|** Lee Rd **** |706-***-**** |
|Phenix City, AL |dsneal2078@gmail.|
|36870 |com |
Dana Neal
|Objective |A Career with a progressive organization that will |
| |use my administrative & professional skills, |
| |education & abilities to effectively contribute to |
| |the company's overall success. |
|Experience |2012-Present Anka Behavioral Health East Point, GA |
| |Utilization Manager |
| |Provide monthly training of all staff on state |
| |guidelines, policy and procedures, computer |
| |programming systems, documentation guidelines, etc.|
| | |
| |Request and clinical authorizations for services, |
| |utilizing the APS Care Connection Online Systems. |
| |Completing MICPS and Treatment Plan for services. |
| |Provide clinical support, direction and guidance to|
| |staff for the continuous care from inpatient |
| |facility to outpatient services. |
| |Verification of insurance and eligibility through |
| |web. Also processing billing/filing insurance |
| |claims. |
| |Serve as liaison between medical, clinical and/or |
| |support service and third-party insurers in the |
| |performance of utilization and quality assurance |
| |management. |
| |Provided monthly training for all staff on computer|
| |systems and documentation, service provisions, |
| |guidelines, insurance, financial (Medicaid, |
| |Medicare, etc.). |
| |Audit records, documentation, and service quality. |
| |Make corrective actions/treatment plans and |
| |recommendations to program managers and other staff|
| |as required. |
| |Establish and evaluate the necessity, |
| |appropriateness and effectiveness of services for |
| |the purpose of controlling cost, while maintaining |
| |quality care. |
| |Review accreditation with JACHO, CARF, ERO, State, |
| |CSB and other regulatory agency standards and |
| |guidelines. Ensure utilization management |
| |documentation is accurately recorded, filed and |
| |disseminated. |
| |Develop and recommend to Q/I team written |
| |procedures for the processes of utilization |
| |management. |
| |Advise attending physician/clinical staff when |
| |medical and service records do not reflect adequate|
| |documentation of active treatment or meet criteria |
| |for service. |
| |Review medical/service records to meet criteria for|
| |authorized services and determine expected length |
| |of stay according to established guidelines. |
| |Maintain up-to-date knowledgebase on changes in |
| |hospital-community, clinical guidelines regarding |
| |review criteria; psychiatric and generic quality |
| |screens; certification requirements; and covered |
| |services. |
| | |
| |2005-2012 New Horizons, CSB Columbus, GA |
| |Utilization Manager |
| |Provide monthly training of all staff on state |
| |guidelines, policy and procedures, computer |
| |programming systems, documentation guidelines, etc.|
| | |
| |Request clinical authorizations for services |
| |utilizing the company's online medical system. |
| |Completing MICPS and Treatment Plans. |
| |Provide clinical support, direction and guidance to|
| |staff for the continuous care from inpatient |
| |facility to outpatient services. |
| |Verification of insurance and eligibility through |
| |web. Also processing billing/filing insurance |
| |claims. |
| |Serve as liaison between medical, clinical and/or |
| |support service and third-party insurers in the |
| |performance of utilization and quality assurance |
| |management. |
| |Provided monthly training for all staff on computer|
| |systems and documentation, service provisions, |
| |guidelines, insurance, financial (Medicaid, |
| |Medicare, etc.). |
| |Audit records, documentation, and service quality. |
| |Make corrective actions/treatment plans and |
| |recommendations to program managers and other staff|
| |as required. |
| |Establish and evaluate the necessity, |
| |appropriateness and effectiveness of services for |
| |the purpose of controlling cost, while maintaining |
| |quality care. |
| |Review accreditation with JACHO, CARF, ERO, State, |
| |CSB and other regulatory agency standards and |
| |guidelines. Ensure utilization management |
| |documentation is accurately recorded, filed and |
| |disseminated. |
| |Develop and recommend to Q/I team written |
| |procedures for the processes of utilization |
| |management. |
| |Advise attending physician/clinical staff when |
| |medical and service records do not reflect adequate|
| |documentation of active treatment or meet criteria |
| |for service. |
| |Review medical/service records to meet criteria for|
