Case Manager

Carol Rene’ Pryce

**A Clinton Court

New Castle, DE 19720

Mobile: 302-***-****

Email: **********@*****.***

WORK EXPERIENCE

State of Delaware-Goodwill Staffing 04/2024-present

Newark, DE

While working as a Social Worker with the Robscott QMB/SSI Medicaid office from April 8, 2024 to present, I was responsible for determining eligibility for clients seeking Medicaid assistance to pay for Medicare Part B premiums, copayments and the remaining 20% of medical expenses not covered by Medicare by interviewing clients or their authorized representatives to obtain information regarding client's gross income and reviewing documentation to determine countable expenses and making recommendations for approval or denial based on QMB/SSI Medicaid policy, providing case management for cases on my caseload and completing yearly redeterminations to determine if client's still meet monthly income requirements per policy and knowledge of policy governing QMB/SSI Medicaid and food benefit administration.

CIS Works

10/2023-04/2024

Middletown, DE

Managing a caseload of participants and maintaining frequent contact throughout the Division of Vocational Rehabilitation Supported Employment (DVR-SE) process, documenting in a detailed and objective manner, completing all documentation and reports by the deadline assigned, communicating with other team members to make sure reports are complete and include all important information,scheduling and conducting CIS intake meetings on MS Teams virtually or in-person, uploading intake paperwork into participant files, sending to appropriate staff, creating and updating Task List Fading Plans (TLFP) for participants, coordinating with the Administrative Assistant to ensure files are created for new participants, attending IEP/LSP/BSP meetings when necessary for those on my caseload, developing and conducting community-based assessments, determining an individual's work skills, attitudes, interests, likes and dislikes, maintaining a professional relationship with all assessment sites, funding sources, participants, and other support team members, assurance that authorizations are received and uploaded into participant file before moving forward with each phase of the process, tracking and monitoring support hours through each phase of the process, reviewing corresponding notes and documentation, responsible for requesting more hours as needed throughout the process, educating and connecting the participant to benefits support and development team when needed, advising the Assistant Director and Manager of Employment Services of any complaints and non-conformance issues and providing Job Coaching as needed.

UnitedHealthCare

5/2023-9/2023

Philadelphia, PA

As a Field Based Healthcare Ambassador with UnitedHealthCare, my role was to manage and provide access to necessary supportive services in the community, to provide case management services as needed and requested, to develop programs and resources that support wellness for individuals receiving Medicare supplemental services under the UHC plan for individuals with 5 or more chronic conditions that required additional supports and services. Some of my duties included completing community in person visits or telephone visits using MS Teams to facilitate these meetings, completing diabetic retinopathy testing using RetinaVue imaging machines, updating consent forms and other documentation related to patient care, making telephone calls to check on patients and completing surveys during these calls as needed, scheduling appointments for in person and telemedicine visits with medical service providers (RN, NP and MD) and setting up referrals for services such as behavioral health, prescription assistance and other services as needed to help the patient remain in the environment most comfortable for them. Using company systems to update, modify and delete information in participant electronic records and sending out documentation as required by the patient based on their individual needs.

Keystone First CHC

9/2022-05/2023

Philadelphia, PA

My role with Keystone First Community Health Choices was to manage and provide access to necessary supportive services in the community, to provide case management services as needed and requested, and develop programs and resources that support wellness for individuals receiving Long Term Support Services under the Home and Community Based Waiver program with Keystone First Community Health Choices. Some of my duties include completing community in person visits using motivational interviewing techniques to update Person Centered Plans to promote improved health and well being, completing assessments when participants have a trigger event that require a temporary and/or a permanent adjustment of services to help the client remain in the community and assistance with referrals for other services they might need due to the change in health circumstances. Using company systems to update, modify and delete information in participant electronic records and sending out letters to notify participants of upcoming meetings, changes in their benefits and other documents as required by law.

State of Delaware

8/2000-10/2020

Bear, DE

Working in multiple positions within different human services agencies with responsibilities such as staff supervision, case management and client monitoring to obtain positive outcomes for vulnerable populations.

As a Senior Social Worker with DDDS from August 2015 to October 2020, I worked as the primary advocate for individuals on my caseload of 32 to 50 clients living in 13-20 group homes with duties that included development and monitoring of Life Span plans for each client annually, facilitating Life Span plan meetings, scheduling meetings for yearly service plans, addressing behavioral issues requiring modifications of the Life Span plan with support team members, communicating with service providers such as residential and day program staff, working with families and guardians to ensure that they are involved in implementation of the client Life Span plan, and ensuring compliance with applicable standards governing DDDS and its regulations by service providers and ensuring that services are being provided according to the client’s Life Span plan and Home and Community Based Waiver Services. Other duties included interviewing clients, their families and/or professional sources on monthly and quarterly basis to determine clients needs for a variety of social services which may include employment, job search and basic skills remediation, developing a comprehensive cost effective service plan utilizing in-house sources, referrals, contracted providers and/or institutions, conducting on-going monitoring and assessment of service delivery for optimum quality and efficiency, and authorizes and recommends changes and adjustments as needed, maintaining comprehensive case records, summaries, statistical and narrative reports and completing required forms, establishing an effective working relationship with clients, family, community and professional sources, providing specialized casework and counseling services in such areas as protective, adoption and options counseling, providing direct casework service through individual/group conferences, counseling and/or site visits, supplying information and responses to inquiries regarding services for clients, family, community and government agencies and providing supportive casework to clients prior to, during or after hospitalization based upon physicians diagnosis and recommended treatment.

