Karen Jones
Chesterfield
Summary
Clinically experienced professional with extensive experience in working with persons with developmental disabilities. Proven ability to work with multi-disciplinary teams and provide high levels of customer service. Responsive, trustworthy, self-starter with excellent written and verbal communications skills. Known for enhancing communication and team collaboration to ensure optimal service delivery.
Overview
19
19
years of professional experience
Work History
Lead Service Authorization Consultant
Commonwealth of Virginia-Dept. of Behavioral Health
Richmond, VA
04.2021 - Current
- Collaborate with stakeholders to ensure services for individuals receiving Developmental Disability (DD) Waiver Services are appropriate according to their assessed needs
- Facilitate and conduct trainings for new staff as well as trainings for providers and Community Service Boards
- Provide oversight of staff performing service authorizations for individuals with Developmental Disabilities Waiver, assuring all criteria are met
- Evaluated existing programs, identifying gaps and proposing enhancements to improve Waiver services.
- Problem solve with Service Authorization Consultants to ensure individuals receive the appropriate services.
- Enhanced communication among team members to foster collaborative and supportive work environment.
Service Authorization Consultant
Commonwealth of Virginia-Department of Behavioral Health
Richmond, VA
05.2012 - 04.2021
- Facilitates the approval process for Developmental Disabilities Waiver Services
- Ensure all individual service plans submitted by assigned Community Service Boards are evaluated for appropriateness based on the individual's needs and in compliance with Medicaid regulations and policies.
- Managed project timelines to ensure compliance with state regulations and guidelines.
- Conduct service authorization trainings for Community Service Boards and private providers.
- Acting as a liaison between providers and support coordinators to resolve discrepancies and assist with problem solving.
Healthcare Compliance Specialist
Commonwealth of Virginia-Department of Medical Assistance Services
Richmond, VA
01.2008 - 05.2012
- Provide oversight of Case Management for IFDDS Waiver Services
- Screening and eligibility determination, waitlist assignment and oversight, enrollment, service initiation, plan of care needs determination/approval, and assessments.
- Plans and conducts comprehensive home and family assessments/level of functioning reviews.
- Developed and implemented compliance policies to ensure regulatory adherence.
- Provided training and guidance on regulatory requirements to Case managers and providers.
MH/MR Case Manager
Henrico Mental Health and Developmental Services
Henrico, VA
06.2007 - 12.2007
- Provide Case Management services to adults and children with dual diagnosis of ID/MR/MH
- Developed individualized service plans to address client needs.
- Coordinated with multidisciplinary teams to ensure comprehensive care for clients.
- Facilitated client assessments to determine eligibility for services and resources.
- Monitored client progress and adjusted care plans based on evolving needs.
Education
High School Diploma -
Thomas Jefferson High School
Richmond, VAMaster of Science - Rehabilitation Counseling
Virginia Commonwealth University
Richmond, VA05-1995
Bachelor of Arts - Psychology
University of Virginia
Charlottesville, VA05-1992
Skills
- Problem-solving
- Attention to detail
- Team leadership & development
- Issue resolution
- Excellent written and verbal communication skills
- Multi-tasker
Timeline
Lead Service Authorization Consultant
Commonwealth of Virginia-Dept. of Behavioral Health
04.2021 - Current
Service Authorization Consultant
Commonwealth of Virginia-Department of Behavioral Health
05.2012 - 04.2021
Healthcare Compliance Specialist
Commonwealth of Virginia-Department of Medical Assistance Services
01.2008 - 05.2012
MH/MR Case Manager
Henrico Mental Health and Developmental Services
06.2007 - 12.2007
High School Diploma -
Thomas Jefferson High School
Master of Science - Rehabilitation Counseling
Virginia Commonwealth University
Bachelor of Arts - Psychology
University of Virginia