|** Lee Rd **** |706-***-**** |

|Phenix City, AL |dsneal2078@gmail.|

|36870 |com |

Dana Neal

|Objective |A Career with a progressive organization that will |

| |use my administrative & professional skills, |

| |education & abilities to effectively contribute to |

| |the company's overall success. |

|Experience |2012-Present Anka Behavioral Health East Point, GA |

| |Utilization Manager |

| |Provide monthly training of all staff on state |

| |guidelines, policy and procedures, computer |

| |programming systems, documentation guidelines, etc.|

| | |

| |Request and clinical authorizations for services, |

| |utilizing the APS Care Connection Online Systems. |

| |Completing MICPS and Treatment Plan for services. |

| |Provide clinical support, direction and guidance to|

| |staff for the continuous care from inpatient |

| |facility to outpatient services. |

| |Verification of insurance and eligibility through |

| |web. Also processing billing/filing insurance |

| |claims. |

| |Serve as liaison between medical, clinical and/or |

| |support service and third-party insurers in the |

| |performance of utilization and quality assurance |

| |management. |

| |Provided monthly training for all staff on computer|

| |systems and documentation, service provisions, |

| |guidelines, insurance, financial (Medicaid, |

| |Medicare, etc.). |

| |Audit records, documentation, and service quality. |

| |Make corrective actions/treatment plans and |

| |recommendations to program managers and other staff|

| |as required. |

| |Establish and evaluate the necessity, |

| |appropriateness and effectiveness of services for |

| |the purpose of controlling cost, while maintaining |

| |quality care. |

| |Review accreditation with JACHO, CARF, ERO, State, |

| |CSB and other regulatory agency standards and |

| |guidelines. Ensure utilization management |

| |documentation is accurately recorded, filed and |

| |disseminated. |

| |Develop and recommend to Q/I team written |

| |procedures for the processes of utilization |

| |management. |

| |Advise attending physician/clinical staff when |

| |medical and service records do not reflect adequate|

| |documentation of active treatment or meet criteria |

| |for service. |

| |Review medical/service records to meet criteria for|

| |authorized services and determine expected length |

| |of stay according to established guidelines. |

| |Maintain up-to-date knowledgebase on changes in |

| |hospital-community, clinical guidelines regarding |

| |review criteria; psychiatric and generic quality |

| |screens; certification requirements; and covered |

| |services. |

| | |

| |2005-2012 New Horizons, CSB Columbus, GA |

| |Utilization Manager |

| |Provide monthly training of all staff on state |

| |guidelines, policy and procedures, computer |

| |programming systems, documentation guidelines, etc.|

| | |

| |Request clinical authorizations for services |

| |utilizing the company's online medical system. |

| |Completing MICPS and Treatment Plans. |

| |Provide clinical support, direction and guidance to|

| |staff for the continuous care from inpatient |

| |facility to outpatient services. |

| |Verification of insurance and eligibility through |

| |web. Also processing billing/filing insurance |

| |claims. |

| |Serve as liaison between medical, clinical and/or |

| |support service and third-party insurers in the |

| |performance of utilization and quality assurance |

| |management. |

| |Provided monthly training for all staff on computer|

| |systems and documentation, service provisions, |

| |guidelines, insurance, financial (Medicaid, |

| |Medicare, etc.). |

| |Audit records, documentation, and service quality. |

| |Make corrective actions/treatment plans and |

| |recommendations to program managers and other staff|

| |as required. |

| |Establish and evaluate the necessity, |

| |appropriateness and effectiveness of services for |

| |the purpose of controlling cost, while maintaining |

| |quality care. |

| |Review accreditation with JACHO, CARF, ERO, State, |

| |CSB and other regulatory agency standards and |

| |guidelines. Ensure utilization management |

| |documentation is accurately recorded, filed and |

| |disseminated. |

| |Develop and recommend to Q/I team written |

| |procedures for the processes of utilization |

| |management. |

| |Advise attending physician/clinical staff when |

| |medical and service records do not reflect adequate|

| |documentation of active treatment or meet criteria |

| |for service. |

| |Review medical/service records to meet criteria for|

