Social Worker Case Manager

Monique Castaneda

P.O. BOX **** San Bernardino, CA 92406

Cell phone – 909-***-****

e-mail address:************@*****.***

EDUCATION

California State University San Bernardino, 5500 University Parkway San Bernardino, CA 92407 Degree earned: Master of Social Work 2008 Major: Generalist Model of Social Work California State University San Bernardino, 5500 University Parkway San Bernardino, CA 92407 Degree earned: Bachelors of Arts 2005 Major: Psychology with a concentration in Biological Psychology PROFESSIONAL EXPERIENCE

Optum /Namm / Prime Care / UnitedHealth Care Social worker Case Manger 550 Concours, Suite 500 40 hour work week

Ontario, Ca 91764

September 2019 to present

Description of duties for position: As a case manager I am responsible for the health care management and coordination of various Independent Physician Association connected to Optum members in order to achieve optimal clinical, financial and quality of life outcomes. As I work with members to create and implement an integrated collaborative plan of care. Coordinates and monitors progress and services to ensure consistent cost effective care that complies with Optum policy and all state and federal regulations and guidelines. I provide the following case management services to members with chronic or complex conditions including of member with mental health diagnosis.

I will identify, assesses and manages members per established criteria of CMS. I develop and implement a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. I perform ongoing monitoring of the plan of care to evaluate effectiveness of the care provided. Provided resources to meet the needs of the patient and family. Riverside Community Hospital Medical Social Worker 5900 Brockton Ave, Riverside Intensive care unit Float on the units November 2018 to September 2019 40 hour work week

Description of duties for position: Perform studies of patients and their families to determine the nature of their problems and develop the most effective methods of treatment plans according to need in a medical setting. I also interview patient and their families and friends to obtain information for case records. Performed a range of therapeutic assignments related to the field of mental or behavioral health services and psychiatric social work, including the design and implementation of personalized treatment plans, evaluations and investigations, and professional counseling, in order to meet the needs of consumers and/or families with mental or emotional disorders and are assigned other work, as required. Interviews consumers, relatives, and other involved persons to gather personal and social data relevant to assessing mental or emotional disorders and developed service plans with consumers and evaluated psychological, economic, vocational, educational, physical, health, socialization, and housing needs. I coordinate with other staff members (psychiatrists, psychologists, and other program staff) and community agencies in carrying out and designing treatment and/or rehabilitation plans, assessed for the psychosocial needs of the patients and initiate appropriate interaction with Patient and family. Coordinate and consult with medical and other Agency staff members and with outside agencies regarding available resources while, interpret significant emotional, social and economic factors to agency team members. In addition to assisting in conducting training of social service aspects of medical treatment for agency personnel outside of the social services unit. Concurrently provided social casework services to facilitated patients and their families adjust to social, emotional, and financial problems created by illness or disability. Phoenix Community Counseling Psychotherapist

820 E Gilbert St.

San Bernardino, CA 92415

December 2017 to November 2018 40 hour work week

Clinical Therapists - Clinical Social Worker - worked in a variety of programs providing rehabilitative mental health/substance abuse services in a clinical, institutional field and community settings to adults and children with severe mental or emotional disorders - to work in forensics, criminal justice, in completing psychosocial assessments.

Molina Healthcare of California Case Manager II

550 East Hospitality Lane

San Bernardino, CA 92408

August 2015 to August 2017 40 hour work week

Description of duties for position: As a case manager I am responsible for the health care management and coordination of Molina Healthcare members in order to achieve optimal clinical, financial and quality of life outcomes. As I work with members to create and implement an integrated collaborative plan of care. Coordinates and monitors Molina member's progress and services to ensure consistent cost effective care that complies with Molina policy and all state and federal regulations and guidelines. I provide the following case management services to members with chronic or complex conditions including: by proactively identifying members that may qualify for potential case management services.

