Dedicated behavioral health professional with over 15 years of experience in case management and utilization management; as well as five years of supervisory experience in the field of banking. Collaborative leader, passionate about partnering with colleagues and using morale-building abilities to enhance employee engagement and promote a positive workplace culture. Avid learner, eager to further develop professional skills; and noted swift capacity to apply newly acquired skills. Key competencies include mentoring and training; compliance with state and federal legislation; risk management; clinical and process auditing; and development of departmental curriculums and job aids.
Hi, I’m
Denay Fullington
Behavioral Health Clinician
Charlotte,NC
Summary
Overview
24
years of professional experience
3
Certifications
Work History
Aetna Inc.
Behavioral Health Utilization Manager
04.2018 - 09.2024
Job overview
- Commercial benefits management for prospective and concurrent retrospective utilization reviews, utilizing ASAM, LOCUS/CALOCUS, and other clinical guidelines to ensure clinically necessary and appropriate behavioral health care.
- Established strong working relationships with inpatient and outpatient behavioral health providers, effectively advocating for patients' needs.
- Identified gaps in service delivery and recommended improvements to optimize resource utilization.
- Participated in weekly interdisciplinary teams to develop effective care plans, addressing physical, social, and emotional aspects of health for optimal outcomes.
- Engaged in cross-functional collaboration with Claims, Appeals, Network Contracting, and Case Management - served as a liaison, providing clear communication for all utilization management matters.
- Mitigated risk by proactively escalating potential quality of care concerns to Behavioral Health Medical Director.
- Co-facilitated a weekly virtual self-care series, as a member of the Black Colleague Resource Group.
Community Care Partners of Greater Mecklenburg
Care Manager
01.2014 - 04.2018
Job overview
- Partnered with Quality Improvement Coordinator on various initiatives in preparation for NCQA accreditation.
- Analyzed data from utilization reports, identifying patterns and opportunities for cost-savings, while maintaining quality patient care.
- Supported planning, implementation, and evaluation of care management projects and policies, as a member of the Process Improvement Committee.
- Performed file reviews and audited clinical documentation for behavioral health and community social worker; and conducted process audits for all staff.
- Completed onboarding and mentoring for new social workers. Supported staff professional development by facilitating trainings in various areas, including behavioral health integration, crisis intervention, and writing effective SMART goals.
- Conducted thorough assessments to identify patients' needs, strengths, and barriers to achieving optimal health.
- Developed and implemented individualized care plans and coordinated necessary services for patients. Closely monitored progress and adjusted care plans as needed to promote ongoing improvement.
- Coordinated referrals for medical specialists, and facilitated integrated health consultations to support improved health outcomes for members with physical-behavioral comorbidities and unmet social needs.
- Maintained a network of community resources to provide comprehensive support services to patients.
- Consulted with supervisor weekly to assess cases and plan strategies for enhancing care.
Community Care Partners of Greater Mecklenburg
MeckLink Care Coordinator
09.2012 - 01.2014
Job overview
- Hired prior to full integration, and directly contributed to the development of organizational policies and procedures related to care coordination.
- Effectively managed a high volume of complex cases, ensuring timely follow-up and appropriate interventions.
- Maintained accurate and up-to-date documentation of patient records in accordance with HIPAA regulations. Used company software and databases to maintain records of services performed and patient conditions.
- Liaised with families, hospital staff, and other healthcare professionals to develop customized care plans to assess both health and social needs.
- Enhanced patient care by monitoring progress towards goals and adjusting care plans as needed to achieve desired results.
- Implemented evidence-based interventions and provided emotional support for patients and families during difficult times, fostering resilience and coping skills.
- Educated patients on self-care strategies, promoting independence and empowering them to manage their health conditions.
- Reduced hospital readmission rates by coordinating effective post-discharge care plans.
- Represented organization in community health fairs to promote wellness and preventive care.
Atrium Health - Behavioral Health Charlotte
Psychotherapist
05.2007 - 09.2012
Job overview
- Performed clinical assessments and contributed to development of treatment plans. Documented patient information and response to clinical interventions.
