Kimberly Wiggins
Clarkesville,GA
Summary
Dynamic Utilization Review Specialist with a proven track record at Eagle Overlook Recovery for Adolescents, excelling in regulatory compliance and interdisciplinary collaboration. Expert in clinical documentation, I effectively guided teams in optimizing patient care, ensuring adherence to standards while fostering a culture of continuous improvement and education.
Overview
16
16
years of professional experience
1
1
Certification
Work History
Utilization Review Specialist
Eagle Overlook Recovery for Adolescents
Dahlonega, GA
02.2020 - Current
- Conducted concurrent reviews to monitor the ongoing appropriateness of services provided to members.
- Maintained accurate documentation related to all activities performed in compliance with departmental policies.
- Provided education and guidance on utilization management principles to internal staff members.
- Participated in interdisciplinary team meetings to discuss complex cases or those requiring an alternative treatment plan or continued stay evaluation.
- Reviewed appeals from providers regarding denied admissions or services according to organizational standards and procedures.
Clinical Director
Eagle Overlook Recovery for Adolescents
Dahlonega, GA
02.2020 - Current
- Reviewed reports from various committees regarding clinical activities.
- Monitored patient progress, ensuring quality care was provided.
- Facilitated communication between physicians, nurses, administrators, and other stakeholders.
- Attended conferences to stay up-to-date on best practices in healthcare management.
- Ensured compliance with all state and federal regulations related to clinical services.
Primary Therapist
Black Bear Lodge
Sautee Nacoochee, GA
04.2015 - 01.2020
- Facilitate Master Level groups (DBT, CBT, Trauma Lecture, Codependency)
- Create individualized treatment plans
- Weekly family and individual sessions
- Facilitate and teach workshops during the 3-day family program
- Run daily therapeutic process group
- Participate in interdisciplinary treatment team staffing and present caseload
Clinical Associate
Black Bear Lodge
Sautee Nacoochee, GA
02.2015 - 04.2019
- Facilitate Psychoeducational groups
- Implement and lead mentorship program
- Participate in interdisciplinary treatment team staffing
- Facilitate experiential therapies and group activities
- Utilize motivational interviewing for de-escalation and crisis intervention
Residential Assistant
Black Bear Lodge
Sautee Nacoochee, GA
04.2014 - 02.2015
- Observe, interact and assess patients hourly
- Timely documentation of patient mood, behavior and mental status
- Facilitate groups on recovery, relapse prevention, life skills and relationships
- Supervise and transport patient outdoor activities
Substance Abuse Counselor
HealthQuest
09.2012 - 04.2014
- Maintained a caseload of 50 patients
- Developed timely individualized treatment plans
- Provided case management and follow up referrals
Mental Health Technician
Laurelwood Psychiatric Hospital
02.2011 - 08.2012
- Maintained patient safety
- Facilitated groups on coping skills, triggers, self-esteem, boundaries and relapse prevention
- Supervised Recreational Therapy and Safety
- Monitored, documented and assessed patients
- Observed and recorded patients every fifteen minutes
Senior Field Instructor
Second Nature Blue Ridge
06.2009 - 02.2011
- Provided support to individuals with trauma, behavioral and substance use disorders
- Mentored and trained upcoming senior field instructors
- Facilitated groups on communication, boundaries, addiction, and anger management
- Administered medications to students while living in wilderness conditions
- Role modeled and taught assertive communication and feedback
- Assessed and executed risk management decisions
Education
Master of Science - Social Work
Widener University
Chester, PA12-2017
Skills
- Utilization management
- Clinical documentation
- Regulatory compliance
- Interdisciplinary collaboration
Personal Information
Work Permit: Authorized to work in the US for any employer
Credentials
- LMSW
- CACII
Certification
- Certified Addictions Counselor
- Licensed Master Social Work
Timeline
Utilization Review Specialist
Eagle Overlook Recovery for Adolescents
02.2020 - Current
Clinical Director
Eagle Overlook Recovery for Adolescents
02.2020 - Current
Primary Therapist
Black Bear Lodge
04.2015 - 01.2020
Clinical Associate
Black Bear Lodge
02.2015 - 04.2019
Residential Assistant
Black Bear Lodge
04.2014 - 02.2015
Substance Abuse Counselor
HealthQuest
09.2012 - 04.2014
Mental Health Technician
Laurelwood Psychiatric Hospital
02.2011 - 08.2012
Senior Field Instructor
Second Nature Blue Ridge
06.2009 - 02.2011
Master of Science - Social Work
Widener University
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