Gioconda Melish
Watertown,MA
Summary
Building on comprehensive case management expertise, I am driven by a mission to advocate for accessible, tailored behavioral care. Fluent in Spanish, Italian, and English, I bridge communication gaps, contributing to a multicultural approach that enhances patient engagement and outcomes.
At my current role at Boston Children's Hospital, I'm focused on effective coordination of behavioral care treatments. Our team's dedication ensures patients access to their necessary care and support in a timely manner.
Overview
8
8
years of professional experience
Work History
Behavioral Health Services Coordinator
Boston Children Hospital
Boston , MA
10.2024 - Current
- In direct collaboration with the Primary Care Department and the Behavioral Integrated Health Program, coordinate all referrals for Outpatient Behavioral Care to providers outside Boston Children's Hospital.
- Facilitates communication, collaboration, and coordination of care. Coordinating appointments, referrals, and transitions of care.
- Effectively communicates with all parties involved: behavioral providers, the patient’s insurance, parents, and/or caregivers to ensure the patient has access to therapy services in a timely manner.
- Follows all referrals through to completed appointments.
- Develop new relationships with providers in the community to enhance our network of behavioral care options for our patients.
Senior Psychiatry Resource Specialist
Boston Children Hospital
Boston , MA
02.2023 - 10.2024
- Works with the patient’s assigned medical and psychiatric team, maintains communication and collaboration among payers, providers, hospital departments, and external agencies in order to promote continuity and coordination of care.
- Collaborates and communicates with multidisciplinary team members and external resources to facilitate psychiatric level-of-care disposition as determined by the clinical team.
- Reviews clinical documentation to ensure it justifies the appropriate level of care prior to submission to payers; can provide verbal presentations to payers if required.
- Completes psychiatric discharge planning tasks, including inpatient admissions referrals, partial hospitalization intake referrals, in-home therapy referrals, CBAT (Community-Based Acute Treatment), residential admissions, and specialized clinic referrals.
- Serves as a resource for clinicians regarding insurance eligibility, coverage, benefits, and provider networks.
Psychiatry Consultation Coordinator-Case Managemen
Massachusetts General Hospital Emergency Room
Boston, MA
06.2017 - 02.2023
- MGH Psychiatry Department, in collaboration with an Interdisciplinary Care Team and others, managed and coordinated all steps related to the patient’s discharge planning for the appropriate level of care: inpatient, residential, CCS, eating disorder and substance recovery program, outpatient psych care, PHP, IOP, etc.
- Duties comprised conducting telephonic pre-admission, providing concurrent and retrospective clinical reviews of behavioral health and substance use for inpatient admissions.
- Assisted the Psychiatry Consultation Department, exploring and arranging all diversionary services, and step-down placements to ensure the patient receives a suitable level of care. Obtained insurance authorizations and engaged with health insurance care managers, local DCF, and DMH liaisons for their support when needed.
- Conducting research for community resources, as well as performing other administrative responsibilities pertaining to case management/operations.
Education
Bachelor of Science - Political Science and Government
Universidad Central De Venezuela
Caracas - Venezuela Skills
- Multilingual
- Patient Advocate
- Care coordination
- Insurance authorization
- Clinical documentation
- Referral management
- Community outreach
- Interdisciplinary collaboration
- Resource management
- Problem solving
- Time management
- Conflict resolution
- Effective communication
- Goal attainment
- Teamwork
- Case Management
- Medicare-Medicaid knowledge
Timeline
Behavioral Health Services Coordinator
Boston Children Hospital
10.2024 - Current
Senior Psychiatry Resource Specialist
Boston Children Hospital
02.2023 - 10.2024
Psychiatry Consultation Coordinator-Case Managemen
Massachusetts General Hospital Emergency Room
06.2017 - 02.2023
Bachelor of Science - Political Science and Government
Universidad Central De Venezuela
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