Jennifer Summers
St Louis,MO
Summary
Recognized for implementing innovative strategies that enhance patient care quality, alongside mentoring and training clinical staff, Dr. Summers' is an expert in medical necessity, utilization review for eating disorders, and evaluation of treatment effectiveness.
Overview
23
23
years of professional experience
Work History
Senior Utilization Review Specialist
Within Health Provider Services
Miami, Florida
08.2023 - Current
- Provide education and guidance on utilization management principles to internal staff members.
- Collaborate with physicians, nurses, dietitians, discharge planners, therapists and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.
- Provide consultation on appropriate use of services to staff members including utilization management strategies.
- Assist in training new team members on utilization review procedures and tools.
- Participate in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
- Educate clinical staff on case conceptualization for co-occurring disorders and treatment planning.
- Cultivate relationships with new payor sources, providing rationale for SCA and authorizations.
- Implement processes, policies, quality of care measures, and performance standards within the department.
- Manage preauthorizations, concurrent reviews, and retrospective reviews effectively.
- Complete M.D. Peer-to-Peer reviews and expedited appeals promptly.
- Support treatment teams with LOC changes, transfers, and discharges efficiently.
- Conduct concurrent reviews to monitor the ongoing appropriateness of services provided to members.
- Monitor trends in utilization patterns and make recommendations for improvement as needed.
- Develop clinical pathways and protocols to ensure quality of care and utilization of resources.
- Adhere to all federal, state and local laws governing healthcare operations.
- Work with insurance companies and patients to determine best courses of action.
- Analyze treatment plans for appropriateness, effectiveness and medical necessity in accordance with established criteria.
- Attend relevant meetings related to Utilization Review activities.
- Assess patient's health needs and identified potential risk areas through review of records and interviews with providers.
- Assess the appropriateness of medical services and procedures based on clinical documentation and criteria.
- Analyze trends in patient care to recommend policy or procedural changes that improve quality and efficiency.
- Coordinate with healthcare teams to develop care plans that meet patient needs and insurance coverage.
- Conduct comprehensive reviews of patient records to ensure medical necessity and compliance with healthcare standards.
- Utilize evidence-based guidelines to support utilization review decisions and recommendations.
Utilization Review Specialist
Lightfully Behavioral Health
Thousand Oaks, California
04.2022 - 07.2023
- Partnered with stakeholders to develop robust clinical model to meet business' short and long-term goals.
- Launched UR department
- Supervised UR specialists
- Educate and train clincial staff on case conceptulation of co-occurring disorders and treatment planning to meet MNC
- Developed business relations with new payor sources
- Conducted thorough reviews of patient treatment plans for compliance.
- Coordinated with healthcare providers to gather necessary documentation.
- Collaborated with physicians, nurses, case managers, discharge planners, social workers and other healthcare professionals to develop a comprehensive plan of care within specified guidelines.
- Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
- Contacted insurance carriers to obtain authorizations for services delivered to patients.
- Analyzed treatment plans for appropriateness, effectiveness and medical necessity in accordance with established criteria.
Lead Utilization Review Specialist
Alsana: An Eating Recovery Community LLC
Ballwin, MO
01.2018 - 03.2022
- Clinical Supervisor to Utilization Review Specialists.
- Anticipated impending peer reviews, identified denial risk-levels, implemented action plans, and pioneered process improvement initiatives.
- Developed Admission Level of Care Scale and Intake Assessments, provided LOC recommendations for all preadmissions.
- Provided reoccurring in-services for Admissions and UR departments.
- Interviewed UR applicants, onboarded new hires.
- Performed pre-authorization, concurrent, retrospective, peer reviews, appeals, and SCAs.
- Innovated, launched Payor Personas, and trained clinical departments on best practice documentation to meet payor standards for recommended lengths of stay, at each LOC.
Utilization Review Specialist
Castlewood Treatment Center
Ballwin, MO
08.2015 - 01.2018
- Performed pre-authorization, concurrent, retrospective utilization reviews.
- Completed M.D. peer-to-peer reviews and expedited appeals.
- Departmental leader and key contributor to treatment team meetings; examined therapeutic, nutritional, and psychiatric interventions in accordance with insurance needs, to promote appropriate length of stay at all LOC.
