Karen Chan Capece
Castro Valley,CA
Summary
Licensed Clinical Social Worker with 20 years of experience in behavioral health administrative and clinical settings. Administrative experience includes director-level roles and responsibilities that span the range of Specialty Mental Health Services (SMHS) and Substance Use Disorder (SUD) services. Primary clinical experience has been in adult inpatient and crisis services. Through successful stakeholder engagement, partnership and program alignment, I have developed and implemented strategies to improve systems and quality of care. I have also led and overseen various State audits and performance reviews which have year-over-year improvements and sustained high compliance and performance ratings. Through a health equity lens and focus, I have led initiatives and projects to successfully outreach, engage and treat individuals and families with cultural, linguistic and other social determinants of health considerations.
Overview
18
18
years of professional experience
Work History
Quality Management (QM) Program Director
Alameda County Behavioral Health Care Services (ACBH)
08.2020 - Current
- Oversee, develop, coordinate, and implement Quality Management Program in accordance with federally mandated quality assessment and performance improvement requirements
- Evaluated and restructured the ACBH QM Program into three aligned Quality Divisions: Quality Assurance (QA), Quality Improvement and Data Analytics (QIDA), and Utilization Management (UM), resulting in improved processes, performance and outcomes (i.e
- Accessible, timely, appropriate, cost-effective and quality services)
- Oversee and direct various State system audits and reviews (e.g
- Department of Health Care Services Triennial Audit; External Quality Review), resulting in year-over-year findings improvements and ratings ranging between 90-100%
- Oversee and direct federal and State reporting requirements (e.g
- Network Adequacy Certification, performance data), that have resulted in 100% compliance findings and/or significantly improved performance metrics
- Lead, partner and collaborate to successfully implement various federal and State policy requirements (e.g
- Centers for Medicare and Medicaid (CMS) Managed Care Final Rule; California Advancing and Innovating Medi-Cal (CalAIM) Behavioral Health Initiatives).
Interim Deputy Director, Plan Administration
ACBH Plan Administration
11.2022 - 06.2023
- Chief Operating Officer (COO) for ACBH administrative arm, comprised of Finance, Information Systems (IS), Mental Health Services Act (MHSA), and Quality Management (QM); partnered with ACBH Deputy Director, Clinical Operations to ensure overall departmental operational effectivity and efficiency
- Executive Sponsor for the ACBH billing and claiming system transition (i.e
- SmartCare), resulting in the successful go-live
- Note: SmartCare Executive Sponsorship from November 2022 – January 2024
- Evaluated Behavioral Health Plan landscape needs
- Strategized, advocated and partnered towards the successful approval of additional staffing through the Board of Supervisors (BOS).
Utilization Management (UM) Division Director
ACBH Quality Management Program
03.2017 - 08.2020
- Oversight and implementation of CMS Managed Care Final Rule coverage and authorization requirements, resulting in the successful implementation of new and revised utilization review and authorization processes to ensure appropriate levels of care and resource management
- Developed utilization data reporting systems for both SMHS and SUD treatment services and rendered presentations that resulted in data-informed system decisions
- Oversaw and directed coordination of the Department of Health Care Services (DHCS) Short Doyle/ Medi-Cal (SD/MC) Hospital Triennial Audit, resulting in 80-100% compliance ratings, compared to the historic under 50%
- Subject matter expert and respondent for a range of federal and State audits and reviews.
UM Clinical Review Specialist Supervisor
ACBH Quality Management Program
11.2014 - 03.2017
- Responsible for overall day-to-day operations
- Improved processes and successfully ensured authorization requirements and timeliness standards were upheld
- Developed, wrote, and implemented utilization review and authorization policies and procedures
- Served as ACBH clinical lead and successfully transitioned the care for large-scale agency-to-agency transfers of hundreds of beneficiaries due to benefit coverage shifts in delivery systems and provider contract changes
- Developed and rendered trainings to ACBH staff and contracted Community Based Organization (CBO) providers.
UM Clinical Review Specialist
ACBH Quality Management Program
11.2013 - 11.2014
- Conducted utilization review and authorization functions in accordance with Medi-Cal medical necessity criteria and authorization requirements
- Served as UM lead to develop, implement, and monitor special projects.
Behavioral Health Clinician II
ACBH Crisis Response Program
09.2007 - 11.2013
- Conducted phone screenings and assessments, to include DSM diagnostics
- Provided crisis intervention, brief outpatient therapy and case management for symptom stabilization
- Assessed and authorized levels of care through direct face-to-face evaluation and/or clinical record review
- Collaborated with law enforcement to render mobile crisis evaluations and wrote involuntary psychiatric legal holds (i.e
- 5150).
Social Worker III
Alameda County Social Services Agency (SSA) SSI Advocacy Unit
07.2007 - 09.2007
- Conducted face-to-face employability assessments for General Assistance (GA) recipients
- Provided information and referral and completed shelter vouchers
- Aided individuals in Social Security Insurance (SSI) application process.
Psychiatric Social Worker
Telecare Villa Fairmont Mental Health Rehabilitation
11.2005 - 07.2007
- Served as an integral part of a multidisciplinary team
- Conducted risk and psychosocial assessments
- Facilitated family meetings and obtained other collateral information, inclusive of historical clinical record review
- Provided individual therapy and rehabilitation
- Conducted and coordinated discharge and aftercare planning.
Education
Masters in Social Welfare (MSW) - Community Mental Health
University of California, Berkeley
Bachelor of Arts (BA) in Psychology -
University of California, Los Angeles
Skills
- Strategic Planning/Implementation
- Change Management
- Regulatory Compliance
- Team Building/Training
- Relationship Building
License
California Board of Behavioral Sciences, LCSW #24781, 2008-Present
Languages
- English
- Chinese (Cantonese dialect)
Timeline
Interim Deputy Director, Plan Administration
ACBH Plan Administration
11.2022 - 06.2023
Quality Management (QM) Program Director
Alameda County Behavioral Health Care Services (ACBH)
08.2020 - Current
Utilization Management (UM) Division Director
ACBH Quality Management Program
03.2017 - 08.2020
UM Clinical Review Specialist Supervisor
ACBH Quality Management Program
11.2014 - 03.2017
UM Clinical Review Specialist
ACBH Quality Management Program
11.2013 - 11.2014
Behavioral Health Clinician II
ACBH Crisis Response Program
09.2007 - 11.2013
Social Worker III
Alameda County Social Services Agency (SSA) SSI Advocacy Unit
07.2007 - 09.2007
Psychiatric Social Worker
Telecare Villa Fairmont Mental Health Rehabilitation
11.2005 - 07.2007
Masters in Social Welfare (MSW) - Community Mental Health
University of California, Berkeley
Bachelor of Arts (BA) in Psychology -
University of California, Los Angeles
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