Utilization Review Case Manager
Resume:
Yolanda Brown
*******@*******-*****.***
New Caney, Texas 77357
OBJECTIVE
A qualified social worker with experience in providing high quality care and support to people who are socially excluded or who are experiencing problems in their lives. Having a consistent track record of working successfully with individuals, families or groups, all within a variety of settings. Possessing an in-depth understanding of relevant legislation, procedures and techniques required. Extensive knowledge of social work principles, techniques and practices and their application to complex cases, group work, and community issues. A highly motivated individual with extensive experience in: Social Work, Utilization Review, Reimbursements, Admissions/Discharges, Contracts, Billing, Collections and Claims Administration.
EXPERIENCE
Mission of Yahweh (Emergency Shelter and Transitional Living Program) Houston, TX
04/2021-10/2022
Lead Case Manager
Coordinate services with life skills volunteers, UT Health, Harris Center, TWC career specialists, and other outside agencies for clients in the program
Provided screening, assessment, advocacy and ongoing case management services for homeless families placed in shelter or transitional housing and for single adults who are in recovery and are transitioning back to the community
Provide comprehensive, trauma-informed service and safety planning, including immediate risk reduction and short-term therapeutic interventions
Provide comprehensive, trauma-informed service and safety planning, including immediate risk reduction and short-term therapeutic interventions
Drive efficiency and effectiveness of the incident management process
Misty Willow Healthcare and Rehabilitation Houston, TX
01/2019-04/2020
Director of Social Services
Performing psychosocial assessments on all patients to determine social service and discharge planning needs; always documents assessments in a timely manner.
Communicates daily with Clinical Services Department staff regarding admissions and discharges
Knowledgeable criteria for Medicare, Medicaid, HMO and private insurance coverage.
Manages all denials and appeals in a timely manner by scheduling peer reviews with physicians and ensuring timely completion of all paperwork.
Completes discharge/aftercare plans in a timely manner.
Communicates with family members and caretakers regarding the needs of the patient and anticipated plans.
Regent Care Center The Woodlands, TX
02/2014-01/2019
Director of Social Services
Planning, organizing, developing and directing the overall operation of the facility's social services department in accordance with current, federal, state, and local standards, guidelines and regulations.
Conducted psychosocial studies of patients and families.
Developed individualized plan of care for the patient
Conducted discharges and or transfers to community programs
Extensive knowledge of MDS and PPS coordination
Established procedures and those directed by the Administrator, to assure the medically related emotional and social needs of the resident are met/maintained on an individual basis.
EDUCATION
2013-Prairie View A&M University
Bachelors of Arts, Social Work
Walden University, Masters of Social Work
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