De'Aira Simmons
McKinney,TX
Summary
Reliable individual bringing 3 years of experience in healthcare environments. Maintains positive relationships with case managers and providers. Remains polished and calm under extreme stress. Detail-oriented team player with strong organizational skills. Ability to handle multiple projects simultaneously with a high degree of accuracy. Seeking to maintain a full-time position that offers professional challenges, utilizing interpersonal skills, excellent time management and problem solving skills.
Overview
5
5
years of professional experience
Work History
Utilization Review Manager
Wellbridge Healthcare Greater Dallas
09.2023 - Current
- Streamlined communication between interdisciplinary teams, fostering collaboration for improved patient outcomes.
- Evaluated clinical data to identify trends in service use, informing strategic planning efforts for resource allocation.
- Reduced hospital costs through efficient management of medical resources and implementation of cost-effective strategies.
- Optimized resource allocation by conducting regular audits and identifying areas for improvement in the utilization review process.
- Maintained confidentiality of sensitive patient information while adhering to HIPAA regulations during the utilization review process.
- Collaborated with insurance companies to ensure proper reimbursement for services provided, maximizing revenue potential.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Maintained professional demeanor by staying calm when addressing unhappy or angry customers.
- Maintained an ICM case load of high-risk members, utilizes the electronic case management system and provides proactive case management services.
- Compliance with organizational policies and procedures, including code of conduct and attendance policy; and policies resulting from the HIPAA privacy rules.
- Effectively cultivate and maintain working relationships with all providers of care and employers by maintaining regular communications and professional rapport.
- Leveraged data and analytics to make informed decisions and drive business improvements.
- Monitor the quality of care of the clients, the member's response to services and products delivered to determine if the goals of the plan of care are being achieved.
- Demonstrates an ability to effectively communicate utilization decisions to healthcare professions.
- Working with healthcare professionals in developing collaborative treatment plans to ensure goals remain appropriate, realistic and what actions may be implemented to enhance positive outcomes and promote optimal health.
- Perform utilization review of developmental disability services, mental health and substance abuse intensive treatment services.
- Effectively cultivate and maintain working relationships with all providers of care and employers by maintaining regular communications and professional rapport.
- Maintained over 100 ICM case load of high-risk members, utilize the electronic case management system, provides proactive case management services, tracking logs for inpatient status, determinations, and appeals.
- Handle all appeals and clinical denials.
- Enhanced regulatory compliance with thorough documentation and timely reporting of utilization review findings.
Qualified Mental Health Professional
Metrocare Services
Dallas, TX
10.2022 - 09.2023
- Facilitated coordination of care with other providers such as psychiatrists, primary care physicians, and social workers.
- Contributed to a positive work environment by maintaining open lines of communication with colleagues and supervisors.
- Managed caseload effectively, prioritizing tasks according to urgency while maintaining high-quality service delivery.
- Ensured compliance with documentation standards, completing accurate and timely progress notes for each client interaction.
- Increased client engagement by utilizing evidence-based practices like Cognitive Behavioral Therapy and Dialectical Behavior Therapy.
- Collaborated with interdisciplinary teams to provide comprehensive care for clients in various settings.
- Conducted psychosocial assessments to identify strengths/weaknesses and formulate appropriate treatment recommendations plans.
- Reduced crisis situations through timely interventions and appropriate referrals to community resources.
- Aided clients in achieving personal goals by providing support, guidance, and practical assistance.
- Documented client progress in confidential files.
- Developed and implemented activities to help clients develop social and independent living skills.
- Collaborated with medical and clinical personnel to coordinate and implement client services.
- Built partnerships with community agencies and service providers to remove access gaps.
- Monitored client progress and provided feedback to families and treatment team members.
- Facilitated support groups for clients to discuss issues related to mental health.
- Provided case management services to monitor client access to resources and services.
- Administered psychological tests and assessments to determine client needs.
- Delivered individualized counseling services to clients working through issues such as mental illness and substance abuse.
- Revised individual treatment plans for clients with mental health concerns to obtain best possible outcomes.
- Observed and monitored client behavior and responses to treatment.
- Documented on 150 clients' progress to keep detailed notes on each client's treatment progress and changes in mental health status.
- Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
- Completed one-on-one counseling with broad range of clients suffering from various diseases and issues.
- Stayed current on mental health research to follow new developments and research in mental health field.
- Promoted mental health awareness within the community through educational workshops and presentations.
Field Marketing and Sale Representative
TTI- Milwaukee
Dallas, TX
03.2022 - 10.2022
- Managed inventory to provide customers with access to products in high demand.
