Ashley Jefferson
Chapin,SC
Summary
Assist in providing client services within wide variety of fields, with strong foundation in psychology, rehabilitation and social work, including support for families. Skilled in assisting clients by identifying and obtaining available benefits and social and community services. Support social workers in developing, organizing and conducting programs to prevent and resolve problems relevant to substance abuse, human relationships, rehabilitation, or dependent care.
Overview
11
11
years of professional experience
1
1
Certification
Work History
Adjunct Faculty
Grand Canyon University
02.2024 - Current
- Maintain a professional working relationship with the cooperating clinic, hospital, school, community agency and/or private practice
- Maintain effective communication with the cooperating field instructor, assigned social work student, and Office of Field Experience (OFE)
- Act as a resource person to the field instructor and the assigned social work student by providing additional sources of information and by having face-to-face and phone contact during the assigned field education course(s)
- Listen to the assigned student’s concerns regarding his/her field education experience and relate those concerns in the end of visit report
- Act as a liaison between the field education site and the social work OFE
- Provide information on the development and implementation of the assigned student’s future professional plans
- Encourage responsibility and creativity in the social work practice experience
- Monitor that both, the field instructor’s and student’s responsibilities (as established in the field education manual) are being honored
- Provide knowledge about evaluation procedures
- Create and maintain a professional, friendly relationship with the assigned social work student and the cooperative field instructor
- File status reports after each meeting with the OFE
- Review Learning Agreement with student and Field Instructor to confirm CSWE social work competency standards are addressed and met
Senior Medical Reviewer
Blue Cross Blue Shield SC
07.2023 - Current
- Functions as team leader/senior-level Medical Reviewer
- Provides leadership/guidance/direction/training to staff
- Maintains working knowledge of unit functions and ability to interpret to new hires, department interworkings and work flow
- Acts as resource for staff/external entities troubleshooting as well as resolving issues
- Keeps manager informed of any problems/issues that need resolving
- Assists management with monitoring workflow and workloads (including reassignment of work to meet timelines, redirecting work intake source to balance workloads), reporting, and addressing aging issues
- Participates in departmental quality reviews
- Follows process to ensure quality plan is adhered to and communicated to all parties
- Gives/receives feedback regarding medical review decision making and technical claims processing issues
- Ensures that quality work instructions/forms/documents are developed/revised as needed
- Provides quality service and communicates effectively with external/internal customers in response to inquiries
- Obtains information from internal departments, providers, government, and/or private agencies, etc
- To resolve discrepancies/problems
- Participates in compliance initiatives and other-directed activities
- Participates/oversees special projects as requested by management
Program Coordinator
Prisma Health-Midlands
11.2014 - Current
- 7+ years of case management experience, working directly with employees, patients, and cross-functional partners on end-to-end solutions
- Exceptional project management, communication, and technical skills to manage patient and internal resources
- Superb documentation skills, including experience communicating complex concepts to different audiences across an organization
- Experience building relationships and influencing others while working cross-functionally
- Extreme attention to detail, ability to adjust on the fly, problem-solving skills, proactivity and a great attitude
- Excellent writing, communication and interpersonal skill
- Has a sense of urgency on all matters
- Highly responsive, proactive, accountable, growth mindset and service-oriented attitude in a fast-paced environment
GEAR UP Project Specialist (Counselor)
Blythewood High School
08.2013 - 06.2014
- Created communication material such as newsletters, emails, and other documents as needed
- Collaborated with psychologist, social workers, administrators and teachers regarding student program and assessments
- Encouraged educational growth strategies by preparing students for college environment
- Collected timesheets and assisted with payroll processing
Education
Master of Arts - Social Work
University of South Carolina
Columbia, SC05-2013
Bachelor of Arts - Sociology
University of South Carolina
Columbia, SC05-2011
Skills
Leadership and Team Management
Program Development and Coordination
Case Management
Management and Client Advocacy
Data Analysis and Reporting
Regulatory Compliance (ERISA, NCQA, URAC)
Motivational Interviewing
Conflict Resolution and Problem Solving
EMR Systems (Cerner, Epic, OneChart)
Accomplishments
- Successfully led a team to implement a new case management protocol, reducing service delivery time by 20%.
- Recognized for excellence in patient advocacy and achieving high member satisfaction scores.
- Developed and launched training modules for new staff, enhancing onboarding efficiency.
Certification
- Licensed Master of Social Work (LMSW)
- Certified Case Manager (CCM) – In Progress
- Motivational Interviewing Certification
- Advanced Leadership Training Program
Timeline
Adjunct Faculty
Grand Canyon University
02.2024 - Current
Senior Medical Reviewer
Blue Cross Blue Shield SC
07.2023 - Current
Program Coordinator
Prisma Health-Midlands
11.2014 - Current
GEAR UP Project Specialist (Counselor)
Blythewood High School
08.2013 - 06.2014
Master of Arts - Social Work
University of South Carolina
Bachelor of Arts - Sociology
University of South Carolina