Feb 2020 – Jan 2025 · 4 yrs 11 mos · Long Beach, CA, United States

Oct 2019 – Present · 6 yrs 7 mos · California

• Perform precert and concurrent reviews for inpatient levels (Detox, Inpatient, Residential, and Partial Hospitalization).
• Collaborate with Facilities and Health Care Providers telephonically to obtain clinical information and ensure quality treatment outcomes in the least restrictive setting utilizing established Medical Necessity Criteria.
• Coordinate with facilities to assist with discharge planning, aftercare follow-up appointments, and integration of services with Cigna Medical and Pharmacy.
• Engage with customers and families to understand needs, facilitate access to Cigna coaching/case management programs and community resources.
• Work in a team environment which includes contributing to team meetings, participating in clinical rounds with Cigna Medical Directors for input on utilization management, and attending all required trainings impacting utilization review and accreditation procedures.
• Manage own caseload and coordinate all assigned cases.
• Perform additional tasks/projects as needed, requested or assigned.

Jun 2018 – Jul 2019 · 1 yr 1 mo · Greater New York City Area

• Utilized expertise of best practice standards to render medical and social necessity determinations
• Adhered to clinical standards of care through collaboration with providers in order to ensure appropriate outcomes
• Communicated with members, family and other medical personnel as necessary to facilitate a desired outcome
• In collaboration with Physician Advisor, assessed appropriateness and effectiveness of medications in order to determine a medication's use, dosage and side effect as applied to different disease states
• Managed electronic files in order to document patient records, treatments and progress
• Practiced and adhered to departmental and state guidelines in order to protect self, members and the organization

Jul 2016 – May 2018 · 1 yr 10 mos · Hempstead, NY

• Completed written notes, reports, progress assessments and updates as required for each client
• Created individual service plans for clients to acquire education, employment, independence & social skills
• Facilitated psychoeducational groups for P.R.O.S Members
• Provided brief individual counseling sessions for assigned caseload
• Coordinated care with various mental health resources

Dec 2015 – Oct 2016 · 10 mos · Hempstead, NY

• Responsible for processing inquiries from other mental health providers.
• Engaged new members in individual session and groups to ease transition into program.
• Conducted initial intake and process paperwork for new referrals.
• Outreached to the mental health community to create relationships and new referrals.
• Conducted charting
• Completed monthly status report for Nassau County.
• Organized member activities with Peer Specialists.
• Responsible for coordinating and managing staff.

Jul 2015 – Nov 2015 · 4 mos · Greater New York City Area

• Conducted intake interviews of patients
• Coordinated with health professionals and staff members and evaluate patient progress
• Counseled clients with substance abuse, tobacco, trauma and gambling issues
• Provided individual and group counseling sessions to patients.
• Task supervisor to interns.

Sep 2013 – Jun 2016 · 2 yrs 9 mos · Flushing, NY

• Offered comprehensive advisement to full-time and part-time students
• Worked with academic and student affairs staff to assist students to declare majors and select appropriate classes
• Planned and facilitated registration workshops for incoming students
• Advised students on academic issues regarding admissions, curriculum and graduation requirements, academic policies, articulation, grading policies and academic standards
• Assisted incoming and continuing students with setting academic goals and developing strategies to achieve these goals
• Developed academic plans and perform graduation audits
• Facilitated to help students explore career interest