Barb Gardetto, LMSW-IPR, LVN, CCM
North Richland Hills, TX 817-***-**** (c) firstname.lastname@example.org
Dynamic Social Work Director with over 25 years’ experience accompanied by well-developed skills in service coordination and monitoring, advocacy, problem-solving, and identifying gaps in services. Proven success in business development, case management, chart audits/utilization review and management, sales & marketing, adult/ pediatric care, training, development and staff management. Specialized training in SSI/SSDI/HHSC(CAS)/Medicare & Advantage Plans/Medicaid (STAR) CHIP, PCS, CSHCN reimbursements, HEDIS Measurement, Texas Medicaid Waiver Programs: (MDCP, STAR-PLUS, DBMD, HCS, TX Home Living & CLASS).
Increased client referral base by 50% in one year. (PT Home Care).
Expanded revenue base by $3 million - 150% increase. (PT Home Care).
Reduced/consolidated work load by shifting Pediatric program to LHH category of service. (PT Home Care).
Developed and implemented programs: Case Management for Pregnant Women/Children (PT Home Care/A to Z Therapy); CCP Pediatric Therapy (PT Home Care/ Behavioral Health (A to Z Therapy).
Created, developed and executed community presentations for: Medicaid Programs/Community Resources/Home Health/Adult/ Pediatric Programs and increased referrals by 25% (All Agencies).
Prepared staff for Initial and Recertification CHAP Accreditation (PT Home Care).
Created, developed, and disseminated marketing materials, crafted strategic sales/ marketing plan. Increased client referral base by 50% (PT Home Care).
Designed, developed, educated, implemented QAPI and Compliance Programs (A to Z Therapy).
Met with key Legislators in Washington D.C. to discuss Home Care issues (2010/2012).
Met with key Legislatures in Austin to discuss home health issues, participate in hearings, advocacy. (2007- present).
UHC/OPTUM HEALTH/USMD 2017-present
Population Health Complex Case Manager, Multi-site (Adults/ Children)
Conduct assessments (motivational interviewing), establish smart goals/POC, concurrent review, coordinate all care, community resource linkage, advocacy, weekly Patient Care Conference to coordinate with Providers and office team. Documentation entered into Vitreous Predictive Model (increase clinical outcomes and cost containment)/ Next Gen. QA/PI/UR/UM. HEDIS Measurement. Assisted with initial NCQA Audit preparation and meet key performance metrics. Monitor L.A.C.E Scoring (10 or greater)/ Population Stratification Bands (4&5). Data analytics, outcomes reporting. Volunteer Hurricane Harvey Coordinator.
Barb Gardetto Page 2
Life Care Hospital/ Haven Home Health (TJC) 2015 - present
Interim Director of Quality/ Case Manager/ Social Worker (Part-time)
Collect/compile/enter data for Incident/Complaint/ Grievance Reports/Chart Audits in Verge. Prepared stats for daily Team Meeting. Collect review Pt. Satisfaction Surveys and submit to Deyta. Review/compile/enter data for LTC Data set in HCS Interactant. Conduct chart audits/ investigations. Provide orientation. Risk management. Participate in Infection Control, QA, Safety, and Fall Committees. Conduct assessments, establish POC/ goals, concurrent review, D/C planning, UR/ UM. HEDIS Measurement. Home visits.
Health South Rehabilitation Hospital (TJC) 2012- 2017
Hospital Case Manager/ Medical Home Health Social Worker
Conduct assessments, establish transdisciplinary POC and goals, concurrent review, coordinate all care, community resource linkage, D/C planning, weekly Team Conference to coordinate with physician and rehab team entered into ACEIT. Obtained insurance authorizations entered into PATCOM from Insurance CM, monitored transitions. Complete PASRR for SNF.UR/UM, HEDIS Measurement. Perform clinical chart reviews and compile data for PAC Meetings. Home visits.
A to Z Therapy Management, LLC. (Pediatric Home Health) 2011 - 2012
Administrator/ Government Affairs/ Case Manager
Ensured compliance with all applicable federal/state program policies. Performed clinical chart reviews. UR/UM, HEDIS Measurement. Conducted quarterly QAPI Meetings. Accompanied regulatory on-site visits. Reviewed P&L Reports/Monthly AR/Collection Meetings. Testified in state rate hearings/HHSC meetings. Managed and trained all staff. Home Visits.
P.T. Home Services of Dallas, Inc. (CHAP/LCHH) (Adults/ Children) 1998 – 2010
Administrator/Government Affairs/ Case Manager
Ensured compliance with all applicable federal/state program policies. Performed clinical chart reviews, collected, measured, compiled data for CQI Report conducted quarterly CQI/ PAC Meetings. UR/UM, HEDIS Measurement. Accompanied regulatory on-site visits. Prepared annual budget agency expenditures. Reviewed P&L Reports/Monthly AR/Collection Meetings with Corporate Team. Developed agency policies. Managed and trained all staff. Home Visits.
Master of Science in Social Work, (Admin. & Community Planning Focus) UT Arlington
Bachelor of Science in Social Work, Kansas State University
Diploma Vocational Nursing, All Saints Vocational Nursing School
Licensed Master Social Worker, (LMSW- IPR), License Number15462
Licensed Vocational Nurse, (LVN), License Number 98431 BCLS/First Aid
Certified Case Manager, (CCM), Certificate Number 4213267 CPW Case Manager
National Association of Social Workers (NASW); NASW (C-ASWCM)
(TAHC&H) Pediatric/ Government Affairs/Medicare/Medicaid Committees 2006-present.
The ARCNETC Board of Directors 2013 – present.
NASW/Texas Elected Delegate/TPACE Chair 2015 – present.
NASW/National Authored Policy Panels (Aging & Wellness/ Family/ Welfare Reform) 2015 – present.