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Utilization Management Specialist Resume Example

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UTILIZATION MANAGEMENT SPECIALIST
Professional Overview

Licensed Master Social Worker with 4 years experience in children, youth, and family, mental health settings, working with diverse populations in the field, health care, outpatient, and inpatient treatment settings.

Education
2007
Southern University and A&M CollegeBaton Rouge, LABachelor of Science: Sociology
  • President of the Sociology Club
  • Member of Association for Women Students
2012
Southern University and A&M College Southern University at New OrleansNew Orleans, LAMasters: Social Work
  • Focus: Children, Youth, and Family
Capella UniversityMinneapolis, MNDocorate : Social Work
Experience
07/2014 - 09/2015
Pathways Health and Community Support － New Orleans, LaUtilization Management Specialist
  • Developed and implemented policies and procedures to meet expectations of the managed care organization.
  • Served as Liaison between the Louisiana region and Magellan Health care services and other payers.
  • Participated in Community Mental Health and Targeted Case Management program improvement efforts.
  • Assisted Clinical Director, Clinical Supervisor and/or clinicians in dealing with issues with HMOs
  • Lead the coordinating of intakes and assessments with incoming referrals
  • Collaborated with assigned case manager to identify members frequent hospital readmissions
  • Monitored the implementation of efficient and effective training manual and operations which included intake processes, authorizations, and best practice concurrent review for each consumer.
  • Fostered relationship with outside agencies to collaborate for client care
03/2013 - 07/2014
Pathways Health and Community Support － New Orleans, LaMental Health Professional
  • Provided intensive mental health in-home and in-school counseling and crisis intervention to children, adolescents, and adults in their natural environment.
  • Integrated appropriate use of theoretical framework, concepts and interventions in the field working with consumers.
  • Identified and resolves barriers that hinder effective consumer care.
  • Developed and implemented behavior management plans, treatment plans, crisis plans and monitored the progress of each client.
  • Established close relationships with schools and other community service providers in coordinating services.
03/2011 - 12/2011
Dryades YMCA Head － New Orleans, LaFamily Service Worker
  • Developed strategies in support of the individualized Family Partnership Agreements based on the assessment data gathered.
  • Facilitated the recruitment and enrollment of eligible families.
  • Coordinated case management functions with appropriate contract agencies and Head Start staff
  • Monitored and maintained statistical records and narrative case notes on individual contacts with children and families.
  • Identified, referred and supported of children with special needs.
  • Assured provision of supportive services to children and families.
08/2011 - 05/2012
Total Community Action, INC. － New Orleans, LAFamily Service Worker Intern
  • Assisted Family Service Worker in recruitment and enrollment of eligible participants.
  • Conducted fieldwork to establish relationship in community and establish and foster relationships to secure community resources.
  • Helped maintain participant records within Child Plus Database System.
  • Organized and facilitated of Parent Resource Fair.
08/2010 - 05/2011
Total Community Action, INC － New Orleans, LAHead Start Intern
  • Monitored and maintained participant records in Fatherhood program.
  • Provided research assistance on current social service policies to Director and Programs Managers.
  • Acted as liaison at Child Hood Safety and Abuse Reports for Head Start Conferences.
06/2008 - 03/2009
ICF International － New Orleans, LADisaster Recovery Housing Advisor
  • Assisted families in securing housing and financial assistance through grant administration with the Louisiana Road Home Program
  • Provided clients with professional advice and casework on a wide range of housing and social welfare issues.
  • Assisted homeowners affected Hurricane Katrina with rebuilding efforts by conducting face-to-face meetings with applicants, provided counseling and disaster assistance to aid in eGrants software.
  • Maintained accurate paper and computerized record of all inquires and responses.
  • Served as a liaison between program management, title companies and applicants qualifying for public assistance grants.
  • Implemented policy changes and regular updates for relevant serves to appropriate program participants.
11/2007 - 03/2011
Community Connections Programs － New Orleans, LAHome Health care Provider
  • Responsible for the assessment, implementation, planning and evaluation for primary care patients.
  • Monitored patient condition by observing physical and mental condition, intake and output, and exercise.
  • Provided education to patient, family and supplemental caregivers on nutrition, physical therapy & first aid.
  • Assisted patients by providing personal services, such as, bathing, dressing, and grooming.
  • Performed home management tasks including housekeeping, laundry, shopping and errands
  • Maintained records of patients care, condition, progress and problems.
Certifications and Licenses
  • Licensed Master Social Worker (Louisiana) #12100
  • Certified CPR and First Aide
  • CertifiedNon Violent Crisis Prevention and Intervention (CPI)
  • Certified in Trauma Focused Cognitive Behavioral Therapy (TF-CBT)
Skills

Case Management, Counseling, Active Listening, Problem Solving, Public Speaking, Time Management, Team Building, Goal Setting and Implementation, Curriculum Development, Group Instruction, and Critical Thinking.

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Resume Overview

Companies Worked For:

  • Pathways Health and Community Support
  • Dryades YMCA Head
  • Total Community Action, INC.
  • Total Community Action, INC
  • ICF International
  • Community Connections Programs

School Attended

  • Southern University and A&M College
  • Southern University and A&M College Southern University at New Orleans
  • Capella University

Job Titles Held:

  • Utilization Management Specialist
  • Mental Health Professional
  • Family Service Worker
  • Family Service Worker Intern
  • Head Start Intern
  • Disaster Recovery Housing Advisor
  • Home Health care Provider

Degrees

  • Bachelor of Science : Sociology
    Masters : Social Work
    Docorate : Social Work

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