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Johanna Demers

**** ********** **.

Valrico, FL 33596

813-***-****

aboweg@r.postjobfree.com

SUMMARY OF QUALIFICATIONS

Highly motivated, results-driven professional residing in Valrico, Florida with degree in

psychology and experience work with clients, HMOs, Medicare, Medicaid, and Commercial

health plans seeking to contribute my educational and volunteer experience to a well

established company working with patients and health insurance companies.

Transferable skills include:

Excellent oral and written communication Attention to detail

Interpersonal communication Organized

Adaptable Goal-Oriented

Individual/Group Instructional Training Creative

Team-player Scheduling

EDUCATION & CERTIFICATION

-Bachelor of Science, Psychology & Clinical Mental Health Care Certification (2009)

-University of Maryland University College, College Park, MD

-Related Course Work: Psychology of Gender, Psychology of Human Sexuality, Sensation and

Perception, Managing Interpersonal Stress, Psychology of Happiness, Psychology of Eating

Disorders, Experimental Methods in Psychology, Social Psychology, Biological Basic of

Behavior, Adult Psychopathology, Psychology Of Religion, Principles of Psychological

Assessment, Human Biology, African American History, History of Japan, Anthropology, and

Statistics.

-Clinical Mental Health Care Certification (May 2009)

-University of Maryland University College

-Professional Crisis Management Certification completion July 1, 2009

-(expiration date: July 2010)

-Behavioral Assistant Training Certification (July 7, 2009)

-CPR- Red Cross (completed July 2009)

-Maryland Resident Health Producer Individual Certification (2008)

-(LN# RPI 100006967 - expiration date: 2010)

-Therapeutic Crisis Intervention ( September 2009)

-HIPPA (2012)

PROFESSIONAL EXPERIENCE

Communication Skills

-Present weekly audits for Case Management, Utilization Review, Pharmacy Appeals, and

Medical Appeals.

-Verify and communicate information for various organizations such as states ( FL, MO,

NY, IL, OH), regulatory affairs committees, ACHA, NCQA, and URAC.

-Collaborates with other teams, departments and providers including but not limited to

Customer Service, Intake, Outpatient, Pharmacy, Transportation and Community Mental Health

Centers as needed.

-Audited Telephonic intake processing for member with significant behavioral diagnoses of

Schizophrenia, Bipolar, Manic Depressive, Mood Disorder Nos, ADD, ADHD.

-Trained direct care staff on behavioral plans for Autistic, Mental Retardation, PTSD,

Schizophrenia, Bi-Polar, Impulsive disorder, aggressive behavioral clients.

-Conducts post hospital discharge follow up calls to members within established

timeframes to assess and overcome barriers to attendance at aftercare appointments.

-Verified information concerning eligibility, provider status, benefit coverage,

coordination of benefits, maintaining confidentiality of company and protected health

information.

-Effectively present information and respond to questions from families, members, and

providers.

-Trained Group Advisors on Behavior Plan for the school and residential treatment

facility.

Organizational Skills

-Organized presentations for national and state auditors.

-Organize and report critical incidents and summaries to regulatory affairs and ACHA.

-Created internal CAP when HMO was out of Medicare, Medicaid, ACHA, and state

requirements.

-Created corrective action plans for HMOs delegates.

-Audit between 200 to 640 files a week for NCQA cooperate accreditation reviews for the

following internal departments: Medical Case Management, Medical Utilization Review,

Medical Appeals, Pharmacy Appeals.

-Review CFARS/ FARS, Critical Incidences, monthly reports for ICM programs, inpatient

admissions, PHP and IOP authorizations for all markets submitted by a behavioral health

delegated entity.

-Coordinated community resources with emphasis on development of natural support system;

coordinates benefits, regulations, laws and public entitlement programs; applies

psychological and counseling theory and industry standard clinical guidelines for members

with the appropriate ICD-9/DSM IV diagnosis, maintains HIPAA standards and confidentiality

of protected health information; reports critical incidents and information regarding

abuse and neglect

-Assisted in reviewing, collecting, and submitting all daily referrals to behavioral

Intensive Case Management to be submitted to assignment from the Sr. ICM Care Manager.

-Managed 95 percent of Behavioral Intensive case management members for Medicaid and

Medicare for the following states: FL, GA, LA, TX, CT, NY, NJ, OH, IL, IN, MO, CA, WA, MI.

-Effectively managed over 200 intensive behavioral cases monthly connecting Medicaid and

Medicare members to local services including: discharge planning, locating medical and

behavioral providers, locating low income housing and shelters, food and clothing

assistance, financial assistance, locating treatment centers, resolving pharmacy issues,

evaluating subsidy levels, finding school and local children programs, and reviewing all

benefits for members.

