Carla Jones
Aubrey,TX
Summary
Hard-working professional with 15 years of experience and a proven knowledge of case management, clinical services, and drug utilization review. Aiming to leverage my skills to successfully fill the RN Case Management and Authorization Review role at your company.
Overview
20
20
years of professional experience
1
1
Certification
Work History
RN CASE MANAGER
Texas Home Health (Formerly Accolade Home Care)
Denton, TX
07.2017 - 02.2024
- Start of Care/Resumption of Care\Recertification/Discharge Assessments, Discharge Planning, Oasis Audit Reviews, Utilization/Optimazation Management, Staff Management/Supervision, Chart Audits, Insurance Authorizations, Medication Management, Disease Process Teaching, Wound Care Assessments, Multidisciplinary Team Collaboration, Referrals, Alternate Admin, In-home IV Therapy Management, Lab Draws
UTILIZATION REVIEW RN
Centene
Jackson, MS
12.2015 - 06.2017
- Preauthorization of the following: Physical Therapy Visits, Occupational Therapy Visits, Cancer Medications and Treatments, Pain Management Medications and Treatments, Surgeries, Hospital Admissions
STAFF RN
Preferred Nurse Staffing
Flowood, MS
04.2015 - 11.2015
- Admissions and Discharges, Medication Administration and Monitoring, Lab Collection, Chart Reviews, Discharge Planning, Supervision of Aides
OR CIRCULATING RN AND ORTHOPEDIC TRAUMA RN
University of Mississippi Medical Center
Jackson, MS
06.2013 - 04.2015
- Admissions and Discharges, Discharge Planning, Lab Collection, Sterile OR prep, Patient Monitoring During Procedures, Confirmation of Surgical Documentation Approval Prior to Procedure, Specimen Labeling and Transportation, Medication Management and Monitoring
OFFICE LPN
Mississippi Arthritis Clinic
Jackson, MS
03.2010 - 07.2012
- Scheduling Appointments, Assist MD/NP with Patient Visits, Lab Collection, Obtaining Prior Authorization for Medications (Biologics), Testing (CT Scans, MRI's, PET Scans, Bone Density Studies)
OFFICE LICENSED PRACTICAL NURSE
Princess Anne Medical Clinic
Virginia Beach, VA
08.2008 - 05.2009
- Assisting MD with Patients, Scheduling of Procedures, Obtaining Prior Approval for Medications and Tests (MRI's, CT and PET Scans), Lab Collection, Medication Administration
OFFICE LICENSED PRACTICAL NURSE AND MEDICAL ASSISTANT
Premier Medical Group (formerly Central Medical Clinic)
Jackson, MS
10.2003 - 07.2008
- Assist MD with Patients, Appointment Scheduling, Lab Collection, Obtaining Prior Authorization for Medications and Tests (MRI's, CT and PET Scans, Bone Density Scans)
Education
B.S. Nursing -
MISSISSIPPI UNIVERSITY FOR WOMEN
12.2014
A.S. Nursing -
MISSISSIPPI UNIVERSITY FOR WOMEN
05.2013
A.S. Practical Nursing -
HINDS COMMUNITY COLLEGE
08.2006
Certification Clinical Medical Assisting -
MEDICAL CAREERS INSTITUTE
08.2000
A.A. General Studies -
HINDS COMMUNITY COLLEGE
05.2000
Skills
- Care Coordination
- Discharge Planning
- Utilization Review
- Community Resources
- Chronic Disease Management
- Healthcare Regulations
- HIPAA Compliance
- Quality Improvement
- Medication Management
- Insurance Knowledge
- RN Case Management
- Care Delivery
- Policy Adherence
- Interdisciplinary Collaboration
- Patient Counseling
- Care Planning
- Patient Care and Education
- Regulatory Compliance
- Referral Generation
- Community Resource Referrals
- Electronic Recordkeeping
- Utilization Reviews
Certification
- BSN
- RN
References
References available upon request.
Timeline
RN CASE MANAGER
Texas Home Health (Formerly Accolade Home Care)
07.2017 - 02.2024
UTILIZATION REVIEW RN
Centene
12.2015 - 06.2017
STAFF RN
Preferred Nurse Staffing
04.2015 - 11.2015
OR CIRCULATING RN AND ORTHOPEDIC TRAUMA RN
University of Mississippi Medical Center
06.2013 - 04.2015
OFFICE LPN
Mississippi Arthritis Clinic
03.2010 - 07.2012
OFFICE LICENSED PRACTICAL NURSE
Princess Anne Medical Clinic
08.2008 - 05.2009
OFFICE LICENSED PRACTICAL NURSE AND MEDICAL ASSISTANT
Premier Medical Group (formerly Central Medical Clinic)
10.2003 - 07.2008
B.S. Nursing -
MISSISSIPPI UNIVERSITY FOR WOMEN
A.S. Nursing -
MISSISSIPPI UNIVERSITY FOR WOMEN
A.S. Practical Nursing -
HINDS COMMUNITY COLLEGE
Certification Clinical Medical Assisting -
MEDICAL CAREERS INSTITUTE
A.A. General Studies -
HINDS COMMUNITY COLLEGE
- BSN
- RN
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