- Enhanced a great rapport with store manager and associates.
- Developed comprehensive reports, enabling management to make informed decisions based on accurate data analysis.
- Cultivated lasting partnerships with industry professionals, ultimately increasing referral business as well as long-term client retention rates.
- Attend all weekly meetings to share ideas and team collaboration.
- Implemented innovative marketing strategies that led to an increase in brand awareness and customer engagement.
- Handled customer complaints quickly and professionally to restore customer confidence and prevent loss of business.
- Exceeded performance targets through diligent work ethic and focus on results-driven tasks.
Service Agent
Goosehead Insurance
Dallas, TX
11.2021 - 03.2022
- Utilized strong communication skills to effectively address customer concerns and provide solutions that met their needs.
- Assisted in training new team members on company policies, procedures, and best practices for successful integration into the team.
- Completed all necessary paperwork accurately and efficiently to ensure proper documentation of transactions.
- Participated in regular meetings to discuss performance metrics, identify areas for improvement, and develop strategies to achieve goals.
- Collaborated with team members to streamline processes and enhance overall service efficiency.
- Demonstrated adaptability by quickly learning new systems, tools, and procedures as needed for optimal performance.
- Handled challenging situations calmly and professionally, finding effective solutions under pressure without compromising quality of service delivery.
- Assisted clients with inquiries, resolving issues promptly and professionally for improved client relations.
Front Desk Office Assistant
Arkansas State University Library
Jonesboro, AR
10.2020 - 10.2021
- Greeted visitors and customers upon arrival, offered assistance, and answered questions.
- Staff with preparation and production, including training and explaining technical concepts
- Understand and apply safety and quality guidelines, meeting all regulations
- Move products, supplies and inventory to support production.
- Enhanced customer satisfaction by efficiently managing front desk operations and addressing guest inquiries.
- Streamlined office communication by accurately directing phone calls, emails, and mail to appropriate staff members.
- Provided exceptional customer service by promptly addressing complaints and concerns, resulting in higher client retention rates.
Pharmacy Technician
Walgreens
Jonesboro, AR
02.2019 - 04.2020
- Promoted patient confidentiality by adhering to HIPAA regulations when handling personal information during transactions.
- Improved patient satisfaction by efficiently processing prescriptions and managing inventory in a timely manner.
- Enhanced pharmacy workflow by assisting pharmacists with medication dispensing, labeling, and packaging.
- Streamlined prescription processing with accurate data entry and verification of patient information.
- Assisted in maintaining a clean and organized work environment, ensuring compliance with safety regulations.
- Increased overall pharmacy productivity by restocking supplies, organizing shelves, and maintaining cleanliness according to standards.
Education
Bachelor of Science - Psychology
Arkansas State University
Skills
- Dedicated, Detail Oriented and Organized
- Business Analysis and Reporting
- Analytical
- Critical thinker
- Relationship Building
- Interpersonal skills
- Networking
- Case Management
- Project Management
- HIPAA Compliance
- Healthcare regulations
- Utilization Management
- Medical Coding
- Case Review Expertise
- Discharge planning coordination
- Clinical assessment
- Insurance Verification
- Medicare knowledge
- Quality Improvement
- Records analysis
- Documentation And Reporting
- Inpatient Care
- Interpersonal and written communication
- Medicaid knowledge
- Discharge Planning
- Utilization review
- Patient Care Plans
- Home Health Care
- Outpatient Care
- Needs Assessment
- Teamwork and Collaboration
- Customer Service
- Team Leadership
- Decision-Making
- Problem Resolution
- Professional and Courteous
- Work Planning and Prioritization
- Scheduling and Coordinating
- Customer Relationship Management
- Team Development/ Staff Training
- MS Office
- Administration and Reporting
- Negotiation
- Performance Evaluations
- Performance reviewing
Personal Information
Title: Qualified Mental Health Professional
Timeline
Utilization Review Manager
Wellbridge Healthcare Greater Dallas
09.2023 - Current
Qualified Mental Health Professional
Metrocare Services
10.2022 - 09.2023
Field Marketing and Sale Representative
TTI- Milwaukee
03.2022 - 10.2022
Service Agent
Goosehead Insurance
11.2021 - 03.2022
Front Desk Office Assistant
Arkansas State University Library
10.2020 - 10.2021
Pharmacy Technician
Walgreens
02.2019 - 04.2020
Bachelor of Science - Psychology
Arkansas State University