Crisis System Manager Resume Example Carefirst

CRISIS SYSTEM MANAGER

Professional Summary

Health Care Professional with over 20 years experience working in behavioral health care managed care.

Professional Experience

Crisis System Manager
July 2012 to May 2014Carefirst － Baltimore , MD

Successfully managed all areas of the largest Behavioral Health Delivery System in the Country.
Formulated and enforced Service Center policies, procedures and quality assurance measures.
Worked directly with key customers, both internal and external, both telephonically and in person to improve services for customers.
Given responsibility for the day to day management and oversight of the Maricopa County Crisis System which included management of over 30 provider/contractors and over 300,000 consumers.
Coordinated with and provided training inter-departmental work groups, CEO, CFO, Clinical Directors and Provider executive staff to address issues related to 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.
Contributed to RFP proposal process and development of electronic and print materials, including training, policies and procedures, and informational literature for providers and internal staff as well as customers.
Assumed responsibility for ensuring the receipt of incoming data and dissemination of outgoing deliverables.
Supervised Crisis Coordination staff to ensure accuracy of data and excellent performance.
Laid off when Employer lost State Contract.

Senior Care Manager
February 2007 to June 2012Bluecross Blueshield Of South Carolina － New Hampshire , OH

Worked remotely for call center conducting telephonic review and authorization of health care services based on medical need of member.
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 out of 5000 nationwide employees.

Care Management Supervisor
April 2006 to December 2007Carefirst － Reston , VA

Supervised 25+ Master's Level Care Managers in a Telephonic Call center which provided benefit information and authorization of services for all children in the State of New Jersey.
Worked with upper management to ensure appropriate changes were made to improve customer satisfaction.
Managed call center operations and provided training and supervision to call center staff members to ensure effective operations and performance.
Ran reports and supplied data to fulfill customer report requirements.
Developed policy and procedures and training manuals for operations and staff.
Provided cross training and supervision of inter-departmental staff.

Senior Care Manager
January 2003 to April 2006Magellan Health Services － City , STATE

Worked in call center 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.

Care Manager/ Crisis Supervisor
December 1997 to November 2002Universal Health Services － City , STATE

Hired as one of 4 employees at the start up of this health care call center.
Developed policies and procedures, as well as documents and training materials.
Conducted telephonic review of behavioral health care needs while providing benefit and authorization of services.
Worked with key customers and providers both telephonically and in person.
Supervised 15 on call crisis service call managers outside of business hours operation.
Provided training to current and ongoing staff.
Selected as IT lead for operations of Call Center.
Laid off when Employer lost contract.

Education and Training

MBA : Healthcare Administration, 2006University of Phoenix － City, State, USAGPA: GPA: 3.5Healthcare Administration GPA: 3.5 Worked FT while attending.

Master of Arts : Clinical/Counseling Psychology, 1999La Salle University PT at University's Psychological Assessment lab － City, State, USAGPA: GPA: 4.0Clinical/Counseling Psychology GPA: 4.0

Bachelor of Science : Liberal Arts Psychology Exercise Science, 1994The Pennsylvania State University － City, State, USALiberal Arts Psychology Exercise Science

Skills

benefits, Call Center, Conflict resolution, customer satisfaction, excellent customer service, Delivery, Government, insurance, Leadership, Director, materials, meetings, Mental Health, Microsoft Office Suite, Network, PHP, policies, problem solving, process improvement, proposal, quality, quality assurance, quality improvement, RFP, supervision, Telecommunications, training materials, training manuals

Additional Information

Licensed Professional Counselor for State of Pennsylvania since 2003. Nationally Certified Counselor since 2003.

Resume Overview

School Attended

University of Phoenix
La Salle University PT at University's Psychological Assessment lab
The Pennsylvania State University

Job Titles Held:

Crisis System Manager
Senior Care Manager
Care Management Supervisor
Care Manager/ Crisis Supervisor

Degrees

MBA : Healthcare Administration , 2006
Master of Arts : Clinical/Counseling Psychology , 1999
Bachelor of Science : Liberal Arts Psychology Exercise Science , 1994

Crisis System Manager Resume Example

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