Denise D. Larsen
Canandaigua ,NY
Summary
Experienced team leader skilled in third party audits , developing effective strategies, providing comprehensive training, and adept at analyzing data to identify trends
Overview
40
40
years of professional experience
Work History
BH HLOC Precert Team Lead
Aetna
07.2023 - Current
- Trained new team members by relaying information on company procedures and safety requirements.
- Promoted a positive work environment by fostering teamwork, open communication, and employee recognition initiatives.
- Served as a role model for the team by demonstrating commitment to excellence, professionalism, and adherence to company values at all times.
- Coached team members in techniques necessary to complete job tasks.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Evaluated staff performance and provided coaching to address inefficiencies.
- Helped meet changing demands by recommending improvements to business systems or procedures.
- Capitalizes on advanced clinical experience and knowledge to manage the coordination and preparation of documentation for third party audits.
- Assists leaders with performance management activities including internal documentation and call observation audits.
-
Social Worker in Private Practice
Denise Larsen, LCSW.
10.2001 - Current
- Assisted clients and their families with personal and environmental difficulties which interfere with their ability to obtain maximum benefits from medical care
- Provides both mental health and chemical dependency therapy with children, adolescents, and adults
- Provides EAP and Assessment Services for several managed care companies and EAP vendors
Work at Home Precert Care Manager
Aetna Behavior Health
04.2019 - 07.2023
- Utilizes clinical skills to coordinate, document and communicate all aspects of the utilization/benefit management program
- Applies critical thinking and is knowledgeable in clinically appropriate treatment, evidence-based care and clinical practice guidelines for Behavioral Health and/or medical conditions based upon program focus
- Provider coaching and mentoring to less experienced Care Managers
- Provides triage and crisis support
- Collaborates with team members and other departments to improve outcomes for our members
- Identifies members at risk for poor outcomes and facilitates referral opportunities to integrate with other products, services and/or programs
- Identifies opportunities to promote quality effectiveness of healthcare services and benefit utilization
Work at Home Senior Care Manager
Aetna Behavioral Health
11.2015 - 04.2019
- Monitor clinical care services related to complex mental health and substance abuse treatment to optimize clinical outcomes
- Provider coaching and mentoring to less experienced Care Managers
- Provide information to members and providers regarding mental health and substance abuse benefits, community treatment resources, mental health managed care programs, and Aetna Behavioral Health policies and procedures, and criteria
Behavioral Health Clinical Specialist
Preferred Care, Inc.
04.2003 - 11.2005
- Provided case management /care coordination for members to assess, plan, implement, coordinate, monitor and evaluate options and services required to meet a member's behavioral health needs
- Implemented and monitored the Medicare Post MI Depression Screening Initiative
- Performed triage and prospective, concurrent and retrospective review of outpatient and inpatient mental health and chemical dependency services in compliance with the member's benefit structure, Preferred Care Medical and Administrative Polices, and InterQual Criteria
Program Manager
Monroe County Single Point of Accessibility
09.2001 - 03.2003
- Responsible for the start-up and ongoing coordination of the Monroe County Children's Single Point of Accessibility (SPOA) Program
- Developed and implemented policy and procedures for the effective management of SPOA
- Provided triage for all incoming referrals to the SPOA Program
- Developed clinical pathways for service delivery
- Participated in the development and refinement of the SPOA computer tracking system
- Maintained communication with both the County and State Office of Mental Health to effectively manage the limited children's mental health resources in the county
- Trained in Shulman's Model of Interactive Supervision
- Field Placement Instructor for SUNY Brockport
Team Leader for Triage and Chemical Dependency Services
CIGNA Behavioral Health
01.1997 - 03.2001
- Coordinated and oversaw the triage care managers and complex case coordinators
- Instrumental in reducing the rate of admission by identifying and utilizing alternative levels of care
- Represented the local CBH office in the CIGNA NCQA, URAC and Department of Health audits