- Coordinated Intensive Care Manager member services with Utilization Review/discharge

planners and Concurrent Review Team.

-Assisted member in locating local community services including shelter, housing, food

banks, reducing bills, creating budgets, ect.

-Helped Organize a committee in which served as a military spousal support system to

military dependent/spouses when military members are not present.

-Created a support network for disabled teenagers to seek activities such as swimming,

track, soccer, and fitness instructions through Old Colony YMCA of Middleboro.

-Designed and taught over 200 swim instructional classes to diverse age groups ranging

from 6 months to adult which increased swim class availability by 60%.

-Interacted daily with over 30 family campsites ensured the health and security of those

on the campground.

Administration/Leadership

-Increased Productivity by 50 percent by proposing and implementing a new intensive care

management system for care managers and clinical coordinators.

-Took CompCare off seven HMO plans external CAPS in a 6 month period for appeals and

denials, call center stats, precertification documentation, timeliness of universes,

timeliness of file pulls, and precessing Outpatient treatment reviews in timely manner

-Trained Case Managers and Clinical Coordinators on community resources and provider

searches.

-Assists in preparing and submitting projects, reports, audits, or assignments as needed

to meet organizational initiatives and/or objectives.

-Developed welcome bag for new administration residents

-Created different situation of role playing for clients to express feelings about

positive and negative outcome of events

-Provided cost, education requirements, and guidance for new arriving military spouses on

island.

-Developed and implemented new water aerobic classes for Gulf Coast YMCA, which brought

in more than $40,000 annually.

-Directly corresponded with the Directors and CEO of the Middleboro YMCA about

implementation of multiple new youth and family camp programs

-Delivered and organized daily in-patient and out-patients charts.

-Organized medical materials including non-sterile materials, sterilized materials, and

hazards materials on pre-op and post-op floor ensured 100% accountability.

-Prepared approximately 50 patients in a three hour period for registration pre-op and

post-op discharge a task normally taking over four hours.Knowledge and Abilities

-Knowledge of: (1) triage and crisis management; (2) customer service skills; (3) linking

and coordination of services; (4) referrals; (5) documentation of outpatient treatment

authorizations; and (7) monitoring, tracking, and reporting of services as needed.

-Knowledge of: (1) community resources with emphasis on the development of natural

support system; (2) benefits and entitlement programs; (3) how to work with families; (4)

confidentiality; (5) information regarding the ramification of abuse and neglect.

-Knowledgeable of and comply with state and federal statutes, rules and policies that

affect the members.

-Knowledge of Microsoft Office including Outlook, Word, Excel, Access, Emma, Centrix,

Intranet, and Internet

-Ability to correctly (spelling and grammar) write business letters and comprehensive

reports.

-Ability to learn company approved software, including database and computer system, and

other industry software in order to perform job duties.

-Ability to remain calm in a fast paced environment with changing priorities and under

pressure.

-Ability to define problems, collect and interpret data, establish facts, draw valid

conclusions and process work to completion.

-Ability to organize tasks and work environment

WORK & VOLUNTEER HISTORY

June 2011- June 2012Quality Behavioral Health Auditor, Comprehensive Behavioral Health,

Tampa FL

January 2011 - June 2011Quality Medical & Pharmacy Aduitor, WellCare, Tampa FL

January 2010- Janiary 2011Behavioral Clinical Coordinator, Wellcare/Harmony Behavioral

Health, Tampa FL

September 2009- PresentBehavioral Analyst/ Specialist, Tampa Bay Academy, Riverview, FL

July 2009- September 2009Behavioral Analyst Assistant, Pediatric Health Choice, Tampa,

FL

October 2008- January 2009Account Executive, Aflac, Marriottsville, MD

June 2005- June 2008Educational Specialist, 353 OSS, Okinawa, Japan

June 2005- January 2009University of Maryland University College Student

June 2003-March 2004Water Fitness Instructor, Mississippi Gulf Coast YMCA, Ocean

Springs, MS

August 2003- December 2003College Student- Assistant Dental Hygienist Certificate

May 2002- October 2002Assistant Camp Director, Old Colony YMCA- Camp Yomechas,

Middleboro, MA

September 2001- June 2002Nurses Assistant Intern, Morton Hospital, Taunton, MA

March 2001- December 2002Special Needs Coach, Town Of Middleboro, Middleboro, MA

June 2000- December 2002Lifeguard/ Swim Instructor, Old Colony YMCA, Middleboro, MA

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