Tikisha Walwyn has over 10 years of experience in behavioral health care advocacy and utilization review. She has worked for several companies including United Health Care, Beacon Health Strategies, and Cedar Crest Hospital, managing Medicaid plans and other programs. Her experience includes assessing patient needs, determining appropriate levels of care, managing treatment plans, and assisting with quality improvement initiatives.

1. Tikisha Walwyn, M.A., LPC 67100
walwynts@gmail.com/713.979.6746
University Of Mary Hardin Baylor Belton, TX Counseling M.A. 05/10
University Of North Texas Denton, TX Sociology B.A. 05/08
Behavioral Health Care Advocate, United Health Care: Optum, Houston, TX 04/15-Present
Utilization review to make patient assessments and determine appropriate levels of care
using the model of best practice. Managing inpatient and outpatient behavioral health
cases throughout the entire treatment plan by consulting with requesting facility/provider to
add value to the treatment plan. Book of business: Medicare Advantage using Centers for
Medicare and Medicaid National/Local Coverage Determinations and Guideline
Summaries. Actively pursuing Six Sigma Green Belt Certification.
Utilization Review Clinician, Beacon Health Strategies, Austin, TX 03/14-03/15
Project manager for Beacon’s Austin Service Center of 50 employees to volunteer for NAMI
(National Alliance of Mental Illness) Walk Austin. Served as Clinical Liaison for Seton Health
Plan marketing team at the Texas Suicide Prevention Symposium: Coming Together to Care
2014 San Marcos, TX. Experience with a variety of managed care techniques intended to
reduce the cost of providing behavioral health benefits and improving the quality of care.
Assists with QI, NCQA, TDI, HHSC, URAC, HEIDIS accreditation standard initiatives and annual
analysis. Manages SB58, Medicaid, Health Exchange, CHIP, and STAR plans. Performs
utilization review of behavioral health services for inpatient (IP), partial hospitalization
program (PHP), intensive outpatient program (IOP), and residential treatment center (RTC)
levels of care based on medical necessity.
Intensive Case Manager, Beacon Health Strategies, Remote 03/13-03/14
First clinical staff member hired to establish Beacon's start up office in Austin, TX. Interim ICM
for Medicaid Cook Plan. Assisted in facilitating a person centered case management plan
to include short and long term goals identified in collaboration with the health plan.
Responsible for the triage, assessment, tracking, and management of members who may
be high risk, high utilizing, at significant clinical risk, or underutilizing behavioral health
services.
Clinical Assessment Specialist, Cedar Crest Hospital & RTC, Belton, TX 09/10-03/13
Increased admissions by 20% during the first year as a 24 hour department. Assisted with
JCAHO accreditation standard initiatives. Performed preauthorization reviews for behavioral
health services in IP, PHP, and RTC for latency, adolescent, adult, geriatric, and military
population with Medicaid and commercial health insurance plans. Used bio-psycho-social
instruments to conduct clinical assessments for admissions. Managed facility bed availability
by scheduling admissions accordingly. Tracked data that captured daily high call volume,
admissions, and deflections. Provided face to face and telephonic crisis counseling.
Assisted with discharge planning to ensure continuity of care.
Mental Health Associate, Cedar Crest Hospital & RTC, Belton, TX 09/08-09/10
Collaborated with a multi-disciplinary treatment team to address the behavioral health
need of patients in IP, PHP, and RTC. Monitored and documented the daily progress of
patients for safety in a 24-hour therapeutic milieu including patients in CPS custody.
References
Barbara Gulley 254.220.7205
Richard Wallace 512.596.7504
Sandy Gahagan 256.603.1071