Jennifer Scheets
Ashland,USA
Summary
Over 22 years of nursing experience with a history of inpatient and outpatient direct patient care, case management/discharge planning, and utilization management. Specialties included are Orthopedics, Pediatrics, Women's Health, Family Medicine, and Behavioral Health. My most recent experience is working as a Utilization Management Nurse with Humana. I also have case management/utilization management experience with a Medicaid health plan, an insurance company handling worker's compensation claims, and for a Behavioral Health/Substance Abuse program.
Overview
11
11
years of professional experience
Work History
Utilization Management Nurse
Humana
Remote
01.2026 - Current
- Analyzed patient care plans to optimize resource utilization and ensure compliance with guidelines.
- Collaborated with interdisciplinary teams to facilitate effective care coordination and improve patient outcomes.
- Monitored and reviewed clinical documentation for accuracy, ensuring alignment with regulatory standards.
- Applied critical thinking skills to assess complex medical cases and determine appropriate levels of care in accordance with industry benchmarks.
- Reduced hospital readmissions through effective discharge planning and coordination of post-discharge care.
Preservice Review Nurse RN
United Healthcare Group
Remote-MO
07.2024 - 12.2025
- Evaluated prior authorization requests to ensure compliance with clinical guidelines
- Coordinated communication between healthcare providers and insurance companies
- Streamlined the authorization process, reducing turnaround times for approvals
- Collaborated with interdisciplinary teams to optimize patient care outcomes
- Promoted a culture of continuous improvement within the Prior Authorization department by regularly reviewing processes and making recommendations for optimization.
- Assisted in maintaining compliance with changing regulations and policies by staying up-to-date on industry trends and best practices.
- Participated in interdisciplinary team meetings, collaborating with other healthcare professionals to ensure seamless coordination of care for patients requiring prior authorizations.
Clinical Coordinator, Registered Nurse
United Health Care Group, Maryland Heights MO
Missouri
03.2022 - 07.2024
- Function as a Case Manager for the Whole Person Care team which manages Medicaid members of all ages whom are apart of the Missouri Medicaid population
- Coordinated patient care processes to enhance service delivery and improve patient outcomes.
- Implemented efficient scheduling systems, reducing appointment conflicts and optimizing staff utilization.
- Collaborated with multidisciplinary teams to develop treatment plans tailored to individual patient needs.
Registered Nurse
Compass Health Network
Columbia, MO
07.2021 - 03.2022
- Function as a Case Manager for consumers served by the medication clinic to promote overall health
- Maintain a list of injections, coordinate ordering and delivery, verify orders are current, and discuss any side effects.
- Complete necessary documentation regarding medication clinic and psychiatric consultation for consumer records
- Daily use of Microsoft Office applications, excel, word, outlook, etc
Registered Nurse
Missouri Orthopedic Institute
Columbia, MO
01.2020 - 08.2020
- Functioned as an inpatient Registered Nurse on an Orthopedic Unit.
- Assessment of patients nursing needs, setting of goals, prescribing appropriate nursing actions to meet those goals and the physical, psychological, social, and rehabilitation needs of the patient, including discharge planning.
- Excellent team player; often floating to other hospital units as needed to fulfill staffing needs
Prior Authorization Nurse
Missouri Care-A Wellcare Company
Columbia, MO
07.2015 - 09.2017
- Promote the quality and cost effectiveness of medical care by applying clinical acumen and the appropriate application of policies and guidelines to prior authorization requests
- Perform telephonic review of prior authorization requests for appropriate care and setting, following guidelines and policies, and approve services or forward requests to the appropriate Physician or Medical Director with recommendations for other determinations
- Complete medical necessity and level of care reviews for requested services using clinical judgment and refer to Medical Directors for review depending on case findings
- Collaborate with various staff within provider networks and case management team electronically or telephonically to coordinate member care
Education
Associate's - Nursing
Moberly Area Community College
Columbia, MO12-2019
Licensed Practical Nursing -
Columbia Career Center
Columbia, MO01-2004
Skills
- Orthopedics
- Pediatrics
- Women's Health
- Clinical judgment
- Family Medicine
- Health promotion
- Behavioral Health
- Care coordination
- Case Management
- Utilization Management
- Discharge planning
Timeline
Utilization Management Nurse
Humana
01.2026 - Current
Preservice Review Nurse RN
United Healthcare Group
07.2024 - 12.2025
Clinical Coordinator, Registered Nurse
United Health Care Group, Maryland Heights MO
03.2022 - 07.2024
Registered Nurse
Compass Health Network
07.2021 - 03.2022
Registered Nurse
Missouri Orthopedic Institute
01.2020 - 08.2020
Prior Authorization Nurse
Missouri Care-A Wellcare Company
07.2015 - 09.2017
Licensed Practical Nursing -
Columbia Career Center
Associate's - Nursing
Moberly Area Community College