Open to opportunities

Lauren Kasper

@laurenkasper

Message

Experienced Utilization Management Coordinator advocating for clients' treatment needs.

Zimbabwe

Message

What I'm looking for

I seek a role that allows me to continue advocating for clients while providing opportunities for professional growth and collaboration within a supportive team environment.

With over nine years of experience in Utilization Management, I am dedicated to advocating for clients needing residential and outpatient treatment for substance use disorders (SUD) and mental health (MH) issues. My role involves completing various reviews based on medical necessity, utilizing ASAM criteria guidelines, and collaborating with care managers and treatment teams to ensure clients receive the best possible care.

Currently, I serve as a Utilization Management Coordinator at Pyramid Healthcare, where I manage a high volume of reviews daily, ensuring compliance with insurance requirements and facilitating communication between treatment providers and insurance companies. My previous roles have equipped me with strong skills in assessment, coordination of care, and effective communication, allowing me to navigate complex cases and advocate for my clients' needs effectively.

Experience

Work history, roles, and key accomplishments

Current

Utilization Management Coordinator

Current

Pyramid Healthcare

Jul 2024 - Present (1 year)

Completed precertification, continued stay, step down, and discharge reviews for various levels of care, utilizing ASAM criteria for medical necessity. Managed 15-20 daily reviews for commercial insurances, SCA Drug and Alcohol Commissions, and County Medicaid.

ASAM Criteria Commercial Insurance Medicaid Communication Critical Thinking Attention To Detail

Utilization Management Coordinator

Retreat Behavioral Health

Aug 2022 - Jun 2024 (1 year 10 months)

Conducted detox, residential, and mental health chart reviews using ASAM/LOCUS criteria with insurance companies. Communicated review outcomes and rationales for denials to treatment teams, and scheduled peer-to-peer reviews.

ASAM Criteria Peer Review Chart Reviews Patient Care Coordination Communication Critical Thinking

Case Manager/County Assessor

White Deer Run

Jul 2019 - Aug 2022 (3 years 1 month)

Met with clients referred by legal/court systems to complete drug and alcohol assessments, determining treatment levels of care. Conducted ASAM and biopsychosocial assessments, entering data into the WICS system, and coordinated care with outside providers.

Case Management Biopsychosocial Assessments Care Coordination Legal System Referrals Data Entry Communication Organizational Skills Critical Thinking

Utilization Management Coordinator

Retreat Behavioral Health

Sep 2016 - Jul 2019 (2 years 10 months)

Completed substance abuse and mental health outpatient chart reviews using ASAM/LOCUS criteria with insurance companies. Communicated review outcomes and rationales for denials to treatment teams, and scheduled peer-to-peer reviews.

ASAM Criteria Peer Review Chart Reviews Outpatient Treatment Communication Critical Thinking

Evening Therapist

Retreat Behavioral Health

Nov 2013 - Sep 2016 (2 years 10 months)

Acted as a liaison between patients and their Primary Therapist during after-hours programming, administering therapy needs and follow-up calls. Developed and facilitated a two-week group program focusing on self-esteem, codependency, and family systems.

Therapy Facilitation Program Development Patient Care Communication Counseling Behavioral Health Treatment Planning Interpersonal Skills

Education

Degrees, certifications, and relevant coursework

York College of Pennsylvania

Bachelor of Science, Sociology

Studied Sociology at York College of Pennsylvania, gaining a foundational understanding of societal structures and human behavior. This education provided a strong basis for understanding the complexities of human interaction and social systems.