Mark Matthews Email & Phone Number

Detroit, Mi, Us

Manage quality of care concerns and member and provider complaint investigations. Present clinical findings to Quality Director for corrective action planning.

Remote/Virtual

Review clinical information from providers to assess for medical necessity and offer case shaping for treatment efficacy. Provide initial and continued stay reviews for inpatient, residential, and partial hospitalization care. Present cases in MD rounds and coordinate peer reviews. Assist with discharge planning and case management.

Greater Detroit Area

Conduct utilization reviews for Wayne County medicaid recipients, primarily serving severe and persistent mental illness.

Conduct utilization reviews with providers to authorize behavioral health and substance abuse treatment based on medical necessity and level of care guidelines. Participate in daily rounds with MD, as well as monthly eating disorder and substance use disorders rounds. Manage high volume caseload.

Southfield, Mi

Manage high-risk members utilizing spectrum of health care services. Coordinate social work needs, provide crisis counseling, emergency referrals, assessments, discharge care planning, and coordinate care with providers to reduce risk of readmission and increase psycho-social health of members on the health plan.

Provide assessments, referrals and crisis counseling. Collect clinical information to make appropriate referral and certification decision for providers to determine levels of care. Evaluate clinical appropriateness of treatment and render certification decisions Directs members to an appropriate therapist or EAP provider and reviews care on a regular basis. Provide member crisis management and risk assessments.

Provide group, individual, and family therapy to male clients in residential setting. Work with chemical dependency and co-occurring disorders, complete documentation for all stages of care, and secure funding through third party insurance and block grant funding. Act as lead counselor and supervise staff and program delivery during program manager’s absence.

Substance abuse therapist for all levels of care.

Supervised team of caseworkers and trained volunteer mentors on family dynamics, child development, and conflict resolution. Facilitated case conferences and reviewed psych-social assessment for all children accepted into the program. Developed new campaign to recruit and train volunteer mentors through media, business partnerships, and mass marketing campaigns. Wrote, developed, and facilitated presentations to businesses including BASF, Blue Cross Blue Shield, and Federal Mogul for mentoring partnerships with Big Brothers Big Sisters. Worked with WDIV/Lila Lazarus, and WXYZ/Diana Lewis for weekly segment on mentoring.

Conduct utilization reviews for mental health and substance abuse treatment based on medical necessity and level of care guidelines. High volume contact with providers and manage large caseload with high productivity. Participate in daily MD rounds and monthly substance abuse and eating disorder treatment rounds.

Lead a team of social workers providing counseling and assistance to at-risk families. Facilitated case conferences, completed employee evaluations, and interviewed and hired staff.

Supervised staff and prevention services at outreach sites. Wrote grants, provided training, measured program outcomes, and maintained relationships with referral sources

Provided group counseling, didactic lectures, and direct care for chemically dependent patients.

Bachelors, English

Masters, Community Agency Counseling

Activities and Societies: Clinical Supervisor/Teaching Assistant Provided clinical supervision for Masters Level counseling students.