Summer R. Chaves
Licensed Professional Counselor Supervisor
Baton Rouge,LA
Summary
Talented Program Director and Licensed Professional Counselor skilled in handling administrative, operational, clinical, and outreach program functions. Proven leader with demonstrated analytical and team building skills. Excel at working with team members and collaborating with other professionals and government entities. Skilled Licensed Professional Counselor with strong background helping severely at risk individuals overcome personal challenges and cope with triggering situations. Focused on facilitating exploration of issues, developing individualized plans and developing important skills as well as work as Licensed Supervisor to ensure competency of provisionally licensed individuals seeking to meet requirements of clinical supervision. Licensed by Louisiana.
Overview
18
18
years of professional experience
3
3
years of post-secondary education
Work History
Program Manager 1-B, PASRR
Louisiana Department Of Health/Office Of Behaviora
Baton Rouge, Louisiana
05.2021 - Current
- Statewide management of the Pre-Admission Screening and Resident Review (PASRR) program as well as other Department initiatives affecting older adults with behavioral health issues
- Ensures individuals are offered the opportunity to receive services in the least restrictive level of care, in compliance with federal and state Olmstead requirements
- Serves as the state level principle staff for services and issues related to the PASRR program, further ensuring compliance with Olmstead activities
- ensure the implementation of programming in a manner that conform to federal standards for PASRR and Olmstead
- functions as the OBH liaison for LDH-related activities such as the Long Term Services Supports and Money Follows the Person, Managed Long Term Supports and Services, and other related initiatives
- implementation of strategic long and short-term goals and objectives of the program as well as the planning, development, and implementation of policies and procedures, which guide the statewide PASRR initiative
- ensures that the applicants are appropriate for nursing home placement, offered placement in the most appropriate setting for their needs, and receive specialized mental health and substance abuse services as needed within mandated timeframes
- Ensures policies and procedures, as well as all other program planning and development are current and outlined in a manner necessary to achieve the federal goals and objectives the PASRR program
- Ensures the program adheres to Medicaid rules and regulations and complies with standards outlined by the federal Department of Justice (DOJ) within its Agreement with LDH
- Works collaboratively with other state agencies, managed care organizations, and advocacy groups to manage operations of PASRR
- Plans, implements, monitors, and makes recommendations for state laws pertaining to PASRR and Older Person initiatives as well as ensuring compliance to Olmstead as it relates to these initiatives
- Works collaboratively with Office of Aging and Adult Services & Office of Citizens with Developmental Disabilities to develop and plan statewide Long Term Supports and Services initiatives for approximately 70,000 individuals with disabilities ensuring the inclusion of behavioral health
- Plans, prepares and implements strategic long and short-term goal and objectives for the PASRR program, ensuring statewide program compliance with state/federal laws and regulations.
- Represents OBH as the state level principal staff in the management of authorization, surveillance, and monitoring of PASRR activities to ensure applicants meet the standards of the PASRR statewide program for appropriate nursing home placement; and, if so, receive clinically appropriate services in the federally-mandated time frame
- Oversee the communication, training and technical assistance with the Managed Care Organizations (MCOs), approximately 250 nursing homes, hospitals and community providers statewide on any questions or concerns that they have about the PASRR process, admissions decisions, and to specialized services. Develops and conducts needed trainings.
- Ensures all home denials (other than LOCET denials) conform to LDH standards. Oversees the collection of information in preparation for client appeals while providing testimony and advocacy behalf of the office and the clients served.
- Acts as an expert and serves as primary liaison for the agency in matters pertaining to the assigned program areas. This includes meeting with federal and state governmental officials, private agencies, professionals, and community based advocacy groups for program and policy areas, as well as working on task forces and executive level committees statewide
- Leads the generation, monitoring & surveillance, and/or revision of interagency agreements and/or protocols for multiple agency responsibilities in regards to common programs and clients.
