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Medical Manager

Location:
San Francisco, CA
Posted:
March 24, 2015

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Resume:

TERESA PICA, LCSW

** **** ****** *** *****, New York 10573

914-***-****

Email acou8x@r.postjobfree.com

PROFESSIONAL EXPERIENCE

SBH HEALTH SYSTEMS, Bronx NY

Social Worker 3/25/13 to

present

Provides social work services to Pediatric. Adult, Oncology, Orthopedic,

Geriatric and Diabetic Clinics.

Responsible for referrals to mental health providers. Links patients to

home health care and visiting nurse services. Insures that patients have

durable medical equipment. Completes HRA 2010e housing applications. Co-

lead of the Patient Centered Care Labor Management Project. Member of two

DSRIP work projects Work Force Team for the PPS and the Behavioral

Health Redesign Team

Clinical Supervisor Health Home Provides clinical supervision

to 10 Health Home patient navigators and 6 case managers.

Approves all clinical documentation required by the Bronx

Accountable Health Network and Patient Centered Medical Home.

Provides training and education to the patient navigators and

case managers.

Clinical Supervisor Care Coordination Program @DAC Provides

supervision to 6 Care Coordinators. Facilitated a Woman's

support group.

Clinical Coordinator/Supervisor 11/14/11 to

Present

Supervises 25 ( 10 CASACS in MMTP, 5CASACs and 2 CASAC-Ts in

detoxification unit, and 1 CASAC, 1 LMSW /CASAC, 1 LCSW and 3CASAC-Ts in

Outpatient Substance abuse Clinic .) Organized and participates in-services

for staff development. Participated in Quality Improvement Committee,

oversaw clinical care and charting to include case conference, psychosocial

evaluations, treatment plans and discharge planning. Assured compliance

with all regulatory agencies such as JCAHO and OASAS. Monitored patient's

charts for accuracy and completeness. Assumed clinical management of the

Outpatient substance abuse Clinic from Administrative Director after failed

OASAS site visit. Completed plan of correction, implemented OASAS

compliant paper work . Trained all counselors on all aspects of new OASAS

regulations to insure compliance. Worked collaboratively with IS

department to implement OASAS required documentation into the electronic

medical record system(Eclipys). Implemented group and individual

supervision in the methadone maintenance clinic. Trained counselors in

the methadone maintenance clinic about evidence based treatment. Prepared

inpatient detoxification unit for JCAHO and OASAS site visits in 2013.

Wrote new policies for department of addiction medicine in preparation

for JCAHO visit. Implemented new OASAS paperwork for inpatient

detoxification unit. Established and maintained relationships with HMOs,

BHO and aftercare programs. Evaluated staff job performance and training

needs. Administrative Supervisor to 4 Physician Assistants. Worked

collaboratively within Addiction Medicine and other Departments to ensure

appropriate referrals. Responsible for all aspects of Health Home in the

Department of Addiction Medicine. Supervisor to Columbia University

Social Work Interns.

Social Worker 1/18/11 to

11/12/11

Primary Social Worker for sixteen patients on two psychiatric units.

Completed psychosocial assessments, formulated, initial individualized

treatment plans and weekly updates. Consulted with team psychiatrist

regarding treatment decisions, medical and psychopharmacological issues,

evaluation of risk factors and legal issues. Executes all charting

requirements and devise appropriate discharge plans. Provided individual

and family counseling and psycho-education. Developed and maintained

collaborative relationship with patient, family, referent, payer and

external support/health care team. Supervised MSW interns from Columbia

University

SOCIAL WPRK PRN

Temporary Social Worker 11/29/10 to

1/15/11

Primary Social Worker for 16 patients on two psychiatric units. Completed

psychosocial assessments, formulated, initial individualized treatment

plans and weekly updates. Consulted with team psychiatrist regarding

treatment decisions, medical and psychopharmacological issues, evaluation

of risk factors and legal issues. Executes all charting requirements and

devise appropriate discharge plans. Provided individual and family

counseling and psycho-education. Developed and maintained collaborative

relationship with patient, family, referent, payer and external

support/health care team

MHN/HEALTHNET, Shelton CT

Care Manager 11/14/05 to

12/9/08

Made medical necessity determinations and refer to appropriate level of

care utilizing the MHN LOC guidelines. Performed telephonic clinical

assessments to determine immediate clinical needs of members and to arrange

emergent/urgent services as needed. Authorized in-patient, alternative

and/or outpatient treatment according to benefit plan and limitations.

Clearly and completely documented all initial concurrent and discharge

reviews, including, but not limited to, diagnosis, symptoms, interventions,

goals and plan for next review and/or after care. Closed all cases

according to the defined case closure procedure and in accordance with

guidelines established by MHN. Participated in training of other Care

Managers as necessary. Trained HLOC Care Managers on LLOC computer

procedures(how to do authorizations). . Care Coordination of patients with

psychiatric illness who had HealthNet Medicare. Performed Risk

Management Activities as needed. Maintained confidentiality of member

specific data. Attended Administrative and Clinical meetings. Performed

special audits, projects, etc. as required

The Connecticut Hospice, Branford CT

Social Worker 9/3/02 to 11/11/05

Primary Social Worker to 20 home care patients. Completed psychosocial

assessments; formulates individual treatment plans and bimonthly updates.

