Summary
Overview
Work History
Education
Skills
References
Timeline
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Candice T. Givens

Norfolk,Virginia

Summary

With a robust background at Elevance Health and City of Virginia Beach, I excel in leveraging my analytical problem-solving and supervisory skills to improve service delivery and team performance. Expert in Medicaid regulations and electronic health records, I've significantly enhanced care coordination and compliance, demonstrating a confident approach to developmental disabled behavioral health management.

Overview

25
25
years of professional experience

Work History

Behavioral Health Managed Care Coordinator

Elevance Health
09.2023 - Current
  • Perform a telephonic or face-to-face history and program needs assessment using pre-defined questions for the identification, evaluation, coordination, and management of Behavioral Health members' program needs.
  • Manages a caseload of 180-200 members who reside in the Gloucester, VA area with chronic illnesses, comorbidities, and/or other disabilities.
  • Identify members with potential clinical health care needs, including, but not limited to, the potential for high-risk complications, and coordinate those members' cases with clinical healthcare management and the interdisciplinary team in order to provide care coordination.
  • Establishes short-term and long-term goals in collaboration with members, caregivers, family, natural supports, and physicians.
  • Identify members who would benefit from expanded services.
  • Document all Annual Health Risk Assessments, MMHS Screenings, Quarterlies, Progress Notes, and Individual Care Plans in the HIP System.

Home and Community Based Services Provider Consultant/Owner/CEO

Caliber & Probe LLC
08.2021 - Current
  • Provide Consultation and Policy Development for four different Home and Community Based Service providers
  • Update Policy and Procedures based on the guidelines that were drafted by the Department of Medical Assistance and Virginia Department of Behavioral Health and Developmental Services Licensing Unit, and Human Rights
  • Assist with implementing Serious Incidents, Level I, II, and III policy and procedures within HCBS agency
  • Kept agencies abreast of all new services and policies developed as they were provided
  • Provided training to administrators on all policies and procedures designed for approved corrective action plans
  • Provided resources to agencies administration to help with resolving client related issues
  • Develop annual satisfaction surveys for each of the five services offered to individuals with Developmental Disabilities
  • Completed and enrolled providers into the Medicaid Enterprise System
  • Trained staff in on the development of Person-Centered Treatment Plans for individuals who received personal assistance service with the Developmental Disabilities Waiver and CCC Plus Wavier
  • Completed and submitted service authorizations in the Medicaid Virginia Waiver Management System and KEPRO System
  • Conducted HIPPA and Documentation Training with staff within agencies

Licensing Analyst I

Elevance Health
10.2022 - 09.2023
  • Assists Registered Nurses with obtaining and becoming licensed in different states so that they can be of service to customers who are enrolled in various medical health insurance plan products that is offered through Elevance Health
  • Mail application forms to nurses for completion prior to submitting applications to the Boards of Nursing
  • Schedule and Conduct online meetings with Registered Nurses via Microsoft teams to complete applications through various state Board of Nursing web portals
  • Mail Fingerprint cards, Employment Verifications, Criminal Background Checks, and other documents identified as needed by Boards of Nursing to grant license
  • Complete payment transactions for all applications, verification of license, and criminal background checks
  • Record all payments and update status of licenses in the Atlas Database System
  • Research and investigate the status of applications in addition to granting of the Registered Nurse license

BH/DS Clinician III Team Leader/Supervisor

City of Virginia Beach
Virginia Beach, USA
08.2012 - 05.2021
  • Supervised 4 to 5 BH/DS Clinicians who each provide DD Targeted, DD Waiver and Enhanced Case Management Services to 30 individuals with 30 individuals with Comorbidity Diagnoses
  • Assist staff with problem solving cases and attend meetings to promote the services being offered
  • Completed monthly supervision with staff and discuss cases as well as their productivity
  • Complete staff Annual Evaluations and monitor Annual trainings needed to be completion
  • Follow up with staff on completion of Corrections of chart reviews, completion of quarterlies timely, and Medicaid billing in the Electronic Health Record by the end of the month
  • Review reports which include annuals completed during the month, weekly quarterly reports, daily productivity reports, timeliness, ECM and 90 Day face to face, and service exemption reports
  • Discuss reports with staff during supervision
  • Submit data to DS Case Management Program Supervisor during monthly supervision
  • Conduct Team Meetings to present information from leadership
  • Serve as one of the Developmental Services Unit Trainers for new Support Coordinators to enter the Agency Trainings included: Register individuals for the DBHDS Required Case Management Module Training, EPSDT, Children Initiative Funding, CCC Plus, Training, and Support Intensity Scale Web Portal Training
  • Served as 1 of 4 Support Intensity Scale Administrators for the City of Virginia Beach Developmental Services Unit
  • Served as consultant to the other Developmental Services Support Coordinators on services that could be accessed for youth and how to access

