Shoshana Altintas
Lexington,South Carolina
Summary
I am a forward-thinking Senior Manager adept at managing a department of 158 employees with 11 direct reports to ensure challenging objectives are met. I impart a clear vision to guide cohesive, high-performing teams in a fast-paced and quickly evolving environment.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Senior Manager
AETNA, A CVS HEALTH COMPANY
07.2021 - Current
- I am responsible for the day-to-day oversight of a robust behavioral health care management department, including seven clinical teams and three non-clinical teams serving 4.7M Medicare Advantage and Dual Special Needs Plan members
- Through my proactive and collaborative leadership style, I have successfully built my department from roughly 70 employees to 158 over 8 months, while stemming attrition and saving Aetna/CVS Health the costs of hiring, onboarding and training replacement staff
- I have also successfully engaged an entirely Work From Home department, ensuring all colleagues are included. Our department employee engagement surveys are consistently among the highest in the overall organization and outscore CVS Health overall, and I have achieved an engagement score of 90 in my team of 11 direct reports
- I lead efforts to redesign our Behavioral Health Care Management programs to ensure the unique needs of the populations we serve are met, and my teams have achieved a 97% member satisfaction rate
- Under my leadership, we have successfully driven down 30-day readmission rates and improved members' quality of life as demonstrated by measurably lowering depression and anxiety symptoms
Clinical Supervisor
AETNA, A CVS HEALTH COMPANY
06.2019 - 07.2021
- Key accomplishments and contributions include: Presentation of case files for review during the NCQA Case Management Accreditation Survey, October, 2019, which resulted in the Medicare CM program receiving ongoing accreditation
- Collaborated with multidisciplinary teams to coordinate care for clients with complex needs, ensuring comprehensive support was provided across all domains of life functioning.
- Completed redesign work on the Initial and Follow Up assessments used in Medicare CM, which have streamlined internal and external audit processes, as well as creating a more efficient work flow for clinicians.
- Monitored, analyzed, and corrected staff performance to raise standards of practice and improve member outcomes.
Clinical Team Lead
AETNA, A CVS HEALTH COMPANY
06.2017 - 06.2019
- As the clinical team lead for the Behavioral Health Medicare RAP (Readmission Avoidance Program) and CMCM (Co-morbid Condition Management) team, I was responsible for ensuring team members are up to date on workflows, required trainings and policy changes
- Responsible for new hire precepting and training and working with the Clinical Supervisor to promote a positive, inclusive work environment
- In addition to responsibilities as Team Lead, I conducted behavioral health case management with Aetna Medicare Advantage Members, maintaining an active caseload of 25-30 members
Clinical Case Manager
AETNA, A CVS HEALTH COMPANY
06.2015 - 06.2017
- As a Behavioral Health Clinical Case Manager, provided support to Medicare Advantage members recently discharged from a Behavioral Health inpatient admission with the ultimate goal of assisting the member in avoiding readmission within the first 31 days of discharge
- Conducted initial and ongoing needs assessments, ensured linkage to appropriate resources and referrals, and provided clinically-based coaching to ensure members achieved their mental health and wellness goals
- Co-managed medical conditions in the context of behavioral health case management, as appropriate
- Additionally, supported multidisciplinary team rounds by providing behavioral health insights to medical case management teammates.
Clinical Manager
HMC HEALTHWORKS
11.2014 - 06.2015
- In this newly created role, co-developed and implemented a utilization management program from the ground up focused on the unique needs of Taft-Hartley Trust members, integrating EAP and traditional behavioral health services. The program was able to achieve URAC accreditation as a result.
- Responsible for day-to-day management of this UM program including direct supervision and training of 20 clinical and non-clinical staff as well as performing Utilization Management, Retrospective Review and Appeals Specialist duties.
- Developed and configured clinical and non-clinical documentation templates and modules in the data collection program, Incedo, and was responsible for maintenance, ongoing configuration needs and problem solving of the system on a day-to-day basis.
