documentation, external audits, fax, letters, logging, notes, Director, managing, meetings, mental illness, mail, PowerPoint, Works, Network, payroll processing, policies, presenting, problem resolution, processes, coding, progress, psychiatrist, psychotherapy, receiving, supervisor, supervisory, phone, treatment plans, troubleshooting

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