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Case Management ￨ Individual / Group Xxxxxxunseling ￨ Treatment Planning ￨ Wellness Management
Adult In- / Out-Patient Xxxxxxunseling ￨ Program Development / Management ￨ Vocational Assessments
Xxxxxxnfidential Data Management ￨ Diversity / Inclusion ￨ Anti-Discrimination ￨ Ergonomic Evaluations
Administrative Operations ￨ Client / Patient Relations ￨ Process Optimization ￨ Budget Xxxxxxntrol ￨ HIPAA
Highly Acxxxxxxmplished Xxxxxxunselor / Case Manager who facilitates the delivery of responsible in- and / or out-patient xxxxxxunseling practices as well as dynamic individual and group therapy to align with industry and facility standards of care and client treatment objectives. Top Performer who demonstrates experience in mental health and substance abuse assessments of adults and adolescents, and who xxxxxxllaborates with multidisciplinary healthcare teams to optimize individual outxxxxxxmes per treatment goals. Ambitious Self-Starter who promotes patient-centered care while simultaneously handling xxxxxxnfidential data / rexxxxxxrdkeeping tasks, who demonstrates a calm and knowledgeable demeanor, and who maintains xxxxxxmposure in high-stress scenarios. Excellent Xxxxxxmmunicator who develops synergistic relationships with healthcare teams, patients, and families, and who applies up-to-date awareness of national care management trends while exhibiting astute professionalism and follow-throughs, as well as a stellar work ethic leading peers by example and with integrity.
Xxxxxxre Xxxxxxmpetencies Include:
Exhibiting case management experience to xxxxxxordinate patient-focused outxxxxxxmes.
Xxxxxxnsistently receiving positive feedback from superiors for strong case management.
Xxxxxxntinually establishing trust and facilitating positive change within high-stress situations.
Actively upholding cutting-edge professional skills and up-to-date industry trends awareness.
Expertly analyzing family dynamics and multifaceted psychological / social issues among clients.
Xxxxxxmmunicating with a gentle, direct, and focused style to assist clients in making difficult decisions.
Achieving skill in delivering excellence in vocational assessments, testing, and xxxxxxunseling of veterans.
The Medical Center of Aurora, Aurora, XXXXXX (2016 2018)
Utilization Review ￨ Case Management
Capitalized on the opportunity to lead forward-thinking review of physician, nurse, and / or social worker notes to summarize medical and / or psychiatric clinical information to accurately substantiate inpatient hospitalization to various insurance xxxxxxmpanies (i.e. Cigna, Anthem Blue Cross Blue Shield). Xxxxxxntributed experience with hospital-based medical rexxxxxxrds system (i.e. Meditech) to evaluate data and submit clinical information to Xxxxxx Medicaid vendors to obtain preauthorization for inpatient psychiatric care. Documented review in MIDAS xxxxxxmputer database and xxxxxxmpleted InterQual criteria, a standardized system used to assess if a patient meets criteria for remaining in an acute care setting.
Xxxxxxordinated xxxxxxmprehensive peer reviews between hospital and insurance xxxxxxmpany physicians.
Exhibited skill with DSM-5 diagnoses and xxxxxxding, clinical knowledge, and progress assessments.
GENEX Services, LLC, Denver, XXXXXX (2003 2016)
Case Manager Vocational ￨ Medical
Utilized broad sxxxxxxpe of industry knowledge toward directing medical case management initiatives via xxxxxxllaboration with diverse workers xxxxxxmpensation carriers, as well as providing vocational assessments for the Department of Veteran Affairs by interviewing veterans and assisting with employment transitioning to a civilian job market. Xxxxxxmprehensively handled job site evaluations to meet State of Xxxxxx criteria for avoidance of repetitive work injuries. Xxxxxxordinated medical care between physicians, insurance xxxxxxmpanies, and employers to meet and / or exceed available treatment and resource goals.
Xxxxxxntinually put quality patient care first and foremost in xxxxxxmpleting system-specific tasks.
Successfully xxxxxxmpleted hundreds of ergonomic evaluations in both industrial and office settings.
Sedgwick Claims Management Services (CMS), Denver, XXXXXX (2001 2002)
Medical Case Manager
Strategically steered medical case management efforts, including reviewing short-term disability claims from Qwest union employees, as well as reviewing medical information / disability forms from employees physicians to determine if illnesses met plan guidelines for disability. Gained knowledge in cardiac, respiratory, and surgical procedures, as well as neurological and psychiatric diagnoses. Xxxxxxnsistently enxxxxxxuraged employees return-to-work to lighter duty while taking into xxxxxxnsideration employees type of disability. Documented telephone calls and xxxxxxrrespondence regarding case management activities, including xxxxxxmmunicating among unions to discuss potential challenges.
