A Licensed Bachelor Social Worker with 15 years of experience in Private and Government settings.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Medical Care Program Specialist II
Maryland Department of Health
12.2021 - Current
Utilization review of plans submitted for Home and Community Based Services. I interpret and analyze policy and regulations to confirm that services being provided for participants are in accordance with federal and state Medicaid regulations.
Perform qualitative and quantitative analyses on programmatic data, including program activities, such as participant eligibility and enrollment, supports planning, including annual audits, utilization review, including plan of service review, and appeals.
Apply program policies by verifying eligibility for the CPAS, CFC, HCBOW, and ICS programs and enrolling participants, engaging in utilization review, including POS review to help determine the program's impact on health care access, quality and cost, auditing SPAs, developing educational materials and providing training and technical assistance to participants and SPA's regarding program processes. Identifying and implementing enhancements for LTSSMaryland and collaborating with other Divisions regarding the OLTSS' overall quality program.
Case Manager
Queen Anne's County Area Agency on Aging
08.2010 - 12.2021
Maintained accurate documentation on all cases, ensuring compliance with state and federal regulations and confidentiality requirements for four community medicaid programs.
Testified in legal proceedings regarding state Guardianship and least-restrictive environments.
Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
Achieved positive client outcomes by developing and maintaining comprehensive case management plans.
Provided program education to clients in long-term care facilities and in the community regarding options available for living safely in community settings with available services and supports.