- Trained and evaluated therapists' and dietitians' clinical documentation to reflect continued stay rationale across all payor sources.
Clinical Manager
McCalum Place Eating Disorder Treatment Center
St Louis, MO
09.2008 - 04.2015
- Worked alongside CFO, CEO, oversaw development, provision, and promotion of adult and adolescent ED services at all LOC.
- Spearheaded Victory Program for athletes with ED.
- Served as organizational leader, supervised therapists, dietitians, contract therapists, and interns; conducted annual reviews, and HR responsibilities.
- Provided individual, group, and family psychotherapy.
- Facilitated multidisciplinary treatment teams, in-services, and implemented quality measures for performance, compliance, and accreditation.
- Partnered with Medical Director, Psychiatrists, Nurse Manager to examine clinical models, patient progress, and treatment outcomes for best practice.
Postdoctoral Fellow, Manager
St Louis Behavioral Medicine Institute
St. Louis, MO
09.2006 - 08.2008
- Supervised by C. Alec Pollard, PhD, Director, Center for OCD.
- Managed IOP, Exposure Response Prevention for OCD.
- Administered Psychiatric Assessments and YBOCS; developed individualized treatment plans for adults and adolescents.
- Facilitated hoarding group.
- Individual, group, family therapist.
- Key contributor to treatment team meetings, program development, expansion of OCD services.
- Conducted research on families of treatment refusers.
Doctoral Intern
The Carson Center for Adults and Families
Westfield, MA
09.2004 - 08.2006
- Dialectical Behavior Therapy trained.
- Provided individual, group, family therapy for PTSD, substance abuse, mood disorders, schizophrenia.
- Administered Psychiatric Assessments; scored, interpreted, presented findings, and individualized treatment plans.
Doctoral Practicum Student
Yale University Center for Eating and Weight Disorders
New Haven, CT
07.2002 - 04.2003
- Supervised by Kelly D. Brownell, PhD, Maureen Schwartz, PhD.
- Administered ED assessments and Bariatric Evaluations.
- Provided individual and group therapy, Research in obesity, self/other attributions, and societal implications.
Education
Doctorate - Clinical Psychology
Antioch University New England
Keene, NH01.2006
Master of Science - Clinical Psychology
Antioch University New England
Keene, NH01.2004
Master of Arts - Counseling Psychology
Antioch University New England
Keene, NH01.2001
Bachelor of Science - Applied Health Science
Indiana University
Bloomington, IN01.1995
Skills
- Clinical review and compliance auditing
- Medical necessity assessment
- Utilization management strategies
- Treatment planning and interdisciplinary collaboration
Publications
- VanDyke, M., Pollard, C.A., Summers, J., Conlon, E., Brief consultation to the families of OCD treatment refusers, 2008
- Summers, J., The role of spirituality among cancer patients: A 'bodymind' relationship (Doctoral dissertation, Antioch University New England, 2006). UMI Dissertation Services., 2006
- Schwartz, M., Summers, J., Book review. Sensing the self: Women's recovery from bulimia., Journal of Psychosomatic Research, 57, 213-214, 2004
Personal Information
Title: PsyD
Timeline
Senior Utilization Review Specialist
Within Health Provider Services
08.2023 - Current
Utilization Review Specialist
Lightfully Behavioral Health
04.2022 - 07.2023
Lead Utilization Review Specialist
Alsana: An Eating Recovery Community LLC
01.2018 - 03.2022
Utilization Review Specialist
Castlewood Treatment Center
08.2015 - 01.2018
Clinical Manager
McCalum Place Eating Disorder Treatment Center
09.2008 - 04.2015
Postdoctoral Fellow, Manager
St Louis Behavioral Medicine Institute
09.2006 - 08.2008
Doctoral Intern
The Carson Center for Adults and Families
09.2004 - 08.2006
Doctoral Practicum Student
Yale University Center for Eating and Weight Disorders
07.2002 - 04.2003
Doctorate - Clinical Psychology
Antioch University New England
Master of Science - Clinical Psychology
Antioch University New England
Master of Arts - Counseling Psychology
Antioch University New England
Bachelor of Science - Applied Health Science
Indiana University
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