Kimberley Adda, Lcsw Email & Phone Number

Dallas, Texas, Us

- Behavioral Health is responsible for planning, directing, and managing behavior health services for the health plan of Baylor Scott and White Health (BSWH)- Leads the clinical development and operation for behavioral health services for members across all lines of business in the health plan. - Collaborates with clinical leadership in care management, utilization management, population health, government programs, and quality departments to ensure a fully integrated and holistic approach to delivering physical and behavioral health services for the health plan members.- Designs, implements, maintains, and evaluates behavioral health program metrics, outcomes, and materials supporting the organization’s behavioral health goals. - Partners closely with clinical training, compliance, and other departments to build and maintain foundational programs to ensure quality member-centric services.- Provides clinical expertise and leadership to improve member experience, quality and cost of care delivered to members.- Develops Non-Quantitative Treatment Limitations (NQTL) guidelines, processes, and requirements to ensure adequate compliance and reporting.- Leads change, embraces new business models, and develops behavioral health programs while providing support to collect and deploy innovative approaches to delivering high-quality member-centric services.

Minnetonka, Mn, Us

Identified and assisted in the launch of CoCM - collaborative care model with Florida Medicaid Population. Coordination of activities within a quality improvement strategy to drive performance improvement toward established quality and affordability goals, regulatory compliance, and adherence to accreditation standards, specific to assigned member population(s)Incorporating applicable accreditation (NCQA), regulatory, and business requirements into programs and projectsDocument programs and interventions HEDIS, and support measurement and monitoring of program effectivenessFacilitate programs for Performance Improvement Projects (PIPs)Monitor performance over time against established performance goals; identify opportunities for improvement (i.e., geographic, demographic)Develop and manage health promotion and member education programs that aid members with accessing careAct as liaison to community partners serving members in assigned population(s); facilitate programs that connect members with community resources; offer “train the trainer” and health education expertise to community partnersProfile network provider performance on assigned measures and outreach to under-performing providers for focused quality improvement projects; coordinate quality of care follow-up with leadershipWork with Clinical teams to align programs for specific populations (i.e., disease management, case management, medication management, and clinical affordability)Using quality and utilization dataIdentify trends in care and utilization resulting new improvement programsAct as a clinical subject matter expert to team members, including peers (i.e., nurses, physicians, dentists, and pharmacists), health plan leaders, external stakeholders, and network providersAbility to organize and manage program implementations

Eden Prairie , Mn, Us

Utilize advanced clinical skills to engage and motivate Consumers via a recovery, health and wellness-oriented approachAssist consumers and their families/caregivers with connections to appropriate psychiatric, medical, and psychosocial referrals and servicesIdentify and remove barriers to procurement, delivery, participation in and success of servicesProvide supportive follow-up, monitoring and education as indicated, in-person and telephonicallyPartner with designated external providers, programs, entities to address the needs, gaps in care, and recovery goals of complex and high risk consumersIdentify and address the needs of members who are consistently high utilizers of services through case conferences and informal communicationsServe as an Optum behavioral health liaison and subject matter expert for clinical and business partnersEstablish and foster positive relationships with medical team, participate in medical-behavioral integration activities and discussionsIdentify high-risk, co-morbid needs of consumersAccept referrals via designated processes, collaborate in evaluating available services, and coordinate necessary psychiatric and community referrals, as neededPartner with internal Optum Behavioral Health Services Teams to coordinate a seamless transition for consumers from an inpatient setting to community based servicesMeet all contractual requirements; collaborate early and frequently with other teams in the management of cases stratified as having intensive, complex, and high-risk needsAssist in the development of a relevant and consumer-specific aftercare planComply with all policies, procedures and documentation standards in appropriate systems, tracking mechanisms and databasesEstablish a cooperative relationship with Optum Behavioral Network Services and the Provider community in order to improve access to services and ensure that consumers are served within proper standards of care

Minnetonka, Mn, Us

Manage utilization of concurrent mental health/substance abuse in-patient, detox, residential, partial hospitalization programs and intensive outpatient programs admissions, concurrent and discharges for commercial insured and special populations using CASII, LOCUS, & ASAMWork collaboratively with Utilization Managers, Social Workers, and Discharge Planers to encourage initial discharge planning; realistic step down or placement arrangements; focus on non-adherent trends and offer suggestions regarding community resources to reduce re-hospitalizations that promote health and wellness.Manage census daily and weekly involving MD rounds appropriate for eating disorders, substance abuse disorders, child specific cases and mental health.Manage substance Abuse Cases with American Society of Addiction Medicine dimensions, ASAM.

