Christopher Lee Costley
Jacksonville
Summary
Member-focused Care Coordinator with exceptional time management, critical thinking, and problem-solving skills. Committed to achieving targets and goals. Seeking rewarding role in a fast-paced and high-volume behavioral/healthcare practice. Eager to add further job experiences/knowledge to better understand how to provide best/appropriate supports for members receiving behavioral/healthcare services. Highly motivated individual and a keen eye for details, project coordination, able to multi task, and understands priorities. Professional with hands-on experience in managing transitions and ensuring seamless processes. Strong focus on team collaboration and achieving results, adaptable to changing needs, and reliable in delivering outcomes. Skilled in project coordination, strategic planning, and stakeholder communication. Known for problem-solving abilities, leadership, and fostering cohesive team environment.
Overview
18
18
years of professional experience
Work History
My Choice Transition Coordinator
Trillium Health Resources
Jacksonville, NC
04.2022 - Current
- Coordinated and conducted Mutlidisciplnary team meetings with discharging facilities to coordinate member care and supports for transitions back to the community or back home with family.
- Completed record reviews for members newly assigned.
- Outreached care team members to obtain necessary documents for member transitions such as updated psychological evaluations, CCA's, guardianship, PT/OT/Speech assessments, IEP's,
- Identified appropriate provider agencies for member transitions out of Developmental Centers like Caswell or Murdoch, PRTF's, SNF's, ED's, and provider agencies.
- Completed referrals with in network and out of network provider agencies to find appropriate placement. Coordinated screening meetings for member's and LRP's with provider agencies and discharging facilities.
- Coordinated and conducted Tailored ISP's, CMCA assessments, Care plan reviews, and submitted to TBS for UM review for services. Completed all processes involved in Initial ISP's for member's new to Innovations waiver services.
- Linked to medical professional supports and assisted with coordinating appointments.
- Assisted with ensuring minors are linked to school systems for their transition back to community.
- Linked to behavioral supports and services for members such as SCS for behavior plan services, RBBHT, ABA, and NC START for member's with challenging behaviors.
- Worked with Money Follows the Person organization for member's new to Innovation services and ensured guidelines with MFP were followed for high engagement and low engagement member transitions.
- Completed MFP debreifing meetings for member transitions onto Innovation waiver services.
- Worked with multiple DSS offices to ensure member's Medicaid reflected IN indicator codes.
- Ensured issues of health and safety (rights restrictions, medical care, abuse/neglect/exploitation, and/or behavior support plan) are addressed and that members are offered a free choice of network providers and that non- waiver service needs have been addressed.
- Ensured Medicaid eligibiility and collaborated with DSS and SSI offices to ensure member's benefits transfer with their transition out of placement facilities such as PRTF's, ICF's, SNF's, ED's, and State Developmental Centers.
- Provided education to LRP's and members for Innovation Services and eligibility requirements along with other eligible services and resources.
- Ensured continued appropriateness of services as needed.
- Ensured that services are monitored as needed (including direct observation of service delivery, telephonic contact, and or emails in all settings.
- Made announced/unannounced monitoring visits.
- Monitored services for compliance with state standards, waiver requirements, and Medicaid regulations, including review of service documentation, review of claims, and member records.
- Promoted problem-solving and goal-oriented partnership with members/legally responsible persons, and providers to troubleshoot any issues that arised with services/treatment.
- Recognized and reported critical incidents.
- Promoted satisfaction with services through ongoing communication and timely follow-up with provider agencies, legal guardians, and member reports for any concerns or issues.
- Monitored transitions of care with members discharging from residential or inpatient settings such as PRTF, SNF's, IDD developmental centers, and ED's.
- Reported and documented any issues reported or observed during a monitoring. Completed HCBS monitoring to ensure compliance. Completed provider contact and LRP follow up to monitor satisfaction of services and to identify any issues or concerns.
- Monitored service delivery for Innovations Waiver Services to ensure that members continued to meet eligibility of Innovation services.
Care Coordinator
Trillium Health Resources/ Coastal Coastal Care
Jacksonville, NC
09.2012 - 04.2022
- Worked 40hrs/wk
- Provided complex care coordination and monitoring to members having a primary Intellectual or Developmental Disability, including a secondary mental health or substance abuse, and complex medical/physical health need.
- Provided a dynamic proactive approach to assessment, monitoring and complex coordination of care to ensure quality supports and consistent adherence to NC waiver requirements. Primary focus was on members that had an Intellectual Developmental Disability and served both children and adult populations.
- Utilized person centered planning methods/strategies to gather information, to get to know the members supported and to adequately address specific needs of the member.
- Provided education and support to members in learning about and exercising rights and responsibilities.
- Completed discovery activities as a component of the planning process.