| |authorized services and determine expected length |

| |of stay according to established guidelines |

| |Maintain up-to-date knowledgebase on changes in |

| |hospital-community, clinical guidelines regarding |

| |review criteria; psychiatric and generic quality |

| |screens; certification requirements; and covered |

| |services. |

| |2007-Present New Horizons CSB (Contract) Columbus, |

| |GA |

| |Treatment Plan Writer / Community Service Case |

| |Manager |

| |Provide assistance to the individual in the |

| |development and coordinator of the IRP/Treatment |

| |Plan. |

| |Provide support and intervention in crisis |

| |situations, and assist the individual of his or her|

| |behavioral healthcare. Provide the individual with|

| |support development of interpersonal, community |

| |coping and functional skills. |

| |Provide clinical support, direction and guidance to|

| |staff for the continuous care from inpatient |

| |facility to outpatient services. |

| |Request clinical authorization for services for |

| |clients. |

| | |

| |Support to facilitate recovery including |

| |recovery-based goal setting and attainment. |

| |Coordination to assist the individual in learning |

| |how to gain access to necessary rehabilitative, |

| |medical and other services, along with assistance |

| |with illness self-management and wellness |

| |promotion. |

| |Request and authorizations for services for |

| |clients. |

| |1996-2005 Northrop Grumman Inc. Columbus, GA |

| |Regional Services Coordinator/Office Manager |

| |Receive telephone calls; give routine and |

| |non-routine information, answer questions and |

| |direct calls and visitors to appropriate person or |

| |office. |

| |Coordinate & prepare travel arrangement, file |

| |travel reimbursements, and submit expense reports. |

| |Maintain supervisor's calendar; schedule |

| |appointments and engagements, prepare notes |

| |regarding topics to be discussed; make travel |

| |arrangements, and prepare travel vouchers and |

| |expense reports. |

| |Prepare and type all variety correspondence, |

| |reports, forms, requisitions, and requests for |

| |personnel actions and legal documents using |

| |Microsoft office or other computer programs. |

| |Responsible for shipping, receive and control mail,|

| |packages, and suspense items. Routing all items to|

| |the appropriate persons or office for action. |

| |Organize and maintain files, records, manuals, |

| |handbooks, and other related materials. |

| |Provide all Human Resources related activities, to |

| |include In/Out Processing of all staff, Health and |

| |Benefits trainings and enrollments, EEO, and all |

| |policy and procedures, etc. |

| |Enter or modify employee information, status, in |

| |Payroll/HR system. |

| |Create and maintain ALL employee files and filing |

| |system. |

| |Provide briefings and trainings to management and |

| |staff. |

| |Purchasing, Procurement and coordination of all |

| |computer equipment, office supplies, etc. |

| |Provide customer service to all internal and |

| |external customers. |

| |Coordinate and Plan all conferences, parties, and |

| |other events. |

| |Provided project management support and guidance to|

| |senior and junior management on contract |

| |administration for various U.S. Government |

| |technical and commercial contracts. |

| |Prepared all financial reports; project plans, |

| |budget, cost of operations and program |

| |accomplishments; project trends. Developed and |

| |implemented a number of project-control and |

| |financial-management tools |

| |Troubleshoot and fix office computers and |

| |networking system for staff. |

| | |

| |Additional Skills - Typing 65 to 70 wpm, filing, |

| |scheduling, etc. Extensive knowledge with |

| |operating software and programming such as MS Word,|

| |Excel, Power Point, Novell Server, MS NT, Corel |

| |Draw, Adobe Photoshop, HP Scan, SAP/Tempo, Surf and|

| |People soft, Catalyst, and Georgia State APS Care |

| |Connection & Knowledgebase, as well as Windows XP |

| |and Outlook. Reports and Spreadsheet experience. |

| |Ensuring all procedures involving cash, |

| |collections, accounts receivable & budget |

| |preparations. Hiring, training, & supervising of |

| |administrative and clinical staff. |

|Education |2001-2006 Troy University Phenix City, AL |

| |B.S., Bachelor of Science, Human Services w/minor |

| |Business Administration |

| |A.S., Associate of Science Business Administration |

| |w/General Studies |

| | |

| | |

| |Reference & Additional Work Experience Upon Request|

Contact this candidate