Summary
Overview
Work History
Education
Skills
Licensure Certifications
Systems Tool Familiarity
Timeline
Generic

Kimberly Kolarik

De Land,IL

Summary

As an assistant manager, my primary objective is to support the functioning of business operations by managing staff, coordinating operations, and ensuring exceptional customer service. I aim to create a positive and productive work environment by communicating with team members, setting clear goals, and monitoring performance.

Overview

14
14
years of professional experience

Work History

Manager of Behavioral Health Grievance and Appeals

Anthem Blue Cross Blue Sheild
01.2022 - 05.2024
  • Responsible for management oversight of receipt, investigation, and processing associated with member/provider grievances and appeals
  • Maintains and coordinates staff activities to achieve departmental and corporate goals to improve service to members and providers, ensuring regulatory compliance
  • Analyzes and develops strategies by achieving performance thresholds within budgetary guidelines
  • Addresses both internal/external customer/provider needs and concerns related to team activities
  • Monitors, trends, and analyzes grievance and appeals data for submission to appropriate parties
  • Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretations of regulatory standards
  • Monitors and supports overall Quality Assurance program standards to meet regulatory compliance/accreditation and the company standards
  • May perform internal audits of grievance and appeals process
  • Ensure appeals and grievances are resolved within regulatory time frames
  • Hires, trains, coaches, counsels, and evaluates performance of direct reports (15-20 direct reports).

Sr. Behavioral Health Appeal Coordinator

Anthem Blue Cross Blue Sheild
05.2017 - 01.2022
  • Monitors, trends, and analyzes grievance and appeals data for submission to appropriate parties
  • Serves as clinical resource expert and mentor to unit and other departments for complex issues and interpretations of regulatory standards.

Outpatient Therapist

Psychology Specialists, LTD
08.2015 - 05.2017
  • Primary therapist offering individual and family therapy; Supporting the Transformations weight loss program; Supporting Primary Care Physician - all associated with Christie Clinics.

Clinical Director

Choices Care Coordination Solutions
09.2014 - 01.2015
  • Manage the day-to-day clinical supervision and operation of an Illinois Care Coordination Entity
  • Participated in policy and implementation development as required of IL HFS State Contract and Rule 132 provisions
  • Supported Strength Based learning within a Systems of Care Foundation
  • Managed a staff of 4 Care Coordinator Supervisors with oversight of 20 Care Coordinators
  • Provided clinical consultation for both Care Supervisors and Care Coordinators in facilitating services for high risk and hard to reach families
  • Created and implemented ongoing reporting strategies of internal development and external support related to youth enrollment and assignments
  • Facility weekly Clinical Group and Team Supervision
  • Responsibility for selecting, interviewing and hiring of new staff
  • Participated in scheduling and implementation of the 2 week New Hire Training.

Inpatient Utilization Manager

Centene/Cenpatico Corp.
02.2012 - 09.2014
  • Responsible for authorization and reviewing utilization of mental health and substance abuse services provided in an inpatient and intermediate care settings
  • Provide and/or review intakes and initial evaluations
  • Ensure compliance with all performance measures in regards to appeals, denials, higher level of care admission certification and concurrent review timeliness
  • Assist with discharge planning
  • Participate in special utilization projects
  • Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.

Short-Term Disability Specialist III

Sedgwick Claims Management Systems
03.2010 - 02.2012
  • Total claim management for short-term psychiatric and medical disability claims using Official Disability Guidelines
  • Benefit determination status based on evaluation of claimant functionality, job duties and best practice guidelines through medical record and live clinical discussion with treatment providers and claimant interviews
  • Claimant advocacy to help facilitate return-to-work planning and job accommodations for successful workplace re-entry and relapse prevention
  • Referral and reconciliation of claims escalated for physician review for benefit determination
  • Complete claimant risk assessment as needed.

Education

Master of Social Work -

Aurora University

Bachelor of Social Work -

Aurora University

Skills

  • Behavioral Health
  • Grievance and Appeals
  • Staff/Dept Management
  • Quality and Compliance
  • Clinical Documentation
  • Internal and External Auditing
  • Communication
  • Problem-solving

Licensure Certifications

  • Licensed Clinical Social Work, Illinois, #140-007969, active, no discipline
  • Licensed Clinical Social Work, Indiana, #34003436A, active, no discipline
  • Licensed Clinical Social Work, North Carolina, #C013929, active, no discipline

Systems Tool Familiarity

  • Microsoft Office 365 including SP and MS Teams
  • Windows 10 and 11
  • FACETS
  • JIRA
  • QUEST Auditing Tools
  • NextGen/Pega
  • ACMS
  • MACESS
  • EPIC

Timeline

Manager of Behavioral Health Grievance and Appeals

Anthem Blue Cross Blue Sheild
01.2022 - 05.2024

Sr. Behavioral Health Appeal Coordinator

Anthem Blue Cross Blue Sheild
05.2017 - 01.2022

Outpatient Therapist

Psychology Specialists, LTD
08.2015 - 05.2017

Clinical Director

Choices Care Coordination Solutions
09.2014 - 01.2015

Inpatient Utilization Manager

Centene/Cenpatico Corp.
02.2012 - 09.2014

Short-Term Disability Specialist III

Sedgwick Claims Management Systems
03.2010 - 02.2012

Master of Social Work -

Aurora University

Bachelor of Social Work -

Aurora University

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Kimberly Kolarik