- Worked with psychiatrist, pharmacist, utilization reviewer, and other members of interdisciplinary treatment team to review patient progress and update treatment plans.
- Provided patients with recommendations for community resources.
- Provided crisis intervention services when needed, effectively addressing acute emotional distress and preventing harm to self or others.
- Developed and updated policies and procedures, maintaining compliance with guidelines relating to HIPAA, benefits administration and general liability.
- Voluntarily sought training in substance abuse counseling, resulting in organizational savings of approximately $10,000 annually.
- Increased patient engagement via innovative, therapeutic process groups on stress management, self-esteem, grief/loss, and other topics.
- Partnered with multi-disciplinary treatment team as a subject matter expert on psychosocial treatment of patients.
- Co-designed a new IOP treatment planning curriculum to target issues specifically related to working persons and streamline documentation of discharge summaries.
- Authored a curriculum and orientation manual for graduate student interns, to promote consistent and accountable supervision and practice
- Drafted a Mecklenburg County community resource guide for internal use - discharge planning.
National Bank of South Carolina
Assistant Branch Manager & Credit Analyst
06.2000 - 08.2005
Job overview
- Completed a nine-month management training program with rotations in all aspects of banking operations.
- Effectively managed risk through strict adherence to compliance guidelines, minimizing financial losses due to fraud or transaction errors.
- Supported the Branch Manager with daily tasks, ensuring smooth branch functioning and effective communication amongst team members.
- Supervised a team of six tellers and two customer service representatives, helping improve skills, achieve daily objectives, and attain advancement.
- Developed and maintained a consumer loan portfolio of $100,000 annually.
- Conducted credit investigations and in-depth financial analysis of commercial loan applicants to assess quality and credit risk; and prepared summary reviews for use by senior personnel.
- Led branch’s community outreach efforts, including partnerships with United Way, Junior Achievement, JDRF and local colleges.
- Assisted Human Resources Director with annual college recruiting efforts and onboarding of new management associates.
Education
University of North Carolina At CharlotteCharlotte, NC
Master of Social Work
University Overview
Wofford CollegeSpartanburg, SC
Bachelor of Science from Psychology
University Overview
Scrum Alliance
Certified Scrum Master (2022-2024)
01.2022
University Overview
National Association of Social Workers - NC
Certified Clinical Supervisor
01.2021
University Overview
Commission For Case Manager Certification
Certified Case Manager (CCM)
01.2016
University Overview
NC Social Work Certification & Licensure Board
Licensed Clinical Social Worker
01.2010
University Overview
Skills
- Enrolled in Google Data Analytics: Professional Certificate via Coursera
- Training & Development
- Resource optimization
- Process improvement strategies
- Medical terminology knowledge
- Documentation accuracy
Accomplishments
Accomplishments
June 2022: Selected as one of 100 high-potential CVS Health colleagues to participate in a year-long, cross-enterprise leadership initiative.
Certification
- CCM - Certified Case Manager
- CCS - Certified Clinical Supervisor
- LCSW - Licensed Clinical Social Worker
Availability
See my work availability
Not Available
Available
monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote
Smart girl, you can do anything...don't ever let the world tell you differently.
Timeline
Behavioral Health Utilization Manager
Aetna Inc.
04.2018 - 09.2024
Care Manager
Community Care Partners of Greater Mecklenburg
01.2014 - 04.2018
MeckLink Care Coordinator
Community Care Partners of Greater Mecklenburg
09.2012 - 01.2014
Psychotherapist
Atrium Health - Behavioral Health Charlotte
05.2007 - 09.2012
Assistant Branch Manager & Credit Analyst
National Bank of South Carolina
06.2000 - 08.2005
University of North Carolina At Charlotte
Master of Social Work
Wofford College
Bachelor of Science from Psychology
Scrum Alliance
Certified Scrum Master (2022-2024)
National Association of Social Workers - NC
Certified Clinical Supervisor
Commission For Case Manager Certification
Certified Case Manager (CCM)
NC Social Work Certification & Licensure Board
Licensed Clinical Social Worker
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