Xxxxxxllaborated among physicians, RNs, and Qwest to determine short-term disability status.
Actively negotiated between management and union officials to achieve mutually beneficial resolutions.
Yyyyyy x. yyyyyy ￨ (xxx-xxx-xxxx
Mile High Xxxxxxuncil on Alxxxxxxholism & Drug Abuse, Denver, XXXXXX (2000 2001)
Spearheaded not-for-profit agency operations initiatives, including recruiting, mentoring, and managing a top-performing team of 3 xxxxxxunselors in the efficient treatment of clients, as well as xxxxxxntinually planning and prioritizing workflow, shaping policy-wide decisions, and promptly responding to and resolving client issues. Xxxxxxst-effectively managed the clinic s budget.
Personally facilitated solutions-focused group and individual therapy activities.
Successfully xxxxxxnceptualized, developed, and implemented a new treatment curriculum.
Disseminated data to State of Xxxxxx s Drug Xxxxxxurt regarding client progress and participation.
Longmont United Hospital, Longmont, XXXXXX (1994 2001)
Led targeted on-call therapy to effectively facilitate 12-step rexxxxxxvery program initiatives in group therapy within the hospital s outpatient alxxxxxxhol and drug clinic, including accurately documenting client participation and treatment progress.
Successfully facilitated 12-step model group alxxxxxxhol and drug therapy as a PRN on an as-needed basis.
Zenith Administrators, Westminster, XXXXXX (1994 2000)
Health Management Xxxxxxordinator
Expertly led third-party administration of medical health plans for Local Union #7 employees of King Soopers, Albertsons, and Safeway. Applied experience within this call center-oriented environment to xxxxxxmplete pre-authorizations for medical procedures using standardized utilization review plan guidelines for ICD xxxxxxding and diagnoses, including providing plan information and clarification for physicians offices requesting insurance preauthorization. Optimized administrative efficiency by using a DOS xxxxxxmputer base to input data on preauthorization and case management.
Xxxxxxmpleted rigorous training in medical terminology, diagnoses using ICD, and procedural xxxxxxding.
Successfully tracked xxxxxxmplex, high-dollar claims and xxxxxxmpleted required case management activities.
Intraxxxxxxrp, Denver, XXXXXX (1987 1993)
Psychiatric Case Xxxxxxordinator ￨ Rehabilitation Specialist ￨ Supervisor
Played a vital role in xxxxxxmpleting on-site visits, as well as visits to psychiatric hospitals and residential treatment centers to evaluate treatment plans and discuss more xxxxxxst-effective treatment alternatives. Interfaced among families, clients, and patients to obtain information and develop resourceful treatment plans. Demonstrated additional previous experience in workers xxxxxxmpensation case management to drive efficient xxxxxxmmunications between workers, physicians, employers, and insurance xxxxxxmpanies. Xxxxxxntinually identified potential jobs for clients, as well as assisting with searches and resume writing.
Led targeted discussions among psychiatric xxxxxxordinators regarding client treatment and care.
Regularly liaised among nursing staff, psychologists, and psychiatrists to discuss treatment plans.
Exhibited experience in writing detailed evaluations and progress reports, as well as market research.
Additional Professional Experience
Therapist Island Grove Regional Treatment Center, Greeley, XXXXXX
DUI Group Therapy ￨ DUI Education Classes ￨ Individual Alxxxxxxhol & Drug Xxxxxxunseling
Psychiatric Team Assistant North Xxxxxx Medical Center, Greeley, XXXXXX
Mental Health Crisis Intervention ￨ Xxxxxxunseling
University of Northern Xxxxxx
Master of Arts in Psychology
Xxxxxxunseling & Guidance with Emphasis in Agency Xxxxxxunseling
University of Northern Xxxxxx
Bachelor of Arts in Psychology
Certifications, Seminars & Xxxxxxntinuing Education
Certified Ergonomic Assessment Specialist II (CEAS)
Alxxxxxxhol & Drug Xxxxxxunselor Level III (State of Xxxxxx)
Certified Case Manager (CCM) ￨ Certified Disability Management Specialist (CDMS)
Alternative Medicine Spinal Disorders ￨ Brain Injuries ￨ Up-to-Date Medical Treatments ￨ Workers Xxxxxxmpensation Laws
InterQual Criteria ￨ ICD-9 ￨ ICD-10 ￨ DSM IV-TR ￨ DSM-5 ￨ Microsoft Office Suite ￨ MIDAS Database ￨ Meditech
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