Abigail Ferguson, LCSW

Responsibilities include:

• Accurate and timely review of clinical for initial, concurrent and post service reviews for behavioral health and substance use inpatient, detox, residential, partial hospitalization and intensive outpatient levels of care.
• Reviewing clinical of Medicaid and Medicare members.
• Understanding medical necessity and applying knowledge to clinical reviews.
• Reviewing electronic medical records via Smart UM and Guiding Care, tracking case completion with Microsoft Excel and OneNote.
• Understanding MCG, LCD/NCD, and ASAM criteria and diagnostic criteria provided by DSM-V-TR.
• Responding to individuals on the BCBS Behavioral Health Crisis Line.

Started on Texas Team 2, managed Commercial and Medicare cases for all facilities located in Texas (3/2022-3/2023). Volunteered to transition to the new National STAR Chat Team, to manage all queue-based chat reviews and provide more consistent service to the facilities/Utilization Review staff across the U.S. who are opting to use Optum’s online portal to submit clinical for review.

Responsibilities included:

• Completing initial and concurrent reviews of clinical for mental health and substance use inpatient, detox, residential, partial hospitalization, and intensive outpatient levels of care.
• Managing cases of members who have Commercial, Medicaid and Medicare insurance policies managed by Optum.
• Identify gaps in treatment,
• Apply the correct guideline tool to support medical necessity(ASAM, LOCUS, CASII or ESCII)
• Complete case staffings with Optum Medical Directors,
• Creating staffing notes to present to Optum Medical Directors during individual staffings, rounds, and grand rounds and collaborating with case management and pharmacy staff.

Started with Edward ED, transitioned from Edward to Elmhurst ED to temporarily to cover the 3rd shift while the position was being permanently filled, trained the new hire on the role in Elmhurst ED, and provided support during the transition. Transferred from Elmhurst ED to Linden Oaks Main Assessment and Referral Center (ARC) location in July of 2021.

Responsibilities included:

• Completing level of care assessments to determine appropriate services
• Giving referrals to the appropriate level of care
• Staffing with the on-call psychiatrist
• Completing any necessary paperwork, including involuntary petitions
• Making referrals to psych units for placement when internal beds weren't available

Starting in 10/21, was asked to work part-time as the ARC Charge.

Responsibilities included:

• Provided support/guidance to the ARC staff
• Managed the flow of assessments onsite and in both Edward and Elmhurst ED
• Provided staffing to Assessment Specialists when appropriate
• Managed bed assignments of admissions
• Assisted with deescalation of crisis situations with patients

Responsibilities included:

• Responding to calls on the DuPage County 24/7 Crisis Hotline and the National Suicide Prevention Lifeline.
• Completing SASS and EDA evaluations on site and in the community and finding hospital placement or providing referrals to the clients.
• Working with clients in person on the 12 bed Respite unit, running groups, providing individual counseling, completing IM+CANS, and assisting with discharge planning.
• Screening individuals for suicidal thoughts at the NAMI ‘Living Room’ peer support program.

The Discoveries program is a specialized program that focuses on teens who self-injure and uses skills taught from DBT and ACT to manage thoughts and urges.

Responsibilities included:

• Met with patients in individual sessions and with patients and their families in family sessions
• Running DBT groups with patients and teaching them skills to cope with thoughts and urges.
• Completed 754.6 of the 600 required hours for this internship at the Masters level.

Responsibilities included:

• Completed 60 hours monthly of on-call shifts for the YWCA Rape Crisis Hotline, answered calls during assigned shifts
• Responded to hospital calls made during shifts to support sexual assault survivors through their rape kit and treatment
• Participated in the Child Assault Prevention Program (CAPP) in elementary and middle schools, teaching children about bullying and abuse prevention
• Completed 450 of the 300 required hours for this internship at the Bachelors level.

Worked part-time at Sharing Connections, a not-for-profit furniture bank in Downers Grove, IL. Promoted from Outreach Intern to Program Coordinator on 05/03/2018.

Responsibilities included:

• Helped the Chief Executive Officer complete mailings to make the community more aware of our services
• Worked with the Chief Operating Officer to assist with program operations
• Answered phones and completed paperwork, scheduled and checked in clients
• Managed volunteers on Saturdays
• Created new programs or made modifications to current programs