Julie Mark

• Managed the Intensive Case Management Program for Emblem Health. Supervised approximately 12 employees, including quarterly audits, sharing metrics and caseload management.
• Maintain departmental and State standards and measures. Plan and implement work flows to prioritize competing tasks in order to meet deadlines and manage time effectively.
• Prepare staff for Article 44 survey, NCQA re-accreditation and various other oversight.
• Complete delegate audit, weekly and monthly Plan reports and various State reports.
• Work with other departments such as claims, utilization management and operations to address any departmental or Plan need, and responsible for responding and resolving DFS complaints.
• Reviewed and updated Policies and Procedures.
• Facilitated integrated rounds with Plan partner.
• Review Power BI and leveraged metrics to identify areas of improvement.

• Supervised fourteen Behavioral Health Staff. Met with all staff weekly, completed monthly and quarterly audits, and managed case loads.
• Used objective tools, information, data and feedback in order to establish performance goals for individuals and the team.
• Participated in QARR/HEDIS initiatives and had an active role in the HARP implementation.
• Evaluated employee performance and coached and trained to improve weak areas.

• Prepares statistical and narrative reports as requested by administrative staff on utilization patterns, illustrating the number of patients admitted, estimated length of stay, and covered/denied days.
• Chart review to ensure that diagnosis, treatment and documentation are meeting the standard of care.
• Prepares narrative reports as requested by administrative staff on utilization patterns, illustrating the number of patients admitted, estimated length of stay, and covered/denied days.
• Ensures compliance with all regulatory agency requirements and contracted Insurance Agencies.
• Train PGY-1 and program staff on current principals and standards of practice of Utilization Management, basic treatment coding, documentation and reimbursement.

methodologies.

• Performed prior authorization review of services requiring notification.
• Managed NYPCHP’s Continuous Quality Improvement Project, requiring a review of at least 500 Behavioral Health Provider charts as directed by NYSDOH. Utilized NCQA and audit tool to compute scores.
• Project managed data collection of over 1,000 providers’ credentials and information for the finance department allowing them to automate billing, minimizing claims errors and contributing to a savings of nearly $1,000,000 dollars.
• Wrote required authorization and denial letters in compliance with Public Health Law.

• Counsel approximately 50 patients around their chronic medical, psychiatric and substance abuse problems.
• Submission of well written, comprehensive reports to Human Resource Administration; continued services contingent upon this submission.
• Reviewed charts and sent corrective action letters to prepare the agency for audits.
• Comprehensive biopsychosocial evaluations to determine appropriateness for home care and nursing visits.