Experienced with team leadership, strategic planning, and operational management. Utilizes effective communication and organizational skills to drive project success. Track record of fostering productive work environments and achieving set goals.
Overview
19
19
years of professional experience
Work History
Manager, Care Management
Humana
04.2019 - 05.2024
Oversaw day to day operations for care management in FL Long Term Care Medicaid program
Led team of up to 18 nurses and social workers to achieve goals set by Humana and the Agency for Health Care Administration (AHCA)
Oversaw the assessment of needs and the development of cost-effective, supportive care plans
Collaborated with Medical Director and nurses during Utilization Review meetings to establish safe care plans and respond to appeals and Medicaid Fair Hearings for complex members
Fostered communication with clients, care managers, and other stakeholders to meet client needs and support best health
Provided coaching and feedback to enhance performance and meet metrics to maximize company revenue
Led weekly meetings of up to 35 associates/clients to provide education, build team, and address client needs
Transition Coordinator
Humana
02.2017 - 04.2019
Provided intervention to achieve goal of reducing/limiting Nursing Home population as set by AHCA
Collaborated with clients/representatives/caregivers, hospital/rehab social workers, vendors, and other stakeholders to provide effective transition planning and overcome client barriers
Analyzed information from interviews, educational and medical records, and diagnostic evaluations to assess clients' abilities, needs, and eligibility for services
Developed cost effective care plans to meet individual needs
Provided data and participated in Utilization Review meetings to ensure safe, cost effective care plans and mitigate likelihood of appeals and Medicaid Fair Hearings.
Assisted clients with securing housing in the community
Provided extensive support to clients and helped with acclimation to new setting
Case Manager
Humana
12.2015 - 02.2017
60+ member caseload
Conducted thorough assessments of clients' situations, identifying issues, goals, and necessary interventions
Collaborated with clients/families/representatives to develop cost effective care plans to achieve best health
Monitored and provided intervention to allow members to reside in the least restrictive environment
Provided ongoing support to limit and decrease hospitalizations and long term care placements
Handled complaints, provided appropriate solutions and alternatives within appropriate timeframes, and followed up to achieve resolution
Provided data and participated in Utilization Review meetings to ensure safe, cost effective care plans and mitigate likelihood of appeals and Medicaid Fair Hearings.
Followed Humana and AHCA guidelines to meet performance metrics
Manager, Care Management
Humana
09.2013 - 12.2015
Oversaw day to day operations for care management in FL Long Term Care Medicaid program
Led team of up to 12 social workers to achieve goals set by Humana and AHCA
Oversaw assessment of needs and development of cost effective, supportive care plans
Provided data and participated in Utilization Review meetings to ensure safe, cost effective care plans and mitigate likelihood of appeals and Medicaid Fair Hearings.
Fostered communication with care managers and other stakeholders to meet member needs and support best health
Provided coaching and feedback to enhance performance
Led meetings of up to 35 associates to provide education, build team, and encourage positive morale
Stepped down from Manager to Care Manager after change in program structure in 2015
Care Manager
Humana
06.2013 - 09.2013
Assessed and evaluated 60+ client needs
Collaborated with clients/families/representatives to develop cost effective care plans to achieve best health
Monitored and provided intervention to allow clients to reside in the least restrictive environment
Provided ongoing support to limit and decrease hospitalizations and long term care placements
Handled complaints, provided appropriate solutions and alternatives within appropriate timeframes, and followed up to achieve resolution
Followed Humana and AHCA guidelines to meet performance metrics
Promoted to Management position in Aug 2013
Company acquired by Humana in Sep 2013
Site Supervisor
Anderson Counseling Services
01.2009 - 01.2013
Completed assessments to identify needs and develop treatment plans for children K-5th grade in traditional public schools and private alternative school
Used advanced counseling skills and evidence based practices to lead individual and group therapy sessions
Collaborated with school officials, parents, psychiatrists, and patients to support students and reduce problematic behaviors in school
Analyzed and documented responses to treatment
MANDT system certified to support individuals, modify behaviors, and reduce injury and violence
Acted a liaison between agency owners and supervisory team during times of change
Trained new team members on site policies and procedures.
Mental Health Counselor
Bridges Treatment Center
06.2005 - 02.2009
Utilized advanced counseling skills and evidence based practices to establish goals and treatment plans with children and adolescents
Provided behavior management and crisis intervention in a residential treatment center, mental health hospital, and group home
Documented psychiatric services and responses to treatment in patient case files
Led counseling groups to discuss topics such as anxiety, depression, and social interaction
MANDT System certified to support individuals, modify behaviors, and reduce injury and violence