Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

J. RACHEL KRAUSS BURROWS

Pittsburgh,PA

Summary

Highly efficient LCSW with over twenty years experience in the behavioral health field and over fifteen years in managed care. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. Dedicated individual with excellent interpersonal and communication skills builds meaningful relationships with clients and coworkers.

Overview

19
19
years of professional experience
1
1
Certification

Work History

Behavioral Health Care Manager, Team Lead

Cigna Medicare
11.2022 - Current
  • Team Lead as of February 2023: :
  • Assist other case managers with complex cases
  • Mentor new case managers, sharing best practices and job duties
  • Support Behavioral Health Care Management manager in creating new processes and work flows, executing daily functions, and supporting team of nineteen
  • Subject Matter Expert on processes, audits, and workflows
  • Care Management duties include:
  • Assist Medicare members and their family through transitions of care and location of network BH outpatient providers
  • Provide comprehensive case management services, create treatment plans, and connect clients and families to appropriate resources
  • Support members in navigating their Medicare by providing expert guidance on coverage benefit
  • Assess mental health needs to determine nature and extent of clients' emotional, behavioral or mental health issues
  • Reduce hospital readmissions with thorough case management and effective coordination of care
  • Conduct assessments to determine individual needs and develop personalized care plan to address stated objectives
  • Connect patients to community resources, increasing support networks and promoting overall wellbeing
  • Demonstrate strong organizational and time management skills while managing multiple projects

Behavioral Health Utilization Manager, Team Lead

Cigna Medicare
02.2022 - 10.2022
  • Team lead for Concurrent Review Behavioral Health Utilization Management team
  • Conducted internal audits to ensure quality and compliance with CMS and NCQA guidelines
  • Provided on-going training to existing staff and training of new staff
  • Assisted team of 12 in daily job duties and procedures, and problem solving complex cases
  • Facilitated meetings and assisted Managers of BH UM team in all other daily functions

Behavioral Health Utilization Manager

Cigna Medicare
10.2019 - 02.2022
  • Performed telephonic and faxed reviews to determine appropriateness of psychiatric and substance use inpatient care for Medicaid and Medicare covered members.
  • Applied behavioral health criteria to conduct reviews according to accepted and established criteria as well as other approved guidelines.
  • Referred cases to Medical directors for peer reviews when cases were not meeting criteria
  • Evaluated and referred cases to quality of care, disease management, and care management programs as needed
  • Assisted with discharge planning
  • Maintained strong working relationship with internal and external customers and documented information into clinical management system

Behavioral Health Community Based Care Coordinator

Cigna Healthspring
05.2011 - 10.2019
  • Coordinated care of over 70 high-risk Medicare members with mental health diagnoses and provided assessment and intervention as needed
  • Worked closely with member, family, and providers telephonically and in person to identify and resolve barriers to care and identify resources
  • Facilitated member care transitions to appropriate level of care and support
  • Collaborated with member and medical providers to develop integrated, individualized care plans for customers with special needs (SNP)

Prevention, Education, & Outreach Coordinator

Value Options Behavioral Health
09.2009 - 04.2011
  • Developed and implemented on-going behavioral health outreach to TennCare Select members (foster children and children with severe disabilities who have Medicaid), family members, schools, and community agencies
  • Oversaw research, development, coordination, and implementation for educational support groups, presentations, outreach events, and other prevention, recovery and education activities
  • Formed and chaired Behavioral Health Advisory Committee

Director of Tenncare Partners Advocacy Line (TPAL)

Mental Health Association Of Middle Tennessee
10.2008 - 07.2009
  • Maintained, updated, and monitored quality of TennCare Partners Advocacy Line program
  • Ensured program achieved its goal to provide highest level of advocacy and outreach to clients who have TennCare (Medicaid) and mental health/substance abuse concerns
  • Hired, trained, supervised, and facilitated development of staff members including Advocacy Specialists, Outreach Specialists, and Manager of Operations
  • Oversaw a budget ranging from $320,000-$640,000 through a contract with the State of Tennessee
  • Interacted and provided policy input for key stakeholders in mental health community, including Bureau of TennCare, non-profit agencies, and TennCare providers/members.
  • Enhanced team collaboration through regular communication, goal setting, and performance evaluations

Manager of Outreach And Education of TPAL

Mental Health Association Of Middle TN
05.2005 - 09.2008
  • Provided outreach, advocacy, education, and TennCare Medicaid information to hundreds of clients with mental illness
  • Directed communications to mental health professionals, advocates, service providers, and clients through newsletter, outreach events, meetings, and trainings/presentations
  • Designed and executed projects and outreach materials
  • Supervised outreach team.

Education

Master of Arts in Social Work - Clinical Social Work and School Social Work

University of Chicago, School of Social Service Administration (S.S.A.)
Chicago, IL
05.2001

Bachelor of Arts - Religious Studies

Connecticut College
New London, CT
05.1997

Took classes in areas of Psychology, Education, Mexican History, and Spanish -

Universidad De Las Americas
Cholula, Mexico
2003

Skills

  • Medicare Behavioral Health Utilization and Case Management
  • Case documentation
  • Organizational change management
  • Data entry, analysis and reporting
  • Management/Supervision and Training
  • NCQA, SNP, and CMS documentation and audits
  • Excellent verbal and written communication skills
  • Ability to handle confidential and personal information with respect and understanding
  • Effectively use creativity, intuition, and imagination in problem solving, networking, and process improvement
  • Multitasking Abilities
  • Social Perceptiveness
  • Analytical and Critical Thinking

Certification

  • Certified Case Manager, 4208683
  • LCSW Tennessee, LSW00000006424
  • LCSW Pennsylvania, CW022021
  • Harvard Global Mental Health Trauma and Recovery Certificate

Timeline

Behavioral Health Care Manager, Team Lead

Cigna Medicare
11.2022 - Current

Behavioral Health Utilization Manager, Team Lead

Cigna Medicare
02.2022 - 10.2022

Behavioral Health Utilization Manager

Cigna Medicare
10.2019 - 02.2022

Behavioral Health Community Based Care Coordinator

Cigna Healthspring
05.2011 - 10.2019

Prevention, Education, & Outreach Coordinator

Value Options Behavioral Health
09.2009 - 04.2011

Director of Tenncare Partners Advocacy Line (TPAL)

Mental Health Association Of Middle Tennessee
10.2008 - 07.2009

Manager of Outreach And Education of TPAL

Mental Health Association Of Middle TN
05.2005 - 09.2008

Master of Arts in Social Work - Clinical Social Work and School Social Work

University of Chicago, School of Social Service Administration (S.S.A.)

Bachelor of Arts - Religious Studies

Connecticut College

Took classes in areas of Psychology, Education, Mexican History, and Spanish -

Universidad De Las Americas

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