Minnetonka, Mn, Us

Developed methods, strategies, and tools to increase efficiency and ensure compliance with Departmental and StaterequirementsAttended Department of Elder Affairs, providers, Hospital, Hospice, and community agencies meetings to improvecare coordination and relations, increase program awareness, and address challenges.Coordinated care in program expansion markets including educating providers, connecting and coordinating withcommunity resources, and referral sources.Conducted assessments as required (including 701B State of Florida assessments), authorized home and communitybased services, ensured/transitioned member to least restrictive appropriate environment, educated member andfamily on diagnosis and community resources, and assisted member/family maintain program eligibility, anddetermine/document advanced directivesCoordinated care with member, family, hospital, SNF, Physician, home health, hospice, and other communityagencies to ensure member’s needs are met and prevent hospitalizations, LTC placement, and decline

Boca Raton, Fl, Us

Manage In-Patient psych admissions (UR) for United Behavioral Health – Public Sector. Intensive Case Management of facility based clinical review of Medicare and Medicaid members.Work collaboratively with Utilization Manager to encourage initial discharge planning; realistic step down or placement arrangements (ALF, residential mental health and or substance abuse, PHP with lodging; out patient; nursing home); suggest changes to meds and or treatment; address non-adherent trends and offer suggestions. Ensure clinical presentation meets UBH/Medicare/Medicaid Guidelines for ongoing stays. Present in clinical rounds with team leads and internal psychiatrists twice a week to ensure appropriate level of care and discharge planning in place. Manage specialized pilot programs consisting of WRAP services; initiate referrals, coordinate with field case manager once assigned and releases signed, participate in weekly clinical rounds addressing members with high utilization.

Hartford, Connecticut, Us

 Reviewed clinical documentation from providers recommending employees out of work on Short and Long Term Disability to determine functional impairment.  Communicate with providers regarding return to work plans with modified or full duty return to work potential.  Advise employees and providers of insufficient clinical documentation and Disability protocols (MDA) and assisted in perfecting claims.  Managed crisis calls with members expressing threats to self harm or harm others including work place violence.  Evaluated cases for work place stress, unfavorable employee reviews and other work related issues verses functional impairment based on a psychological impairment. Managed case load of 70-100.  Discussed potential options for treatment in order to return employee to work such as inpatient treatment, partial hospitalization, treatment with specialists, and modified work schedules.

Toronto, On, Ca

Primary responsibilities: Assigning and monitoring referrals per EAP/Elder Life Works programs. This included initial contact with employee to identify realistic and objective expectations of request, assessed need for education, programs and services, explored family dynamics and emotionality regarding presenting issue. Internal Case Manager’s responsibility is to assign and covey objectives to field case manager with experience in areas of concern. Examples: LTC, family dynamics, advocacy for elder, civil rights & right to self determination, Medicare/Medicaid programs, mental health programs, and other entitlements. Internal Care manager continued to manage case for timeliness, appropriateness, and accuracy throughout process. Recruited and negotiated rates with independently contracted professional case managers and initiated process of credentialing to increase network of providers. Maintained current data base of definition and eligibility requirements for Disability, Medicare & Medicaid programs, pharmaceutical programs, Veterans Affairs program; national associations such as National Alliance for Mental Illness, Alzheimer’s Association, Alzheimer’s Foundation, and community based programs (Medicaid-waiver, Irrevocable/LTC trusts, SHIP) to optimize proficiency in review of care plans provided to employees. Conducted monthly web-based (Web-Ex) orientations with care managers

Toronto, On, Ca

Toronto, On, Ca

Manage cases medically and psychosocially complex Medicare population for private provider.Identify risk factors for re-hospitalization through trends, telephonic assessments, coordinating primary care physician and specialists care plans, & discharge planners. Develop comprehensive care plans with multidisciplinary input and ensure that patients and family members become and remain involved with care plan. Monitor care plans weekly, monthly, or quarterly based on acuity level. Coordinated a team of RN, LPN’s, and CMA’s & MSW’s assigned to complex population to ensure that patient and or care giver issues are being addressed consistently, ethically, and comprehensively. Advocate for patients rights to self determination, provide psycho-education regarding variety of issues such as anxiety, depression, care giver burn out, medication compliance. Provide referrals to community based resources such as Med-Wavier, QMB, SLMB, Hospice, SS Extra Assistance with RX, etc. as needed. Addressed need for patient advocacy for eligibility exception based on evidenced based medicine and best practices required for letter of medical necessity. Develop and maintain current base of resources for Rx assistance programs, transportation services, Adult Day care, Mental Health treatment, and direct pharmaceutical assistance programs, etc.

Tampa, Florida, Us

Direct contact with adolescents referred through the Broward County School Board for truancy and related issues. Responsible for psychosocial assessments, suicide risk assessments, treatment planning and monthly review, and short term individual and family counseling using Solution Focused Model.Developed and effectively executed case plan objectives, treatment referrals, medical/dental needs, linking and advocating with appropriate school staff to address educational needs such as IEP reviews, tutoring, and monitoring. Prepared and appeared for Pre-Disposition CINS/FINS court cases, case staffing committees to includes the state attorney and school board team leaders. Designated as a Counsel on Accreditation (COA) facilitator for QA accreditation. Supervised 2 teams each consisting of a Counselor I, bachelors level, and Counselor II, masters level case managers and therapist in truancy division.

Provided individual, family and group therapy using Reality/Choice Model with youth incarcerated in Department of Juvenile Justice level 6 and 8 facilities.Completed in- depth assessments, homicidal/suicidal assessments, CFARS, clinical treatment plans and BHOS – Multiaxial DSM Evaluation and ICD- 10 coded diagnosis certification. Responsible for maintaining weekly Medicaid/DJJ documentation including weekly summaries, clinical treatment plan reviews, and crisis interventions.Provided discharge planning and referrals to step-down community probation programs in coordination with Medicaid eligible programs and benefits for children. Accomplishments included supervising MSW clinical intern’s daily tasks and responsibilities as well as assisted in their learning of DJJ system and clinical practices.

Msw, Social Work

Bsw, Social Work