Utilization Review Mental Health

Sheila Swipes

PROFESSIONAL SUMMARY

Dedicated professional with 30 years of experience in Behavior Healthcare of which the last 23 years has been as a Utilization Review Specialist. Solid team player with a positive demeaner and proven skills in establishing rapport with patients, assigned treatment team members and payors. Committed to maintaining professional relationships to increase profitability while maintaining top rate patient care. CORE COMPETENCIES

● Case Management ● Patient Care ● Collaboration

● Chart Analysis ● Healthcare Regulations /

Compliance

● Discharge Planning

EXPERIENCE

Clarity Child Guidance Center Utilization Review Specialist San Antonio, TX 2020 - 2025

● Performed utilization review functions for the child and adolescent inpatient and partial units for mental health

● Reviewed clinical information for concurrent reviews and extended length of stay

● Worked in partnership with the interdisciplinary team through rounds to facilitate that care meets the clinical needs Laurel Ridge Treatment Center Utilization Review Specialist San Antonio, TX 2017 – 2020

● Performed utilization review functions for the child and adolescent inpatient and partial units for mental health

● Reviewed clinical information for concurrent reviews and extended length of stay

● Worked in partnership with the interdisciplinary team through rounds to facilitate that care meets the clinical needs Rockford Center UHS Utilization Review Specialist Newark, DE 2003 - 2017

● Performed utilization review functions in all units of the hospital: Inpatient mental health for adults, adolescents, and children. Inpatient detox and CDIOP for adults. Partial Hospital (PHP) mental health for adults, adolescents, and children

● Developed a utilization review process used with Child Mental Health Programs for the State of Delaware

● Facilitated multidisciplinary treatment team meetings

● Reviewed clinical information for concurrent reviews and extended length of stay

● Utilized effective management, coordination of services, resource management and patient advocacy Connections CSP Group Home Manager Wilmington, DE 2001 – 2003

● Efficiently managed a group home for residents with chronic mental illness through motivating direction of a team of staff members

● Effectively interviewed, hired and trained new staff, created schedules, and supervised personnel; facilitated ongoing mandatory training and monthly staff meetings

● Provided direct resident care from administering medication, facilitating group and individual psychotherapy, and connecting with outside resources as needed

● Strategically allocated and administered budget to optimize the use of resources and control costs for the facility Connections CSP Clinical Supervisor Wilmington, DE 1998 – 2001

● Worked with a clinical team of 13 staff to include physician, program manager, nurses and clinical technicians caring for 110 chronically mentally ill adults in the community

● Completed in home psychiatric assessments to determine specific needs for patients

● Developed and implemented treatment plans and modified as needed

● Administered medication per doctor’s orders

Boerne, TX. • 302-***-****

************@*****.***

● Worked the program manager with all development and maintenance of written policies and procedures for all significant team functions and tasks

Ministry of Caring Job Placement Coordinator Wilmington, DE 1997 – 1998

● Provided job placement assistance to disadvantaged residents in the community

● Built strong relationships with employers in the community and basic job training to community residents to facilitate successful job placements

● Provided budgeting assistance to disadvantaged community residents

●

EDUCATION

Masters in Science – Community Counseling

Wilmington University, New Castle, DE.

2000

Bachelor of Arts – Psychology - Double minor in Human Development and Criminal Justice University of Alabama, Tuscaloosa, AL.

1994

SKILLS

● Proficient in Microsoft Word, Excel, Teams, Outlook, Adobe Acrobat, Midas, HCS, Avatar and RightFax

● Proven strong analytical, problem solving, oral and written communication skills

● Enthusiastic team player with the ability to build strong relationships

● Able to prioritize work and manage time efficiently to meet deadlines

● Received multiple Service Excellence Awards at Rockford Center

●

Contact this candidate