Utilization Manager Resume Profile

SUMMARY A top-performing project manager credited with driving performance improvements in diverse healthcare settings. Strong expertise in mental health/developmental disability case management, providing compassionate care and resolutions to patient challenges. Highly accomplished in teambuilding and collaboration, with the ability to build and maintain strong working relationships.

Areas of Expertise

Project Management

Case Management

Mental Health

Developmental Disabilities

Strategic Counsel

Problem/Resolution Analysis

Organizational Change

Process Improvements

Administration

Patient Relations

Collaboration

Team Building

Key Skills Assessment

Performance Excellence Subject matter expert in identifying problems and solutions that ensure quality assurance and improve service delivery.
Team Building Committed to improving teams through the exchange of knowledge, experience, and goal sharing to optimize strategies and generate growth.

Professional Experience

Confidential

Quality Improvement Consultant

Initiated continuous improvement to state services/programs by functioning as an educator, analyst, facilitator, consultant and/or project manager in collaboration with a broad range of internal and external stakeholders.
Leveraged benchmarking and best practices to deliver a higher degree of quality patient- and family-centered service for individuals dually diagnosed and have a mental health diagnosis.
Oversaw program funding, ensuring proper allocation of resources to the Home and Community-Based Services Medicaid Waiver Programs and the State of Georgia's Grant in Aid.
Developed policies and procedures, positive behavior support training, mission statements, organization structure standards and documentation systems, improving organizational practices.
Honed proficiency with provider and medical records/claims, fulfilling accurate record management.
Responsible for patient and care giver outreach.

Confidential

Program Manager

Managed the residential services for 68 people challenged with cognitive and developmental disabilities, including operational and administrative leadership for facilities and personnel in a 24-hour support environment.
Managed budgets of 1.5M and operational reports summarizing detailed day-to-day activities, account reconciliation and operational budgets.
Ensured program compliance with all Federal, State and County regulations, including licensure requirements.
Served in HR capacity by: confirming staff members met training standards, coordinating interdisciplinary team meetings, monitoring all annualized individualized case management plans, level of care determinations and prior authorization budget approvals, and mediating employee grievances.

Confidential

Assistant Area Director Lead Support Coordinator

Led day-to-day operations for leading provider of multi-tiered system of administrative leadership that monitors health and safety, providing a collaborative model to self-directed services for the intellectually delayed.
Responsible for coordinating staff coverage, conducting sites and assessing residents' daily progress.
Used person-centered planning to oversee 1,000 clients, tracking ISP goal progress, DMA 6, SIS and ensuring quality of service delivery.
Introduced management standards according to State and Federal guidelines for the Center for Medicaid, financial and personnel reporting, while collaborating with senior management to set productivity benchmarks and monitor staff compliance with policies and procedures that govern the Medicaid Waiver.
Optimized productivity through ongoing statistical, budgetary and services reviews and analyses, generating broad quality improvements.

Confidential

Social Service Tech

Oversaw case management, by providing chart and financial analysis, family education on diagnosis, and leading group sessions.

Confidential

Assistant Area Director

Assigned caseloads according to demographic locations, conducted Health Risk Screening Tools and received supports intensity training.
Administered the supports intensity scale an evaluation of the supports an intellectually disabled individual would need in personal, work-related and social activities in order have a meaningful life .

Confidential

Utilization Manager

Confidential

Addiction Counselor

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