DANIELLE LAWSON
Chicago,IL
Summary
I am a dedicated Healthcare Professional with a background in Care Management and passion for Quality Improvement within managed care. My career has been centered around providing comprehensive care coordination to individuals, promoting independence, and addressing complex healthcare needs.I thrive in collaboration high pressure environments and value the opportunity to work with interdisciplinary teams to improve the quality of care and enhance the member experience.
Overview
14
14
years of professional experience
Work History
LTSS Quality Improvement Professional 2
Humana
Schaumburg, IL
11.2021 - Current
- Lead quality investigations and actively participate in process improvement initiatives for the IL LTSS Program.
- Conduct comprehensive and focus audits, evaluating compliance and documentation quality.
- Track and manage remediation activities, ensuring timely issue resolution.
- Contribute insights and best practices in monthly Metric Review meetings.
- Provide training and coaching to care coordinators, managers, and LTSS teams, emphasizing quality and documentation.
- Successfully manage 1-2 process improvements projects annually and oversee Policy and Procedure /Job Aids annual updates and review
- Assisted in preparing and presenting cases during CMS audits, Mock audits, Critical Incident audits, and HSAG audits.
Care Coach 1 LTSS
Humana
SCHAUMBURG, IL
10.2020 - 11.2021
- Provided case management and service coordination to a caseload of up to 100 Medicaid/Medicare dual eligible members with state waiver benefits.
- Conducted ongoing clinical comprehensive assessments and evaluated members' needs.
- Approved and modified service authorizations.
- Developed and implemented care plans, including a waiver service plan, in collaboration with the member, caregiver, physician, and/or other appropriate healthcare professionals to address the member's needs and goals.
- Assessed for barriers to care, provided care coordination, and assisted members in addressing psycho/social and medical concerns.
- Facilitated interdisciplinary care team meetings for approval or denial of services and informal ICT collaboration.
- Educated members on and coordinated community resources.
- Maintained accurate and detailed member records.
- Precepted new care coaches following established standards of practice and organizational policies.
Care Management Coordinator
Aetna Better Health of Illinois
DOWNERS GROVE, IL
03.2014 - 11.2018
- Completed clinical comprehensive assessments of Colbert Class members to determine appropriateness for discharge from nursing home facilities
- Coordinated with nursing home facility staff, in conjunction with federal and state departments to reintegrate nursing home clients who were seeking to live in the community
- Managed caseload of up to 65 medically high risk members living in a community/nursing home setting
- Developed care plans using SMART Goal format and monitored adherence, evaluated effectiveness, and facilitated changes as needed
- Assessed and referred members to community programs and services (DRS/IDOA waiver services)
- Coordinated member referrals for community services, medical/specialty providers in the community and performed follow-up activities as needed
- Managed transitions and provided ongoing care coordination for Class member 12 months post transition.
- Provided comprehensive case management and crisis intervention services to members for twelve months post-transition in a community setting.
Clinical Counseling Intern
Governors State University
UNIVERSITY PARK, IL
08.2012 - 08.2013
- Managed caseload of 15 clients from various ethnic and cultural backgrounds
- Conducted individual counseling sessions to address mental, academic and emotional problems
- Provided crisis intervention services for students experiencing mental health and/or alcohol/drug emergencies
- Assessed and wrote treatment plans and weekly progress notes for each client assigned to caseload
- Planned and ran several counseling related outreach events targeted at university students
- Assisted with special events/projects that enhanced the operations of the counseling center
Mental Health Worker
Heartland Health Outreach
CHICAGO, IL
11.2009 - 11.2011
- Collaborated with nursing home facility staff, in conjunction with federal and state departments to reintegrate nursing home clients who were seeking to live out in the community
- Assessed, identified, and responded to emergency or crisis needs of the client
- Identified clients' preferences, strengths and barriers before transitioning clients into the community
- Initiated linkages with housing and community services that supported transition from the nursing home to the community
- Completed home visits of of up tp 50 transitioned clients to monitor stability while living in the community
- Attended meetings and trainings necessary for professional development and as required by the agency.
- Provided clients with recommendations to community resources.
Education
Master of Arts - Clinical Mental Health Counseling
Lewis University
Romeoville, ILCertified Case Manager (CCM) -
Commission For Case Manager Certification
Skills
- Client Assessment/Evaluation
- Effective Oral & Written Communication
- Care Management
- Crisis Intervention
- Discharge Planning
- Patient Education and Counseling
- Process Improvement
- Policies & Procedures
- Audits Compliance
- Quality Metrics
- Care Planning
- Job Aids
Timeline
LTSS Quality Improvement Professional 2
Humana
11.2021 - Current
Care Coach 1 LTSS
Humana
10.2020 - 11.2021
Care Management Coordinator
Aetna Better Health of Illinois
03.2014 - 11.2018
Clinical Counseling Intern
Governors State University
08.2012 - 08.2013
Mental Health Worker
Heartland Health Outreach
11.2009 - 11.2011
Master of Arts - Clinical Mental Health Counseling
Lewis University
Certified Case Manager (CCM) -
Commission For Case Manager Certification