Jenna Ford BSN, RN
136 Pietro Drive Negaunee,MI
Summary
Dynamic Registered Nurse with over 12 years of experience, showcasing strong clinical judgment and a high level of autonomy. Excelled in process improvements and patient care, as well as enhancing patient satisfaction significantly with close attention to detail. Skilled in both critical thinking and compassionate communication, adept at managing high-pressure situations efficiently.
Overview
13
13
years of professional experience
Work History
Registered Nurse Specialty Care
Bellin Health
07.2023 - Current
- Adept at designing, optimizing and reviewing processes for possible changes.
- Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
- Conducted training sessions for staff regarding new methods.
- Communicated results to patients by phone with explanation provided in a culturally, linguistic manner
- Educated patients on health conditions, medications, procedures and testing.
- Enhanced patient satisfaction by providing compassionate, holistic nursing care that addressed physical, emotional, and spiritual needs.
- Executed comprehensive review of provider documentation to ensure compliance in care plans, procedure and medication requests.
- Performed IV catheter insertions to facilitate echocardiogram procedures.
- Scheduled patients for testing, procedures and office visits
- Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs
Clinical Coordinator - Appeals Lead
Upper Peninsula Health Plan
05.2020 - Current
- Acted as departmental resource on appeals matters.
- Assisted in completion of Star ratings report.
- Created case files and participated in member requested Michigan Department of Insurance and Financial Services (DIFS) appeals, Michigan State Fair Hearings and Medicare Administrative Law Judge (ALJ) hearings.
- Compiled reporting, analyzed data, reviewed and labeled policies for National Committee for Quality Assurance (NCQA) accreditation.
- Completed quarterly Medicare, Medicaid and Upper Peninsula Blue (UP Blue) reporting.
- Created and revised member material appeal response templates for Centers for Medicare and Medicaid Services (CMS) Health Plan Management System (HPMS) approval.
- Developed appeals team schedule and assisted in revising policies and procedures.
- Followed up on Beneficiary & Family Centered Care-Quality Improvement Organization (BFCC-QIO) appeals.
- Obtained additional documentation required for appeal review.
- Presented in data validation and participated in Health Services Advisory Group (HSAG) audit.
- Proficient in handling and managing quality of care grievances, member appeals and UP Blue while overseeing provider appeals caseload.
- Responded to attorney inquiries and litigation notices.
- Rendered appeal decisions to member/member representative within established timeframes.
- Uploaded cases to Independent Review Entity (IRE) for review.
Clinical Coordinator - Utilization Management
Upper Peninsula Health Plan
05.2017 - 05.2020
- Assisted in management and presentation of provider appeals to Administrative Appeal Panel.
- Completed quarterly research and revised Utilization Management criteria for Clinical Advisory Committee (CAC) approval.
- Developed Long-term Services and Supports (LTSS) process and Standard Operating Procedure (SOP).
- Experience with handling and processing member appeals and quality of care grievances.
- Proficient in analyzing data and reporting for Maternal Infant Health Program (MIHP).
- Reviewed readmissions for Medicare and Medicaid members and collaborated with Claims for recoupment.
Clinical Coordinator - Care Manager
Upper Peninsula Health Plan
04.2015 - 05.2017
- Collaborated with providers to prevent gaps in care and to ensure needs are being addressed.
- Connected members with resources and coordinate care.
- Helped members navigate healthcare system.
- Managed caseload of over 250 members.
- Provided education to members to promote understanding of health conditions, medications and services offered.
- Worked with members to help manage and improve health conditions.
Registered Nurse, Cardiac
UP Health System, Marquette
10.2013 - 04.2015
- Accurately documented treatment, medications and IVs administered, discharge instructions and follow-up care.
- Assessed need for ordered lab tests with accurate interpretation of results.
- Collaborated with various healthcare professionals to determine specific and individualized care plan based on goals and long-term health.
- Coordinated nursing care on unit through staff assignments and supervised staff, as Charge nurse.
- Interpretation of electrocardiogram rhythms for continuous monitoring.
- Pharmacological and non-pharmacological management and treatment of various disorders and diseases.
- Skilled in collection of health data involving patient, family and other health care providers in age-specific and culturally sensitive manner.
- Triaged incoming phone calls from emergency rooms and inpatient units to determine needs and prioritize care.
- Utilized current research findings and current practice guidelines to strengthen patient care.
RN Charge Nurse, Supervisor
Norlite Nursing Center
06.2013 - 10.2013
- Assessed and analyzed residents daily and on admission of overall well being to develop appropriate interventions.
- Completed accurate documentation.
- Informed and discussed changes of assessment with physician when appropriate.
- Collaborated effectively with ancillary staff per facility protocol.
- Performed various duties to provide quality nursing care to residents to maintain level of functioning.
- Supervised 4 licensed practical nurses (LPNs) and managed daily scheduling of nursing and certified nurse assistants (CNAs), tasking and administration.
Certified Nurse Assistant
Norlite Nursing Center
05.2012 - 06.2013
- Attended to individual needs of residents, to include assistance with grooming, bathing, oral hygiene, feeding, incontinent care, toileting, transferring, ambulation, and range of motion.
- Facilitated individualized care plan for residents.
- Provided individualized attention, to encourage each resident's ability to maintain or attain highest practical physical, mental and psychosocial well-being.
- Provided quality nursing care to residents in environments that promote rights, dignity, freedom of choice and individuality.
Education
Bachelor of Science - Nursing
Northern Michigan University
Marquette05.2013
High School Diploma - General
Negaunee High School
Negaunee, MI06.2008
Skills
- Works efficiently under pressure
- High level of autonomy
- Member focused
- Strong clinical judgment
- Courteous demeanor
- Excellent attention to detail
- Fast learner
- Problem resolution capability
- Process improvements
Community Service
- Brothers/Big Sisters, Negaunee, MI
- Janzen House, Marquette, MI
- Room at the Inn, Marquette, MI
- Homeless mission trip, Milwaukee, MN
Additional Information
I continually strive to ensure that my work is accurate and concise. By being organized, detail oriented and thorough, I am able to provide a high level of quality in the work that I perform.
Timeline
Registered Nurse Specialty Care
Bellin Health
07.2023 - Current
Clinical Coordinator - Appeals Lead
Upper Peninsula Health Plan
05.2020 - Current
Clinical Coordinator - Utilization Management
Upper Peninsula Health Plan
05.2017 - 05.2020
Clinical Coordinator - Care Manager
Upper Peninsula Health Plan
04.2015 - 05.2017
Registered Nurse, Cardiac
UP Health System, Marquette
10.2013 - 04.2015
RN Charge Nurse, Supervisor
Norlite Nursing Center
06.2013 - 10.2013
Certified Nurse Assistant
Norlite Nursing Center
05.2012 - 06.2013
Bachelor of Science - Nursing
Northern Michigan University
High School Diploma - General
Negaunee High School
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