Utilization Management/Social Worker
Resume:
Kelli M. Keys, MSW, LCSW, LCAS
Charlotte, NC 28269
Phone: 803-***-****
Email: *****.*******@*****.***
Education Masters of Social Work August 2011-May 2013
Winthrop University, Rock Hill, SC
Bachelor of Science in Sociology August 2005-May 2010
College of Charleston, Charleston, SC
Licenses/Certifications LCSW Certification (North Carolina) October 2015-October 2023
LCAS Certification (North Carolina) June 2018-May 2024
Relevant Experience
Partners Behavioral Health Management, Gastonia, NC October 2021-Present
MH/SU Utilization Management Child Services Team Lead
●Acts as a liaison between Care Managers and Peer Reviewers
●Processes authorization requests for all levels of care to support fellow Care Managers as leadership during periods of high volume and to ensure coverage
●Provide clinical guidance to Care Managers in cases where medical necessity is questionable and UM leadership is unavailable
●Participates in all rounds sessions with Chief Medical Officer to promote consistency
●Assist with developing and presenting UM Specific trainings both internally and externally
●Assists providers with technical issues, questions, and concerns with regarding the UM Process,
●Completes QA Data/Reporting for Utilization Management Review Team
●Complete audits and identifies training needs within the MHSU Utilization Management Team
●Serves as the go-between person when providers submit Enhance Rate Requests for services, ensuring all documents are correct and completed prior to sending to UM Manager for review.
MH/SU Utilization Management Clinician
●Performs prior authorization review, continued stay and benchmark reviews for children and adults who have been diagnosed with Intellectual/Developmental Disability, Mental Health and Substance Abuse Disorders.
●Consulting with Partners BHM physician regarding request in which there is a question of medical necessity, health and safety issues, medications, and needing for Peer Review when Utilization Reviewer cannot approve request.
●Provide linkage, authorizations and level of care determinations to core services agencies and providers, assisting providers with creative problem solving to suggest alternative approaches to care.
●Performs care management to ensure continuity for care and that consumers receive the right service, at the right time, at the right frequency.
●Provide back-up coverage for after-hours triage of behavioral health crisis call line.
●Member of the Peer Review Task Force (reviewing procedures and implementing changes to the Peer Review process)
ThriveWorks Counseling, Charlotte, NC March 2021-October 2021
Remote Therapist
●Diagnoses and treats mental health disorders.
●Creates individualized treatment plans according to patient needs and circumstances.
●Meets with patients regularly to provide counseling, treatment and adjust treatment plans as necessary.
●Conducts ongoing assessments of patient progress.
Cardinal Innovations, Charlotte, NC April 2020-October 2021
Utilization Management Clinician
●Performs prior authorization review, continued stay and discharge reviews for children and adults who have been diagnosed with Intellectual/Developmental Disability, Mental Health and Substance Abuse Disorders.
●Conduct chart reviews of instances of care authorized for utilization purposes, case reviews for individuals that are identified as either over or under-utilizers of services
●Provide linkage, authorizations and level of care determinations to core services agencies and providers, assisting providers with creative problem solving to suggest alternative approaches to care.
●Performs care management to ensure continuity for care and that consumers receive the right service, at the right time, at the right frequency.
Anuvia Prevention and Recovery, Charlotte, NC March 2016- March 2020
Assessment Counselor
●Facilitate Comprehensive Clinical Assessments to clients dealing with substance use and mental health concerns
●Making appropriate recommendations for different types of level of care for client’s
●Provides case management services
●Assist in making referrals to other providers
●Provide clinical supervision for MSW interns and LCSW-A
Interim Assessment Team Supervisor (February 2019-May 2019)
● Managed the Assessment Team
● Managed Assessment Calendar (how many clients could be seen in one day
● Complete SUDDS-5 on clients who were working with Department of Social Services to receive Food Stamp or WorkFirst Benefits
● Coordinated services for clients who were working Youth and Family Services
Clinical Support Specialist
●Providing clinical support to the first shift staff.
●Assist in substance abuse counseling for consumers with substance abuse/mental health issues who are admitted to the Samuel Billings Center (SBC).
●Assist floor staff with admissions
●Complete diagnosis for incoming clients during the admissions process.
●Facilitate Psychoeducational Groups
Salvation Army: Center of Hope, Charlotte, NC October 2014- March 2016
Veteran’s Program Coordinator
●Completing daily tasks that are geared to the consumers related to housing, employment, medical concerns, vocational skills.
●Learned the ethical and proper ways to work with consumers in these vulnerable populations
●Complete the intake process of new clients (PCP (Person Centered Plans), NC-Topps, etc.), discharge summaries, database training, medication assessments, etc.
Clinical Social Worker/ Case Manager September 2013-September 2014
●Provide weekly case management services to help residents successfully transition and maintain housing and addressing therapeutic issues.
●Assess need for supportive services and link residents to internal and external resources, including medical care, mainstream benefits, mental/behavioral health, and substance abuse recovery services.
●Maintain client’s weekly progress notes and implement individual service plans with clients
Charlotte Rescue Mission: Dove’s Nest, Charlotte, NC August 2012- August 2013
Medical Technician
●Administers prescribed medications to residents and maintains related medical records under supervision of the nurse
●Records name of drug, dosage, and time of administration on specified forms or records identified to each resident.
Advanced Placement Intern
●Assisted in developing children-based activities that addressed common cultural barriers (ex. race, sexual abuse, bullying, etc…)
●Assisted in developing a Policies and Procedures Manual for the Children’s Program.
●Contacted and developed relationships with current and potential volunteers at Dove’s Nest.
●Co-facilitated and lead individual counseling session, groups, and psycho-educational classes.
●Engaged in the Disciplinary Process with residents (ensuring that disciplinary actions for each resident are within the NASW Code of Ethics and Dove’s Nest Structured Guidelines.
Winthrop University, Rock Hill, SC August 2012- April 2013
Admissions Specialist & Teaching Assistant (Graduate Assistantship)
●Developed and maintained a database for MSW program applicants
●Provided administrative supports to the MSW admissions committee
●Initiated regular admissions-related communications with prospective MSW program applicants
●Met with professors to discuss students' grades, and assisted in correcting and grading student’s assignments
Hope Haven, Inc. Charlotte, NC January 2012-August 2012
Contract Worker
●Worked alongside the Clinical Director and Substance Abuse Counselors with the daily tasks that are geared to the consumers
●Completed intake, Person-Centered Plans, progress and discharge summary notes for single women consumers
●Provided case management to those individuals working along with the court system including updates to probation officers and courts/urinalysis/service plans.
Generalist Practice Placement Intern
●Work alongside the MSW Clinical Supervisor and a Substance Abuse Counselor with the daily tasks that are geared to the consumers.
●Learned the ethical and proper ways to work with consumers in these vulnerable populations
●Learned the intake process of new clients (PCP (Person Centered Plans), NC-Topps, etc.), discharge summaries, database training, medication assessments, etc.
References Available Upon Request
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