Austin Pittman
Sonora,KY
Summary
Compassionate Case Manager accustomed to treating diverse patient needs while managing dynamic conditions. Collaborative professional possessing excellent clinical knowledge and judgment combined with strong documentation and problem-solving abilities. Well-versed in managing emergent cases with professionalism.
Overview
5
5
years of professional experience
Work History
Case Manager
Kentucky Administrative Office Of The Courts
Elizabethtown, KY
11.2024 - Current
- Manage the needs of participants who are referred to specialty courts.
- Collaborate with multiple legal agencies (probation and parole, judicial offices, local police).
- Communicate with treatment providers to ensure that participants are following treatment requirements.
- Meet with participants on a weekly, biweekly, or monthly basis.
- Develop treatment plans, and identify barriers that participants might have.
- Document case notes for assigned judges.
- Attend and document court proceedings.
Utilization Review Coordinator
Sandstone care
Denver, CO
03.2023 - 11.2024
- Manage in-house clinical and ensure that they meet medical necessity for ASAM, LOCUS, or CALOCUS criteria.
- Schedule and conduct live reviews for initial pre-certification, and concurrent reviews with insurance payors.
- Partner with the client's clinical team to ensure appropriate clinical care will be provided for reviews.
- Use online systems like Availity and BlueApprovR to check eligibility and submit requests via the portal when needed.
- Obtain and keep a good relationship with the case managers assigned to clients' cases.
- Work on different levels of care (CD: detox, IOP; MH: Residential, PHP, and IOP).
- Schedule peer reviews for the facilities when requested.
- Use software like Salesforce to keep track of single-case agreements, and Microsoft Teams for internal review documentation.
- Call and verify if authorization is required for a certain level of care.
- Submit authorizations in billing systems and EMRs to ensure documentation is in the official chart.
Utilization Review Specialist
AVA Billing & Consulting
06.2022 - 01.2023
- Manage multiple mental health and substance abuse facilities clinically, and make sure that they meet criteria for medical necessity.
- Scheduled and conducted live reviews for initial pre-certification and concurrent reviews with carriers.
- Used different EMR systems like BestNotes, KIPU, LightingStep, and Zen Charts when obtaining clinical data for reviews.
- Communicated with the facilities directly every day and informed them of what clinical services were needed to ensure that the continued stay was approved.
- Used systems like Availity to check eligibility and submit requests via the portal when needed.
- Obtained and maintained a good relationship with the case managers assigned to clients' cases.
- Worked on different levels of care (CD: detox, IOP; MH: PHP, IOP).
- Scheduled peer reviews for the facilities when requested.
- Submitted appeals for denials when requested by the facility.
- Used software like Salesforce to keep track of reviews, due to its effectiveness.
- Called insurance payers and verified whether authorization was required for a certain level of care.
- managed the clinical reviews for facilities all over the country including Texas, California, Colorado, North Carolina, Oklahoma, and New Jersey
Utilization Review Specialist
Stepworks Recovery Centers
Elizabethtown, USA
07.2021 - 06.2022
- Identify the level of care for patients based on ASAM criteria
- Understand substance abuse treatment (assessments, treatment planning, continuing care recommendations, medication)
- Understand the managed care system (ASAM criteria, behavioral health insurance benefits and preauthorization, utilization review, peer reviews and discharge reviews)
- Provide verbal and written documentation required by insurance providers
- Provide the documentation for utilization reviews, discharge reviews and peer reviews
- Prepare, submit and follow up on appeals
- Maintain electronic medical records
- Regularly communicate with appropriate step works team members to insure all steps are taken to obtain authorizations
- I also have experience using software like availity express and provider networks like the wellcare provider portal
- I also have an understanding for commercial insurance
Shift Leader
StepWorks Recovery Center
Elizabethtown, USA
01.2020 - 07.2021
- Directly work with patients
- Administered medications,
- clerical work (answering phones, taking messages)
- ensured patient safety
- Conducted admissions.
- Supervised groups, AA/NA meetings.
Education
Western Kentucky University -
Western Kentucky University
Bowling Green, KY05.2016
High school diploma -
John Hardin High School
Elizabethtown, KY05.2015
Bachelor of Arts - Human Services
Southern New Hampshire University
trueSkills
- Motivational interviewing
- Small team leadership
- Counseling techniques
- Teaching
- Documentation review
- Crisis Intervention
- Interpersonal Communication Skills
- Rapport building
- Skilled in Microsoft Office Applications
Personal Information
Work Permit: Authorized to work in the US for any employer
Experience
- Experience with case management and utilization review.
- Experience using provider software such as KYMMIS, AVAILITY, and provider portals to submit pre-authorizations and reviews.
Boardexperience
- Served on the Resident Housing Association board, Western Kentucky University, 2015-2016
- Active Chair/President of governance board, Transgender Health and Wellness Clinic, Palm Springs, California, 01/01/24
Timeline
Case Manager
Kentucky Administrative Office Of The Courts
11.2024 - Current
Utilization Review Coordinator
Sandstone care
03.2023 - 11.2024
Utilization Review Specialist
AVA Billing & Consulting
06.2022 - 01.2023
Utilization Review Specialist
Stepworks Recovery Centers
07.2021 - 06.2022
Shift Leader
StepWorks Recovery Center
01.2020 - 07.2021
Western Kentucky University -
Western Kentucky University
High school diploma -
John Hardin High School
Bachelor of Arts - Human Services
Southern New Hampshire University
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