Customer Service Management
Resume:
HENRIETTA SMITH
DURHAM, NC *****
**************@*****.***
SUMMARY
A proficient, self- starter, and team oriented individual. Possess
experience performing responsible work assisting in the administration of
profit and non-profit agencies. Exercise leadership, training, supervisory
and customer service skills with individuals or groups. Proven ability to
perform multitasks. Dynamic team player sought by upper level management
for special projects and challenging assignments.
PROFESSIONAL
EXPERIENCE
Infinite Wellness Concepts
11/2009-
8/2012
Utilization Management Perform duties related to the day-to-day
operations of the Consumer care load functions to include working with
members to identify needs and goals to achieve empowerment and improved
quality of life. Assess members' current functional level and, in
collaboration with the member, develop and monitor the Case Management
Treatment Plan, monitor quality of care; assisting with discharge planning,
participating in special clinical projects and communicate with
departmental and plan administrative staff to facilitate daily operations
of Case Treatment functions. Collaborate with both medical and behavioral
providers to ensure optimal care for members.
Duties and responsibilities
o Leads, supervises and directs the workload in the utilization
management Department
o Working with office staff, Clinicians, authorization entities,
quality management and leadership staff on staffing of cases
o Represents utilization management at various committees, professional
organizations and Local Management Entity meetings
o Keep current with regulatory changes
o Performs utilization review. Conducts and submits admission and
concurrent authorization for approval to appropriate entities.
o Review each submission to determine the appropriate of admission and
that all meet the entrance criteria prior to submission to physician.
o Develop system for timely review of authorizations for concurrent
services
o Insure agency is in compliance with third party billing requirements,
identify criteria for admission to obtain reimbursement or services
o Collaborate with other departments in the development of step down and
discharge criteria.
Director QA/QI
o To review business statistics.
o To determine and document any areas that may need improvement..
o Inspecting and sampling the entire manufacturing process is another
part of quality assurance job description.
o To review and analyze the effectiveness of the modifications made.
o To ensure that all procedures within the company conform to health and
safety regulations, financial policies and legislation such as equal
opportunity.
o To educate the sales and marketing departments regarding the specific
requirements of clients.
o Advising the executive management team about program related issues of
process and substance.
o Identifying and developing future goals and activities for the Quality
Improvement & Efficiency program and participating in decision and
priorities and activities.
o Developing new projects for the Quality Improvement & Efficiency
Program including conducting background research as needed,
identifying and evaluating potential opportunities.
o Supervises and evaluates the performance to key staff
o Oversees and facilitates Client Rights committee meeting.
Community Support Team-Lead Qualified Professional
o Working with Adults (Full-Time)
o Develop crisis plans and participate in "first responder" crisis
response on a 24/7/365 basis to consumers experiencing a crisis
o Ensure compliance with all Progressive Interventions policies and
procedures, as well as local, state, and Federal regulations.
o Coordinate and oversee initial and ongoing assessment activities
o Conduct CST Strength and Needs Assessments
o Ensure NCTOPPS assessments are prepared and submitted on time
o Ensure submission of opening paperwork is accurate, complete and
timely
o Facilitate Person Centered Planning meetings and ongoing treatment
team meetings
o Consult with identified providers, include their input into the Person
Centered Planning process, inform all involved stakeholders, and
monitor the status of the recipient in relationship to the treatment
goals
o Develop and revise individual's Person- Centered Plan
o Provide case management functions of linking and referring
o Arrange for the recipient to receive benefits and services
o Monitor the provision of services
o Approve and sign off on all Support staff documentation ensuring the
timely submission and accuracy
o Identify and intervene to address barriers that impede the development
of skills necessary for independent functioning in the community in
the role of an advocate.
o Meet billing requirements
o Assist in training staff
o Participate in peer review
o Assist in the assignment of new admissions
o Review PCP's & ITR's
o Submit PCP's & ITR's electronically
o Review Weekly hours for unbilled hrs. *on Tuesday
o Update Master Spreadsheet & notify QP's when updated/Revised PCP's are
due (14 days in advance)
o Manage 3 QP cases
o Document Lead QP notes twice a week
o Check VO website twice daily for authorization updates & call to
verify unauthorized cases.
PROGRESSIVE INTERVENTIONS
07/2009-11/2009
Assistance Program Manager
o Providing monthly individual supervision of QP's
o Monitoring documentation of staff to ensure compliance with Medicaid
standards
o Monitor weekly billing
o Orientation and ongoing training of the Qualified Professional
o Assist with Crisis situations
o Crisis phone rotation
o Additional duties as delegated by the Director
Community Support Team-Lead Qualified Professional
o Develop crisis plans and participate in "first responder" crisis
response on a 24/7/365 basis to consumers experiencing a crisis (Full-
Time for 3 months)
o Ensure compliance with all Progressive Interventions policies and
procedures, as well as local, state, and federal regulations.
o Coordinate and oversee initial and ongoing assessment activities
o Conduct CST Strength and Needs Assessments
o Ensure NCTOPPS assessments are prepared and submitted on time
o Ensure submission of opening paperwork is accurate, complete and
timely
o Facilitate Person Centered Planning meetings and ongoing treatment
team meetings
o Consult with identified providers, include their input into the Person
Centered Planning process, inform all involved stakeholders, and
monitor the status of the recipient in relationship to the treatment
goals
o Develop and revise individual's Person- Centered Plan
o Provide case management functions of linking and referring
o Arrange for the recipient to receive benefits and services
o Monitor the provision of services
o Approve and sign off on all Support staff documentation ensuring the
timely submission and accuracy
o Identify and intervene to address barriers that impede the development
of skills necessary for independent functioning in the community in
the role of an advocate.
