Jennifer M. Pierce

Work History

Humana

05.2021 - Current

Project Lead on Ohio and Indiana Medicaid implementation
Implemented process improvements for the Medicaid startup team in Ohio and Indiana.
Developed performance metrics for the Ohio Medicaid team.
Created cost-saving strategies for Medicaid.
Fostered cross-functional collaboration across all areas of Medicaid.
Spearheaded metrics development for the Ohio Medicaid team.
Identified process improvement initiatives and consistently worked to complete associated tasks.
Established and maintained a SharePoint site for all Centralized Medicaid teams.
Collaborated with various departments in the implementation of Medicaid programs in these states, including provider engagement.
Developed and delivered educational materials for the Utilization team across both states, focusing on the processes to be followed.
Integrated Ohio MCD processes with Claims, Contracting and Pharmacy successfully
Helped develop processes based on UM trends.
Developed and presented presentation to the state on Provider services for Home Health and PDN
Monitor Reports and implement changes as needed
Assisted Ohio reach 100% on NCQA audits.
Silver Star Award in 2024 x2, Bronze Star Award 2023, Star Award 2022

Humana

05.2018 - 05.2021

Maintained medical standards for all clients based on their individual health benefit plans.
Conducted pre-certification, retrospective, out of network and appropriateness of treatment setting reviews within scope of licensure.
Developed relationships to help improve health outcomes for members.
Ensured compliance to rules and regulation established by management.
Documented review information in computer
Recorded and reported all information within scope of authority.
Certified Case Manager 2017

Humana

01.2015 - 01.2018

Supervised day-to-day operations and staff, 20 direct supports by assigning and monitoring daily work productivity.
Lead for STARS team in region and improved STARS compliance by over 25%
Supervised and guided care management staff in viable, cost-effective and compliant assessment of members' needs.
Ensured that staff were trained and evaluated on their knowledge of the adherence to compliance policies and procedures specific to their jobs.
Developed and fostered growth of associates by developing and teaching classes for HCM-RNs on how to become a Certified Case Manager; 7 HCMs passed CCM test with this course.
Created and facilitated presentation with Humana Physician on congestive heart failure (CHF) for a Learning and Development event. Researched and provided analysis and conclusions for presentation.

Humana

01.2013 - 01.2015

Coordinated the integration of services and development of acute and long-term care plans with the member and the member's primary care physician.
Certified as an Onboarding Mentor for new hires.
Clinical Educator Program 2015- Created and Presented on CHF in 2015, 2016, 2017 for Learning and Development Program. Proven successful experience in completing efficient health-related research, with associated analysis and conclusions with this project.
Assessed members and developed care plans which helped to meet their short and long term care goals/needs.
Chronic Disease Management.
Organized and maintained confidential records and files (electronic and hard copy).
Communicated effectively and documented interactions with internal and external customers.
Established strong and trustworthy relationships with members and providers.

ALTEGRA HEALTH

Weston, Florida

01.2017 - 12.2017

TRILOGY HEALTH SERVICES

Louisville, KY

01.2006 - 01.2013

Responsible for executive oversight of day-to-day clinical operations of a 120 bed rehab, dementia and long term care facility.
Additional responsibilities include quality, risk, and service excellence of all clinical and ancillary support units.
In this role, I have overall accountability and comprehensive decision making authority for clinical aspects for health services.
Enforced and maintained state regulations of facility and assisted with state inspections.
Implemented new online scheduling process, policies and procedures.
Created and Implemented new care plans and education for Nurses and Certified Nursing Assistants.
Initiated the Restorative Nursing Program to improve quality of care.
Reduced nursing staff turnover rate to below 20%.
Achieved and maintained an average census of 117 in a 120 bed facility.
Maintained rank in Top 10 facilities within Trilogy for documentation and state compliance.

NORTON HEALTHCARE

Louisville, KY

01.1988 - 01.2006