Evalynne Martin
Danvers,MA
Summary
Seasoned Utilization Review Manager with a proven track record at Carelon Behavioral Health, adept in leveraging InterQual criteria and managed care to enhance service utilization and patient outcomes. Skilled in clinical assessment and crisis intervention, demonstrating exceptional collaboration and decision-making skills to improve treatment plans and ensure regulatory compliance.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Utilization Review Manager
Carelon Behavioral Health
Boston, MA
04.2016 - Current
- Utilized evidence-based guidelines to support utilization review decisions and recommendations.
- Ensured compliance with regulatory requirements related to utilization review.
- Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
- Maintained up-to-date knowledge of changes in healthcare regulations, policies, and evidence-based practices.
- Monitored utilization of services to ensure they are appropriate and cost effective while maintaining quality standards.
- Evaluated patient care and outcomes to identify opportunities for improvement in treatment plans.
Psychiatric Crisis Clinician
Beth Israel Lahey Health
Salem, MA
06.2008 - 04.2016
- Provided crisis intervention services via telephone or face-to-face contact when needed.
- Evaluated potential risks associated with suicidal ideation or homicidal behavior among patients.
- Collaborated with mental health professionals and other staff members to perform clinical assessments or develop treatment plans.
- Facilitated de-escalation techniques to reduce the intensity of clients' emotional distress.
Education
Master of Arts - Counseling
Gordon-Conwell Theological Seminary
Hamilton, MA06-2008
Skills
- Utilization management
- Managed care
- InterQual criteria
- Clinical assessment
Certification
- Licensed Mental Health Counselor
Timeline
Utilization Review Manager
Carelon Behavioral Health
04.2016 - Current
Psychiatric Crisis Clinician
Beth Israel Lahey Health
06.2008 - 04.2016
Master of Arts - Counseling
Gordon-Conwell Theological Seminary
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