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Samantha Lucas

@samanthalucas

Behavioral health clinician at Summit Community Counseling, combining outpatient therapy with Medicaid payer expertise to reduce authorization friction.

United States

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What I'm looking for

I’m interested in work in utilization management, care management, quality improvement, network strategy, or integrated behavioral health leadership, where I can bring clinical judgment to payer problems and payer fluency to clinical care.

At Summit Community Counseling, I provide outpatient psychotherapy to children, adolescents, and adults, using trauma-informed and neurodivergent-affirming approaches. I also designed and launched a multi-week social and coping-skills group for neurodivergent adolescents.

At Centene Corporation, I managed a 150–200-provider network across Medicaid, Medicare Advantage, and Marketplace products. I investigated denial root causes and worked with providers and internal teams on corrective actions to reduce recurring submission and processing errors.

My work at UnitedHealthcare included coordinating care for medically and psychosocially complex members in Arizona Medicaid long-term care. I developed person-centered plans, coordinated transitions and services, and served as a Team Lead and Subject Matter Expert, mentoring peers and completing chart audits.

Earlier, at St. Luke's Behavioral Health Center, I performed concurrent utilization review and appeals for acute psychiatric and substance-use treatment. I bring experience across clinical care and payer operations to utilization management, care management, quality improvement, network strategy, and integrated behavioral health.

Experience

Work history, roles, and key accomplishments

Current

Outpatient Therapist, CSW

Current

Summit Community Counseling

Dec 2025 - Present (9 months)

Provides individual outpatient psychotherapy to children and adolescents using trauma-informed, strengths-based approaches. Conducts biopsychosocial assessments, develops treatment plans, and produces medical-necessity documentation.

CBT Solution Focused Collaborative Therapy Motivational Interviewing Trauma Informed Care Biopsychosocial Assessments DSM V TR Treatment Planning Risk Assessment BIRP Case Notes Group Facilitation

Provider Engagement Account Manager

Centene Corporation

Jul 2024 - Sep 2026 (2 years 2 months)

Managed a territory of 150-200 contracted providers across Medicaid, Medicare Advantage, and Marketplace products. Investigated complex denials, served as clinical translator, and trained provider groups on compliance and workflows.

Provider Network Management Claims Resolution Credentialing HEDIS Quality Improvement Value Based Care Medicaid Medicare Advantage Marketplace Health Information Workflows

MSW Intern, Behavioral Health Case Manager

Banner Behavioral Health Hospital

May 2025 - Sep 2025 (4 months)

Completed 120+ hours in an acute inpatient psychiatric setting. Conducted biopsychosocial assessments, co-developed plans of care, and facilitated discharge planning.

Biopsychosocial Assessments Psychosocial Screening Interdisciplinary Rounds Discharge Planning Psychoeducation Group Facilitation

MSW Field Training Intern

University of Denver

Aug 2024 - Mar 2025 (7 months)

Completed 200 hours of competency-based clinical training in a simulated agency environment. Trained in cognitive behavioral therapy, motivational interviewing, and problem-solving therapy.

CBT Motivational Interviewing Problem Solving Treatment (PST)Diagnostic Formulation Plan of Care Development Therapeutic Interventions Documentation Ethical Practice

Senior Provider Relations Advocate

Optum / UnitedHealth Group

Mar 2023 - Mar 2024 (1 year)

Managed high-volume provider accounts and strategic partnerships across Medicaid and Medicare populations. Resolved escalated authorization, claims, and network adequacy issues.

Provider Relations Care Coordination Referral Access Network Adequacy Claims Resolution Authorization

ALTCS Case Manager / Care Coordinator

UnitedHealthcare / UnitedHealth Group

Dec 2017 - Mar 2023 (5 years 3 months)

Managed a caseload of 100+ medically and psychosocially complex members in Arizona Medicaid long-term care. Conducted biopsychosocial assessments, developed person-centered plans, and coordinated benefits and transitions of care.

Case Management Care Coordination Biopsychosocial Assessments Person Centered Planning Medicaid Medicare Transitions Of Care DME Community Service Team Lead Patient Chart Audits CMS NCQA

Inpatient Utilization Review Case Manager

St. Luke's Behavioral Health Center

Feb 2014 - Dec 2017 (3 years 10 months)

Performed concurrent utilization review and appeals for acute psychiatric and substance-use treatment. Validated medical necessity, level of care, and length of stay for commercial and Medicaid payers.

Utilization Review Appeals Medical Necessity Criteria Level Of Care Length Of Stay Management Authorization Compliance Documentation Reimbursement