- Identifies and ensures expenditures related to the operations are appropriately budgeted, tracked and documented for Medicaid reimbursement. This will occur through the establishment of standards for operations, training, and quality monitoring through outcomes data.
- Provides functional supervision to Licensed Clinical Social Workers within the PASRR program in regards to determinations. Assigns and reviews work and trains staff as it pertains to the PASRR program, clinical best practices, and Department of Justice Agreement. .
- Oversight of contract with Psychiatrist within the PASRR program, who provides medical consultation for Level II determinations for nursing home placement. Assigns and reviews work in relation to payment of contracted services, trains, sets performance indicators, and monitors overall contract performance
- Organizes, schedules, and coordinates PASRR procedures, further evaluates preparedness and response efforts of staff in implementing programming.
- Conducts training on PASRR procedures and latest trends for the entire program and OBH.
- Directs the development and implementation of a quality management system tracking quality of care standards, outcomes measures, mechanisms for problem identification and resolution/follow up
- Oversees statewide program compliance with state/federal laws and regulations.
- Plans the implementation of new or changed statewide treatment service initiatives, ensuring collaboration with other program offices, community partners, and clients regarding the modifications to this statewide initiative.
- Develops and implements programs in keeping with the OBH state plan, ensuring standards maintain fidelity to professionally/nationally recognized best practices, and that which has been outlined by the federal Department of Justice.
- Ensures collaboration with the MCOs through the management of Level II evaluations completed throughout the state by their PASRR Level II Evaluators.
- Creates and conducts trainings on best practices to PASRR Level II Evaluators and MCOs.
- Directs policy development for the PASRR program, developing standards and ensuring the programs have the necessary structures, systems and processes in place to deliver services. Assure that written policies and procedures take into account national trends, state capacity, funding options and other relevant variables.
- Keeps abreast of current trends in assigned programs; researches, analyzes, and interprets the impact of federal and state legislation and changes in service delivery to agency staff and service providers; updates professional skills. Review research and proposed models for services.
- Prepares and/or monitors Contracts/RFP's, Memorandum of Understandings (MOUs), and recommends/requests grant applications be made.
- Develops, implements and manages a system of program related performance indicators that provides information for assessment of services provided. This information is provided to management at all levels an ongoing basis for program review and continuing assessments of program activities and resources.
- Reviews evaluative data, which oversees and makes recommendations following analysis.
- Directs the monitoring of the delivery of services at the regional/provider level in an effort to look for consistency in service delivery and makes recommendation for training and technical assistance.
- Completes certification reviews, through which will identify areas of non-compliance with developed performance measures as well as trends in service delivery, providing assistance to achieve necessary corrective action.
- Ensures a system of accountability and measuring of performance is in place. Participates in ongoing program surveillance and monitoring reviews, while subsequently providing technical assistance/training as needed to nursing homes, hospitals, and community providers.
- Completes analysis of trends, and develops report cards profiles, which delineates comparison with established benchmarks and national norms.
- Develops and provides an objective tool for making required decisions/modifications concerning the service delivery system.
- Manages, develops, and refines data systems and reports necessary to provide oversight and compliance with PASRR requirements and efficiencies while collaborating with & monitoring information technology contractors.
- Provides ongoing feedback to the Assistant Secretary and other Office of OBH Administrators regarding their success with meeting established outcome measures.
- Recommends appropriate quality improvement strategies.
