JENNIFER L. BECKER
Registered Nurse Case Management Lead
Averill Park,NY
Summary
Supportive Team Lead experienced and dedicated to enhancing both employee and member satisfaction. Organized team lead that continually builds positive rapport, inspires trust and guides teams toward achievement of organizational goals. Strong facilitator adept at working cross-departmentally with co-management and top-level leadership.
Overview
14
14
years of professional experience
6
6
years of post-secondary education
Work History
Team Lead
Carelon
10.2018 - Current
- Responsible for leading the care management within the scope of licensure for members with complex and chronic care needs
- Assisting case management team with the assessment, development, implement, coordination, monitor and evaluation of care plans to achieve optimal outcomes to our members and our business group
- Serve as first line for conflict resolution within both the team and our members
- Assist in the development of training, process evaluating and completing quality audits
- Interface with the Medical Directors on the development of care management and treatment plans of our members
- Monitor and evaluate the effectiveness of the care management plan and apply modification as needed
- Assist in problem solving with providers, claims, and members
- Schedule and conduct meeting with care management associates, presents cases for discussion at Grand Rounds/Care Conferences and participate in interdepartmental work groups as needed
- Conduct audit activities and assist management team with monitoring and prioritizing workflow, deliver constructive coaching and feedback to care management team, and develop corrective action plans upon request of management team as needed.
- Managed schedules, accepted time off requests and found coverage for short shifts.
- Audit team performance and compliance with NCQA and HEDIS standards.
- Complete weekly scheduling and monthly department reports for case managers.
Registered Nurse Case Manager Sr.
Anthem
Albany, NY
06.2016 - 10.2018
- Facilitate a caseload of patients with a diverse number of physical illnesses
- Assist members with proper healthcare services, triaging members via telephone to assist both patients and their families with sometimes complicated situations in order to achieve a better quality of life and achieve optimal health outcomes
- Train office staff on desktop updates
- Precept new staff as needed both in person and virtually
- Cover team lead activities as needed
- Participate with management and staff to identify process improvements and program enhancements
- Communicate with other case managers, health professionals, coordinators as well as Anthem’s members; to achieve optimal care, quality outcomes and promote effective use of resources for our members
- Assess for medical necessity by utilizing the applicable medical policy and industry standards
- Work with medical directors in interpreting appropriateness of care
- Collaborate with providers to assess member’s needs for early identification and proactive planning for discharge
- Facilitate member’s transition of care through the health continuum
- Consult with clinical reviewers and medical directors to ensure medically appropriate, high quality, cost effective care throughout the medical management process.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
Registered Nurse Case Manager II
Anthem
Albany, NY
11.2014 - 06.2016
- Facilitate a caseload of patients with a diverse number of physical illnesses
- Assist members with proper healthcare services, triaging members via telephone to assist both patients and their families with sometimes complicated situations in order to achieve a better quality of life and achieve optimal health outcomes
- Assess for medical necessity by utilizing the applicable medical policy and industry standards
- Work with medical directors in interpreting appropriateness of care
- Communicate with hospital staff, as well as doctor offices to ensure quality outcomes and promote effective use of resources for our members
- Train office staff on desktop updates
- Reaches team as well as organizational goals and objectives with moderate supervisory support
- Perform special assignments as needed.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
Registered Nurse Case Manager I
Anthem
Albany, NY
08.2013 - 11.2014
- Facilitate a caseload of patients with a diverse number of physical illnesses
- Assist members with proper healthcare services, triaging members via telephone to assist both patients and their families with sometimes complicated situations in order to achieve a better quality of life and achieve optimal health outcomes
- Assess for medical necessity by utilizing the applicable medical policy and industry standards
- Communicate with hospital staff, as well as doctor offices to ensure quality outcomes and promote effective use of resources for our members
- Organize and prioritize work to meet team and unit objectives
- Utilize team leads and managers for support in reaching goals.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
Registered Nurse
Albany Memorial Hospital
Albany, NY
06.2010 - 01.2013
- Collaborate in total care on medical/surgical, dialysis, hospice, and hematology/oncology patients
- Conduct patient assessment and develop, implement and evaluate individualized care plans
- Educate patients and family members on the diagnosis, disease process, medications, and prevention of disease process progressing
- Act as patient advocate, answering questions, concerns and meeting patient’s needs
- Utilize time management skills while caring for up to ten patients
- Selected for preceptor certification, to train and orient new RN’s to the unit
- Coordinate services, treatments and consultations using Meditech computer system.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
Education
Bachelor of Science - Health Sciences Coordination
01.2022 - 05.2023
Associate Degree in Nursing -
08.2007 - 05.2010
Licensed Massage Therapist - Massage Therapy
10.2001 - 07.2003
Skills
Performance improvement
Production monitoring
Patient and family advocacy
Strong clinical judgment
Activities
- Academic Honors throughout entire nursing education
- Marion Luft Fleischer Award (May 2010)
- Medical Staff Award (May 2010)
- Julia O. Wells Scholarship recipient
- Academic Achievement Award in Microbiology (2009)
Timeline
Western Governors University - Bachelor of Science, Health Sciences Coordination
01.2022 - 05.2023
Team Lead - Carelon
10.2018 - Current
Registered Nurse Case Manager Sr. - Anthem
06.2016 - 10.2018
Registered Nurse Case Manager II - Anthem
11.2014 - 06.2016
Registered Nurse Case Manager I - Anthem
08.2013 - 11.2014
Registered Nurse - Albany Memorial Hospital
06.2010 - 01.2013
Albany Memorial Hospital - Associate Degree in Nursing,
08.2007 - 05.2010
Center For Natural Wellness School of Massage Therapy - Licensed Massage Therapist, Massage Therapy
10.2001 - 07.2003