BH/DS Clinician II – Intellectual Disable Support Coordinator

City of Virginia Beach
Virginia Beach, USA
08.2007 - 08.2012
  • Provided Targeted/ DD Waiver Case Management Services to 32 consumers who were Dually Diagnosed with an Intellectual Disability, Autism, and Mentally Ill
  • Served a Liaison for individuals who had an intellectual disability in jail
  • Completed assessments such as the Level of Functioning Assessment on a yearly basis to determine eligibility for DD Wavier Case Management Services
  • Utilized all Assessments to develop Individual Service Plan along with individual desires
  • Knowledge of the Intellectual disabled Medicaid Waiver System
  • Completed 90 Face to Face to monitor services and health/safety of the individual
  • Coordinate and link individual to services that would allow them to achieve objectives written on their treatment plan
  • Offer choice in providers
  • Review and approve provider treatment plan along with service authorizations for individual to receive services
  • Submit Authorizations to DBHDS Service Authorization for approval
  • Advocate on the individuals’ behalf so their rights were not violated and offered choice
  • Place supports around the individual to reduce hospitalizations and incarcerations
  • Utilize Anasazi Electronic Health Records to bill for consumer services provided, completion of daily progress notes, quarterlies, development of treatment plans

BH/DS Clinician I – Intellectual Disable Case Manager

City of Virginia Beach
Virginia Beach, USA
12.2006 - 08.2007
  • Provided Targeted ID Waiver Case Management Services to 30 consumers who were Dually Diagnosed with an Intellectual Disability and Mentally Ill
  • Completed assessments such as the Level of Functioning Assessment on a yearly basis to determine eligibility for DD Wavier Case Management Services
  • Utilized all Assessments to develop Individual Service Plan along with individual desires
  • Knowledge of the Intellectual disabled Medicaid Waiver System
  • Completed 90 Face to Face to monitor services and health/safety of the individual
  • Coordinate and link individual to services that would allow them to achieve objectives written on their treatment plan
  • Offer choice in providers
  • Review and approve provider treatment plan along with service authorizations in order for individual to receive services
  • Submit Authorizations to DBHDS Service Authorization for approval
  • Advocate on the individuals’ behalf so their rights were not violated and offered choice
  • Place supports around the individual to reduce hospitalizations and incarcerations
  • Utilize Anasazi Electronic Health Records to bill for consumer services provided, completion of daily progress notes, quarterlies, development of treatment plans

Clinician II

City of Chesapeake
Chesapeake, USA
10.2001 - 12.2006
  • Provided Targeted/ ID Waiver Case Management Services to 35 consumers who were Dually Diagnosed with an Intellectual Disability and Mentally Ill
  • Utilize Assessments determine eligibility for ID Wavier Case Management Services Such Level of Functioning to determine eligibility for services
  • Develop the Individual Service Plan to include the individual desires
  • Forward referrals to different outside entities so the individual can obtain or maintain benefits
  • Mentor and train new staff members entering case Management
  • Maintain individual paper records such as completing progress notes, contact logs, treatment plans, and quarterly reviews
  • Completed 90 Face to Face to monitor services and health/safety of the individual
  • Coordinate and link individual to services that would allow them to achieve objectives written on their treatment plan
  • Offer choice in providers
  • Review and approve provider treatment plan along with service authorizations for individual to receive services
  • Submit Authorizations to DBHDS Service Authorization via fax for approval
  • Advocate on the individuals’ behalf so their rights were not violated and offered choice
  • Place supports around the individual to reduce hospitalizations and incarcerations
  • Served as the ID Case Management Representative on the Quality Assurance and Utilization Review Committee
  • Help the committee with developing agency policies in addition to procedures for the CSB to ensure that all the requirements for DBHDS and Department of Medical Assistance Services are achieved
  • Served on the Consumer Advisory Committee to advocate for continuation of funding for client services

BH/DS Assistant – Part Time

City of Virginia Beach Department
Virginia Beach, USA
12.2000 - 10.2001
  • Provided supportive living training in the homes of individuals who have an Intellectual Diagnosis and Mentally Illness
  • Supportive Living training provided consist of skill building in ADLs, IADLS routine and general supports, and safety supports that enable the individual to acquire, retain or improve the self-help, socialization, and adaptive skills necessary to reside successfully in the community
  • Support the individual in replacing challenging behaviors with positive, accepted behaviors for home and community-based environments

