Job Coach Mental Health
Resume:
Araceli Fausto, MA, LPC, CCM
Live Oak, TX. *****
Education
Webster University 2009-2010 San Antonio, TX.
Master’s Degree in Counseling
University of the Pacific 2000-2005 Stockton, CA.
Bachelor’s Degree in Psychology with and emphasis in Clinical Psychology and a minor in English. Work Experience
Evolent July 2021-present Remote
Clinical Manager
Supervise clinical operations of utilization management and case management staff.
Monitor data to assess trends and ensure reviews and assessments are compliant with company standards.
Collaborate with health plan and local mental health agencies to help facilitate services for members.
Oversee the workflow and day-to-day operations of high-risk case management and utilization management functions, including implementation of policies and procedures
Ensure compliance with established initial and concurrent review, case management, referral, pre- certification and authorization policies, procedures and processes
Act as a liaison with other business units and facilitate on-going communications between case management and utilization management staff, community agencies and contracted providers
Provide oversight of telephonic review of inpatient admissions with doctors, hospitals, and other providers
Monitor the effectiveness for existing outreach efforts and ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk
Analyze data to address trends or potential quality improvement opportunities including provider issues, service gaps and member needs
Evolent March 2021 – July 2021 Remote
Utilization Manager
Authorize and review utilization of mental health and substance abuse services for outpatient and inpatient.
Provide and/or review intakes and initial evaluations, monitor quality of care, and participate in special utilization projects.
Create reports to analyze utilization of services.
Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
Ensure compliance with all performance measures in regard to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
Interact with physicians and social workers for discharge planning.
Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
Compile and report daily review activity and facility statistics.
Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
Track benefit usage and advise appropriate parties of exhaustion of benefits.
Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.
Cenpatico January 2014 – February 2021 San Antonio, TX Clinical Manager
Supervise clinical operations of utilization management and case management staff.
Monitor data to assess trends and ensure reviews and assessments are compliant with company standards.
Collaborate with health plan and local mental health agencies to help facilitate services for members.
Oversee the workflow and day-to-day operations of high-risk case management and utilization management functions, including implementation of policies and procedures
Ensure compliance with established initial and concurrent review, case management, referral, pre- certification and authorization policies, procedures and processes
Act as a liaison with other business units and facilitate on-going communications between case management and utilization management staff, community agencies and contracted providers
Provide oversight of telephonic review of inpatient admissions with doctors, hospitals, and other providers
Monitor the effectiveness for existing outreach efforts and ensure appropriate knowledge/education and interventions are conducted for members defined to be at risk
Analyze data to address trends or potential quality improvement opportunities including provider issues, service gaps and member needs
Cenpatico December 2012 - January 2014(Promotion) San Antonio, TX Utilization Manager
Authorize and review utilization of mental health and substance abuse services for outpatient and inpatient.
Provide and/or review intakes and initial evaluations, monitor quality of care, and participate in special utilization projects.
Create reports to analyze utilization of services.
Authorize, direct and monitor care for mental health and substance abuse problems according to clinical information given by providers and internal criteria for medical necessity and appropriateness of care.
Ensure compliance with all performance measures in regard to appeals, denials, higher level of care admission certification and concurrent review timeliness, Outpatient Treatment Report review timeliness, readmissions, and others as indicated.
Interact with physicians and social workers for discharge planning. Direct and coordinate follow-up to ensure plans for continuity of care and adherence to HEDIS standards.
Compile and report daily review activity and facility statistics. Participate in quality improvement activities, supporting network development and interfacing with treatment facilities and the professional community.
Verify subscriber eligibility and existing benefits for mental health and substance treatment, prior to authorizing all levels of treatment including concurrent outpatient.
Track benefit usage and advise appropriate parties of exhaustion of benefits.
Interact with Medical Director or designee to discuss clinical authorization questions and concerns regarding specific cases.
Center for Health Care Services 2007 – 2014 San Antonio, TX Case Manager I and FACT Team Leader
Coordinate skills training and case management services with individuals with mental disorders.
Manage and maintain a case load of 400 clients and perform clerical duties as necessary.
Evaluate, assess, maintain, and create treatment plans for specific client’s needs.
Supervised FACT team (2011-2012); provided services and ensured compliance with local, state, and federal guidelines.
Increased team efficiency / productivity by 50% and improved team’s compliance from 50% to 100% within 1 month of taking over team.
Coordinate services with individuals, insurance companies, and community resources.
Ensure that services are delivered according to treatment plans and service package guidelines.
Served as back up to Clinic Administrator and would oversee all clinical operations.
Provide mental health consultation, reviewed, and provided clinical approval of treatment plans Manteca CAPS 2006 Manteca, CA
Instructor in Behavior Management Program
Supervise and conduct individual and group training sessions for patients and create ISP plans.
Perform behavior analysis on consumers and assess and implement behavior modification techniques.
Assist consumers with incontinence, personal hygiene, transportation, and feeding needs. Howard Training Center 2005 Modesto, CA
Job Coach / Assistant Case Coordinator
Provide support, training, transportation, and supervision to clients working independently at worksites.
Manage behavior in accordance to established plans, contracts, and procedures.
Complete written reports, maintain files, and assist in the development and implementation of ISP plans.
Central Valley Autistic Project 2002 Modesto, CA
Tutor
Educate Autistic children with basic verbal skills and implement programs that assist with memory.
Provide child with basis for appropriate peer play.
Observe and keep track of child’s behaviors.
Sacred Heart Church 2000 - 2004 Turlock, CA
XV Program Coordinator / Secretary
Organize and taught developmental / religious courses.
Create weekly bulletins and flyers to promote church activities and perform clerical duties. Skills
Proficient in the following applications: Microsoft Word, Excel, Publisher, TruCare, Workday, Identifi, Omni, and PowerPoint. Fluent in Spanish and CCM certified. Licensed in the state of Texas and Washington.
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