Carla De Divitiis
Davie,FL
Summary
Organized and dependable. Successful at managing multiple priorities with a positive attitude. Highly effective at problem solving and decision making.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Integration Manager
Community Based Care- Integrated Health, Assistance
2015.06 - Current
- Provide technical assistance, ongoing support, guidance/feedback on documentation, and care coordination responsibilities for CBC staff to ensure that members’ health care needs are met
- Provide one on one support to the assigned Behavioral Health Care Coordinator (BHCC) and Nurse Care Coordinator (NCC)
- Ensure care coordination is provided to and documented for Child Welfare Specialty Plan (CWSP) members
- Resolve and close the loop on issues escalated by caregivers, parents, Dependency case managers, and CBC staff using escalation process with the health plan
- Monitor the assigned CBC’s quarterly and document findings on healthcare management functions
- Review policies and procedures annually
- Track and monitor submissions of Transition of Care forms and Independent Living Transition plans
- Review Integrate caseload documentation monthly, report findings and provide ongoing feedback to improve quality documentation based on healthcare management functions
- Review HEDIS data and facilitate ongoing discussions to improve measures which impact Child Welfare Specialty Plan members
- Participate in member specific staffing meetings to help improve medical and behavioral outcomes
- Participate in workgroups to assist with implementation of programs and workflows to improve care coordination
- Specialized training for BHC’s, NCC’s, Dependency case managers, and CBC staff on contract requirements, health plan benefits, care coordination expectations and documentations.
Behavioral Health Service Manager
Cenpatico serving Sunshine Health, Foster Care
2014.06 - 2015.05
- Review and assist continuity of care service needs to children transitioning into the Child Welfare Specialty Plan program
- Participate in Interdisciplinary team meetings to assist with behavioral health needs and provide additional resources to members and families
- Increase community relations with providers, dependency case worker, and CBC’s coordinators to meet member’ needs
- Educate and facilitate access to health services and benefits.
Disability BH Clinical Case Manager
Aetna Life Insurance Company
2010.10 - 2014.06
- Provide disability case management services in short term complex disability claims
- Assigned to Boeing Company
- Conduct comprehensive evaluation of disability claimant’s functionality
- Engage in crisis intervention and follows threat protocol as clinically appropriate
- Partner with treating providers to establish appropriate return to work options and/or return to work barriers, as clinically as appropriate
Care Manager
Magellan Health Services of Florida
2007.02 - 2010.10
- Therapeutic Foster Care/Group Care, Monitor Residential, Outpatient and Inpatient levels of care services related to mental health treatment to ensure medical necessity and effectiveness
- Authorize and review utilization based on Medicaid Medical Necessity Criteria of mental health outpatient services as well as STFC and STGC levels of care
- Participate in the creation and implementation of utilization work flows
- Participate in outreach visits including Quality Improvement Audits to in-network providers
Education
Master - Clinical Psychology
Murray State University
Murray, KYBachelor of Psychology -
Faculdades Metropolitanas Unidas
Skills
- Problem solving
- Critical Thinking
- Organization
- Hardworking
- Advocate
- Time management
- Work independently
- Teamwork
- Training
- Costumer Services
- Communication and Interpersonal
- Team Development
Languages
Portuguese
Native or Bilingual
Spanish
Limited Working
Certification
LIcensed Mental Health Counselor since January 2006
Timeline
Integration Manager
Community Based Care- Integrated Health, Assistance
2015.06 - Current
Behavioral Health Service Manager
Cenpatico serving Sunshine Health, Foster Care
2014.06 - 2015.05
Disability BH Clinical Case Manager
Aetna Life Insurance Company
2010.10 - 2014.06
Care Manager
Magellan Health Services of Florida
2007.02 - 2010.10
Master - Clinical Psychology
Murray State University
Bachelor of Psychology -
Faculdades Metropolitanas Unidas
LIcensed Mental Health Counselor since January 2006
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