I conduct assessment of member needs by collecting in-depth information from Molina's information system, the member, member's family/caregiver, hospital staff, physicians and other providers. I will identify, assesses and manages members per established criteria of Molina and CMS. I develop and implement a case management plan in collaboration with the member, caregiver, physician and/or other appropriate healthcare professionals to address the member needs. I perform ongoing monitoring of the plan of care to evaluate effectiveness. I will document care plan progress in Molina's information system. While evaluating effectiveness of the care plan and modifies as appropriate to reach optimal outcomes. I will measure the effectiveness of interventions to determine case management outcomes. Promotes integration of services for members including behavioral health and long term care to enhance the continuity of care for Molina members, conducts face to face in the SNF environment as required.

In addition I will participate in Interdisciplinary Care Team (ICT) meetings, assists orientation and mentoring of new team members as appropriate. I maintain professional relationships with provider community and internal and external customers. I have the ability to communicate effectively, problem solve, and work effectively with people. Maintain excellent organizational skill with the ability to manage multiple priorities, work independently and handle multiple projects simultaneously. I have strong analytical skills, knowledge of applicable state, and federal regulations as well have knowledge of ICD-10, CPT coding and HCPC. I am familiar with SSI, Coordination of benefits, and Third Party Liability programs and integration & NCQA standards, state/federal regulations and measurement techniques. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). While, continuing to establish and maintain a positive and effective work relationships with coworkers, clients, members, providers and customers. San Antonio Regional Hospital Medical Social Worker (PER DIEM) San Bernardino Rd Upland CA Maternity, Labor and Delivery, Pediatrics, Neonatal February 2015 to August 2015 Intensive-Care Unit - NICU, Emergency Department 40 hour work week

Description of duties for position: caseload of patients that need a variety of social service interventions. Conduct psycho-social assessments and make recommendations for post hospital care on patients with mental health concerns. Work collaboratively with the case managers in the discharge planning process. Assist patient and their family and/or support systems with coping skills as it relates to major medical illnesses. I investigated and/or supported cases involving neglect, abuse, emotional or behavioral problems, physical/mental disabilities or other health conditions. I was involved in assisting clients with emergency situations and assessment of risk, safety and biopsychosocial welfare. I developed and implement treatment care plans and monitoring progress toward such goals and provide support, counseling and referrals to promote client self-sufficiency. As a medical social worker I was able assist in to diffusing crisis situations and handle preliminary assessments independently, working with children’s protective services, adult protective, and adoption and family reunification. I worked with various departments and capacities including Department of Children’s Services, Victim Witness Program - San Bernardino County, Aging and Adult Services, California Children’s Services and Public Health. Arrowhead Regional Medical Center

400 North Pepper Avenue Social Service Practitioner Colton, CA 92324 Dialysis/ Emergency Department

May 29, 2009 to February 2015 Float on the units

40 hour work week

Description of duties for position: was responsible for health care management and coordination of patients in order to achieve optimal clinical, financial and quality of life outcomes. Works with members to create and implement an integrated collaborative plan of care. Coordinates and monitors patient’s progress and services to ensure consistent cost effective care that complies with policy and all state and federal regulations and guidelines. My essential functions are to provide case management services to members with chronic and/or complex conditions including by proactively identifies members that may qualify for potential case management services. I have complete assessment of the patients’ needs by collecting in-depth information from Meditech information system, the patient, patient’s family/caregiver, hospital staff, physicians and other providers. In this process I Identify, assess and manage patients per established criteria. With the collaboration of the patient, caregiver, physician and/or other appropriate healthcare professionals to address the patient’s needs I will develop and implement a case management plan for the patient in an ongoing monitoring of the plan of care to evaluate effectiveness plan and modifies as appropriate to reach optimal outcomes and the effectiveness of the interventions to determine case management outcomes. In addition, I have provided placement of services for patient included the following: behavioral health and long term care, conducts face to face interviews, maintained department productivity and quality measures and demonstrates dependability and reliability. Social Service Practitioner (SSP) I worked with various departments and capacities including Department of Children’s Services, Victim Witness Program - San Bernardino County, Aging and Adult Services, Public Health, California Children’s Services and at the County hospital. I maintain effective team member relations in participating in Interdisciplinary Care Team (ICT) meetings, assists orientation and mentoring of new team members as appropriate, maintains professional relationships with provider community and internal and external customers, participates in appropriate conferences to continue to enhance skills/abilities and promote professional growth.