Clinical Supervisor
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
07.2012 - 11.2014
- Supervised a team of 12 case managers working with commercial, Medicaid and Medicare Advantage members, and provided coverage for overflow cases, and when CMs were on scheduled leave
- Point-of-contact for clients transitioning services from former MCOs to APS, including identifying needed resources, program and gap analysis, and assisting members and providers in the transition
- Regularly interacted with physician advisors, account executives, providers, patients and all other APS departments to facilitate and support collaborative, effective work processes
- Regularly audited all high-dollar claims for one client, which resulted in the identification of over $100,000 of improperly paid claims, leading to a significant cost savings for the client
- Worked with Program Director in the development and facilitation of three quality improvement projects related to key clinical, patient safety and service performance metrics
- These QIPs were focused on improving rates of 7-day follow up compliance in Commercial and Medicaid patients, identifying and reducing instances of over-utilization, inappropriate utilization and improper billing of outpatient mental health services in Commercial patients, and in reducing the prescription of antipsychotic medications to children under the age of 4 in a Medicaid population
- Presented the findings and outcomes from these QIPs during a successful URAC HUM re-accreditation site visit.
Intake Team Lead
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
05.2010 - 07.2012
- Managed multiple responsibilities in concurrent positions as Intake Team lead and Clinical Care Manager
- Provided administrative supervision of 5-member Intake Team Care Management staff
- Trained all new clinical staff members in APS corporate policies and procedures, care management, and IT systems
- Maintained staff scheduling and call outs
- Tracked and monitored team statistics, including all telephone calls, precertifications, and reviews
- Collaborated with Director to develop and implement any needed corrective actions plans
- Assigned daily case reviews and member follow-up calls to Care Management staff
- Evaluated, approved, or requested additional information for high-dollar claims for claims department
- Processed and examined retrospective reviews of medical records for appeals and complaints department.
Clinical Care Manager
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
11.2006 - 05.2010
- Managed calls from members experiencing mental health or substance abuse-related crises
- Performed telephonic assessment and referral of members requesting Employee Assistance Program (EAP) services
- Nurtured positive working relationships with network providers and facilities
- Directed telephonic initial and concurrent review of ongoing inpatient, partial hospital and intensive outpatient mental health and substance abuse treatment for APS members
- Acted as point of contact for EAP-referred State of Maryland employees, supervisors, and treatment providers
- Applied medical necessity and ASAM/TAC guidelines to ensure proper utilization of mental health and substance abuse benefits
- Provided case management services including coordination of care, discharge planning assistance and outreach to members, their families, and their providers.
Education
MASTER OF SOCIAL WORK -
Walla Walla University
College Place, WABACHELOR OF SCIENCE - General Studies with concentration in Psychology and Music
Washington Adventist University (formerly Columbia Union College)
Takoma Park, MDSkills
- Strategic Planning
- Cross-Functional Collaboration
- Operations Management
- Cross-functional Team Coordination
- Data-driven decision-making
- Cross-Functional Communication
- Talent Development
- Employee Development
Certification
Licensed Independent Social Worker – Clinical Practice, State of South Carolina License number 16259
Licensed Certified Social Worker – Clinical, State of Maryland License number 12704
Timeline
Senior Manager
AETNA, A CVS HEALTH COMPANY
07.2021 - Current
Clinical Supervisor
AETNA, A CVS HEALTH COMPANY
06.2019 - 07.2021
Clinical Team Lead
AETNA, A CVS HEALTH COMPANY
06.2017 - 06.2019
Clinical Case Manager
AETNA, A CVS HEALTH COMPANY
06.2015 - 06.2017
Clinical Manager
HMC HEALTHWORKS
11.2014 - 06.2015
Clinical Supervisor
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
07.2012 - 11.2014
Intake Team Lead
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
05.2010 - 07.2012
Clinical Care Manager
UNIVERSAL AMERICAN/APS HEALTHCARE, INC.
11.2006 - 05.2010
MASTER OF SOCIAL WORK -
Walla Walla University
BACHELOR OF SCIENCE - General Studies with concentration in Psychology and Music
Washington Adventist University (formerly Columbia Union College)
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