Clinical Manager
Louisiana Healthcare Connections, Outpatient Behavioral Health
Baton Rouge
01.2019 - 05.2022
- Duties included, but are not limited to: Oversite of Outpatient Behavioral Health program to ensure compliance with state, corporate, and NCQA contractual standards; write and manage all BH Outpatient policies and procedures;
- Collaborative work with with all LHCC physical health departments to develop fully integrated behavioral health outpatient department;
- Participated in RFP, IPRO, and NCQA preparation and onsite visits;
- Participated inmultiple LDH work groups (MHR reform, ABA services, ACT services and PASRR);
- Managed and Supervised team of clinically licensed Utilization Managers (20), clinically licensed Supervisors (2), non-clinical Referral Specialists (14), and non-clinical Denial Coordinators (4);
- Develop team correction plans, conduct team evaluations and meetings to ensure department is complaint with all standards
- Analyze and verify data needed for weekly, monthly, quarterly, and annual state reports
- Developed and conducted interdepartmental trainings to ensure efficiency of processes as well as broadening the team’s scope of knowledge regarding state deliverables and broadening skills sets for career development
- Developed and conducted training and training materials for non UM staff and PH teams to assist with BH UM authorization extensions as well as trained all BH Referral Specialists on how manage and respond to provider requests for clinical criteria so that we are compliant with House Bill 424
- Ensured that LHCC BH department was complaint with new legislation (HB 424, Act 330, Amendment 3, and Act 582) managing a 24 hour/7 day a week on call schedule to address any provider questions regarding clinical criteria as well as ensuring staff are available to review PA requests within a one calendar day turnaround time and ensuring that all MHR approvals are for correctly licensed and credentialed providers and locations
- Worked with Medical Directors on development and implementation of a pilot study aimed at not only fiscal reduction of over utilized behavioral health services but also to provide structure and treatment efficacy to an evidenced based intervention to identified members.
- Promoted high morale and staff retention through dynamic communication, prompt problem resolution, proactive supervisory practices and facilitation of positive work environment.
- Regularly evaluated employee performance and provided feedback.
- Implemented ongoing learning strategies such as tutorials, instructional modules, and supervised hands-on sessions to help clinical and non-clinical staff to ensure efficiency and understanding of workflows and processes.
- Worked with Medical Directors on trainings for clinical review that were delivered to licensed staff.
Supervisor
Centene, Envolve People Care/Louisiana Healthcare Connections, Outpatient Behavioral Health
Baton Rouge
02.2018 - 01.2019
- Duties include but are not limited to clinical and administrative supervision of Utilization Managers on the unit
- Oversite of day to day work processes and productivity of unit to ensure all contractual obligations are being met
- Track, report, and coach Utilization Managers regarding any errors that would put the unit at risk for NCQA, IPRO, and state contract reviews
- Oversite of ABA review implementation and handled all provider, state, and legislative complaints in conjunction with multiple LHCC and LDH departments
- Training of clinical team on ABA criteria, assessment, documentation, and clinical review.
- Address various provider issues, complaints, concerns, and collaborate and consult with various departments to address and resolve provider issues in a timely and professional manner
- Oversite of all behavioral health Chisholm cases and notifications to LHD, members, providers, and support coordinators.
- Trained clinical staff on Chisholm lawsuit and clinical implications.
Utilization Manager
Centene, Envolve People Care, Outpatient Behavioral Health
Baton Rouge
06.2016 - 02.2018
- Duties included reviewing and obtaining clinical documentation to determine medical necessity of requested services (inpatient psychiatric, residential, ASAM, Evidence Based Community Based, Rehabilitative, and outpatient) and appropriate for member’s current presenting needs
- Collaborate with PH and BH Case Management, as well as provider agencies to coordinate robust discharge planning and care for members
- Participate in weekly multidisciplinary rounds to ensure optimal care and service coordination for each member
- Conceptualize secondary reviews for Medical Directors when members do not meet the medical necessity criteria to be in the requested level of care
- Complete assigned special projects and collaborate with other business units on Single Case Agreements, retrospective reviews, provider issues, authorization issues, and notice of coverage to providers
- Conducted national training to all OP UM’s assisting in the LA market.
Team Coordinator
Spectrum Rehabilitation Services
Denham Springs
07.2014 - 06.2016
- Functioned as a team leader, area coordinator, and supervisor for a team of mental health professionals
- Provided clinical supervisor for PLPCs and other non-licensed individuals.
- Provided training to clinical team on assessment of individuals, best practices in treatment of ADHD, ODD, and other diagnosis impacting clients.
- Provided training to clinical team on best practices in writing treatment goals and interventions.
