Bridget Rurka, LCSW
Bruce Twp,MI
Summary
Dedicated Social Worker licensed in IL and MI with years of experience in healthcare, managed care, and case management fields. Solution focused and collaborative. Advanced clinical and analytical skills.
Overview
9
9
years of professional experience
Work History
Manager, Behavioral Health
Evolent
02.2024 - Current
- Supported 20 staff on the Behavioral Health Utilization Management and Case Management Teams.
- Facilitated client meetings for monthly metrics reports of programs by analyzing data and identifying trends.
- Held biweekly 1:1s with staff to provide performance feedback, process updates and support.
- Served as point of contact for providers and clients with authorization questions and issues.
- Audited UM Cases and CM calls. Provided scores along with performance tracking on a consistant basis.
- Assisted with NCQA auditing to speak to BH processes and communicated corrections, process updates and best practices to the teams.
- Presented complex cases in client meetings to discuss best care practices, decrease discharge barriers and establish collaboration between Utilization Management and Case Management Teams.
- Led internal meetings to communicate process changes to staff, provide resource guides, and create a transparent, effective and efficient work environment.
- Assessed inventory, workload and staffing needs on a daily basis.
- Provided on-call assistance for after hours and weekend staff
Behavioral Health Utilization Manager
Evolent
04.2022 - 02.2024
- Reviewed and applied medical necessity criteria to 20-25 authorizations per day for Medicaid and Medicare authorizations for multiple levels of care; inpatient and outpatient psychiatric, ABA, community based services, psychological testing, SUD detox and RTC, BH RTC, ECT, TMS, and Spravato requests
- Hosted internal rounds meetings with Utilization Managers, Medical Directors and Case Management liaisons.
- Participated in Interdisciplinary Team meetings with clients and third party vendor Case Managers to discuss complex cases and represent the Behavioral Health team
- Assisted with the implementation of the Gold Card and Bundle pilot. Served as point of contact for provider escalations during the process. Created censuses, tracked discharge clinical and recorded statistics on LLOC utilization. Checked authorizations to ensure accuracy.
Behavioral Health Utilization Manager/Case Manager
Centene Corporation
09.2015 - 04.2022
- Completed initial and concurrent reviews for Medicaid authorizations for multiple levels of care.
- Collaborated with hospital utilization reviewers and providers to obtain complete clinical review via fax, voicemail, and live reviews. Served as point of contact for hospitals to assist with answering questions, discharge planning, obtaining discharge clinical, providing determinations.
- Participated in multiple workgroups to assist with planning and implementing changes for Centene's acquisition of Meridian Health Plan.
- Worked with medical directors, managers and case managers during rounds meetings to discuss complex cases, evaluate needs and diminish barriers to care.
Education
Masters of Social Work -
Wayne State University
Detroit05.2015
Bachelor of Science - Psychology
Wayne State University
Detroit, MI05.2012
Skills
- Expert with Interqual, ASAM, MCG and LOCADTR criteria
- Excellent time management with strict adherence to deadlines
- Great interpersonal skills
- Knowledgeable on NCQA and CMS compliance standards for Medicaid and Medicare
- Proficient with Microsoft Word, OneNote, Outlook and Excel
- Critical thinker and problem solver
- Experienced in project management and staff management
- Confident in analyzing and reporting metrics and data
Timeline
Manager, Behavioral Health
Evolent
02.2024 - Current
Behavioral Health Utilization Manager
Evolent
04.2022 - 02.2024
Behavioral Health Utilization Manager/Case Manager
Centene Corporation
09.2015 - 04.2022
Masters of Social Work -
Wayne State University
Bachelor of Science - Psychology
Wayne State University
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