Mary Hoffman

• Uses appropriate screening criteria knowledge and clinical judgment to assess member needs to ensure access to medically necessary quality behavioral/substance abuse healthcare in a cost-effective setting in accordance with UM Clinical Guidelines and contract.
• Refers cases to Peer Reviewers as appropriate.
• Performs psychiatric and substance abuse assessment coordination implementation, case planning, monitoring, and evaluating to promote quality member outcomes to optimize member health benefits and to promote effective use of health benefits and community resources.
• Collaborates with interdisciplinary teams to provide integrated care for patients with complex needs.
• Develops strong relationships with community providers to facilitate seamless transitions between levels of care for clients.

• Maintains a working member caseload drawn from a daily psychiatric acute care hospital census.
• Collaborates with members, utilization managers, hospital social workers, family members, mental health centers and various other community agencies to develop an effective and appropriate hospital discharge plan for the member.
• Provides seven day follow up to the member/family to ensure that the member is receiving appropriate outpatient mental health care in the community and to remove any barriers to that care.
• Collaborates with the Colorado Mental Health Institute at Fort Logan to provide consultation and assistance with discharge planning and community follow up for CCHA members currently hospitalized there.
• Collaborate with CCHA BTOC - Behavioral Health Transitions of Care - teammates and Lead Behavioral Health Care Coordinator to manage daily work flow.
• Completes all requires Anthem trainings, all required CCHA quarterly trainings, and all trainings required to maintain state social work licensure in a timely manner.

Facilitated clients' successful transition from locked psychiatric facility to community in the following ways:

• Built trusting relationships with assigned clients and collaborated with all entities involved with providing care to that client, including but not limited to, Colorado Mental Health Institute Fort Logan and Pueblo staff, acute psychiatric hospital staff, outpatient mental health center staff, placement staff (assisted living facilities, nursing homes, landlords), and support networks (family, friends, peer specialists).
• Identified gaps in service for clients and determined if needed services were covered by Medicaid or a third payer source. If not covered, determined if needed services were clinically indicated and if so, provided/purchased said identified services for clients.
• Facilitated discharge/transition team collaboration by initiating and maintaining group communication throughout the transition process via emails, phone conferences, and in-person meetings.
• Negotiated with outpatient mental health centers, potential placements, and any other treatment provider (e.g., substance use treatment provider) to establish transition services which would persuade said entities to accept clients, including but not limited to, one-to-one aides, DME not covered by Medicaid, SOMB risk assessments, and various trainings for facility staff.
• Provided transportation as needed for clients both during and after discharge from the hospital.
• Managed corporate credit card, completed required paperwork in a timely manner, and completed all required company trainings and competencies.
• Provided individual supervision to MSW license-eligible colleagues and peer specialists, as well as participating in clinical team case consultation.
• Worked in Utilization Management Department as needed to cover open shifts. Communicated with hospitals and mental health centers to facilitate the authorization process for various levels of psychiatric care for adults and children meeting criteria.

Worked in Emergency Room, Medical/Surgical Floors, and Inpatient Psychiatric Unit:

• Provided mental health and substance abuse evaluation and brief targeted intervention to address emotional, substance use, social, and environmental issues to patients in the emergency room and on the medical/surgical floors.
• Facilitated psychiatric hospitalization (voluntary & involuntary) as needed.
• Provided counseling to patients to address issues of grief and loss, and collaborated with Hospice and probate court to address end-of-life issues.
• Provided clinical supervision to a hospital social work intern.
• Provided psychosocial assessment, treatment planning, therapeutic groups utilizing Dialectical Behavior Therapy (DBT), and discharge planning to patients on the inpatient psychiatric unit.

Worked in Child & Adolescent Outpatient Services:

• Provided psychosocial assessment, treatment planning, individual psychotherapy, family therapy, and targeted case management services to children and adolescents diagnosed with Severe Emotional Disturbance (SED) and their families.
• Assessed crisis situations and collaborated with Crisis Team to determine need for inpatient psychiatric hospitalization.
• Participated in Parent Management Training - Oregon Model (PMTO) program, which teaches advanced parenting skills, and trained parents in this method.