Robert Shutter Email & Phone Number

New York, NY, US

New York, NY, US

• Lead system-wide utilization management strategy for eleven acute care hospitals in collaboration with finance and nursing leadership.
• Responsible for program goals of denial reduction, increase in percentage of successful denial appeals, length of stay management, all-cause readmission rate improvement, and system-wide standardization of UM workflows.
• Facilitate councils and subcommittees focusing on UM decision-making and QAPI, care/case management, denial, and vendor operations, reporting and dashboard design/implementation, policy development, and workflow.
• Initiate documentation improvement initiatives using tools and solutions within the electronic health record to ensure compliance with local, State and Federal requirements, and guarantee optimal reimbursement for.
• Oversee clinical guideline usage, train utilization review nurses and physician advisors, facilitate vendor in-services, develop reporting to track/monitor individual user and team productivity, and create/implement.
• Create interdepartmental workgroup to standardize definitions, develop training tools and P&Ps, and promote system-wide approach for alternate level of care.

Boston, Massachusetts, US

• Provide oversight of utilization management programming and activities for risk and ASO accounts comprised of Commercial, Medicare, and Medicaid memberships.
• Develop, implement, and maintain standard operating procedures, clinical and administrative policies, and performance metrics to meet URAC and NCQA standards in accordance with local, State, and Federal requirements.
• Optimize existing, and develop new reporting to track and monitor trending and outcomes for internal and external stakeholders to ensure alignment with contractual requirements and performance guarantees.
• Facilitate complex case conferences with external stakeholders in collaboration with State agencies such as OMH, DOH, OASAS, and SPOA.
• Supervise clinical leadership team, facilitate daily clinical rounds, support necessity criteria development and application, and ensure alignment with clinical guideline application through routine interrater.

Boston, Massachusetts, US

• Responsible for oversight of utilization and intensive case management activities for HIV special needs plan as part of the NYS Medicaid expansion through HARP.
• Develop and implement workflows and standard operating procedures to ensure alignment with State requirements and health plan contract expectations.
• Hire, train, and supervise clinical staff, facilitated daily rounds, lead weekly team meetings and case consultations, and oversee performance evaluations.
• Support clinical decision-making through use of medical necessity criteria and clinical best practice guidelines in collaboration with the Medical Director
• Collect, analyze and interpret data and outcomes for reporting to the health plan and to the State, including data and outcomes specific to the implementation of specialized HARP Home & Community Based Services (HCBS).

Norfolk, VA, US

• Support oversight of utilization review and administrative activities for Public and Federal Health Plans.
• Ensure daily task assignment for team members and provided guidance related application of medical necessity criteria in clinical decision-making.
• Orient and train new staff to ensure understanding of and adherence to workflows and standard operating procedures.
• Manage assigned caseload while conducting utilization review.
• Attend daily Rounds, individual supervision, and clinical trainings provided by city and State agencies.

Norfolk, VA, US

• Conduct utilization review for all levels of care with strict adherence to medical necessity criteria to ensure appropriateness of treatment based on clinical need.
• Serve as dedicated Care Manager supporting Medicare membership, inclusive of assessment, care coordination, care planning, and complex case discussions.
• Manage several integrated healthcare initiatives including ambulatory follow-up for HEDIS, diabetes/weight management, and cardiac event programs.
• Oversee implementation and management of ABA services program.
• Participate in clinical rounds with staff MDs and external client contacts for review of behavioral and pharmacological interventions for effective treatment planning.
• Complete on-going staff trainings and trained new staff as needed.

New York, NY, US

• Complete comprehensive intakes and biopsychosocial assessments.
• Provide open-ended, psycho-dynamically-oriented treatment to Hunter College employees and their families while under direct clinical supervision.
• Managed caseload of 8-10 clients in individual treatment.
• Engage in crisis intervention, provide referrals, and utilize case management skills when applicable.
• Created articles featured in a bi-annual Hunter College publication (Outlook!).
• Facilitate psycho-educational group seminars offered to Hunter College employees.

Managed a caseload of both grade school and high school students focused on assessment, weekly individual counseling, goal setting relevant to student IEPs, and parent, teacher and/or collateral meetings; Functioned under direct clinical supervision; Responsible for crisis intervention and mediation as needed; Created, planned and facilitated.

Nationwide hotline addressing the needs of victims of domestic violence and their families; Responsible for one weekly, 12-hour on-call shift fielding client calls; Extensive, state-mandated 36-hour training completed; Maintained a high level of autonomy when dealing with consumers while keeping in close contact with LCSW agency consultant.

Boston, Massachusetts, US

Planned and executed dynamic interior and exterior landscape installations for private and commercial clientele in both residential and corporate settings; Completion of various custom projects entailing thorough study of designs and materials to ascertain scope of labor including hardscaping, plant materials, irrigation systems, lighting and/or various.

Responsible for fielding and responding to calls received at a nationwide helpline regarding topics specific to both the local and national LGBT community; Completed extensive training on engagement and supportive skills related to issues such as gender identity, suicide assessment and prevention, HIV/AIDS and STDs, anti-gay/lesbian harassment and.

Masters Degree, Social Work

Bachelor Of Music, Vocal Performance