Jennifer Shannon
Cuyahoga Falls,Ohio
Summary
Tenured Registered Nurse with over 20+ years in insurance-related healthcare. Currently working as a Senior Clinical Practice Performance Consultant. Given my varied experience in both Medicare and Commercial populations, currently looking to expand my career.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Senior Clinical Practice Performance Consultant
Optum
Cuyahoga Falls, Ohio
10.2023 - Current
- Assists nearly 40 Primary Care Providers with their clinical quality measures and identifies risk adjustment coding opportunities.
- Educates all providers in-person monthly on a set agenda as well as coaches lower-performing providers on specific identified opportunities, from both prospective and retrospective audits.
- Collaborates with Medical Director weekly to identify educational opportunities and attends quarterly all-provider meetings.
- Collaborates with multiple payers to identify population trends and create actionable plans for lower measures.
Utilization Management Nurse Consultant
CVS HEALTH CORPORATION
Cuyahoga Falls, OH
11.2018 - 09.2023
- Reviewed all requests for Medicare Predetermination, including highly specialized reviews such as molecular and genetic testing, DME and various medical and surgical procedures.
- Utilized attention to detail in most recent chosen position as a Letter Language Expert. Worked successfully with a core group of nurses helping to formulate specific member-friendly language in order to perfect member and provider correspondence.
- Frequently led the team as a subject matter expert for new team members, being able to answer questions and review difficult cases.
Case Manager- UAW (United Auto Workers) Team
CVS HEALTH CORPORATION
Cuyahoga Falls, OH
05.2016 - 11.2018
- Collaborated and traveled with the UAW Account Team to different UAW sites to engage with members about the UAW Medicare Plan.
- Collaborated with UAW to plan or implement programs designed to improve overall health of its members.
- Referred members to specialized health resources or community agencies to furnish additional assistance.
- Assisted individuals with eligibility for available benefits.
- Collaborated with healthcare team to improve care quality, reduce costs and gauge patient progress.
Specialty High Risk Case Manager
CVS HEALTH CORPORATION
Cuyahoga Falls, OH
01.2015 - 05.2016
- Utilized predictive modeling to identify high-risk members
- Worked with the high-risk members to help reduce their ED visits and hospital admission frequency
- Followed up with them over a period of six months to make sure they were receiving adequate care
- Referred to community agencies as available to assist in closing gaps in care
Education
Bachelor of Science - Nursing
The University of Akron
Akron05.1991
Skills
- Data Analytics
- Value-Based Care
- Provider Education
- Risk Adjustment Coding
- Quality Metrics
- Utilization Management
- Case Management
- Interdisciplinary Collaboration
- Leadership
- Fluent in Microsoft Products
Certification
- CCM, Certification in Case Manager, 2013
- CRC, Certification in Risk Adjustment Coding, 2024
Timeline
Senior Clinical Practice Performance Consultant
Optum
10.2023 - Current
Utilization Management Nurse Consultant
CVS HEALTH CORPORATION
11.2018 - 09.2023
Case Manager- UAW (United Auto Workers) Team
CVS HEALTH CORPORATION
05.2016 - 11.2018
Specialty High Risk Case Manager
CVS HEALTH CORPORATION
01.2015 - 05.2016
Bachelor of Science - Nursing
The University of Akron