- Duties included, but were not limited to, coordinating all referral services for clients in Prairieville area (law enforcement, state agencies, doctors, CSOC, FINS, and other mental health provider agencies), collaborating with all schools in Prairieville area on behavioral/mental health and crisis needs for students, providing front line crisis counseling to schools when needed, and management of utilization reviews for all clients serviced by the team.
Program Director
NHS
Baton Rouge, LA
02.2012 - 06.2014
- Developed ACT program in Hammond, LA from ground up, laying out framework and defining roles.
- Daily duties included, but were not limited to, direct supervision and discipline of staff, managing yearly budget, conducting monthly quality improvement for NHS Corporate office, maintaining and obtaining all credentials and licenses required by Magellan (Medicaid), DHH, and OBH offices for each region
- Trained licensed staff on best practices of assessing individuals with severe mental illness.
- Participated in assigned special projects around the state, assisting other program directors, managing daily operations of facilities and staff, conducting 1915i assessments, and maintaining client authorization of services through utilization and concurrent reviews as required by Magellan
- Conducted monthly internal audits of all program systems to determine that fidelity to FACT model was being met
Licensed Mental Health Professional
Spectrum Rehabilitation Services
Denham Springs
10.2010 - 03.2012
- Provided intensive mental health services to children and adolescents in Ascension Parish as well as supervision for new Mental Health Professionals.
- Provided clients with recommendations to community resources.
- Evaluated patients and implemented comprehensive treatment plans to enhance mental health.
- Worked collaboratively with other mental health professionals to provide consistent care and minimize diversion.
- Directed family-centered, strengths-based, culturally competent and individualized intakes and assessments.
Program Director
Medical Management Options
Baton Rouge
04.2010 - 09.2010
- Managed daily operations of program and supervision of all staff
- Worked regularly with community liaisons and new referral sources
- Developing new treatment tracks and groups for individuals with Chronic Pain issues
- Provide educational in-services for Louisiana Association of Behavioral Health
- Assured program met CMS and DHH standards.
Program Director
Medical Management Options IOP
Gonzales
01.2010 - 04.2010
- Launched program and managed the daily operations
- Secured physicians, personnel, and all contracts for new program
- Assisted community liaison in marketing efforts on a regular basis
- Conducted intake and assessment of all referrals
- Responsible for all private insurance verification and utilization reviews on all patients.
- Met with project stakeholders on regular basis to assess progress and make adjustments.
Program Director
Medical Management Options PHP
Gonzales
08.2009 - 04.2010
- Oversaw administrative duties to ensure effective management of facility an adherence to CMS and DHH rules.
- Orchestrated smooth and efficient program development by collaborating cross-functionally across departments.
- Scheduled and supervised staff meetings to discuss new ideas and update participants on program details and milestones.
Intensive Outpatient Program, Program Director
Medical Management Options, Promise
12.2008 - 10.2009
- Managed employees and daily operations of program
- Supervised all employees to ensure efficient and effective treatment was provided
- Managed all discharges and admissions to program
- Provided marketing for program in community and surrounding areas to increase census.
Baton Rouge Partial Hospitalization Program Counselor
Medical Management Options
01.2008 - 12.2008
- Provided mental health services for chronically mentally ill adults and geriatric populations
- Provided psychotherapy in group and individual settings.
Counselor
Ascension Mental Health and Addictive Disorders Clinic
05.2007 - 01.2008
- Provided mental health and substance abuse services for children and adolescents
- Worked with Ascension Parish Schools to provide substance abuse prevention programming to area schools.
- Worked with prescribing professionals to get patients necessary medications.
- Assessed clinical risk and danger to children and families and determined appropriate level of response and intervention.
Counselor
Louisiana State University, University College Center
09.2006 - 05.2007
- For Advising and Counseling, for the Center for Advising and Counseling Performed academic counseling duties for students in the UCAC
- These duties included but were not limited to individual advising sessions, presentations, updating the University College staff on College of Business policy changes, assisting with coordination of graduation ceremony activities.
