Lori Smith
Chicago
Summary
Experienced Manager with a background in coordinating and managing healthcare services to ensure optimal patient outcomes. Strengths include strong knowledge of healthcare regulations, ability to analyze data for decision making, and fostering interdisciplinary collaboration for service improvement. Noted for improving efficiency in previous roles by streamlining processes and implementing cost-effective strategies.
Overview
22
22
years of professional experience
Work History
Health Guide
Transcarent
09.2024 - Current
- Provide one-on-one guidance to clients on preventive care, chronic disease management, and healthy lifestyle choices.
- Assist members in navigating healthcare systems, including scheduling appointments, understanding insurance benefits, and finding providers.
- Conduct health risk assessments and wellness screenings, referring members to appropriate services as needed.
- Develop individualized health action plans and follow up regularly to track progress.
- Collaborate with clinical teams, social workers, and community partners to address social determinants of health.
CARE COORDINATION AND UTILIZATION MANAGER
ProMedica Senior Care
07.2021 - 11.2023
- Monitor team members to initiate authorization of benefits, medical necessity for ongoing treatment, and guiding teams to next level of care step down
- Analyze data to track trends, including length of stay, documentation meeting medical necessity, and appropriateness of treatment for level of care
- Managed both budgeting and staffing
- Review and evaluate clinical information to determine necessity of hospital readmissions, and treatment provided
- Provide trainings to improve clinical documentation and meet goals set on appeals and denials
- Responsible for the timely compilation, review and submission of medical information relating to the post-acute skilled stay
- Negotiates appropriate levels of care for contracted and non-contracted terms with the payor case manager
- Communicates information to care team and coordinates patient's smooth transition to the next level of care
- Obtains accurate information from physicians, patient, and payor source regarding the expected discharge plan and communicates this information to the interdisciplinary team
- Verify eligibility and benefits
- Assist corporate billing department with billing issue on behalf of the member
- Manage the care plan throughout the continuum of care as a single point of contact
- Complete continued stay reviews and update extended authorizations timely in addition to coordinating and monitoring length of stay for alternative payor models.
SOCIAL SERVICE DIRECTOR
Symphony Post Acute Network
04.2012 - 07.2021
- Coordinates discharge planning to ensure a timely discharge through early identification, assessment and intervention for post subacute care needs
- Collaborates and communicates with multidisciplinary team in all phases of discharge planning, ensures and maintains plan from patient and family, physician, and payor as indicated
- Patient assessment, plan coordination and changes to the plan occur, as necessary, to ensure that the patient is discharged when medically ready to acute hospitals; Rehabilitative facilities; Extended care facilities; other Sub acute care; Psychiatric and chemical dependency care; Return to home; or Other living arrangements
- Provide behavioral health assessment, psychotherapy, substance abuse screening and/or assessment, psychosocial support and referral services
- Certify patients who require involuntary inpatient hospitalization
- Facilitate transfer process for patients requiring an in-patient level of psychiatric care
- Serves as the point person for the plan of care as it applies to discharge planning needs through facilitation of direct and continuous communication and collaborative decision making, including participation in multidisciplinary rounds and case conferences.
SOCIAL SERVICE COORDINATOR
HCR ManorCare
05.2009 - 04.2012
- Responsible for the completion of social service components of MDS
- Complete psychosocial assessments, identifying needs/problems and developing goals and treatment plans
- Maintains open communication with staff to assist them in being informed of residents personal and psychosocial needs
- Serves as an advocate for residents to assure their individual rights
- Participate in weekly care plan conferences
- Maintain contact with residents family, involving them in meeting residents needs
- Discharge planning
- Provide support and counseling to patients and families.
SOCIAL SERVICE ASSISTANT
Windmill Nursing Pavilion
02.2005 - 07.2008
- Write, implement, and revise goals for patients
- Oversee day to day group activities of the residents
- Conduct facility tours
- Assisted psychiatrist with psychotropic drug reduction program
- Discharge planning
- Facilitate in-house groups
- Collaborate with outside agencies for community support.
COUNSELOR
Indian Oaks Academy
09.2004 - 02.2005
- Facilitate in-house groups
- Assure that house rules and procedures are maintained
- Accompanied youth to appointments
- Monitored youth/family visits
- Fostered healthy relationships with youth and staff.
COMPANION
Cook County Public Guardian
07.2003 - 09.2004
- Assist client with activities of daily living
- Assist client with medication management, shopping, and transportation
- Assist with maintaining healthy sense of well-being.
Education
Bachelor's Degree - Psychology
Hampton University
Hampton, VA01.2003
Skills
- Very effective communication skills (both spoken and written)
- Great organizational skills
- Goal-oriented
- Proactive
- Excellent at reporting
- Process improvement strategies
- Budget Management
- Staff Management
- Process Improvement
- Team Development
- Training and Development
- Problem-solving aptitude
- Adaptability and Flexibility
- Staff Training
- Problem Resolution
- Administration and Reporting
- Effective Communication
Timeline
Health Guide
Transcarent
09.2024 - Current
CARE COORDINATION AND UTILIZATION MANAGER
ProMedica Senior Care
07.2021 - 11.2023
SOCIAL SERVICE DIRECTOR
Symphony Post Acute Network
04.2012 - 07.2021
SOCIAL SERVICE COORDINATOR
HCR ManorCare
05.2009 - 04.2012
SOCIAL SERVICE ASSISTANT
Windmill Nursing Pavilion
02.2005 - 07.2008
COUNSELOR
Indian Oaks Academy
09.2004 - 02.2005
COMPANION
Cook County Public Guardian
07.2003 - 09.2004
Bachelor's Degree - Psychology
Hampton University
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