Manager, Intensive Case Management, Ambulatory Follow Up and Outpatient Program Management @ ValueOptions, Inc.®
Supervisor, Case Management @ EmblemHealth
Supervisor @ HIP Health Plan
Education:
SFFI, Field Instruction @
Adelphi University Graduate School of Social
About:
Manager/Psychiatric Social Worker with extensive experience in program creation and implementation, training and clinical supervision, data management, strategic planning, interdisciplinary collaboration, and regulatory compliance.
Manager, Intensive Case Management, Ambulatory Follow Up and Outpatient Program Management @ ● Responsible for clinical and administrative oversight of all Outpatient programs at the New York City Service Center of ValueOptions
● Provide
Manager/Psychiatric Social Worker with extensive experience in program creation and implementation, training and clinical supervision, data management, strategic planning, interdisciplinary collaboration, and regulatory compliance.
Manager, Intensive Case Management, Ambulatory Follow Up and Outpatient Program Management @ ● Responsible for clinical and administrative oversight of all Outpatient programs at the New York City Service Center of ValueOptions
● Provide supervision and training to 17 clinical and nonclinical staff members in 3 distinct outpatient program
● Coordinate programs with Utilization Management and Psychiatrists to provide seamless quality of care for all members
● Ensure all outpatient programs operate according to regulatory, clinical and fiscal guidelines
● Responsible for all day to day operations of all outpatient programs including recruiting and hiring staff, auditing staff phone calls and case files, and creating productivity reports and assessment tools resulting in data driven programmatic decisions
● Utilized Strategic Planning skills to create an enhanced program for the effective management of the Medicaid line of business for our largest client
● Created Policies and Procedures, Workflows and Work Plans that were utilized by the highest levels of management to present to our clients
● Managed Outpatient programs to meet budgetary requirements while providing access to quality Behavioral Health Services From January 2012 to Present (4 years) Supervisor, Case Management @ From June 2009 to Present (6 years 7 months) Supervisor @ Currently provide clinical supervision and training to five Master's Level Case Managers who provide Intensive Case Management and Depression Disease Management to identified members
Responsible for populating, assigning and overseeing the databases for Disease Management and Intensive Case Management.
Ensure that program enrollment benchmarks for Intensive Case Management and Depression Disease Management are met if not exceeded.
Implement quarterly case audits to ensure adherence to all NCQA guidelines.
Develop standardized workflows for all Case Managers
Create productivity guidelines for all Case and Disease Management programs
Develop Strategies to reduce inpatient utilization
Interface with internal Care and Case management Departments as well as external Disease Management Vendors to facilitate the coordination of care of members
Responsible for mid year and end of year performance evaluations for all Case Managers
Represent the Case Management Unit in company-wide meetings targeted at decreasing the utilization costs and improving continuity of care for the highest utilizing/highest risk members
Utilize a Predictive Model with multiple variables to determine which members are at highest risk for re-hospitalization and need Intensive Case Management From January 2009 to Present (7 years) Assistant Director, Clinical Network Relations @ Oversaw and managed the HIP Mental Health Provider Network
Participated in collaborative meetings with The Provider Relations Department to enhance the HIP Mental Health Provider Network to best serve a diverse membership
Sheri Duxin, LCSW Page 2 of 3
Responsible for improving the quality and efficiency of the HIP Mental Health Provider Network
Created database of providers with their areas of specialization and language proficiencies as well as availability for urgent and emergent visits
Researched evidence-based treatments for members diagnosed with Autistic Spectrum Disorders; identified and reached out to providers who are qualified to provide treatment to this population
Reported to Senior Director of Behavioral Health on how to integrate the evidence based treatments for Autistic Spectrum Disorders into covered mental health benefit package
Acted as liaison to Mental Health Call Center to provide crisis intervention to members in distress
Served as Point Person for all member requests that required out of network authorizations including neuropsychological testing
Documented, investigated and rectified all member complaints relating to the HIP Mental Health Provider Network From June 2008 to Present (7 years 7 months) Associate Director @ Managed staff utilization and developed an on-call schedule, which ensured coverage during emergencies or walk-ins; designed interventions to enhance access to care which resulted in a significant increase in center productivity; established a crisis group to welcome clients five days per week; monitored and managed acute cases, enabling clients to avoid hospitalization; administered all existing and new clinic programs; developed innovative clinical programs to address the unique needs of patients within the region.
Ensured treatment plans and reviews complied with OMH/NCQA criteria; developed timely and informative monthly and annual reports, enhancing communication between the center and Mental Health Care Management.
Served as a key member on organization-wide Quality Improvements and interfaced with VP of Mental Health Care; frequently interfaced with Human Resources, unions, and EAP centers to orchestrate and support employees in their return to work; coordinated communication and service delivery efforts with Medical Group personnel; established connections with vocational programs and helped clients secure rehabilitation services and employment.
Partnered with Human Resources in hiring staff, and partnered with union representatives from two collective bargaining units to navigate the discipline and grievance process; conducted performance evaluations for nine non-medical clinicians; effectively led and motivated a multidisciplinary team - directly driving a 30% increase in center productivity.
Supervised 4 graduate students from Yeshiva, Columbia, NYU, and Adelphi; conducted field advising for 12 -15 graduate students per year from Columbia. From June 2006 to Present (9 years 7 months) Adjunct professor/Field Advisor @ Facilitated the development of students throughout placements in a wide range of community, mental health and social service organizations. From January 1997 to January 2008 (11 years 1 month) Associate Director @ From January 2000 to January 2006 (6 years 1 month) Psychiatric Social Worker @ Provided goal-focused psychotherapy to HIP members utilizing multiple modalities; managed heavy caseloads and performed diagnostic evaluations as well as psychosocial assessments; served as a key member of a multidisciplinary team charged with collaboration on treatment plans and coordination of care.
Facilitated the introduction of a number of new services and approaches (e.g. EMDR and solution-focused therapy).
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Established close working relationships with physicians and other staff members, and collaborated in the development and delivery of treatment plans with medical facilities, schools, and a number of relevant external agencies.
Introduced weekly meetings and in-service sessions which provided an opportunity for all staff - doctors, social workers and psychologists - to share and acquire new knowledge. From January 1995 to January 2000 (5 years 1 month) Psychiatric Social Worker @ Planned and implemented new and innovative services that met the specific needs of the client population; these included the development of a large group program and a DBT skills-training group, which supported the development of coping skills, depression support, and the enhancement of social skills.
Delivered group and family therapy to a highly diverse population and addressed a wide range of complex issues including gender-based trauma and sexual abuse.
Served as a field instructor for HIP employees pursuing graduate studies in social work.
Organized and delivered a workshop on the utilization of solution-focused therapy with low-functioning psychiatric patients; this day-long seminar was attended and well-received by representatives from HIP centers across the U.S. From January 1984 to January 1995 (11 years 1 month) Director @ From January 1981 to January 1984 (3 years 1 month) Social Worker @ From January 1980 to January 1981 (1 year 1 month)
Training, Prolonged Exposure Therapy @ New York State Psychiatric Institute 2003SFFI, Field Instruction @ Adelphi University Graduate School of SocialMasters, Social Work @ New York University, Graduate School of Social From 1978 to 1980 Bachelor of Arts, sociology/anthropology @ Hofstra University From 1973 to 1978 Post Masters, Supervision @ Hunter College School of Social Work 2005 Sheri Duxin is skilled in: Wellness, Crisis Intervention, Family Therapy, Therapists, Psychotherapy, Behavioral Health, Clinical Supervision, Treatment, Mental Health, Psychiatry
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