Ellen Mrha
Durham,NC
Summary
Capable clinician adept at utilizing multi-disciplinary method to implementing patient care. Enthusiastic about applying several years' experience to help patients alleviate symptoms and improve health. Upbeat and outgoing professional with meticulous and systematic approach.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Behavioral Health Utilization Clinician
Centene
12.2019 - Current
- Perform duties to authorize and review utilization of mental health and substance abuse services provided in inpatient, outpatient, and intermediate care settings.
- Authorize, direct, and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
- Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification, and concurrent review timeliness.
- Interact with the Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases, including sending cases for peer-to-peer reviews.
- Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
Quality Improvement Specialist
Rural Health Group
Roanoke Rapids, NC
06.2016 - 01.2019
- Facilitated and led staff training and coaching to enhance culture change and ongoing quality improvement processes.
- Worked closely with the Quality Improvement Director, contributing to 14 primary care clinics in achieving Patient Centered Medical Home (PCMH) status through National Committee for Quality Assurance.
- Executed training initiatives, onsite consultation to support implementation of PCMH concepts and guidelines.
- Reviewed service delivery processes and analyzed outcome data to identify opportunities for improvement and develop solutions to eliminate performance gaps.
- Instrumental in the practice implementation of care coordination, care management, chronic disease management, and behavioral health services.
- Presented strategies to medical providers and practice teams for improving patient outcomes.
Clinical Director of Integrated Care Programs
Monarch
Albemarle, NC
07.2014 - 05.2016
- Created, executed, and monitored integrated care programs: Coordinating care with primary care, transitional care from inpatient stays, and licensed behaviorists embedded in medical homes.
- Designed performance measures for integrated care initiatives and reported protocols used by the Quality Assurance department.
- Drafted and presented reports and documentation to senior leadership, and developed Standard Operating Procedures (SOP’s) and workflows relative to clinical practices and business operations.
Integrated Care Specialist
North Carolina Office Of Rural Health
Raleigh, NC
02.2010 - 05.2014
- Trained primary care safety net providers on standardized care pathways that applied evidence-based screening and brief treatment for behavioral health conditions, including tobacco dependence, risky drinking, depression, anxiety, and intimate partner violence.
- Delivered tools to enhance healthcare providers' patient engagement techniques to increase patient self-management skills of chronic diseases such as diabetes, hypertension, and obesity.
- Served as Project Coordinator for Behavioral Health Access Plan for the Uninsured (BHAP), a six-month action research demonstration that implemented integrated care across four diverse primary care safety net agencies through federal HRSA SHAP funding
- Applied SWOT analysis to complete BHAP narrative evaluation and detailed technical support delivered, performance measures met, project-level and overall accomplishments, and barriers/implications for future initiatives.
Grievance Appeals Clinician
Value Options Behavioral Health
Durham, NC
04.2008 - 02.2010
- Summarized clinical justification of Peer Advisor decisions, recommendations, and denials or modifications as related to Division of Medical Assistance's medical necessity admission, continued stay, and discharge criteria.
- Researched, analyzed, and documented appeal summaries for mediation and formal appeal hearings.
- Worked closely with various clinical team members, peer advisor staff, clinical supervisors, and the organization's medical director to ensure positive patient outcomes.
Clinical Care Manager
Value Options Behavioral Health
Durham, NC
08.2006 - 04.2008
- Conducted mental health telephonic assessments/referrals, gathering clinical information to assess acuity level.
- Provided level of care recommendations and certification decisions.
- Staffed case with Medical Director to ensure medical necessity was met and evidence-based practices were being implemented by providers.
- Facilitated coordination of care with utilization review staff to ensure continuity of care.
Kidney Transplant Social Worker
Duke University Hospital
Durham, NC
11.2001 - 08.2006
- Conducted biopsychosocial assessments for pre-transplant candidates to assess readiness for transplant, identified risk factors, and developed a plan of care.
- Worked closely with other medical providers to relay psychosocial concerns and facilitate multidisciplinary care for patients and their support systems.
- Developed and implemented a system for transplant social workers to use behavioral agreements with high-risk transplant candidates.
- Provided counseling, motivational interviewing, and cognitive-behavioral techniques to assist patients and their caregivers throughout the continuum of transplant care.
- Delivered ongoing case management, referrals, and community resources to assist patients in preparing for transplant or postoperative care.
- Counseled patients and family members to address grief reactions to the death of a loved one.
Program Director
Summit House Residential Treatment Center
Garner, NC
09.1998 - 09.2000
- Orchestrated daily operations of a residential treatment program for non-violent female offenders and their children.
- Facilitated treatment for trauma, addiction, untreated psychiatric, and medical conditions.
- Developed and implemented behavioral modification programs utilizing cognitive-behavioral, psychodynamic, reality-based, and systems-oriented treatment modalities to address behavioral needs.
- Delivered ongoing training to staff members on implementing behavioral modifications daily.
Education
Masters of Social Work - Social Work
University of Pittsburgh
Pittsburgh, PA06-1993
Bachelor of Arts - English And Women's' Studies
Mount Holyoke College
South Hadley, MA05-1990
Skills
- Treatment determination
- Clinical Quality Improvement
- Evidence-Based Practice
- Behavioral Interventions
- Patient Education
- Patient Care
- Patient relationship management
- Treatment Planning
- Clinical Documentation
- Direct Patient Care
- HIPAA
- Patient evaluations
- Patient Health Education
- Maintaining quality assurance standards
- Managing patient cases
- Patient Assessments
Certification
Licensed Clinical Social Worker
North Carolina Licensure for Clinical Social Work #C003191 9/1998-6/2026
Timeline
Behavioral Health Utilization Clinician
Centene
12.2019 - Current
Quality Improvement Specialist
Rural Health Group
06.2016 - 01.2019
Clinical Director of Integrated Care Programs
Monarch
07.2014 - 05.2016
Integrated Care Specialist
North Carolina Office Of Rural Health
02.2010 - 05.2014
Grievance Appeals Clinician
Value Options Behavioral Health
04.2008 - 02.2010
Clinical Care Manager
Value Options Behavioral Health
08.2006 - 04.2008
Kidney Transplant Social Worker
Duke University Hospital
11.2001 - 08.2006
Program Director
Summit House Residential Treatment Center
09.1998 - 09.2000
Masters of Social Work - Social Work
University of Pittsburgh
Bachelor of Arts - English And Women's' Studies
Mount Holyoke College
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