- Ensured that members/legally responsible persons are informed of services available (all types of Medicaid and state funded services), service options available (Individual/Family directed services for Innovation members), processes (requirements for specific services), and natural and community services.
- Assisted members/legally responsible persons in choosing service providers, ensuring objectivity in the process.
- Assisted the member supported to direct the planning process/plan development to the extent desired by the member.
- Facilitated timely development of the Health Risk Assessment, Individual Support Plan, Crisis Plan and other assessments that were needed.
- Actively collaborated with members supported and members of the support team to ensure development of a comprehensive plan that reflected member's needs and desired life goals as well as, the physical, behavioral health and social determinant needs, service delivery, and health/safety of the member.
- Collaborated with integrated care team members
- Assisted members in navigating the healthcare and social support systems to ensure overall health and wellbeing.
- Promoted use of natural/community resources through the assessment, planning, and linkage process.
- Ensured that assessments and plans are updated as needed, whenever the member's life circumstances changed.
- Provided education on self direction model in the Innovations Waiver (Agency with Choice and Employer of Record) and assisted members with Community Navigator services if they were appropriate.
- Linked to psychological, behavioral, educational, Allied therapy evaluations, medical supports, and the Supports Intensity Scale as appropriate for the members needs.
- Assisted with interpreting Supports Intensity Scale with family/members in preparation for members planning process.
- Monitored per established time frames to ensure quality of care, health/safety of the member, as well as the continued appropriateness of services as needed.
- Ensured that services were monitored as needed including direct observation of service delivery, telephonic contact, and emails in all settings.
- Made announced and unannounced monitoring visits.
- Monitored services for compliance with state standards, waiver requirements, and Medicaid regulations, as applicable. Including review of service documentation and review of claims.
- Promoted problem solving and goal oriented partnership with members/legally responsible persons, and providers.
- Recognized and reported critical incidents.
- Promoted satisfaction with services through ongoing communication and timely follow up on any concerns/issues.
- Determined appropriate services for members with I/DD and co-occurring mental health and substance abuse disorders.
- Coordinated and monitored hospital and institutional admissions and discharges and follow ups.
- Ensured the coordination of care with each member's CCNC physician/health home.
- Ensured member engagement as needed to promote optimal healthcare and desired outcomes were achieved.
- Ensured members were linked to a Primary Care Physician and specialists. If member was not linked with a PCP was responsible for assisting with linking to needed supports.
- Provided follow up to members who received crisis services.
- Educated members/families on details surrounding the member's service budget.
- Verified that services were delivered as outlined in the Individual Support Plan (ISP) and addresses any deviations in service or follow up with the provider agency as applicable.
- Ensured that letters of medical necessity/doctor's orders are obtained.
- Verified members continuing eligibility for Medicaid and 'IN' indicators and promptly follow ups on identified issues.
- Proactively responded to a member's movement outside the MCO's geographic area to ensure changes in their Medicaid County of eligibility were addressed prior to any loss of services.
- Coordinated Medicaid deductibles with the member/legally responsible person and providers.
- Proactively monitored documentation/billing to ensure that issues/errors are resolved as quickly as possible.
- Ensured all clinical documentation met state, agency, and Medicaid requirements/standards.
- Maintained documentation compliance/quality as required per MCO and State requirements.
- Coordinated Medicaid eligibility and benefits.
- Worked under minimal supervision and performed job responsibilities with minimal instruction.
Shift Coordinator/Qualified Professional
Recovery Innovations
Jacksonville, NC
04.2011 - 08.2012
- Worked 40hrs/wk
- Ensured quality of individualized care in a managed care setting at a mobile crisis/facility based crisis center.
- Served populations with MI/IDD/SA who experienced crisis situations and those that needed further care such as Facility Based Crisis Services or inpatient care services.
- Provided assessments, person centered planning, crisis planning, and linking of resources for members that were in need of services.
- Provided education of services and resources available for members about their rights and supports to utilize for their needs.
- Linked to appropriate services for members for their desired outcomes.
- Worked with members to establish realistic and appropriate goals and interventions that worked best for them.
- Coordinated with other agencies/providers/hospitals to ensure members needs were addressed and supported as well as linking to further services.
- Coordinated with LME/MCO's when services were provided as well as to determine the appropriateness of the services for the member.
- Collaborated with agencies, team members, natural supports, law enforcement, to best support members needs as well as to best assess the members situation.
- Monitored and supervised the health/safety of the member and the services provided.
- Supervisory experience gained for 7 staff at 3 different facilities.
- Provided supervision of staff and educated/supported issues discussed from staff in regards to members situations/assessments/supports/linkage of services.
- Engaged in admissions and discharge planning for members accessing services.
- Provided critical thinking and problem solving techniques with staff supervised.