- Oversaw the regional Medicare HMO product
- Assisted in writing and designing quality improvement activities/studies
Professional Relations Manager
CIGNA Behavioral Health
01.1996 - 04.1997
- Negotiated contracts and alternative pay arrangements with representatives of psychiatric hospitals, clinics, and individual providers
- Conducted site visits and record reviews on high volume providers and facilities
- Documented and investigated member's complaints against providers and well as any potential quality of care concerns
- Collaborated with providers and facilities on corrective action plans as needed
- Was the site Risk Manager working along side assigned legal counsel, regulatory agencies, and both internal and external customers to address any potential risks to the organization or service delivery
- Launched a quarterly provider newsletter
- Was instrumental in the formulation of the Provider Advisory Board
- Functioned as the liaison between care managers, professional relations, and the provider network
- Initiated and led educational seminars for the provider network
- Arranged CME credits for seminars and trainings
Lead Clinician for Inpatient Services
CIGNA Behavioral Health
12.1994 - 01.1996
- Managed a staff of four full time clinicians providing oversight for the inpatient team
- Delivered outstanding account management through visits/calls/problem resolution to key customers
Care Manager
CIGNA Behavioral Health
04.1991 - 12.1994
- Managed inpatient and outpatient mental health and chemical dependency services for an ASO account
- Developed treatment options and successfully negotiated with participants, providers, employers, internal EAP representatives and families for optimal treatment results
- Provider discharge planning, triage and follow-up of high-risk cases to ensure successful outcomes as measured by admit and readmit rates
Program Director for the Adolescent CD and Dual Diagnosis Unit
Benjamin Rush/Rush Recovery Center
01.1987 - 01.1991
- Supervised an inpatient multidisciplinary team of thirty-five employees (including psychiatric aids, nursing personnel, social workers, staff psychologist and drug and alcohol counselors) setting work schedules, determining salaries, and resolving any performance issues
- Oversaw the Office of Mental Health, the Office of Alcohol and Substance Abuse Services audits, as well as other regulatory agency audits
- Executed the daily operations of the adolescent unit, including daily programming, staffing, and educational needs
- Taught classes on addiction at Upstate Medical Center to medical students
- Field placement liaison for local colleges for the School of Social Work
Staff Certified Social Worker
Ontario County Mental Health
01.1986 - 01.1987
- Coordinated and oversaw the Ontario County Jail Psychiatric Services
- Provided mental health services to adults, children, adolescents, and families
Staff Certified Social Worker
Family Counseling Service
01.1985 - 01.1986
- Administered the Yates County Interfamilial Sexual Abuse Program
- Duties included validation of sexual abuse, court testimony and abuse resolution
- Provided mental health services to children, adolescents, adults, and families
- Provided EAP services
Education
Master of Science - Social Work
Virginia Commonwealth University
Richmond, VASkills
- Attention to detail
- Conflict resolution
- Coaching and mentoring
- Teamwork and collaboration
- Multitasking Abilities
- Regulatory compliance
- Problem-solving
- Staff education and training
- Analytical thinking
Certifications
NYS Licensed Clinical Social Worker; Certified Case Manager
Timeline
BH HLOC Precert Team Lead
Aetna
07.2023 - Current
Work at Home Precert Care Manager
Aetna Behavior Health
04.2019 - 07.2023
Work at Home Senior Care Manager
Aetna Behavioral Health
11.2015 - 04.2019
Behavioral Health Clinical Specialist
Preferred Care, Inc.
04.2003 - 11.2005
Social Worker in Private Practice
Denise Larsen, LCSW.
10.2001 - Current
Program Manager
Monroe County Single Point of Accessibility
09.2001 - 03.2003
Team Leader for Triage and Chemical Dependency Services
CIGNA Behavioral Health
01.1997 - 03.2001
Professional Relations Manager
CIGNA Behavioral Health
01.1996 - 04.1997
Lead Clinician for Inpatient Services
CIGNA Behavioral Health
12.1994 - 01.1996
Care Manager
CIGNA Behavioral Health
04.1991 - 12.1994
Program Director for the Adolescent CD and Dual Diagnosis Unit
Benjamin Rush/Rush Recovery Center
01.1987 - 01.1991
Staff Certified Social Worker
Ontario County Mental Health
01.1986 - 01.1987
Staff Certified Social Worker
Family Counseling Service
01.1985 - 01.1986
Master of Science - Social Work
Virginia Commonwealth University
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