Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Diane Bray

Clayton

Summary

Experienced healthcare professional with over 20 years in clinical roles, specializing in utilization management, case management, and therapy. Proven ability to navigate HIPAA, Medicaid, and NCQA guidelines effectively. Strong interpersonal, organizational, and communication skills contribute to delivering exceptional healthcare services.

Overview

22
22
years of professional experience
1
1
Certification

Work History

Case Manager

Premera Blue Cross Blue Shield
10.2023 - Current

Coordinated services among clients, providers, and community resources to enhance support.

  • Monitored client progress and adjusted care plans to ensure optimal outcomes.
  • Facilitated communication between healthcare professionals and clients for seamless care delivery.
  • Facilitated communication among healthcare professionals and clients.

Utilization Management Supervisor

Eastpointe
05.2022 - 09.2023
  • Provided leadership and direct supervision to licensed clinical staff for optimal performance.
  • Oversaw administrative and clinical operations within department, ensuring compliance with standards.
  • Monitored strategic goals and performance benchmarks to enhance staff effectiveness.
  • Developed and enforced department policies and procedures to streamline operations.
  • Managed caseloads, conducted clinical audits, and executed performance evaluations.
  • Modified work procedures to improve efficiency and operational effectiveness.
  • Facilitated training sessions and mentoring programs for new employees.
  • Coordinated regular team meetings for enhanced communication, feedback, and development.

Utilization Management Clinician

Eastpointe
02.2011 - 05.2022
  • Reviewed mental health service requests to assess medical necessity.
  • Ensured consumers received treatment in least restrictive settings through thorough service plan evaluations.
  • Conducted prior authorization and continued stay reviews across outpatient, inpatient, and residential services.
  • Collaborated with providers to collect clinical information for medical necessity determinations.
  • Complied with HIPAA and Medicaid regulations throughout all processes.

Case Manager

Carolina Choice
New Bern
05.2010 - 02.2011
  • Delivered case management services to clients with chronic mental illness, facilitating access to community resources and supports.
  • Supported clients in identifying and participating in activities that enhanced community engagement and belonging.
  • Guided clients in improving well-being and adopting proactive self-care strategies.

Case Manager

Spokane Mental Health
Spokane
09.2003 - 03.2010
  • Delivered case management services to clients with chronic mental illness, facilitating access to community resources.
  • Guided clients in identifying activities that enhanced belonging and community engagement.
  • Supported clients in improving well-being and adopting empowered self-care practices.

Education

MA -

Argosy University
Hawaii
01.2001

Skills

  • Counseling and crisis intervention
  • Coping skills development
  • Community resource access
  • Documentation and standards
  • Independent task completion
  • Team collaboration and leadership
  • Professional communication
  • Care coordination and advocacy
  • Case assessment and planning
  • Regulatory compliance and HIPAA adherence
  • Treatment planning and goal setting
  • Performance evaluation and conflict resolution
  • Effective communication strategies
  • Relationship building and stakeholder collaboration
  • Resource management and utilization review
  • Ethical judgment in decision-making
  • Training facilitation and staff education
  • Stress management techniques
  • Active listening skills

Certification

  • LCMHC
  • LMHC

Timeline

Case Manager

Premera Blue Cross Blue Shield
10.2023 - Current

Utilization Management Supervisor

Eastpointe
05.2022 - 09.2023

Utilization Management Clinician

Eastpointe
02.2011 - 05.2022

Case Manager

Carolina Choice
05.2010 - 02.2011

Case Manager

Spokane Mental Health
09.2003 - 03.2010

MA -

Argosy University
Diane Bray