KAYLIN BOCI
Waterford,NY
Summary
Dynamic clinical leader with over 10 years of progressive leadership experience in behavioral health and managed care. Proven ability to lead utilization and case management operations, ensure regulatory compliance, and drive operational excellence. Recognized for successfully leading NCQA audits, launching innovative clinical programs, and consistently exceeding performance and client satisfaction benchmarks. Collaborative leader dedicated to high-quality, value-based clinical care.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Director of Clinical Services
Carelon Behavioral Health
05.2017 - 11.2025
- Directed Utilization Management and Case Management operations for a large commercial account, overseeing daily clinical workflows and performance metrics.
- Led and supervised multidisciplinary clinical teams, ensuring timeliness, quality, and adherence to regulatory and contractual requirements.
- Ensured full compliance with NCQA standards, contributing to consistently successful UM and CM audits.
- Updated and maintained policies and procedures in alignment with federal, state, and local regulatory bodies.
- Served as a key contributor to the development and launch of a Substance Use Center of Excellence, partnering with a nationally recognized provider.
- Maintained high client satisfaction by consistently meeting or exceeding contractual Performance Guarantees.
- Presented clinical and operational insights at statewide Employee Assistance Program (EAP) Coordinator trainings.
- Engaged network providers to address performance challenges, recognize achievements, and strengthen partnerships.
- Presented utilization trends, outcomes data, and emerging clinical insights at quarterly Joint Operating Committee (JOC) meetings.
- Developed innovative programming supporting value-based care models, including initiatives focused on eating disorders and substance use treatment.
- Collaborated with behavioral and physical health medical directors to support integrated, whole-person care.
- Facilitated cross-departmental collaboration with claims, customer service, account management, and contracting teams to optimize outcomes.
Manager of Clinical Services
Carelon Behavioral Health
01.2015 - 05.2017
- Supervised Intensive Case Managers, Clinical Care Managers, and Clinical Service Assistants.
- Conducted annual performance evaluations and provided ongoing coaching and professional development.
- Guided staff in managing complex clinical cases and resolving care coordination challenges.
- Participated in NCQA audits and served as a member of the Quality of Care Committee.
- Collaborated with facilities through monthly meetings to ensure alignment and satisfaction with program initiatives.
- Reviewed and determined eligibility for disabled dependent status.
- Created, reviewed, and updated workflows to maintain compliance with standards of care.
- Interviewed, hired, and trained new clinical staff.
Clinical Care Manager
Carelon Behavioral Health
09.2011 - 01.2015
- Coordinated care with mental health and substance use treatment facilities to meet comprehensive member needs.
- Conducted clinical assessments and provided crisis intervention, ensuring appropriate and timely referrals.
- Ensured continuity of care through collaboration with inpatient and outpatient providers.
- Developed and managed comprehensive treatment plans for members enrolled in Intensive Case Management.
- Participated in multidisciplinary rounds with psychiatrists, nurses, social workers, and clinical staff.
- Provided therapeutic counseling and completed clinical reviews for medical appropriateness using established criteria.
- Maintained accurate and timely electronic documentation in accordance with company and regulatory standards.
Medicaid Service Coordinator
Catholic Charities Disabilities Services
12.2005 - 09.2011
- Created and reviewed Individualized Service Plans (ISPs) for OPWDD-eligible individuals.
- Advocated for the rights and needs of assigned individuals across service systems.
- Completed intake interviews and eligibility determinations.
- Documented services in compliance with regulatory requirements.
- Coordinated with community, government, and educational agencies to ensure comprehensive support.
Program Aide
New York State Office for People With Developmental Disabilities
01.2002 - 10.2005
- Served as liaison to program coordinators across 16 field offices.
- Monitored federal grant expenditures and analyzed database information.
- Prepared reports for project director monitoring visits.
- Developed and delivered PowerPoint presentations for staff training conferences.
- Updated and maintained policy manuals.
Education
Master of Social Work -
State University of New York At Albany
Albany, NY05-2010
Bachelor of Arts - Psychology
The College of Saint Rose
Albany, NY05-2005
Skills
- Strategic planning and program development
- NCQA and regulatory compliance
- Utilization and case management
- Clinical team leadership
- Staff development and training
- Operational efficiency
- Continuous improvement initiatives
- Stakeholder and client engagement
- Value-based care strategies
- Cross-functional collaboration
Certification
Licensed Master Social Worker (LMSW), New York State Office of the Professions
Timeline
Director of Clinical Services
Carelon Behavioral Health
05.2017 - 11.2025
Manager of Clinical Services
Carelon Behavioral Health
01.2015 - 05.2017
Clinical Care Manager
Carelon Behavioral Health
09.2011 - 01.2015
Medicaid Service Coordinator
Catholic Charities Disabilities Services
12.2005 - 09.2011
Program Aide
New York State Office for People With Developmental Disabilities
01.2002 - 10.2005
Master of Social Work -
State University of New York At Albany
Bachelor of Arts - Psychology
The College of Saint Rose