Janet Woosley
Lancaster,OH
Summary
Talented Team Leader experienced and dedicated to enhancing employee satisfaction and business success. Diplomatic and friendly with proven commitment to employee training. Hardworking team player bringing necessary experience and knowledge to tackle any operational demand.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Team Lead BSN Clinical Care Reviewer
Ohio Medicaid CareSource
10.2023 - Current
- Implement, manage and education CCRs on Medicaid guidelines for review
- Oversee day to day workflow issues with CCR team
- Develop plan for management of workload after analyzing trends and act as advocate for the CCR team
- Provide guidance, orientation and training
- Standardized activities and outcome reporting related to UM Department initiatives
- Oversee utilization review, discharge planning activities, and monitoring of appropriate delivery of healthcare services in a cost-effective manner
- Assist manager and director in development of process improvement activities and substituting in both roles when needed
- Liaison between case management, claims, customer service and contracting assisting in problem resolutions
- Auditing of CCRs to assure compliance with CareSource policies and regulatory bodies; NCQA and ODJFS
- Completion of CCR team evaluations and assist with development of team goals
- Design and implement UM informational and team meetings.
- Coached team members in techniques necessary to complete job tasks.
- Trained new team members by relaying information on company procedures and safety requirements.
- Evaluated employee skills and knowledge regularly, training, and mentoring individuals with lagging skills.
- Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Managed schedules, accepted time off requests and found coverage for short shifts.
- Directed and supervised team of 12 engaged in utilization review and professional development.
- Audited team performance and compliance with ODM and NCQA standards.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Worked with team to identify areas of improvement and devised solutions based on findings.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
- Promoted high standards through personal example to help each member understand expected behaviors and standards.
- Assisted in recruitment of new team members, hiring highest qualified to build team of top performers.
- Communicated KPIs outlined in annual plan to inform employees of expectations and deliverables.
- Devised and implemented processes and procedures to streamline operations.
RN Clinical Care Reviewer
CareSource
11.2021 - 10.2023
- Complete pre-service and post-service reviews on outpatient procedures and home care benefits
- Coordinate care at the most appropriate level
- Maintain knowledge of state and federal guidelines, state contracts and provider agreements
- Identify quality issues and refer
- Identify and refer to care management when appropriate.
- Audited charts and reviewed clinical documents to verify accuracy.
- Participated in evidence-based practice project implementation, nursing competency development and nursing simulation activities.
- Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
RN Care Manager
CareSource
04.2021 - 11.2021
- Engage the member and complete a health and psychosocial assessment, taking in to account the cultural and linguistic needs of each member
- Engage the member in a variety of settings
- Develop an individualized care plan
- Identify and manage barriers to meeting healthcare goals.
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Updated patient charts with data such as medications to keep records current and support accurate treatments.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Participated in nursing simulation activities, evidence-based practice project implementation and competency development to further nursing education.
- Implemented care plans for patient treatment after assessing physician medical regimens.
Team Lead RN Patient Care Coordinator for MyCare Ohio, Medicare Advantage and DSNP
CareSource
07.2019 - 03.2021
- Implement, manage and education PCCs on Medicare and Medicaid guidelines for review
- Oversee day to day workflow issues with PCC team
- Develop plan for management of workload after analyzing trends and act as advocate for the PCC team
- Provide guidance, orientation and training
- Standardized activities and outcome reporting related to UM Department initiatives
- Oversee utilization review, discharge planning activities, and monitoring of appropriate delivery of healthcare services in a cost-effective manner
- Assist manager and director in development of process improvement activities and substituting in both roles when needed
- Liaison between case management, claims, customer service and contracting assisting in problem resolutions
- Auditing of PCCs to assure compliance with CareSource policies and regulatory bodies; CMS and ODJFS
- Completion of PCC team evaluations and assist with development of team goals
- Design and implement UM informational and team meetings.
- Minimized resource and time losses by addressing employee or production issue directly and implementing timely solutions.
- Monitored team performance and provided constructive feedback to increase productivity and maintain quality standards.
- Conducted training and mentored team members to promote productivity, accuracy, and commitment to friendly service.
Clinical Care Coordinator Manager
Community Mercy Home Care
08.2013 - 02.2015
- Medicare/Medicaid Agency
- Supervised a 20 person clinical staff
- ICD-9 coding
- Implemented training and procedures for clinical staff
- Built strong relationships with patients and families for optimized care satisfaction.
- Coordinated, monitored, assigned, and documented patient and clinical care activities.
- Oversaw annual evaluations.
- Mentored new clinical staff members for proper onboarding and orientation processes.
Case Manager
Community Mercy Home Care
09.2009 - 12.2011
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Developed comprehensive discharge plans to transition clients to appropriate service providers in community.
Registered Nurse
Miami Valley Hospital
05.2007 - 09.2009
- Collaboration with clinical teams to meet patient needs
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
Registered Nurse
Mercy Medical Center
08.2001 - 05.2007
- Collaborated with members of the clinical team to meet patient needs
- Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process, and management and lifestyle options.
- Managed care from admission to discharge.
- Discharge planning.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications via oral, IV, and intramuscular injections and monitored responses.
Education
Healthcare Administration
LIBERTY UNIVERSITY
Lynchburg, VA12.2025
Master of Arts (M.A.) Public Policy - Public Policy
LIBERTY UNIVERSITY
Lynchburg, VA08.2015
Bachelor of Science - Nursing
INDIANA WESLEYAN UNIVERSITY
Marion, IN12.2011
Associate of Applied Science - Nursing
SINCLAIR COMMUNITY COLLEGE
Dayton, OH11.2006
Skills
- Employee engagement
- Task prioritization
- Coaching and mentoring
- Critical thinking
- Emotional intelligence
- Production Monitoring
- Trend Tracking
- Performance Monitoring
- Regulatory Compliance
- Schedule Management
- Performance management
- Effective communication
Certifications Licensure
- Ohio MSL
- Indiana RN
- CMCN
References
References available upon request
Affiliations
American Association of Managed Care Nurses (AAMCN)
Women's Employee Network (WEN)
Military & Veteran Support Unit (MVSU)
Certification
Certified Managed Care Nurse (CMCN)
Timeline
Team Lead BSN Clinical Care Reviewer
Ohio Medicaid CareSource
10.2023 - Current
RN Clinical Care Reviewer
CareSource
11.2021 - 10.2023
RN Care Manager
CareSource
04.2021 - 11.2021
Team Lead RN Patient Care Coordinator for MyCare Ohio, Medicare Advantage and DSNP
CareSource
07.2019 - 03.2021
Clinical Care Coordinator Manager
Community Mercy Home Care
08.2013 - 02.2015
Case Manager
Community Mercy Home Care
09.2009 - 12.2011
Registered Nurse
Miami Valley Hospital
05.2007 - 09.2009
Registered Nurse
Mercy Medical Center
08.2001 - 05.2007
Healthcare Administration
LIBERTY UNIVERSITY
Master of Arts (M.A.) Public Policy - Public Policy
LIBERTY UNIVERSITY
Bachelor of Science - Nursing
INDIANA WESLEYAN UNIVERSITY
Associate of Applied Science - Nursing
SINCLAIR COMMUNITY COLLEGE
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