Camille Carter
Plantation
Summary
Licensed Clinical Social Worker with extensive experience in behavioral health utilization review and quality improvement. Manages full caseloads while ensuring compliance with state and federal guidelines, achieving high audit performance. Facilitates collaborative treatment planning across interdisciplinary teams to enhance care effectiveness and patient satisfaction.
Overview
21
21
years of professional experience
1
1
Certification
Work History
Behavioral Health Utilization Review Clinician
Centene
Fort Lauderdale
01.2023 - Current
- Conducted behavioral health prior authorization and concurrent reviews to assess medical necessity, appropriate level of care, and ensure compliance with regulatory and internal guidelines
- Collaborated with behavioral health providers and medical directors on level-of-care determinations, treatment needs, and discharge planning to enhance patient outcomes
- Reviewed clinical documentation to identify gaps and inconsistencies, facilitating improvements in quality and compliance
- Independently manage a full overnight caseload, demonstrating strong clinical judgment, efficiency, and accountability without direct supervision
- Consistently achieve audit performance scores exceeding 95%, reflecting high documentation accuracy and adherence to quality standards
- Quickly adapt to new lines of business, criteria sets, and workflows, supporting evolving operational and quality needs
Pediatric Case Manager
Sunshine Health – Centene
02.2017 - 01.2023
- Developed and maintained ongoing care and service plans in collaboration with pediatric providers, specialists, IPAs, and community resources
- Coordinated care among members, families/caregivers, and interdisciplinary provider teams to ensure person-centered, timely services
- Identified care gaps and barriers to access, implementing targeted care management interventions to enhance quality outcomes and resource utilization
- Evaluated pediatric members’ clinical, psychosocial, and social determinants of health needs, identifying barriers to care and prioritizing member and family identified goals
- Monitored and followed up on changes in condition and progress toward care plan goals, revising plans accordingly.
- Connected members and families with community resources for housing stability, foster care support, justice system navigation, and independent living assistance
- Educated members and caregivers on disease processes, benefits, and care options, equipping them with strategies to effectively close care gaps
- Maintained comprehensive documentation in compliance with state, federal, and payer requirements, supporting quality audits and oversight
- Provided feedback to leadership on opportunities to enhance quality, efficiency, and cost-effective care delivery
Long-Term Care Case Manager
Florida Community Care
Doral
10.2018 - 02.2020
- Completed initial and annual needs-based assessments using Florida 701B to evaluate medical, behavioral, functional, and psychosocial needs
- Developed and updated person-centered care plans aligned with regulatory requirements and member goals
- Coordinated services with providers, specialists, and community agencies to address barriers to care and enhance member outcomes
- Monitored member progress and documented changes in condition to maintain continuity of care and meet compliance standards
- Acted as clinical resource for providers and internal teams on care coordination and service delivery best practices
Outpatient Therapist (Contractor)
Multicultural Alliance Healthcare Solutions
Fort Lauderdale
12.2015 - 10.2018
- Conducted intakes, biopsychosocial assessments, and treatment planning to develop tailored therapeutic interventions
- Provided individual and family therapy using CBT, TF-CBT, motivational interviewing, and strengths-based approaches
- Maintained clinical documentation to ensure seamless continuity and enhance quality of care for clients
- Collaborated with child welfare professionals, educators, and healthcare providers to coordinate comprehensive support services
- Linked clients to behavioral health, housing, and social support resources
Child & Family Therapist
Community Partners
Riviera Beach
07.2012 - 06.2016
- Delivered individual, group, and family therapy, ensuring comprehensive documentation for effective treatment tracking
- Completed diagnostic assessments and clinical justifications to ensure appropriate level of care for clients
- Participated in interdisciplinary team meetings to enhance treatment planning and drive quality outcomes
- Supervised graduate-level interns and reinforced documentation and ethical standards
Independent Living Specialist | Re-Entry Counselor | House Parent | Wilderness Counselor
Eckerd Community Alternatives
Floral City
01.2005 - 12.2008
- Managed high-acuity caseloads for foster care, juvenile justice, and re-entry populations to ensure tailored support and effective outcomes
- Coordinated housing, benefits, behavioral health services, and life-skills support to facilitate successful integration into community
- Provided 24-hour supervision, medication management, and detailed documentation
- Developed discharge and transition plans that promoted long-term stability and independence for clients
Education
Master of Social Work (MSW) - Children & Families Concentration, Child Welfare Certificate
Florida Atlantic University
Bachelor of Arts - Sociology, Ethnic Studies
California State University, San Bernardino
Skills
- Provider collaboration and education
- Quality improvement and performance support
- HEDIS and NCQA standards
- Behavioral health utilization review
- Medical record compliance
- Care gap identification
- Social determinants of health
- Managed care operations
- Interdisciplinary coordination
- Regulatory adherence
- DSM-5 knowledge
- Motivational interviewing
Certification
- Licensed Clinical Social Worker (Florida), Georgia, North Carolina
Title
Licensed Clinical Social Worker
Timeline
Behavioral Health Utilization Review Clinician
Centene
01.2023 - Current
Long-Term Care Case Manager
Florida Community Care
10.2018 - 02.2020
Pediatric Case Manager
Sunshine Health – Centene
02.2017 - 01.2023
Outpatient Therapist (Contractor)
Multicultural Alliance Healthcare Solutions
12.2015 - 10.2018
Child & Family Therapist
Community Partners
07.2012 - 06.2016
Independent Living Specialist | Re-Entry Counselor | House Parent | Wilderness Counselor
Eckerd Community Alternatives
01.2005 - 12.2008
Master of Social Work (MSW) - Children & Families Concentration, Child Welfare Certificate
Florida Atlantic University
Bachelor of Arts - Sociology, Ethnic Studies
California State University, San Bernardino