- Reviewed staff performance utilizing data reports, assessments completed, and direct supervision when interacting with members at the crisis facilities.
- Increased productivity with staff via reports, productivity measurement tools/programs, and note reviews/service billing so that services were more effectively and efficiently provided as possible.
- Provided services and oversight of staff providing services to stay within compliance of state and MCO's compliance/regulations and contractual agreements.
- Ensured services provided were within compliance/regulations for billing of those services.
- Provided crisis response to members in the community and at the facilities that were in need of crisis supports.
- Collaborated with other teams at the crisis facility to ensure services were transitioned smoothly from mobile crisis to facility based crisis services.
- Completed team meeting/information exchange from shift to shift for appropriateness of services and member engagement within all 3 facilities.
- Ensured record compliance per MCO's regulations of members receiving services so that services were able to be billed for and provided without lapse or discontinuation of services.
- Assessed members for eligibility of services and benefits.
- Acknowledged member issues and resolved their problems quickly and efficiently as possible.
- Collaborated with colleagues to discuss appropriate services/eligibility of services/community resources.
- Attended team meetings to discuss structure of program and services/resources lacking for members service linkage and quality of care.
- Effectively communicated with other employees and upper management to ensure complete care of members.
Case Manager / Qualified Professional
Coastal Residential Services, Inc
Jacksonville, NC
09.2008 - 06.2011
- Worked full time 40hrs/week for 2 years and 2 months, worked part time for 7 months about 25hrs/week.
- Provided services in all areas of case management with MH/IDD/SA populations such as Target Case Management, Community Support Team, and CAP.
- Linked and referred to services/resources as appropriate for members needs.
- Provided direct care services to members and followed/implemented plan of care developed for services.
- Abided by service definitions per MCO/State/Medicaid regulations for services provided with members.
- Assessed appropriateness of services being referred to and received by members.
- Assisted with person centered planning, crisis planning, involved natural supports/extended family supports with care coordination of the members receiving services.
- Conducted Plan meetings with member, legally responsible person, team members, and preferred attendees desired by the member to effectively and appropriately link to needed services/supports for the members.
- Completed Plans to request services with establishing attainable goals and appropriate interventions to support members with reaching those desired outcomes.
- Worked in conjunction with Doctor's and Licensed Staff for oversight with plan development and requested services for medical necessity and appropriateness of service linkage.
- Maintained compliance with service definitions according to State/MCO/Medicaid regulations and procedures for service delivery under CAP waiver, and CST services for members.
- Educated members and legally responsible persons of their rights and services/eligibility.
- Coordinated care/services with members/legally responsible persons with professional supports such as psychiatrists and primary care physicians to ensure overall health and well being.
- Monitored health and safety of members and linked to necessary supports to ensure this was addressed appropriately for each member is issues were presented.
- Monitored services in person and via meetings/discussions with staff providing services to ensure that services were provided appropriately as well as the quality of the services.
- Coordinated with LME/MCO's/agencies/professional supports for services being requested for State and Medicaid funded services.
- Assisted with continuation of Medicaid eligibility.
- Ensured medical necessity of services being requested and received.
- Provided advocation for members and legally responsible persons within their rights and services that they were eligible for as well as community resources that were available to them.
- Provided first responder services for crisis situation that occurred with members as needed to ensure their health and safety as well as their overall well being.
- Completed follow ups for crisis situations to ensure that members were being supported appropriately after receiving crisis services and updating assessments and plans as needed for each situation.
- Ensured documentation of services within MCO/State/Medicaid rules and regulations and contractual agreements.
- Ensured privacy of Personal Health Information for each member supported with services and referrals.
- Ensured members records/services were in compliance with State/MCO/Medicaid regulations and contractual agreements.
- Gathered all necessary assessments, documents, consents, and information needed to compile members records as well as updating them as need and on an annual basis.
Education
Bachelors of Arts - Psychology
East Carolina University
Greenville, NC07-2005
High School Diploma - undefined
Jacksonville High School
Jacksonville, NC05-2000
Skills
- Detail-oriented problem solver
- Proficiency in conflict resolution
- Time management and goal-oriented
- Comprehensive communication
- Customer satisfaction
- Excellent organizational skills
- Positive attitude
- Good eye for detail
- Critical thinking and analysis
- Discharge planning
- Patient record reviews
Timeline
My Choice Transition Coordinator
Trillium Health Resources
04.2022 - Current
Care Coordinator
Trillium Health Resources/ Coastal Coastal Care
09.2012 - 04.2022
Shift Coordinator/Qualified Professional
Recovery Innovations
04.2011 - 08.2012
Case Manager / Qualified Professional
Coastal Residential Services, Inc
09.2008 - 06.2011
High School Diploma - undefined
Jacksonville High School
Bachelors of Arts - Psychology
East Carolina University