Summary
Overview
Work History
Education
Skills
Timeline
Generic

Jene' R. Elder

Trotwood,Ohio

Summary

Seeking full-time employment with a growing and teaching health-care organization.

Healthcare professional with proven track record in delivering high-quality patient care and medical support. Skilled in collaborating with healthcare teams to ensure optimal patient outcomes and adapt to evolving medical needs. Known for reliability, adaptability, and strong problem-solving abilities.

Overview

20
20
years of professional experience

Work History

LPN, Care Manager

CARESOURCE
08.2010 - Current
  • Verifying patient accounts for accuracy and demographic information to ensure HIPPA regulations.
  • Trained in regulations related to individuals whom seek Government Assisted Managed HealthCare.
  • Case manage a caseload. Assist with provider searches, equipment needs and collection of data related to member’s case goals.
  • Required to assist and provide information to members, and providers to help them understand member's benefits better.
  • Ability to show strong skills with problem solving when needed.

LPN

EXPRESS SCRIPTS
01.2006 - 01.2010
  • Verifying patient accounts for accuracy and demographic information to ensure HIPPA regulations.
  • Trained in regulations related to Medicare, Managed Care, and state regulations for various LOB's (lines of business).
  • Request and receive clinical information for prior authorization request from providers and pharmacists and apply to criteria.
  • Document requested clinical information from providers and pharmacists.
  • Approve cases or prepare cases for further review if a criterion is not met.
  • Utilize problem solving with members and providers about approvals or denials and advise of their benefit plans.

Education

Certificate of Licensure - Practical Nursing

Rets Tech Center
Dayton, Ohio
01.2003

Skills

  • Medical documentation
  • Nursing ethics
  • Care planning
  • Case assessments
  • Clinical documentation
  • Medication reviews
  • Medical chart documentation
  • Workflow coordination
  • Patient education
  • Care transitions
  • Critical thinking
  • HIPAA guidelines
  • Decision-making
  • Patient advocacy
  • Multidisciplinary team collaboration
  • Utilization management
  • Drug utilization review
  • Clinical judgment
  • Multi-tasking and prioritization
  • Documenting intake
  • HIPAA compliance
  • Maternal-child nursing
  • Medication administration
  • Vital signs monitoring
  • Documentation and reporting
  • InterQual criteria
  • Utilization review
  • Prior authorization
  • Managed care
  • Medicaid
  • Telephonic nursing
  • Case management
  • Problem-solving
  • Attention to detail
  • Patient condition monitoring
  • Care coordination
  • Documentation
  • Goal setting

Timeline

LPN, Care Manager

CARESOURCE
08.2010 - Current

LPN

EXPRESS SCRIPTS
01.2006 - 01.2010

Certificate of Licensure - Practical Nursing

Rets Tech Center
Jene' R. Elder