Rhiannan Francis
Winter Garden
Summary
Licensed Mental Health Counselor skilled in utilization management and patient assessment, with extensive experience in crisis intervention and care plan development. Proficient in collaborating with healthcare teams to ensure compliance and optimize quality of care across various settings, enhancing client relationships and outcomes.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Utilization Review Clinician
Centene Corporation
Orlando
12.2021 - Current
- Reviewed and authorized mental health and substance abuse service utilization, ensuring appropriate care in inpatient settings.
- Authorized and supervised care based on clinical information and criteria for medical necessity.
- Conducted comprehensive assessments to identify member health needs, informing tailored care plans.
- Collaborated with interdisciplinary teams to coordinate patient care services.
- Monitored quality of care and analyzed utilization and cost data for effectiveness.
- Verified subscriber eligibility and benefits for mental health and substance treatment, facilitating timely service authorization.
- Ensured compliance with regulatory guidelines and organizational policies consistently.
Utilization Review Coordinator
Central Florida Behavioral Hospital
Orlando
11.2020 - 12.2021
- Conducted admission and concurrent reviews for medical necessity across various levels of care.
- Collaborated with healthcare teams to develop and refine patient care plans, ensuring alignment with medical necessity standards.
- Facilitated resolutions and approvals by submitting cases for criteria failures, streamlining the review process and expediting patient access to necessary care.
- Monitored authorization requests and tracked approval statuses efficiently.
- Identified insurance benefits, pre-certified patient care, and completed admission requirements.
- Educated staff on regulatory requirements and best practices in utilization review, enhancing compliance and patient care outcomes.
- Delivered hospital and program information to agencies and professionals for outside referrals.
Intake Assessor
Central Florida Behavioral Hospital
Orlando
11.2018 - 11.2020
- Conducted comprehensive assessments to identify patient needs for inpatient behavioral health services.
- Assessed risk factors for suicide and other self-harm behaviors.
- Coordinated intake processes to ensure timely patient admissions.
- Reviewed and evaluated patient histories to ensure appropriate care levels and enhance treatment outcomes.
- Communicated effectively with patients and families regarding services offered.
- Delivered timely crisis intervention support.
- Responded promptly to inquiries from referral sources regarding availability of beds or wait times for admission into program services.
- Performed administrative tasks for patient admissions, including insurance updates and form completion, to streamline intake process.
Mental Health Therapist
True Core Behavioral Solutions
Orlando
11.2016 - 11.2019
- Delivered counseling services to youth in residential treatment, focusing on individual challenges and personal growth.
- Created a safe therapeutic environment for adolescents, addressing anger, aggression, substance use, impulse control, decision making, and illegal behaviors.
- Performed client assessments and developed treatment plans.
- Led psycho-educational groups for adolescents on anger management, teen relationships, life skills, substance use, coping skills, and empathy training.
Advance Care Planning Specialist II
Vital Decision
White Plains
04.2016 - 11.2016
- Facilitated nationwide conversations with clients and families to guide them through advance illness and decision-making processes.
- Empowered clients to better plan for their future by identifying their quality of life priorities and become more active in integrating these priorities into their medical decisions about their care, both now and in the future.
- Employed a client-centered, solutions-focused approach grounded in Motivational Interviewing (MI) to empower clients in controlling their care decisions.
- Applied techniques to enhance clients' self-awareness and confidence in planning for future health concerns.
Domestic Violence Counselor
My Sister's Place
Yonkers
11.2015 - 04.2016
- Conducted individual and family counseling sessions for survivors of Intimate partner violence and their children.
- Motivated clients to gain autonomy and control in relationships.
- Educated and assisted clients in the achievement of healthy relationships.
- Worked collaboratively with Child Protect Services (CPS) staff and the Department of Social Services (DSS) to develop appropriate plans of action for each family.
- Provided crisis intervention and safety planning, and accompanied clients to court while advocating for public assistance.
- Maintained program statistics and drafted monthly/quarterly reports in compliance with funding requirements and objectives.
Education
Master of Arts - MENTAL, COUNSELING
University of Central Florida
Orlando, FL08-2015
Bachelor of Science - Psychology
Andrews University
Berrien Springs, MI05-2012
Skills
- Utilization management
- Patient assessment
- Medical necessity criteria
- Healthcare systems navigation
- Interdisciplinary collaboration
- Clinical documentation
- Clinical assessment
- Motivational interviewing
- Therapy and counseling
- Individual and family support
- Resource identification
- Leadership
- Skill training
- Teaching and mentoring
Certification
- LMHC #16773
Timeline
Utilization Review Clinician
Centene Corporation
12.2021 - Current
Utilization Review Coordinator
Central Florida Behavioral Hospital
11.2020 - 12.2021
Intake Assessor
Central Florida Behavioral Hospital
11.2018 - 11.2020
Mental Health Therapist
True Core Behavioral Solutions
11.2016 - 11.2019
Advance Care Planning Specialist II
Vital Decision
04.2016 - 11.2016
Domestic Violence Counselor
My Sister's Place
11.2015 - 04.2016
Master of Arts - MENTAL, COUNSELING
University of Central Florida
Bachelor of Science - Psychology
Andrews University