While working as a Senior Social Worker with Long Term Care (LTC) Medicaid from May 2011 to August 2015, I was responsible for determining financial eligibility for clients seeking LTC Medicaid assistance by interviewing clients or their authorized representatives to obtain information regarding client's income and resources, reviewing documentation to determine countable and excluded assets and resources, making recommendations for approval or denial based on LTC Medicaid policy, providing case management for cases on my caseload and completing yearly redeterminations to determine if client's still meet income and resource levels per policy and knowledge of Policy 20000 governing LTC Medicaid benefit administration. I was also selected to be a member of the Policy and Planning Manual Committee to update LTC Medicaid policy and rewriting procedure using Peabody format.

As a Social Service Specialist with Emergency Services from July 2010 to May 2011, I was responsible for conducting individual interviews to determine client eligibility for emergency services such as electricity, rental, kinship, food, diabetes, medical, teen program and homeless shelter vouchers for clients using state government Policy 6000 governing benefit administration. Screening clients during assessment interviews to determine client needs in accordance to program guidelines, requesting documentation from clients to determine eligibility, making sure cases are processed within 48 hours, using CAPS and DCIS II departmental systems to enter client data and answering client telephone calls to answer general questions regarding program guidelines.

Working for the Unemployment Insurance division from August 2000 through October 2009, I advanced to increasingly responsible positions within the agency starting as a front line worker processing claims for unemployed clients, requesting wages when needed, setting up overpayments, and submitting information to determine INS compliance. I was promoted to a Claims Deputy position where fact finding interviews were conducted to determine unemployment eligibility based on employment separation and Title 19 of the Delaware code governing unemployment benefit eligibility, requesting documentation to support each party's side of the story and acting as an agency witness during appeal and board hearings appealing a decision. This position culminated in my promotion to a management role as the Interstate Liable Office Supervisor position where I had oversight over six to nine employees and acted as the Coordinator for the state of Delaware to assist other state agencies and clients who had Delaware monetary unemployment entitlement to answer unemployment claim questions, handling complex client case issues and explaining Delaware unemployment guidelines to other state agencies so they could inform clients applying for state of Delaware benefits through the agency in their home state. Directed the daily activities of departmental employees by managing office operations, assessing staff claims processing and case adjudications to ensure that work was being completed timely and that correct procedure was being used when processing claims, managing office inventory, maintaining employee attendance records, certifying employee time sheets to ensure payroll accuracy, completing yearly performance evaluations and providing corrective disciplinary action for staff when necessary. Maintaining high standards in compliance with Title 19 of the Delaware code regulatory guidelines, met or exceeded Federal timeliness standards of 87% or greater with case adjudications and timely payment of client benefits despite increased workload due to Federal Emergency Unemployment Compensation and state of Delaware Extended Benefits between July of 2008 until my departure in October of 2009. In addition, I increased employee knowledge by assisting them with growth and development by informing staff of changes in regulatory standards or office policy by meeting with them for training to ensure that they understood and complied with new policies and/or regulations. Managed daily operations of the department with a primary focus on maintaining customer service goals and objectives established by Upper Management with respect to processing client claims and completing case adjudications timely. In addition, I addressed more complex customer complaints that were referred to me by the Directors Office to provide resolution and assisted my staff in problem solving to ensure quality customer service for all clients we served.

Powell Life Skillswith individuals with 11/2015-11/2016

Dover, DE

As a Residential Specialist working with individuals with intellectual and developmental disabilities providing oversight for them by assisting them with their daily living tasks (ADL's) such as cooking, labeling food to prevent client illness or proper dress and grooming, meal prep, completing household chores, assisting with medication administration, transportation to and from social activities, appointments and other events of their choice and completing fire drills, maintaining an emergency kit with food, medication and clothing in case of emergency within the home and other required safety checks with the individuals I was responsible for. In addition, all activities were documented in communication logs, in Therap, which was used to track all client activities and verbal reports were provided to staff whenever there was a shift change. My position ended when the company owner retired and her company shut down.

EDUCATION

Springfield College

Wilmington, Delaware US

94 Semester hours completed towards BS

Major: Human Services

I graduated with my Associates in Arts and Sciences degree from Wilmington University on January 29, 2012 and started my completion degree in the Bachelors program in Behavioral Sciences at Springfield College. Most of my core classes have been related to the human services field and these courses included Introduction to Human Services where students were introduced to the Human Services field by reviewing client needs, services, requisite skills, and the attitudes of an effective Human Services worker, Dynamics of Group Communication I which was an overview of the theories, principles, and techniques of organization, leadership, and participation in the group process with an emphasis placed upon the development of therapeutic communication skills by providing weekly speeches before classmates and being graded on content and ability to enunciate before a group of individuals, Theories of Counseling which was an overview of basic counseling theories and techniques in terms of the client-worker relationship, Psychology which was a survey of general principles underlying human behavior, mental processes and includes a study of the nervous system, perception, learning, motivation, personality, psychological disorders, methods of assessment and research principles and Math for Behavioral Sciences which was an arithmetic review of practical mathematics such as ratios and proportions, percentages, basic algebraic principles, introductory statistical concepts, and word problem applications. I also completed classroom requirements as a Drug and Alcohol Counselor through Catholic Charities Basic Counselor program so I am familiar with conducting client assessment interviews, facilitating client sessions and developing plans to assist clients in maintaining sobriety and personal goals.

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