School counselor
St. Theresa of Avila School
Gonzales, LA
08.2005 - 09.2006
- Performed academic, individual, and group counseling duties for all students of St Theresa School (over 700 students)
- Also completed administrative duties including, but not limited to, administering state standardized tests, scheduling students, assisting with disciplinary issues, and other administrative duties as assigned
- Served on Special Needs Committee to develop, implement, and monitor children’s accommodation plans
- Executed all failure and retention letters and assisted parents with finding additional resources necessary for students in these cases.
- Developed new student orientation programs to build excitement around transfer and enrollment.
- Maintained positive relationships with students, faculty, alumni and administration.
- Provided crisis intervention in response to emergencies, employing existing trust and rapport to deescalate situations.
- Reviewed and discussed new students' academic credentials, interests and educational goals.
- Conducted educational trainings to teachers and staff on various social and behavioral health topics impacting students.
Intensive Outpatient Program
Benton Rehabilitation Hospital
06.2004 - 02.2005
- Provided group therapy and case management to adults with mental illnesses and chemical dependencies
- Hold current license in good standing for Licensed Professional Counselor with Supervisor designation in the state of Louisiana Completed Lean Six Sigma White and Yellow Belt work of project management Completed Dale Carnegie Team and Communication Effectiveness Seminar and DISC training 2020 360 Revie Overall 98% rating in leader effectiveness (for reference, Centene average was 84% leader effectiveness) Currently represent LHCC/Centene on multiple work groups with LDH for reform of various behavioral health programs
Education
MASTER OF ARTS - COMMUNITY COUNSELING
Louisiana State University
01.2001 - 05.2004
BACHELOR OF ARTS - SOCIOLOGY
Louisiana State University
Skills
Effective leader
Biopsychosocial assessments
Expertise in crisis intervention techniques
Strong public speaker
Adept at conflict resolution
Intervention planning
Team leadership and direction
Performance monitoring
Policy and procedure improvements
Affiliations
Hold current license in good standing for Licensed Professional Counselor with Supervisor designation in the state of Louisiana
Completed Lean Six Sigma White and Yellow Belt work of project management
Completed Dale Carnegie Team and Communication Effectiveness Seminar and DISC training
Timeline
Program Manager 1-B, PASRR
Louisiana Department Of Health/Office Of Behaviora
05.2021 - Current
Clinical Manager
Louisiana Healthcare Connections, Outpatient Behavioral Health
01.2019 - 05.2022
Supervisor
Centene, Envolve People Care/Louisiana Healthcare Connections, Outpatient Behavioral Health
02.2018 - 01.2019
Utilization Manager
Centene, Envolve People Care, Outpatient Behavioral Health
06.2016 - 02.2018
Team Coordinator
Spectrum Rehabilitation Services
07.2014 - 06.2016
Program Director
NHS
02.2012 - 06.2014
Licensed Mental Health Professional
Spectrum Rehabilitation Services
10.2010 - 03.2012
Program Director
Medical Management Options
04.2010 - 09.2010
Program Director
Medical Management Options IOP
01.2010 - 04.2010
Program Director
Medical Management Options PHP
08.2009 - 04.2010
Intensive Outpatient Program, Program Director
Medical Management Options, Promise
12.2008 - 10.2009
Baton Rouge Partial Hospitalization Program Counselor
Medical Management Options
01.2008 - 12.2008
Counselor
Ascension Mental Health and Addictive Disorders Clinic
05.2007 - 01.2008
Counselor
Louisiana State University, University College Center
09.2006 - 05.2007
School counselor
St. Theresa of Avila School
08.2005 - 09.2006
Intensive Outpatient Program
Benton Rehabilitation Hospital
06.2004 - 02.2005
MASTER OF ARTS - COMMUNITY COUNSELING
Louisiana State University
01.2001 - 05.2004
BACHELOR OF ARTS - SOCIOLOGY
Louisiana State University