Flavia Pancorvo

• Serve as the behavioral health expert, as it relates to the Florida Medicaid Handbook/Policies and rules, within Community Based Care Integrated Health.
• Provide consultation & expertise to the CBCIH team and Community Based Care (CBC) Lead Agency staff with regards to the requirements of Florida Medicaid.
• Provide guidance & technical expertise as needed to the CBCIH Integration Managers to ensure the proper monitoring of compliance and utilization management activities of the CBC lead agencies.
• Participate in monthly and quarterly operational calls with CBC Nurse Care Coordinators (NCC) and Behavioral Health Care Coordinators (BHCC).
• Participate in CBC Multi-Disciplinary Team meetings at least annually for each CBC and when requested by a CBC behavioral health coordinator. Created and implemented the Higher Level of Care(HLOC) Multi-Disciplinary Team (MDT) Statewide note.
• Provide annual evaluations to the BHCC’s as it relates to the HLOC MDT to ensure quality of discussion and documentation.
• Compile and present Behavioral Health reports on Quality Improvement Activities.
• Develop, implement and monitor Behavioral Health processes.
• Development, maintenance and distribution of the Specialized Directory of Providers.

Provide support and guidance to CBCs in regards to specific complex cases involving enrollees in the Sunshine Child Welfare Specialty Plan.

• Train CBCIH staff, CBC staff, etc. on mental health and substance abuse topics as they relate to compliance with contract requirements, best practice, Medicaid regulations and statutes, HEDIS and the contractual requirements of the Sunshine Health contract with CBCIH.
• Provide clinical oversight the CBC BHCCs as part of the coordination and review of services provided by the CBCs.
• Participate in the creation and annual reviews of Unit Policy and Procedure Manuals to ensure all policy and procedures reflect current state, federal and system of care requirements.
• Participate in the agency strategic plan & quality improvement processes as it relates to meeting Behavioral Health target goals.
• Participate in BHCC training and onboarding for new hires.
• Assists in the development, implementation and statewide training of Behavioral Health Policies and Procedures.
• Assists in managing and interpreting the data and developing strategies to meet annual Behavioral Health Healthcare Effectiveness and Information Set (HEDIS) goals.
• Meets with leadership from the Sunshine Child Welfare Specialty plan to identify issues, barriers and engage in strategic planning.
• Interacts with various community stakeholders and entities to ensure cooperation and accessibility to Behavioral Health Services.

• Provide consultation for the activities of the CBC Coordinators in the South Florida region.
• Monitor each CBC’s Multi-Disciplinary Team process through quarterly onsite reviews.
• Assist in the coordination of disease management protocols between CBC Coordinators and managed care partners.
• Provide technical assistance to the CBC Coordinators on specific cases as they are identified.
• Work with the CBC Coordinators to identify alternative placements and treatment options when a child does not meet medical necessity criteria for a requested level of care.
• Monitor each CBC quarterly for compliance with requirement of the Sunshine Child Welfare Specialty Plan and the Medicaid Managed Care Contract.
• Provide clinical training as appropriate per monitoring findings or as requested by the CBC.
• Represent Integrated Health with the provider groups and CBCs assigned.
• Serve as point of access for residential placement into and out of the Sunshine Child Welfare Specialty Plan.
• Participate in the agency strategic plan and quality improvement processes.
• Provide supervision to the three CBCIH Miami Nurse Care Coordinators.

• Managed Short Term Disability Claims for the Behavioral Health Unit for various Commercial accounts.
• Responsible for reviewing and making recommendations on Short Term Disability claims for Mental Health Disorders.
• Referral to vocational training.
• Managed a caseload of 70 open claims.
• Managed crisis calls.

• Managed Short Term Disability Claims for the Behavioral Health Unit for various Commercial accounts.
• Responsible for reviewing and making recommendations on Short Term Disability claims for Mental Health Disorders.
• Referral to vocational training.
• Managed a caseload of 70 open claims.
• Managed crisis calls.

• Provision of direct supervision for up to 7 full time Customer Service Associates.
• Responsible for operational call center activities including meeting expected call performance metrics (ASA, SVL, Abandonment rates and hold times) and reporting of the metrics.
• Responsible for monitoring agent calls to ensure quality assurance on a monthly or as needed basis through the Qfiniti system.
• Responsible for preparation and presentation audits in regards to call center operations.
• Responsible to ensure first call resolution is met.
• Utilization of tools such as the Avaya and CMS system to gather and report call center operation performance.

