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Health Services Director Bh Case Management Resume Example

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JC
Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Summary
  • Agile, results-oriented, solution-focused and motivated leader with strengths in communication and collaboration to build necessary relationships and cohesive teams to support program and organizational goals
  • Proficient in building on individuals' strengths and history of fostering accountability to optimize team performance and efficacy
  • Knowledge and understanding of person-centered practices and the impact of case management interventions on utilization of services and improvement of quality of life and health outcomes
  • Strong at leveraging data to inform operational processes, adjustments, and strategies and allocation of resources
Skills
  • Leadership experience includes 8 years as Clinical Director at community mental health crisis center + 7 years as manager Amerigroup in TX
  • Managed integrated team delivering case management of behavioral health (BH) and physical health (PH) conditions and utilization management (concurrent reviews) of BH inpatient admissions of membership
  • Utilizes data to deliver purposeful strategies to impact health outcomes and allocate and maximize existing resources
  • Strong transparent communication to build cohesive teams and eliminate fragmentation in collective efforts
  • 13 years of community mental health experience, familiarity and strong understanding of community mental health systems and respective State contractual requirements and expectations
Experience
03/2021 to Current Anthem, Inc. Behavioral Health Services | City, STATE,

Health Services Director, Behavioral Health Case Management (present)

  • Implements and ensures compliance with corporate management/global program policies, practices, and procedures.
  • Establishes relationships with health plan leadership and other business users to support and remove barriers to meeting performance goals
  • Participates with leadership to establish strategic plans and objectives (i.e. service level targets, financial targets, development and implementation of new programs).
  • Delivers data and project updates to all areas requiring information for management reporting, analysis and executive decision making
  • Provides support to health plan Case Management leadership to grow and upskill associate performance and improve delivery of case management services

Manager, BH Services, TX Medicaid Special Populations (2014-2021)

  • Responsible for management of clinical team (behavioral health, social work, and nursing professionals) providing integrated care to members with Intellectual and Developmental Disabilities (IDD)
  • Monitored and tracked adherence with TX STAR+PLUS contract for Service Coordination requirements for Non-Dual IDD plan membership
  • Overseeing case management functions of team to address the behavioral health and physical health conditions of IDD members
  • Responsible for overseeing the Utilization Management (UM) function of the team for assigned membership's BH inpatient admissions and ensuring UM clinical guidelines and turnaround times were followed.
  • Created partnerships with Local IDD Authorities administering waiver services to facilitate care coordination seamless efforts with external partners to address long term support services (LTSS) needs
  • Leveraged years of expertise in community mental health to create, obtain, and/or deliver effective, pragmatic training materials for new or current staff members to better meet the needs of members
  • Co-hosted townhall meetings with health plan leadership as a subject matter expert in community waiver IDD and mental health services to cultivate and strengthen relationships with key external stakeholders improve overall delivery of care services and improve favorable positioning when responding to State's Request for Proposals
  • Completed quarterly assessments of direct reports to evaluate ongoing performance and promote staff members accountable to case management objectives
  • Collaborated across departments to form relationships that ensured escalation processes were created to facilitate timely removal of barriers impeding quality customer service and member care
  • Coordinated and delivered clinical and non-clinical trainings to internal and external stakeholders to improve health outcomes

Behavioral Health Case Manager I, October 2013-May 2014

  • Applied corporate workflows to deliver care management for members with complex needs utilizing needs assessments and leveraging clinical judgement and motivational interviewing skills to develop health goals with members.
  • Worked across interdisciplinary teams to coordinate for identified long term services and supports, physical health and behavioral health services necessary to improve health outcomes.
  • Monitored daily inpatient census for admissions of service delivery assigned members and proactively reached out to discharge planner at facilities to support successful discharge and increase community tenure.
01/2000 to 09/2013 Multiple Center For Health Care Services | City, STATE,

Clinical Services Director (2010-2013)

  • Clinically and administratively responsible for the operations of four 24/7 programs providing clinical and administrative oversight to ensure best clinical and business practices as well as compliance with DSHS Performance Contract for Crisis Respite and Crisis Residential Services.
  • Overseeing case management operations to impact and reduce utilization of higher levels of care, hospital and jail diversion and recidivism

Other positions held:

  • Mobile Crisis Assessor (2008-2010)
  • Utilization Manager (2007-2008)
  • Crisis Case Manager (2005-2007)
  • Intake Assessor (2002-2005)
  • IDD Service Coordinator (2000-2002)
Education and Training
Expected in 2004 Master of Arts | Counseling Webster University, San Antonio, Texas GPA:
Expected in 1998 Bachelor of Arts | Psychology, Sociology University of the Incarnate Word, San Antonio, Texas GPA:
Licensures & Certifications
  • Licensed Professional Counselor Supervisor, Texas State Board of Examiners of Professional Counselors
  • Certified Crisis Worker, American Association of Suicidology
  • Certified Mental Health First Aid Instructor, National Council for Behavioral Healthcare
  • Certified Master Trainer- Road to Recovery: Trauma in Children with IDD, UT Center for Disabilities Studies
  • Certified Person Centered Thinking Trainer
  • Certified Trainer-Vicarious Trauma/Vicarious Resilience, Be Strong Families
  • Certified Clinical Trauma Professional (CCTP) Certification, International Association for Trauma Professionals

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Resume Strength

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Resume Overview

School Attended
  • Webster University
  • University of the Incarnate Word
Job Titles Held:
  • Anthem, Inc.
  • Multiple
Degrees
  • Master of Arts
  • Bachelor of Arts

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