Jereme Wesley
Mesquite,TX
Summary
Passionate, high-performing, detail-oriented, and results-driven professional of 10+ years with an extensive combination of clinical and non-clinical knowledge and successful experience. Highly skilled in grasping new concepts and implementing them in new work processes. Proficient at understanding company goals and excelled at combining professional dedication and productivity to collaboratively achieve them. Expert in navigation and documentation in electronic medical records such as TruCare, Amisys, Epic, and Microsoft applications to keep track of daily production and reporting. Ability to train, lead, and promote teamwork in a diverse work environment by creating team-building opportunities.
Overview
13
13
years of professional experience
Work History
•Program Coordinator
Superior Health Plan
11.2018 - Current
- Centene) - Initiate authorization requests for output or input services in keeping with the prior authorization list
- Research claims inquiry specific to the department and responsibility
- Perform tasks necessary to promote member compliance such as verifying appointments, obtaining lab results
- Assess and monitor inpatient census
- Screen for eligibility and benefits
- Identify members without a PCP and refer to Member Services
- Screen members by priority for case management (CM) assessment
- Perform transition of care duties to include but not limited to, contact the member’s attending physician, member or medical power of attorney, other medical providers (home health agencies, equipment vendors) for information pertaining to special needs
- Coordinate services with community-based organizations
- Attend marketing and outreach meetings as directed to represent the plan
- Produces and mails routine CM letters and program educational material
- Data enter assessments and authorizations into the system, project management, pulling reports
Certified Tobacco Treatment Specialist/Lifestyle Coach
Envolve PeopleCare
03.2015 - 11.2018
- Provides treatment, evidence-based interventions, support and resources to help individuals who are suffering from nicotine addiction and has the desire to quit telephonically.
Clinical Enrollment Specialist
Redbrick Health
04.2014 - 03.2015
- Perform assessments and check eligibility on members from various backgrounds to enroll them into a disease management program to help better manage their health.
Patient Care Technician/CNA
Our Children’s House, Baylor of Dallas
07.2013 - 02.2014
- Provided care delegated by Registered Nurses or Medical Doctors, to children ages 0-18 years old with a variety of conditions including, but not limited to: communication disorders, developmental delay, traumatic injuries, feeding disorders, premature birth, and birth defects.
Patient Care Technician
Presbyterian of Dallas
03.2011 - 07.2013
- Assist all medical personnel in providing emergent care to individuals of all ages who come into the hospital for various reasons during a 12 hour shift.
Education
Bachelors of Science - Human Services with a Family and Child Service Cert
University of Phoenix
Nursing Assistant Certification -
Texas Career Institute
2011
Medical Assistant Certification -
Remington College
2009
High School Diploma -
South Garland High School
2008
Skills
- Communicate effectively (verbal/written), phone etiquette, scheduling, referrals, preceptor, initial health assessments, authorizations, POC (point of contact),project management, electronic medical records (EMR), 40 wpm, problem solving, adaptability, critical thinking, time management, project management, collaboration, care plan, goal setting, secretary, vitals, ambulatory, specimen collections, injections, blood draw, EKG, assist in minor procedures, catheterization, patient transport, suicidal observation, rounding, suture removal, casting, customer service, eligibility determination
Additional Information
- AWARDS , Dean’s List, Top Performer
Timeline
•Program Coordinator
Superior Health Plan
11.2018 - Current
Certified Tobacco Treatment Specialist/Lifestyle Coach
Envolve PeopleCare
03.2015 - 11.2018
Clinical Enrollment Specialist
Redbrick Health
04.2014 - 03.2015
Patient Care Technician/CNA
Our Children’s House, Baylor of Dallas
07.2013 - 02.2014
Patient Care Technician
Presbyterian of Dallas
03.2011 - 07.2013
Bachelors of Science - Human Services with a Family and Child Service Cert
University of Phoenix
Nursing Assistant Certification -
Texas Career Institute
Medical Assistant Certification -
Remington College
High School Diploma -
South Garland High School
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