Residential Counselor

Barry Robinson Treatment Center
06.2000 - 09.2000
  • Serve as a Residential Counselor for children who had been diagnosis with Intellectual Disable and Emotional Disturbed
  • Utilize Behavioral Modification ABA techniques and assisted the youth to develop independence with utilizing coping strategies when becoming unsafe while in residential treatment
  • Provide trainings to youth on Socialization Skills based on youth’s treatment plan developed
  • Supervised youth to ensure health and safety while socializing with other peers from other cottages
  • Complete treatment progress notes on each child that were assigned to during the shift
  • Attend and participate in treatment team meetings to review youth progress and to determine ready for discharge

Community Service Associate II-Part-Time

Hampton Newport News Community Service Board
03.2000 - 06.2000
  • Provide Training to Intellectual Disable clients on goals and objectives developed on the Individual Service Plan that reside in a group home setting
  • These training may include but are not limited to the following: Meal Prep, Money Management, Household Maintenance, Socialization Skills, Medication Management, Grocery Shopping, and Safety Procedures
  • Transport Clients to and from Recreational activities
  • Complete task analysis sheets to monitor client's progress on goals

Education

Master of Arts Degree - Severe Disabilities- Rehab Counseling

Norfolk State University
Norfolk, Virginia
12.2001

Bachelor of Arts Degree - Psychology

Norfolk State University
Norfolk, Virginia
05.2000

Computer Information Systems Program Completion - Microsoft Programs, Excel, Database, Internet

Norfolk Vocational Technical School
Norfolk, VA
06.1996

Classes - Clinical Mental Health Counselor Licensure

Walden University
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Skills

  • Research Proficiency
  • Analytical Problem Solving
  • Communication and Negotiating Skills
  • Networking
  • Knowledge of CCC Plus Waiver (MCO) and Developmental Disability Waiver
  • Operation of Electronic Health Care Records Systems
  • Marketing Skills (Coordinate and Participate in Fairs)
  • Knowledge of Procurement and Reimbursement Practices
  • Recruitment of staff and knowledge of hiring practices
  • Supervisory Training
  • Able to interpret and implement DBHDS state licensure and Medicaid regulations
  • Coordination of services through the use of Medical HMO and TriCare guidelines
  • Interpret and analyze data reports to evaluate department and staff performance
  • Development of Single Client Agreements, and Implementation of Contracts
  • Trainer on Regulations
  • Medicaid audit and DBHDS licensure audits
  • Development of Corrective Action Plans
  • Knowledge of the Department of Justice settlement and Medicaid final rule
  • Knowledge of practices for crisis intervention and positive behavioral supports
  • DBHDS Modules Completions for Support Coordinators and Additional Required Trainings
  • Qualified Developmental Disable Professional
  • Medicaid billing – service authorization and coding
  • Qualified Mental Health Professional - Adults

References

References available upon request.

Timeline

Behavioral Health Managed Care Coordinator

Elevance Health
09.2023 - Current

Licensing Analyst I

Elevance Health
10.2022 - 09.2023

Home and Community Based Services Provider Consultant/Owner/CEO

Caliber & Probe LLC
08.2021 - Current

BH/DS Clinician III Team Leader/Supervisor

City of Virginia Beach
08.2012 - 05.2021

BH/DS Clinician II – Intellectual Disable Support Coordinator

City of Virginia Beach
08.2007 - 08.2012

BH/DS Clinician I – Intellectual Disable Case Manager

City of Virginia Beach
12.2006 - 08.2007

Clinician II

City of Chesapeake
10.2001 - 12.2006

BH/DS Assistant – Part Time

City of Virginia Beach Department
12.2000 - 10.2001

Residential Counselor

Barry Robinson Treatment Center
06.2000 - 09.2000

Community Service Associate II-Part-Time

Hampton Newport News Community Service Board
03.2000 - 06.2000

Master of Arts Degree - Severe Disabilities- Rehab Counseling

Norfolk State University

Bachelor of Arts Degree - Psychology

Norfolk State University

Computer Information Systems Program Completion - Microsoft Programs, Excel, Database, Internet

Norfolk Vocational Technical School

Classes - Clinical Mental Health Counselor Licensure

Walden University

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Candice T. Givens