Knowledge/Skills/Abilities

• Demonstrated ability to communicate, problem solve, and work effectively with people.

• Excellent organizational skill with the ability to manage multiple priorities.

• Work independently and handle multiple projects simultaneously.

• Strong analytical skills.

• Knowledge of applicable state, and federal regulations.

• Knowledge of ICD-9, CPT coding and HCPC,

• Knowledge of SSI, Coordination of benefits, and Third Party Liability programs and integration.

• Ability to take initiative and see tasks to completion.

• Computer skills and experience with Microsoft Office Products.

• Excellent verbal and written communication skills.

• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)

• Software package for Statistical Analysis (SPSS)

• Mega-Stat - Business Statistics

Riverside County Regional Medical Center 951-***-**** 26520 Cactus Avenue Medical Social Worker I

Moreno Valley CA 92555 Medicine Unit

September 11, 2008 to May 22, 2009 40 hour work week Description of duties for position: Perform studies of patients and their families to determine the nature of their problems and develop the most effective methods of treatment plans according to need in a medical setting. I also interview patient and their families and friends to obtain information for case records. Performed a range of therapeutic assignments related to the field of mental or behavioral health services and psychiatric social work, including the design and implementation of personalized treatment plans, evaluations and investigations, and professional counseling, in order to meet the needs of consumers and/or families with mental or emotional disorders and are assigned other work, as required. Interviews consumers, relatives, and other involved persons to gather personal and social data relevant to assessing mental or emotional disorders and developed service plans with consumers and evaluated psychological, economic, vocational, educational, physical, health, socialization, and housing needs. I coordinate with other staff members (psychiatrists, psychologists, and other program staff) and community agencies in carrying out and designing treatment and/or rehabilitation plans, assessed for the psychosocial needs of the patients and initiate appropriate interaction with Patient and family. Coordinate and consult with medical and other Agency staff members and with outside agencies regarding available resources while, interpret significant emotional, social and economic factors to agency team members. In addition to assisting in conducting training of social service aspects of medical treatment for agency personnel outside of the social services unit. Concurrently provided social casework services to facilitated patients and their families adjust to social, emotional, and financial problems created by illness or disability. Riverside County Regional Medical Center 951-***-**** 26520 Cactus Avenue Clinical Therapist (PER DIEM)

Moreno Valley CA 92555 Emergency Department

July 11, 2008 to September 11, 2008 40 hour work week Description of duties for position: Performed a range of therapeutic assignments related to the field of mental or behavioral health services and psychiatric social work, including the design and implementation of personalized treatment plans, evaluations and investigations, and professional counseling, in order to meet the needs of consumers and/or families with mental or emotional disorders and are assigned other work, as required. Interviews consumers, relatives, and other involved persons to gather personal and social data relevant to assessing mental or emotional disorders and developed service plans with consumers and evaluated psychological, economic, vocational, educational, physical, health, socialization, and housing needs. Coordinates with other staff members

(psychiatrists, psychologists, and other program staff) and community agencies in carrying out and designing treatment and/or rehabilitation plans, assists the consumers and other concerned individuals in understanding the nature of major psychological illnesses and their psychosocial effects. Assisted the consumers and their families in understanding and choosing options of mental health treatment and initiates and conducts individual, collateral, group, and family therapy sessions. Established and maintained effective contacts with local area mental health resources including community members, parents, schools, residential facilities and other agencies/organizations and performed specialized tasks including involuntary hospitalization procedures (5150) and Tarasoff assessments. In addition participated in mental health conferences and local area committees, Prepared reports and writes correspondence and provided guidance to volunteers and staff.

Contact this candidate