Daniel McCormick
Santa Rosa,CA
Summary
Motivated and dependable professional working in utilization review and management. Maintains positive relationships with case managers and reviewers. Excellent communication skills and professionalism. Remains polished and calm under extreme stress. Compassionate and empathetic with a strong knowledge of counseling skills and techniques.
Overview
3
3
years of professional experience
1
1
Certification
Work History
Utilization Review Specialist
Duffy's Napa Valley Rehab
03.2023 - Current
- Wrote appeals for insurance denials to insurance providers and the DMHC.
- Performed prior authorization review of services requiring notification.
- Performed admission reviews for medical necessity based upon ASAM criteria.
- Obtained authorizations from multiple insurance carriers for various levels of care.
Counselor I & Utilization Review Specialist
Azure Acres
05.2020 - 12.2021
- Performs admission reviews for medical necessity based upon ASAM criteria
- Provides clinical trainings on documenting to medical necessity and payor requirements
- Participates in quarterly internal audits of patient charts to ensure compliance with Acadia and managed care guidelines
- Evaluates insurance guidelines and benefit coverage to determine appropriateness of services
- Capable of completing up to 15 review calls daily
- Obtains authorizations from multiple insurance carriers for various levels of care, working closely with other department
- Reviews denials and writes appeals
Education
Master of Arts - Clinical Mental Health Counseling
Sonoma State University
Rohnert Park, CA05.2025
Bachelor of Arts - Psychology
Sonoma State University
Rohnert Park, CA05.2023
Associate of Arts -
Santa Rosa Junior College
Santa Rosa, CA05.2021
Skills
- Interpersonal and written communication
- Case management
- Benefit checks, pre-certification, and concurrent reviews
- Denials and appeals
- Documentation and reporting
- Discharge planning coordination
- Word, Excel, Powerpoint
Relevant Coursework
- Case Management
- Education and Prevention
- Ethics
- Skills and Techniques
- Family Systems
- Co-Occurring Disorders
Certification
- Certified Addiction Treatment Counselor II (CATC II)
- Certified Mandated Reporter
- CPR certified
Timeline
Utilization Review Specialist
Duffy's Napa Valley Rehab
03.2023 - Current
Counselor I & Utilization Review Specialist
Azure Acres
05.2020 - 12.2021
Master of Arts - Clinical Mental Health Counseling
Sonoma State University
Bachelor of Arts - Psychology
Sonoma State University
Associate of Arts -
Santa Rosa Junior College
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