| |authorized services and determine expected length |
| |of stay according to established guidelines |
| |Maintain up-to-date knowledgebase on changes in |
| |hospital-community, clinical guidelines regarding |
| |review criteria; psychiatric and generic quality |
| |screens; certification requirements; and covered |
| |services. |
| |2007-Present New Horizons CSB (Contract) Columbus, |
| |GA |
| |Treatment Plan Writer / Community Service Case |
| |Manager |
| |Provide assistance to the individual in the |
| |development and coordinator of the IRP/Treatment |
| |Plan. |
| |Provide support and intervention in crisis |
| |situations, and assist the individual of his or her|
| |behavioral healthcare. Provide the individual with|
| |support development of interpersonal, community |
| |coping and functional skills. |
| |Provide clinical support, direction and guidance to|
| |staff for the continuous care from inpatient |
| |facility to outpatient services. |
| |Request clinical authorization for services for |
| |clients. |
| | |
| |Support to facilitate recovery including |
| |recovery-based goal setting and attainment. |
| |Coordination to assist the individual in learning |
| |how to gain access to necessary rehabilitative, |
| |medical and other services, along with assistance |
| |with illness self-management and wellness |
| |promotion. |
| |Request and authorizations for services for |
| |clients. |
| |1996-2005 Northrop Grumman Inc. Columbus, GA |
| |Regional Services Coordinator/Office Manager |
| |Receive telephone calls; give routine and |
| |non-routine information, answer questions and |
| |direct calls and visitors to appropriate person or |
| |office. |
| |Coordinate & prepare travel arrangement, file |
| |travel reimbursements, and submit expense reports. |
| |Maintain supervisor's calendar; schedule |
| |appointments and engagements, prepare notes |
| |regarding topics to be discussed; make travel |
| |arrangements, and prepare travel vouchers and |
| |expense reports. |
| |Prepare and type all variety correspondence, |
| |reports, forms, requisitions, and requests for |
| |personnel actions and legal documents using |
| |Microsoft office or other computer programs. |
| |Responsible for shipping, receive and control mail,|
| |packages, and suspense items. Routing all items to|
| |the appropriate persons or office for action. |
| |Organize and maintain files, records, manuals, |
| |handbooks, and other related materials. |
| |Provide all Human Resources related activities, to |
| |include In/Out Processing of all staff, Health and |
| |Benefits trainings and enrollments, EEO, and all |
| |policy and procedures, etc. |
| |Enter or modify employee information, status, in |
| |Payroll/HR system. |
| |Create and maintain ALL employee files and filing |
| |system. |
| |Provide briefings and trainings to management and |
| |staff. |
| |Purchasing, Procurement and coordination of all |
| |computer equipment, office supplies, etc. |
| |Provide customer service to all internal and |
| |external customers. |
| |Coordinate and Plan all conferences, parties, and |
| |other events. |
| |Provided project management support and guidance to|
| |senior and junior management on contract |
| |administration for various U.S. Government |
| |technical and commercial contracts. |
| |Prepared all financial reports; project plans, |
| |budget, cost of operations and program |
| |accomplishments; project trends. Developed and |
| |implemented a number of project-control and |
| |financial-management tools |
| |Troubleshoot and fix office computers and |
| |networking system for staff. |
| | |
| |Additional Skills - Typing 65 to 70 wpm, filing, |
| |scheduling, etc. Extensive knowledge with |
| |operating software and programming such as MS Word,|
| |Excel, Power Point, Novell Server, MS NT, Corel |
| |Draw, Adobe Photoshop, HP Scan, SAP/Tempo, Surf and|
| |People soft, Catalyst, and Georgia State APS Care |
| |Connection & Knowledgebase, as well as Windows XP |
| |and Outlook. Reports and Spreadsheet experience. |
| |Ensuring all procedures involving cash, |
| |collections, accounts receivable & budget |
| |preparations. Hiring, training, & supervising of |
| |administrative and clinical staff. |
|Education |2001-2006 Troy University Phenix City, AL |
| |B.S., Bachelor of Science, Human Services w/minor |
| |Business Administration |
| |A.S., Associate of Science Business Administration |
| |w/General Studies |
| | |
| | |
| |Reference & Additional Work Experience Upon Request|