o Meet billing requirements
o Assist in training staff
o Participate in peer review
o Assist in the assignment of new admissions
COMPREHENSIVE COMMUNITY CARE, INCORPORTETED
02/2009-07/2009
Qualified Professional
o Provide an array of services; treatment plans, case management to
specialized caseload of clients for Adults and children, (Full-Time)
o Including:
o Coordinate and overseeing the initial and ongoing assessment
activities, initial development and ongoing
of Person centered plan; monitoring of implementation of plan.
o Assist consumers' in accessing available benefits and services.
o Maintain all applicable professional, legal and ethical standards,
including confidentiality, dual relations, and
o Informed consent.
o Provide clinical documentation, reports, and records to meet State,
Federal, Regional and departmental
o Standards and requirements
FAMILY AND YOUTH SERVICES, INCORPORATED
Qualified Professional
11/2007-
11/2008
o Develop and revise individual' Person Centered Plan for Adults and
Children. (Full-Time)
o Consult with identified providers, include their input in the PCP
process, inform all involved collaterals and
o Monitor status of progress toward goals.
o Provide case management functions to arrange, link or integrate
multiple services and continually assess the
o Need for services.
HIV Case Manager
11/2007-11/2008
o Worked with Adult Population (Full-Time)
o Coordinate and follow through with client contact on a regular
basis.
o Population served was both Adults and Children
o Complete the client care plan within 10 days of the client
assessment or annual re-assessment.
o Adhere to Medicaid guidelines and regulations.
o Develop and maintain positive relationship with the providers of
services established within the community.
o Provide timely billing for Medicaid.
o Maintain satisfactory case management progress notes daily after
each client interaction.
o Track clientele medical condition including vital lab reports.
o Attended regular meetings and training.
o Properly utilize the eight core components of case management on
a daily basis.
o Good written and verbal communication skills.
o Problem solve
o Critical Thinking
o Multi-tasked
o Other assigned tasks.
DUKE UNIVERSITY
06/2003-02/2006
Durham, NC
Counselor (Qualified Professional)
Responsibilities included developing projects, plans and creative efforts
in providing a full range of counseling services to patients and families
who receive care from the Duke Infectious Diseases Clinic. (Full-Time)
o Facilitate positive connections, group discussions and Peer
Educational Training
o Generate referrals for study programs to compile information for
research and statistics
o Provide support services and case management for Mental Health Clients
both Adults and Children population
o Provide ongoing, face to face in home counseling
o Provide counseling and advocacy to caseload
o Provide accurate and detailed information to clients concerning HIV
and taking medication
o Provide training and education to clients, families and Case managers
about practicing sex safe and how to put on a condom and the different
types of condoms even female condoms.
o Set on the CAB board and Project Straight talk board
o Did testing for HIV using Oral Quick (Pre-Post Testing)
o Help write Grants to receive more funding (SAMHA)
o Did Recruitment for programs for Duke Infectious Diseases Clinic
o Provided counseling to patients and families with helping them cope
with being newly diagnosed
o Responded to calls from social workers, case mangers and chaplains
o Provided HIV counseling and education to clients in the STD, TB,
Family Planning, Adult Health and HIV clinics.
o Provided disease investigation, patient tracking and referral for
treatment of persons diagnosed with sexually transmitted disease.
o Assist Adults and Children with mental health referral for outpatient
therapy
o Facilitate support groups for substance abuse
o Taught classes on Self care (Had practicing safe sex discussions and
provided consumer with educational materials to help reduce sexual
transmitted diseases in the Black community)
BATTELLE SURVEY RESEARCH ASSOC.
09/2005-07/2006
Durham, NC Field
Interviewer (Part-time)
07/2005 -
06/2006
Responsibilities included developing strategies and creative efforts to
collect and compile factual data from subjects for various Researches.
(Adults/Part-Time)
o Coordinated screening appointments and sessions
o Compiled data and collected surveys to ensure quality assurance
o Monitored and provided consent forms
o Reported changes and completed various reports
o Maintained client information data base system
DURHAM HOUSING AUTHORITY
Durham, NC
Recertification Specialist
05/2000-
05/2003 06/2000-
06/2003 Responsibilities and duties included Recertifying Section 8
housing applications to client in maintain housing.
o Certification and Re-certification of Section 8 housing applications
o Provided support services and Case Management
o Facilitate lease and contract review sessions
o Provide exceptional public and customer service.
o Rendered services to customers and individuals
THE HOUSING AUTHORITY OF THE CITY OF DURHAM
Outreach Worker
11/1999-04/2000
01/2000 -6/2000
Responsibilities included developing strategies and creative efforts to
assist economically disadvantaged individuals to become employed.
o Provide intake services and generate referrals for public housing
residents
o Complete monthly reports
o Conduct community based in-home evaluations
o Provided follow up and tracking to ensure client needs are met
o Provided counseling and case management to caseload
EDUCATION
Currently In Grad School - Walden University - Mental Health Counseling
6/12
Volunteering on the PTA Board as Co-Vice President
North Carolina Central University, Durham NC-December 1999
Degree in Sociology with a concentration in Human Services. Areas of study
include Sociology, Housing Management, Computer Information Systems,
Statistics, Counseling and Research. Certified Housing Manager
SKILLS
* Analytical, Problem solving, Research and Critical thinking skills
* Computer technology: Word, Excel, Power point, Publisher, Internet,
Email, etc
* Accounting, Financial Management, Quantitative Statistics
* Has the ability to provide crisis intervention and Counseling
* NCI core
* Blood Borne Pathogens
* First Aid/CPR
* Crisis Response/Planning
* Documentation
Contact this candidate