Well-rounded professional experienced in applying principles of social sciences and business administration to personnel administration, case management, and provider relations. Fiscally responsible and focused on adequate delivery of services to the community with expertise in community resources. Extensive knowledge of human behavior and social services industry trends along with performance, assessment methods and implementation of service plan processes.
Knowledge of Medicaid and Managed Care organizational procedures
Organizational and Time Management skills
Legal and Ethical standards
Ability to work independently and in multidisciplinary team setting
Conflict resolution skills
Interpersonal relationship building skills
Excellent writing, oral, and analytical skills
Computer literate in Microsoft Word, Excel and Access
Case Management Coordinator10/2009 to Current Aetna, Inc – Phoenix,
Provide ALTCS case management to members residing in Skilled Nursing Facilities and community setting receiving Medicaid/AHCCCS benefits under Mercy Care Plan.
Utilize critical thinking and judgment to collaborate with members, families and providers, and provide information relating to care management procedures in order to facilitate appropriate healthcare outcomes for members with provision of care coordination, support and education through appropriate allocation of available resources.
Provide with conflict resolution between member, Ombudsman and Managed Care Organizations.
Complete assessment reviews to designate adequate services for medical and behavioral health needs.
Provide training to providers, members and their families on Medicaid benefits and Managed Care Organization, State laws, rules and regulations related to their enrollment status.
Crisis Specialist 305/2009 to Current Crisis Response Network, Inc – Phoenix,
Receive, triage and complete intervention of crisis calls.
Utilize effective clinical skills to engage and assess the level of acuity and risk of crisis callers.
Provide support, resolution and referral resources to prevent future crisis situations or assist with immediate referral process for next level of care service to include: intake, peer support services and/or mobile crisis team.
Assist with supervisory tasks to support other crisis specialists, mobile crisis teams, crisis transport, community organizations such as Police, Fire Department and community hospitals, as assigned.
Perform tasks within the context of inspiring hope and supporting recovery and resiliency.
Crisis Call Center Supervisor12/2007 to 05/2009 Crisis Response Network, Inc – Phoenix,
Maximized the effectiveness and efficiency of Crisis Call Center operations through active and direct system monitoring of the Crisis Call Center staff.
Responded quickly and effectively with resolution to escalated issues by crisis staff, RHBA/Provider Networks, Police and Fire Departments within Maricopa County.
Proficiently engaged in multi-tasking in a fast paced and high volume work environment.
Provided leadership and training to Crisis Specialists to facilitate their gain of clinical skills in establishing and maintaining clinical rapport with crisis callers.
Worked with staff to develop their maximum potential, provided support and direction in achieving personal growth and development within workforce.
Documented supervisions according to AZDHS-DBHS laws, standards and regulations.
Exercised confidentiality in implementation of performance corrective plans and disciplinary actions.
Maintained a positive and collaborative relationship with Managed Care Organizations, their network providers, payor sources, and community stakeholders.
Grievance and Appeals Coordinator09/2007 to 12/2007 Magellan Health Services, Inc – Phoenix,
Responsible for timely resolution and implementation of corrective action measures to alleged and admitted violation of Medicaid recipients' rights under the AZ Department of Health Services-Division of Behavioral Health Services standards and regulations.
Completed screening and assignment of grievances, appeals and provider claims disputes in compliance with all State and Federal laws and regulations along with contractual requirements.
Advocated for member rights within the Managed Care Organization, assured grievance and appeal trends including Notice of Action appeal rights were reported in docket file system, and addressed accordingly.
Consumer Rights Specialist04/2007 to 09/2007 ValueOptions, Inc – Phoenix,
Completed screening process for appeals, grievances and provider claim disputes for Regional Behavioral Health Authority recipients.
Determined and implemented resolution as well as corrective measures as appropriate to resolve substantiated rights violations.
Assigned cases accordingly to appeals coordinators and grievance investigators for further fact-finding and conflict resolution as required in compliance with all State and Federal regulations.
Crisis Specialist III/Supervisor04/2005 to 04/2007 ValueOptions, Inc – Phoenix,
Completed supervisory tasks to support and provide leadership to other crisis specialists, mobile crisis teams and crisis transport in delivery of service and crisis operations.
Completed triage process and intervention of crisis calls.
Effectively utilized clinical skills in assessing risk and level of acuity of crisis callers.
Provided support and resources for immediate treatment services, to include mobile team intervention and/or referral with crisis transport to higher level of care as determined clinically appropriate and necessary.
Crisis Specialist I01/2003 to 04/2005 ValueOptions, Inc – Phoenix,
Triaged and engaged callers in crisis intervention.
Completed risk assessments and determined acuity of crisis.
Provided support and resources to address symptom management and effective use of coping skills, determined need for immediate treatment services with dispatch of crisis mobile teams and/or referral with crisis transport to a higher level of care as needed.
Rehabilitation Specialist08/2002 to 04/2005 ValueOptions, Inc – Phoenix,
Assessed behavioral health recipient's current condition and level of social functionality.
Utilized a variety of approaches to psychosocial rehabilitation and intervention to promote recovery within site based programs as well as successful community integration experiences.
Provided individualized support and skill teaching to promote new role development and self-sufficiency.
Assisted individuals in gaining access to needed psychiatric, medical, social, residential, financial and other services as appropriate, helping individuals reach their goal of becoming engaged in meaningful community activities.
Perinatal Case Manager09/2001 to 08/2002 Department of Public Health – Phoenix,
Managed and tracked delivery of comprehensive perinatal services that met the individual needs from initial perinatal visits through postpartum to assure continuity of care in accordance to the Healthy Start Federal program policy and procedures.
Maintained close contact with clients to ensure compliance with prescribed treatment plans including medical appointments, referrals and consultations, and social issues.
Human Services Specialist II/Support Coordinator02/2000 to 08/2001 Department of Economic Security – Phoenix,
Provided support coordination to children receiving services through the Division of Developmental Disabilities.
Established and maintained case plans, schedules, timetables, priorities, and agendas that included home visits, attending IEP meetings and implementation of home community based services.
Engaged in interviewing skills eliciting information and gaining insight into families dynamics through the interview process, interacted with families and identified case problems, needs and evaluated the usefulness of resources.
Completed process of obtaining information for the purpose of eligibility redetermination for services and for the process of ALTCS' Notice of Action appeals.
Learnfare Case Manager08/1998 to 10/1999 La Causa, Inc – Milwaukee,
Provided case management services to a caseload of assigned program recipients of the welfare program W-2 Works whose children were considered to be truant, facing academic hardship and/or at risk for expulsion from school.
Developed service plans, attended IEP meetings and monitored compliance with families participating in W-2 Works program.
Developed and used expertise to address specific issues affecting participants, including, financial stresses, teen pregnancy, AODA, and domestic violence.
MBA: Business Administration2005Western International University
Bachelor of Arts: Sociology1998University of Wisconsin