• Responsible for outpatient clinical operations: Utilization Management and Cost of Care strategies.
• Responsible for the supervision of 12 licensed clinicians including the Outpatient Supervisor.
• Interdepartmental coordination to ensure continuity of care and appropriate utilization of covered benefits.
• Coordination between Residential, Inpatient and Crisis Stabilization admissions and step down to Outpatient services.
• Monitoring and managing of crisis calls.
• Management of Emergent, Urgent and Routine access to care.
• Participation in agency audits (pre-delegation/customer audits).
• Participation in new business development and implementation.
• Staff development and management, including recruitment, supervision and training.
• Implementation of corporate clinical philosophy and clinical policies and procedures.
• Participation in Quality Improvement activities including QIAs (Clinical and Service), URAC accreditation, Critical Incidents, Quality of Care Concerns and Grievance incidents.
• Participation in provider relations activities.
• Membership, participation and reporting to various committees to include, Cost of Care, Utilization Management, Network Strategy and Quality Improvement Committees.
• Chair of the Enrollee Service Committee.
• Collaborates with customers to make efficient decisions regarding the membership.

• Supervise Care Management team set improvement milestones when indicated.
• Lead the Care Managers in the monitoring and managing inpatient, outpatient and intermediate levels of care related to mental health and substance abuse treatment.
• Manage day to day activity of care manager team to ensure client commitments and other Magellan performance expectations are achieved.
• Assists clinical management in the development and implementation of strategic and operational goals and plans.
• Ensures appropriate clinical supervision and case consultation for clinical staff, including psychiatric consultation. Assists, on an as needed basis, in response to peak work periods.
• Ensures Medical Necessity is followed for all levels of care in compliance with the Medicaid Limitation Handbook when applicable.

• Monitor Residential, Outpatient and Inpatient levels of care services related to mental health treatment to ensure medical necessity and effectiveness.
• Participate in the creation and implementation of utilization work flows.
• Create protocols in keeping with Medicaid standards to ensure quality of care.
• Develop tracking system for incoming outpatient requests and distribution management.
• Provide education in regards to Comprehensive Behavioral Health Assessments, Therapeutic Behavioral On-Site Services, Targeted Case Management, Specialized Therapeutic Foster Care and Specialized Therapeutic Group Care.
• Present in provider forums, and participate in outreach visits including Quality Improvement Audits.
• Compile monthly clinical reports reflecting trends regarding requests for service.
• Develop discharge plans in conjunction with providers and facilities, and oversee their implementation.
• Interact with Physician Advisors to discuss clinical/authorization questions and concerns regarding specific cases.

• Aided in the implementation of Child Welfare Pre Paid Mental Health Plan, Area 9 Pre-Paid Mental Health Plan and Molina Contract.
• Created request forms that are utilized by providers for authorization of outpatient services.
• Participated in work groups that created work flows utilized by staff.
• Provided community outreach and provider training sessions.
• Utilization management for outpatient services.
• Assignment of incoming requests to the staff.
• Assisted in discharge planning in collaboration with providers and facilities.
• Provided assistance and training to members and providers.
• Provided telephone triage and crisis intervention.

• Responsible for the management and operation of the region.
• Oversight of billing, invoicing and payroll processes.
• Hiring and Supervision of office personnel.
• Oversight of the contract management process.
• Development of a marketing plan for the region.
• Secure contracts for services with agencies.
• Develop and maintain relationships with referral sources.
• Oversight of the data collections process, including client and collateral satisfaction survey.
• Oversight and management of the referral and intake process.
• Provide clinical supervision and service delivery oversight.
• Oversight and management of grievances and incidents.

• Provide in home therapeutic services (TBOS) for children and their families utilizing the family centered approach.
• Provide the required contact/daily reporting date, reports, plans of service of treatment, and court reports.
• Build and maintain positive relationships with personnel from referring/collateral agencies.
• Maintain collateral relationships with referring and participating providers.
• Trained the new staff on family centered treatment