Shelley Lari, LCSW-R

** ******** ******

Walden, NY 12586

347-***-****

ad3lir@r.postjobfree.com

Dedicated Licensed Clinical Social Worker with a passion for improving the lives of

individuals and families through comprehensive mental health care. Seeking a

challenging role as a Mental Health Clinician to leverage my extensive clinical

expertise, therapeutic skills, and deep commitment to promoting emotional well-being and recovery in diverse populations

EXPERIENCE:

Optum/United Health Care, New York, NY 8/2016 – 10/2023

Division of Clinical Quality Senior Clinical Quality Analyst

Responsible for ensuring the highest quality performance from staff and contracted service providers. My work is self-directed and not prescribed, involving less structured, more complex issues.

Provide direction and guidance on clinical quality improvement and management programs, including accreditation. Conduct clinical quality audits and ensure compliance with NCQA requirements.

Report and analyze member care quality, and develop plans and programs to support continuous quality improvement using HEDIS and other tools.

Conduct on-site facility, agency, and clinician audits nationally. Upon completion, score audits and write audit reports, as well as Plans of Corrective Action, to address identified issues.

Actively collaborate with cross-functional teams and departments to identify areas of improvement and streamline processes, fostering a culture of continuous quality enhancement and efficiency.

Stay updated on industry trends, regulations, and best practices in healthcare quality assurance, integrating this knowledge into the development and enhancement of quality improvement initiatives to remain at the forefront of the field.

Private Practice Orange County, New York 3/2002 - 7/2018

LCSW-R

Conducted comprehensive assessments of individuals, families, and groups, utilizing evidence-based therapeutic techniques to provide counseling and support for clients dealing with various mental health challenges.

Developed and implemented individualized treatment plans, set goals and objectives in collaboration with clients, and regularly evaluated progress to ensure effective therapeutic interventions.

Provided crisis intervention and immediate support to clients in acute distress, effectively managed crisis situations while ensuring the safety and well-being of clients.

Advocated for clients' rights and needs within various systems, including healthcare, legal, and social service agencies, to ensure access to necessary resources and services.

Collaborated closely with healthcare professionals, including psychiatrists, nurses, and case managers, to coordinate care and developed holistic treatment plans that addressed both mental and physical health needs.

Led psychoeducational and therapeutic groups, creating a safe and supportive environment for clients to share experiences, develop coping skills, and enhance interpersonal relationships.

Maintained accurate and confidential client records, ensured compliance with all relevant ethical, legal, and regulatory standards, including HIPAA and state licensing requirements.

Demonstrated cultural sensitivity and competence in working with diverse populations, recognized and respected individual differences and the impact of cultural factors on mental health.

Stayed updated on the latest research, treatment modalities, and ethical standards in the field of social work through ongoing professional development and continuing education.

Provided supervision and mentorship to social work interns and junior staff, contributing to their professional growth and development.

Engaged in community outreach and education initiatives, participated in public awareness campaigns and workshops to promote mental health and well-being.

Maintained active licensure as a Licensed Clinical Social Worker (LCSW-R), adhered to the highest ethical and professional standards in the field.

Institute for Community Living, New York, NY 7/2015 - 8/2016

Division of Quality Improvement and Assurance

Utilization Review Specialist

Coordinated and scheduled concurrent care reviews with Managed Care Organizations, emphasizing the demonstration of medical necessity.

Conducted quality audits of ICL programs on an annual or as-needed basis to determine conformance with regulatory agencies and ICL standards for service delivery.

Developed and provided consultation and education to administration and program staff, emphasizing the principles of medical necessity criteria.

Collaborated with interdisciplinary teams to ensure the alignment of care reviews with the organization's medical necessity standards and guidelines.

Effectively communicated audit findings and recommendations to program leaders, contributing to continuous improvement in service delivery.

Played a key role in ensuring compliance with regulatory requirements, facilitating the successful achievement of program goals and objectives.

Managed the documentation and reporting of care review activities, maintaining accurate records for reference and analysis.

Demonstrated proficiency in utilizing relevant software and tools for data analysis and reporting, enhancing the efficiency of quality audit processes during the Managed Care transition. Knowledgeable about Managed Care guidelines, CARF standards, OMH rules and regulations, as well as HIPAA confidentiality practices.

F.E.G.S., New York, NY 6/2010 - 5/2015

Division of Corporate Compliance

Utilization Review Specialist

Evaluated the quality of care and utilization of services, ensuring treatments met client needs and resulted in positive outcomes.