Provided counseling to patients and families related to hospice care,

anticipated grief, bereavement, and death and dying. Worked

collaboratively with Hospice MD and nurses regarding treatment decisions,

medical and psychopharmacological issues. Attended weekly interdisciplinary

team meetings. Monthly peer chart review to insure compliance with

Medicare.. Linked patients to community agencies and resources. Covered

inpatient hospice every Wednesday evening and every other Saturday.

Provided monthly on-call coverage for all 5 home care offices and inpatient

unit. Lead a death awareness seminar for hospice volunteers.

NEW YORK PRESBYTERIAN HOSPITAL, White Plains, NY

Treatment Coordinator 12/19/99 - 8/30/02

Served as primary therapist for a caseload of seven in-patient psychiatric

patients. Completed psychosocial assessments; formulated initial

individualized treatment plans and weekly updates. Consulted with team

psychiatrist regarding treatment decisions, medical and

psychopharmacological issues, evaluation of risk factors and legal issues.

Executed all charting requirements and formulated appropriate discharge

plans. Provided individual and family counseling and psycho-education.

Developed and maintained collaborative relationship with patient, family,

referent, payer and external support/health care team. Facilitated a

spirituality group with a Baptist pastor. Worked evenings in the

evaluation center - responsible for all aspects of admission paper work

including initial psychiatric assessment. Identified as a Super User for

electronic medical record and trained unit social workers on emr went it

went live on the unit.

NETWORK BEHAVIORAL HEALTH, Harrison, NY

Care Coordinator 6/6/97 -

12/16/99

Assessed NBH client member/beneficiaries and refer them to the most

appropriate level of care or to a mental health/substance abuse

practitioner. Assured quality of care and cost effective treatment by using

clinical policy and medical necessity criteria in the evaluation

procedures. Protected the use of the members mental health/substance abuse

benefit for medically necessary treatment Trained all new Care

Coordinators on the computer system and how to do authorizations for all

levels of care.

UNITED HOSPITAL MEDICAL CENTER, Port Chester, NY

Social Worker Department of Psychiatry and Substance Abuse

4/3/95 - 6/3/97

Completed psychosocial assessments for a dual diagnosis unit with a

caseload of ten MICA patients. Completed initial treatment plans and weekly

updates. Served as liaison between treatment team and managed care

companies. Provided individual and family counseling and psycho-education.

Facilitated dual diagnosis process groups, twelve step, women's and ACOA

groups. Linked patients to appropriate level of care upon discharge.

Researched, developed and presented a highly effective educational program

for staff members including doctors on HIV transmission and the disease

process after discovering that the majority of the staff had little or no

practical knowledge of the virus and treatment protocols Completed chart

audits in preparation for JCAHO and OMH audits when there was no Social

Work Supervisor. The unit passed both of these audits.

.

WESTCHESTER COUNTY DEPT. Of COMMUNITY MENTAL HEALTH, White Plains, NY

Program Specialist/Case Manager- Mental Health Alternatives to

Incarceration 1/4/95 - 3/30/95

Managed a caseload of ten MICA clients who were involved with the criminal

justice system. Developed treatment plans for clients, linking clients to

psychiatric day treatment, long-term care and alcohol/substance abuse

programs. Secured entitlements for clients acted as liaison between client

and criminal justice systems and advocated for clients during court

proceedings. Worked collaboratively with the Department of Probation,

community based organizations and treatment facilities. Updated treatment

plans and kept accurate records.

STATEN ISLAND UNIVERSITY HOSPITAL, Staten Island, NY

Social Worker/Case Manager 7/5/93 -

12/20/94

Served as a case manager for two adult primary care clinics for the

treatment of substance abusers and non-substance abusers infected with HIV.

Completed psychosocial assessments, linked patients to services advocacy

and acted as liaison between patients and other services. Completed

quarterly re-assessment and treatment plans for patients, coordinated and

participated in weekly interdisciplinary rounds. Provided psychotherapy,

supportive and bereavement counseling for individuals, families and groups.

Educated patients and family members on HIV transmission and the disease

process. Worked collaboratively with medical staff and community based

organizations.

METROPOLITAN HOSPITAL, New York, New York

Social Worker 6/1/92 to

7/1/93

Served as Case Manager for inpatient and outpatient units for those

infected with HIV disease. Completed psychosocial assessments, linked

patients to services advocacy and acted as liaison between patients and

other services. Completed quarterly re-assessment and treatment plans for

patients, coordinated and participated in weekly interdisciplinary rounds.

Provided psychotherapy, supportive and bereavement counseling for

individuals, families and groups. Educated patients and family members on

HIV transmission and the disease process. Worked collaboratively with

medical staff and community based organizations.

EDUCATION

COLUMBIA UNIVERSTIY, New York, NY

School of Social Work,

SIFI Certification

NEW YORK UNIVERSITY, New York, NY

SILVER SCHOOL OF SOCIAL WORK

Masters in Social Work - May 1992

MANHATTANVILLE COLLEGE, Purchase, NY

Bachelor of Arts in Political Science - May 1986

COMPUTER SKILLS

Windows, Microsoft Word, Excel, WordPerfect, Eclipsys, InterQual

VOLUNTEER WORK

Sunday School Teacher, Youth Group Leader, Confirmation Teacher



Contact this candidate