KERENE SPENCER
Coral Springs
Summary
Dedicated Behavioral Health Case Manager/Care Coach with a strong background in supporting high-risk populations through comprehensive behavioral and physical health care coordination. Skilled in member engagement, care plan development, crisis support, interdisciplinary collaboration, and connecting members to community-based resources, while ensuring adherence to NCQA and HEDIS quality standards. Highly organized and trauma-informed, with a consistent track record of managing complex caseloads through virtual and field visits and improving member health outcomes.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Care Manager (ECC / Enhanced Care Coordination)
Centene Corporation, Managed Care & Healthcare Solutions
02.2025 - 02.2026
- Develops, assesses, and facilitates complex care management activities for primarily physical needs members to provide high quality, cost-effective healthcare outcomes including personalized care plan development and education for members and their families.
- Evaluates the needs of the member, barriers to accessing the appropriate care, social determinants of health needs, focusing on what the member identifies as priority and recommends and/or facilitates the plan for the best outcome
- Develops ongoing care plan developement / service plans and collaborates with providers to identify providers, specialists, and/or community resources to address member's unmet needs
- Identifies problems/barriers to care and provide appropriate care management interventions
- Coordinates as appropriate between the member and/or family/caregivers and the care provider team to ensure members are receiving adequate and appropriate person-centered care or services
- Provides ongoing follow up and monitoring of member status, change in condition, and progress towards care plan developement/ service plan goals; collaborate with member, caregivers, and appropriate providers to revise or update care plan developement / service plan as necessary to meet the member's goals / unmet needs
- Provides resource support to members and care managers for local resources for various services (e.g., employment, housing, participant direction, independent living, justice, foster care) based on service assessment and plans, as appropriate
- Facilitate care management and collaborate with appropriate providers or specialists to ensure member has timely access to needed care or services
- May perform telephonic, digital, home and/or other site outreach to assess member needs and collaborate with resources
- Collects, documents, and maintains all member information and care management activities to ensure compliance with current state, federal, and third-party payer regulators
- Provides and/or facilitates education to members and their families/caregivers on disease processes, resolving care gaps, healthcare provider instructions, care options, referrals, and healthcare benefits
- Provides feedback to leadership on opportunities to improve and enhance care and quality delivery for members in a cost-effective manner
- Other duties or responsibilities as assigned by people leader to meet business needs
Care Navigator- SMI (Severe Mental Illness)
Centene Corporation, Managed Care & Healthcare Solutions
08.2024 - 02.2025
- Provide telephonic case management/ face to face field visits for high-risk members with complex behavioral health and medical needs, collaborating with providers to assess needs, set goals, and implement action plans for SMI patients.
- Implement SMI patient-centered strategies that empower members to improve quality of life through an integrated, whole-person approach.
- Ensure adherence to NCQA guidelines and HEDIS measures, supporting documentation and quality standards.
- Support compliance with referral, pre-certification, and authorization processes in collaboration with Medical Management to streamline service coordination.
- Review and approve initial and ongoing assessments and care plan developement to ensure alignment with established requirements and program expectations for SMI patients.
- Coordinate service requests and authorizations with Utilization Management (UM) teams, ensuring agreement and alignment between the members, agency, and MCO.
- Facilitate SMI member linkage to MCO services and support programs in collaboration with community-based agency partners.
- Assist with arranging transportation and removing barriers that impact member appointment attendance and treatment compliance.
- Communicate SMI member health status updates and key indicators to agency staff to support successful community living outcomes.
- Participate in weekly rounds with agency partners to review progress, address barriers, and adjust care plan developement development as needed for SMI patients.
LTSS & HCBS Case Manager/Care Coordinator
Humana Inc.
05.2021 - 06.2024
- Managed care coordination for members face to face in field visits requiring long-term treatment ensuring continuity of care and adherence to treatment plans through EMR documentation Systems.
- Conducted comprehensive assessments to identify medical, behavioral, and social needs
- Collaborated with interdisciplinary teams including providers, social workers, and specialists to develop individualized care plan developement in Assisted Living (ALF).
- Monitored member progress and adjusted care strategies to improve outcomes and reduce hospital readmissions.
- Ensured compliance with healthcare regulations including HIPAA and internal policies with patients and Assisted Living (ALF).
- Educated members and families on treatment plans, available resources, and preventive care strategies.
- Documented all case activities in accordance with regulatory and organizational standards.
- Patient assessments conducted throughtools such as UAS, CARES, and other tools.
- 701(b) Certified
Trinity CMHC, Inc. - Mental Health Counseling
12.2019 - 04.2021
- Completed 2000 required supervised clinical hours in accordance with state licensing requirements. Provided counseling support under licensed supervision.
- Provided crisis counseling to survivors of human trafficking, domestic violence, sexual abuse, and other trauma-related events.
- Developed individualized treatment plans and connected clients to appropriate resources following treatment completion.
- Responsible for reporting critical incidents to appropriate internal or external parties such as state and county agencies.
- Prepared written reports for court and appeared in court when necessary to support client cases.
- Provided reunification therapy, marital counseling, and individual counseling services based on client needs.
- Monitored and reviewed discharge plans and after-care arrangements to support continuity of care.
- Reviewed and audited clinical charts for documentation quality, accuracy, and completeness.
Education
Master of Science (MS) - Clinical Counseling
Nova Southeastern University
05-2022
Master of Business Administration (MBA) - Management
Nova Southeastern University
05-2016
Skills
- Care planning
- Case assessments
- Clinical documentation
- Service coordination
- Treatment management
- Care quality assessments
- Long-term care coordination
- Care transitions
- Patient & family support
Certification
- Registered Mental Health Counselor (RMHC) – State of Florida
- Registered Clinical Social Work Intern / Substance Abuse Registered Intern (or applicable credential)
- Certified Nursing Assistant (CNA)
- Basic Life Support (BLS) / CPR & First Aid
- Dementia Care Certification
- HIPAA Compliance Certification
- Crisis Prevention & Intervention (CPI)
Timeline
Care Manager (ECC / Enhanced Care Coordination)
Centene Corporation, Managed Care & Healthcare Solutions
02.2025 - 02.2026
Care Navigator- SMI (Severe Mental Illness)
Centene Corporation, Managed Care & Healthcare Solutions
08.2024 - 02.2025
LTSS & HCBS Case Manager/Care Coordinator
Humana Inc.
05.2021 - 06.2024
Trinity CMHC, Inc. - Mental Health Counseling
12.2019 - 04.2021
Master of Business Administration (MBA) - Management
Nova Southeastern University
Master of Science (MS) - Clinical Counseling
Nova Southeastern University
Community Service
VA Hospital, Provided mentorship and support to at-risk youth and adolescents facing behavioral, social, and environmental challenges, Assisted in developing life skills, conflict resolution, and coping strategies, Supported program activities focused on youth development and behavioral improvement, Maintained confidentiality and ethical standards when working with minors
PROFESSIONAL HIGHLIGHTS
- Managed an active caseload of 100+ members, providing whole-person care coordination across behavioral and physical health needs through in-person field visits.
- Completed 25–40 outreach attempts daily to improve member engagement, follow-up adherence, and care plan development progress.
- Connected 15–30 members monthly to community resources addressing SDOH barriers (housing, transportation, financial hardship) through hands on engagement.
- Coordinated 15–25 referrals/authorizations per month with UM/Medical Management to reduce delays and improve continuity of care.
- Maintained 95–100% audit-ready documentation, supporting compliance with NCQA standards and HEDIS measures.