Conducted admission and continued stay reviews, demonstrating an in-depth knowledge of all local, state, and federal laws related to the agency's operation.

Assisted with the facilitation of the agency's adverse outcome event data and tracked corrective actions to ensure compliance and quality improvement.

Participated actively in creating Performance Improvement initiatives, collaborating with the team to identify areas for enhancement in service delivery.

Collaborated with multidisciplinary teams to develop and implement strategies for enhancing the quality of care and optimizing service utilization.

Maintained comprehensive knowledge of industry regulations, ensuring the agency's policies and practices remained compliant with all applicable laws.

Played a pivotal role in the analysis of adverse outcome event data, contributing valuable insights to mitigate risks and improve patient care.

Contributed to the development of performance metrics and benchmarks to monitor the agency's effectiveness in delivering high-quality care.

Utilized data analysis tools and reporting systems to track and report on key performance indicators, facilitating data-driven decision-making for quality improvement initiatives.

PSCH, Inc., New York, NY 5/2008 - 6/2010

Director of Social Work for Developmental Disabilities Services

Supervised social work staff in day treatment program settings, overseeing services for developmentally disabled and dually diagnosed consumers.

Conducted staff development activities, provided in-services for day program and residential staff, and completed psychosocial assessments for clients.

Assisted with family interventions when necessary, ensuring comprehensive support for consumers and their families.

Initiated and hosted Consumer Council meetings for New York and New Jersey residential consumers, organizing related activities to foster consumer engagement and feedback.

Coordinated referrals to PSCH Informed Consent activities, ensuring compliance with informed consent procedures and ethical guidelines.

Actively participated in the PSCH Incident Review Committee, contributing insights and recommendations to enhance the safety and well-being of consumers.

Collaborated with interdisciplinary teams to ensure the effective delivery of services and the alignment of program goals with the needs of consumers.

Provided mentorship and guidance to social work staff, fostering their professional growth and development within the day treatment program.

Maintained thorough and accurate documentation of client assessments, interventions, and progress, ensuring compliance with regulatory requirements.

Demonstrated proficiency in crisis intervention and management, ensuring the safety and stability of consumers during challenging situations.

Conducted clinically focused chart reviews, in residential and day treatment settings, as part of an interdisciplinary team. Responsibilities included but were not limited to crisis intervention, program research and development, and the development and implementation of staff competency trainings.

Proficiency obtained in developing staff training curriculum and organizing data to create PowerPoint trainings.

Mary Immaculate Hospital, New York, NY 4/2005 - 3/2007

Psychiatric Licensed Certified Social Worker

Completed psychosocial assessments, provided counselling, conducted family interventions, and performed crisis intervention for clients in both chemical dependency and acute psychiatric inpatient units.

Ensured appropriate discharge planning and aftercare referrals, promoting the smooth transition and on-going care for clients.

Facilitated case management and contributed to psychiatric care reviews for managed care clients as an integral part of a multidisciplinary treatment team.

Demonstrated proficiency in time management and multitasking within the fast-paced environment of an acute inpatient unit, serving clients with diverse psychiatric and chemical dependency diagnoses.

Fidelis Care Of New York, New York, NY 9/2004 - 4/2005

Clinical Case Manager

Managed the psychiatric treatment of consumers for a managed care organization serving Medicaid, Medicare, Family Health Plus, and Child Health Plus members in NYC and NYS.

Conducted case management to determine medical necessity criteria, utilizing Milliman and Rothman criteria as the basis for evaluation.

Reviewed outpatient care, partial hospitalization, and inpatient acute psychiatric admission cases, including those related to drug and alcohol detoxification and chemical dependency rehabilitation admissions.

Provided 7, 30, and 60-day follow-up for designated at-risk subscribers, as determined by NYS HEDIS protocol, ensuring on-going care and monitoring for their well-being.

St. Joseph’s Hospital, Flushing, NY 6/1997 - 8/2004

Department of Social Work Services, Department of Behavioral Health

Completed psychosocial assessments and discharge planning in an acute inpatient hospital setting, covering both medical-surgical and psychiatric floors.

Provided supportive therapy to individuals and families, conducted family meetings, and offered appropriate aftercare referrals to ensure comprehensive care for patients.

Rotated social work coverage for the emergency room, where crisis intervention, psychosocial assessments, and community referrals were promptly provided to address urgent needs.

EDUCATION, CERTIFICATIONS:

State University of New York at Stony Brook

Master of Social Work 1997

State University of New York at Binghamton

Bachelor of Arts in Social Science 1994

SIFI Certified

References Available Upon Request

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