Erica DeGonia, LCPC
Granite City
Summary
Compassionate Care Manager with 20 years of experience enhancing patient care through team leadership and support. Skilled in assessing needs, developing care plans, and advocating for patient rights. Focused on improving health outcomes and fostering collaboration among staff and patients.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Senior Care Advocate-Clinical Claim Review Team
United Health Group
Remote
03.2023 - 04.2026
- Led and mentored team of seven, enhancing case documentation quality
- Provided consultation and staffing for complex cases
- Delegated cases to team members for efficient workflow
- Audited team reviews to ensure compliance with guidelines
- Facilitated meetings with team members
- Collaborated with claims partners
- Performed medically necessity reviews to evaluate compliance with guidelines
Care Advocate-Clinical Claim Review Team
United Health Group
Remote
03.2015 - 03.2023
- Conducted comprehensive research and analysis of medical records, treatment plans, and claim information to inform clinical reviews.
- Exercised sound judgment in clinical decision-making based on National Guidelines.
- Conducted retrospective reviews received via electronic medical records system for higher levels of care.
- Developed workflows that enhanced compliance with documentation standards.
- Consistently met documentation standards with a 98% or higher compliance rate over three years.
- Participated in clinical supervision, staff meetings, case staffings and in-service opportunities.
Care Advocate-Assessment and Triage
United Health Group
Maryland Heights
12.2005 - 03.2015
- Conducted initial assessments to gather clinical information from facilities, facilitating transitions to higher levels of care.
- Documented comprehensive case information, including assessments, interventions, and referrals, ensuring accurate records for quality care.
- Evaluated online requests for OP services, streamlining the triage process for timely member support.
- Assisted members with healthcare inquiries and service navigation.
- Educated clients on benefits, services, and wellness resources available.
- Trained and supervised new employees.
Case Manager
Mental Health Network
St. Louis
02.2005 - 12.2005
- Coordinated resources for members post-discharge to facilitate smooth transitions to home care.
- Maintained accurate case records and documentation according to agency guidelines.
- Monitored client progress through regular follow-up contacts.
- Conducted inpatient utilization reviews to ensure compliance with admission criteria and concurrent review standards.
- Evaluated outpatient treatment plans to confirm alignment with client goals and progress.
Intensive Outpatient Therapist
Gateway Regional Medical Center
Granite City
08.2003 - 02.2005
- Counseled clients in a group and individual setting
- Conducted mental health assessments in inpatient and outpatient settings to inform treatment strategies.
- Developed treatment plans with members to ensure stability and success.
- Created comprehensive curriculum for effective program implementation, enhancing therapeutic outcomes.
- Assisted in the Partial Hospitalization program for children and adolescents
- Collaborated with primary care physicians, psychiatrists, schools, social workers, probation officers to ensure comprehensive care for clients.
- Maintained accurate records and documented patient progress to ensure compliance with regulatory standards.
Psychosocial Rehab Counselor
Chestnut Health Systems
Granite City
02.2000 - 08.2003
- Conducted individual counseling sessions to address client mental health needs.
- Facilitated group therapy meetings that fostered communication and support, improving participant engagement.
- Educated clients about coping strategies and resources available for mental wellness.
- Assisted clients in developing healthy coping skills that could be used during times of stress or difficulty.
- Monitored client progress and adjusted treatment plans for effectiveness.
- Assisted clients with resumes, applications, and interviewing skills.
- Led vocational training program that enhanced participant skills and employability.
- Established a safe, supportive environment conducive to learning and personal growth for all clients.
- Collaborated with multidisciplinary teams, including psychiatrists, social workers, physicians, and other professionals.
Education
Master of Arts - Counseling
Webster University
St. Louis, MO01-1999
Bachelor of Arts - Psychology
University of Missouri-St. Louis
St. Louis, MO01-1995
Skills
- Medical necessity review
- Clinical decision-making
- Case documentation
- Intake assessment
- Team collaboration
- Time management
- Patient advocacy
- Communication skills
Certification
Licensed Clinical Professional Counselor in the state of Illinois
Timeline
Senior Care Advocate-Clinical Claim Review Team
United Health Group
03.2023 - 04.2026
Care Advocate-Clinical Claim Review Team
United Health Group
03.2015 - 03.2023
Care Advocate-Assessment and Triage
United Health Group
12.2005 - 03.2015
Case Manager
Mental Health Network
02.2005 - 12.2005
Intensive Outpatient Therapist
Gateway Regional Medical Center
08.2003 - 02.2005
Psychosocial Rehab Counselor
Chestnut Health Systems
02.2000 - 08.2003
Master of Arts - Counseling
Webster University
Bachelor of Arts - Psychology
University of Missouri-St. Louis