Jamie Ball-Turner
Mental Health Professional
Nashville,TN
Summary
LPC with 10+ years of experience in the mental health field. Specializing in utilization review, care management, and case management.
Overview
14
14
years of professional experience
7
7
years of post-secondary education
Work History
BH Care Manager Utilization Review
Elevance Health
10.2022 - Current
- Managing psychiatric and substance abuse facility-based and outpatient programs through telephonic or written review.
- Referring cases to Peer Reviewers as appropriate.
- Applying appropriate screening criteria and clinical judgement to ensure access to medically necessary quality behavioral healthcare.
- Utilizing ASAM and MCG criteria to make clinical decisions.
- Performing psychiatric and substance abuse disorder assessment coordination implementation and case planning to promote quality member outcomes.
- Staffing complex cases with medical directors in a team setting to assist with clinical determinations.
BH Utilization Review Care Manager
Humana
03.2020 - 09.2022
- Performing pre-certification and concurrent telephonic reviews with facilities for the IP, RTC, PHP, and IOP levels of care
- Working with Medicaid, Medicare, and Commercially insured facilities, specializing in both mental health and chemical dependency
- Utilizing MCG and ASAM criteria to make medical necessity determinations.
- Assessing and coordinate DC planning with the case management and care coordination departments.
- Attending medical rounds to staff complex cases with medical directors.
- Completing documentation to send cases to Quality Review.
Behavioral Health Case Manager
Blue Cross Blue Shield
09.2019 - 03.2020
- Maintaining a case load of members with complex behavioral health needs.
- Interviewing, identifying, and documenting member needs for resources, services, and other support using information from assessments, evaluations, observations, and interviews to develop care plans.
- Formulating and implementing individualized care plans to promote goal attainment.
- Answering the crisis line and helping connect members with needed resources to resolve crises.
- Completing comprehensive biopsychosocial assessments highlighting member’s most critical behavioral health need areas and creating care plans to address these needs.
- Working alongside the Utilization Management department to discuss levels of care and authorizations for members.
Utilization Review Specialist
Journey Pure
05.2017 - 09.2019
- Completing pre-certification and continued stay insurance reviews for all levels of care at a substance abuse treatment center, including Detox, Residential, Partial Hospitalization, and Intensive Outpatient
- Reviewing all clinical, medical, and referral documentation to determine the most appropriate level of care for patients utilizing ASAM guidelines
- Documenting all insurance reviews and outcomes in the patient's EMR
- Educating counseling staff regarding the documentation needed to adequately document patient care that reflects medical necessity
- Initiating and schedules peer reviews and expedited appeals
- Working with providers to prepare for peer to peer reviews
- Collaborating with the treatment team to discuss clinical authorization and quality of care.
Utilization Review Specialist
The Ranch
11.2016 - 05.2017
- Completing comprehensive biopsychosocial assessments for clients being admitted to Intensive Outpatient
- Partial Hospitalization, and Residential levels of care with co-occurring disorders
- Gathering and reviewing all available medical records, documentation, and benefits information for initial and concurrent review with payers
- Conducting pre-certification and concurrent reviews with payers and level of care chart reviews
- Coordinating peer review participation and scheduling
- Attending and participating in treatment team meetings as the payer expert to ensure appropriate authorization outcomes and provide ongoing education regarding payer requirements
- Utilizing Medical Necessity and ASAM guidelines to determine the level of care most appropriate for patients.
Intake Therapist
The Next Door
10.2013 - 10.2016
- Completing intake psychosocial assessments with clients utilizing ASAM criteria.
- Making pre-certification and concurrent review requests with MCOs.
- Communicating with referral sources in order to get collateral information to assist in grant approval while maintaining a professional working relationship
- Completing ongoing utilization review for all levels of care.
Transitional Living Therapist
Youth Villages
10.2010 - 10.2013
- Providing mental health counseling services to young adults exiting DCS custody/foster care.
- Practicing Trauma-Focused Cognitive Behavioral Therapy with clients with a history of trauma.
- Responding to client crisis events by implementing safety plans
- Constructing individualized treatment plans.
- Completing assessments including pre-admission assessments, psychosocial assessments, strength and needs assessments, and independent living skill assessments.
- Making referrals into community resources, including employment and educational assistance programs.
Education
Master of Arts - Clinical Professional Psychology
Roosevelt University
09.2007 - 08.2010
Bachelor of Arts - Psychology
Auburn University
Auburn, AL 09.2003 - 05.2007
Timeline
BH Care Manager Utilization Review
Elevance Health
10.2022 - Current
BH Utilization Review Care Manager
Humana
03.2020 - 09.2022
Behavioral Health Case Manager
Blue Cross Blue Shield
09.2019 - 03.2020
Utilization Review Specialist
Journey Pure
05.2017 - 09.2019
Utilization Review Specialist
The Ranch
11.2016 - 05.2017
Intake Therapist
The Next Door
10.2013 - 10.2016
Transitional Living Therapist
Youth Villages
10.2010 - 10.2013
Master of Arts - Clinical Professional Psychology
Roosevelt University
09.2007 - 08.2010
Bachelor of Arts - Psychology
Auburn University
09.2003 - 05.2007
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