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Disability Claims Adjudicator Resume Example

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DISABILITY CLAIMS ADJUDICATOR
Highlights
  • Ability to de-escalate clients in vulnerable emotional states
  • Understanding of human development
  • Team Builder among staff, clients, other stakeholders of an agency
  • DSM-IV knowledge
  • Program Management
Experience
06/2016 to Current
Disability Claims AdjudicatorState of Tennessee-Disability Determination Services DDS － Nashville, TN
  • Assess claimant's medical condition and identify impairments through review of medical records to adjudicate claims.
  • Determine claimant's medical eligibility for SS disability using medical, psychiatric, vocational, and educational data according to policy.
  • Analyze information and evaluate options to choose the best actions and solve problems throughout the disability claims process.
  • Operate federal/state computer systems and programs to enter case documentation, diaries, and complete reports as needed.
  • Access claimant's vocational status.
12/2013 to 01/2016
Case Manager 4/Regional Team LeaderCPS- Assessment State of Tennessee DCS － TN
  • Assess the underlying needs and core family concerns in order to address key issues that will ensure safety.
  • Model a holistic approach to problem solving through exploring multiple sources and "thinking outside the box" to promote child welfare outcomes.
  • Determine if abuse or neglect has occurred, who the abuser is, the level of risk or harm to the child, and the need for a safety plan.
  • Serve as a liaison between court system, school, and provider agencies.
  • Address conflicts among co-workers and leadership using conflict resolution skills to provide a harmonious working environment.
  • Discuss case information with subordinates to guide decision making process regarding case needs, resource allocation and outcomes.
  • Assign cases and work assignments to DCS Case Managers 1,2, and 3 through use of departmental systems for entering child welfare information (TFACTS).
  • Ensure client confidentiality and follow policy and procedures.
  • Document case conferences, performance evaluations, disciplinary actions and other information as needed into TFACTS or Edison to ensure appropriate supervision.
  • Lead for 9 Social Workers and supervise 14 field county offices.
01/2013 to 10/2013
DirectorResCare/Magnolia-Oak Bridge － Nashville, TN
  • Oversee day-to-day operations of the facility.
  • Provide case management services and individual counseling to clients.
  • Ensure compliance for state licensure.
  • Supervise, Hire, and Train staff.
  • Enter clinical notes in state database system.
  • Approve payroll and oversee the budget.
  • Ensure program rules and policies are followed.
  • Provide continuum case management services for 90 days to previous clients.
  • Seek community resources and develop community relationships to serve resident's needs.
  • Intake and Discharge of all clients.
01/2012 to 08/2012
Program SupervisorExchange Club Family Center － Murfreesboro, TN
  • Supervise visitation monitors.
  • Receive payment for visits.
  • Ensure a safe environment for children and families.
  • Resolve any issues that occur during visits with staff and or families.
  • Enter contact notes for families served.
  • Approve monitor notes for court and case file.
  • Ensure program rules and court orders are enforced.
  • Document interactions between non-custodial parent and child.
  • Monitor visits between non-custodial parent and child.
08/2010 to 06/2011
Residential Case ManagerState of Tennessee WH Youth Development Center, Inman Group Home Murfreesboro － Nashville
  • Supervise interns and other direct care staff.
  • Assist in all supervisory task as Assistant Director of the facility.
  • Provide case management services and individual counseling for children and families to achieve safety and permanency and well-being.
  • Serve as a liaison between court system, school, and provider agencies.
  • Document client activity and interaction in measurable terms within the state database.
  • Lead Aggression Replacement Training (ART) group.
  • Develop and assist in the implementation of treatment plans Conduct staff in-service training and family education group.
  • Ensure client confidentiality and follow policy and procedures.
  • Refer clients to community resources and agencies.
  • Complete comprehensive assessments to determine service needs.
  • Audit files and records to ensure they meet licensure requirements by the state and for accreditation.
  • Attend every clients IEP meeting.
  • Testify in court hearings.
  • Met with students in confinement to ensure mental health needs were met.
  • Advocate at disciplinary board hearings.
02/2010 to 08/2010
Residential Office Manager/ Staff SupervisorRenewal House － Nashville, TN
  • Supervise 10-15 staff members.
  • Approve time sheets.
  • Conduct quality assurance reviews of client files.
  • Manage the office of residential programs by providing customer service to clients and staff.
  • Hire and train new staff and oriented new residents.
  • Maintain database of clients protected health information.
  • Complete federal and state reports for funding.
  • Enter billing/insurance claims for services rendered in TN-WITTS database.
  • Lead facilitator of weekly clinical treatment team meetings.
  • Train in Dialectical Behavior Therapy (DBT).
  • Provide mentoring to clients with co-occurring disorders.
03/2008 to 02/2010
Residential Case Manager
01/2007 to 03/2008
Case ManagerFoster Care
Education
2013
Master of Science: Public Service ManagementCumberland University － Lebanon, TennesseePublic Service Management
2007
Bachelor of Science: Social WorkMiddle Tennessee State University － Murfreesboro, TennesseeSocial Work
Skills
approach, ART, agency, billing, budget, case management, conferences, conflict resolution, counseling, client, clients, customer service, database, decision making, documentation, insurance, leadership, Team Builder, notes, Director, review of medical records, meetings, mental health, mentoring, Access, office, monitors, payroll, policies, problem solving, Program Management, protected health information, quality assurance, safety, supervisory, supervision, Therapy, treatment plans, written communication skills
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Resume Overview

Companies Worked For:

  • State of Tennessee-Disability Determination Services DDS
  • CPS- Assessment State of Tennessee DCS
  • ResCare/Magnolia-Oak Bridge
  • Exchange Club Family Center
  • State of Tennessee WH Youth Development Center, Inman Group Home Murfreesboro
  • Renewal House
  • Foster Care

School Attended

  • Cumberland University
  • Middle Tennessee State University

Job Titles Held:

  • Disability Claims Adjudicator
  • Case Manager 4/Regional Team Leader
  • Director
  • Program Supervisor
  • Residential Case Manager
  • Residential Office Manager/ Staff Supervisor
  • Case Manager

Degrees

  • Master of Science : Public Service Management
    Bachelor of Science : Social Work

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