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Jeri Moody
Crossville,TN
Work Preference
Summary
Registered Nurse specializing in managed care and telephonic case management for Medicare, D-SNP, and C-SNP members with complex chronic conditions. Proven ability to enhance patient outcomes through effective care coordination, comprehensive assessments, and streamlined documentation using AI-enabled tools.
Overview
35
35
years of professional experience
1
1
Certification
Work History
Telephone Case Manager (RN)
Aetna
10.2025 - Current
- Managed D-SNP/C-SNP member caseload, completing assessments and developing individualized care plans to enhance member support.
- Coordinated services and referrals, supporting medication adherence and promoting self-management for improved health outcomes.
- Utilized AI-enabled tools to streamline documentation processes, enhancing workflow efficiency and reducing administrative burden.
RN Claims Reviewer
Celerian Group
07.2024 - 09.2025
- Reviewed DME claims to ensure medical necessity and documentation completeness, aligning with payer criteria.
- Contacted providers to obtain necessary records and clarify discrepancies, facilitating timely resolution of claim issues.
- Provided direct patient care in diverse healthcare settings.
- Administered medications and monitored patient responses effectively.
- Collaborated with multidisciplinary teams to develop care plans.
RN Case Manager
Centene / WellCare Healthcare
07.2014 - 12.2023
- Managed care for Medicare members with complex medical and behavioral health needs, ensuring appropriate services and support.
- Collaborated with physicians, facilities, and community resources to improve continuity of care.
- Coordinated authorizations for transportation, procedures, diagnostics, and specialist care to facilitate timely access to necessary treatments.
- Identified DME needs and educated members on chronic condition management and care goals to enhance self-management and adherence.
Registered Nurse
Vanderbilt Coumadin Clinic
01.2011 - 12.2013
- Educated patients on anticoagulation therapy to enhance understanding of safety and dietary considerations.
- Adjusted dosing per protocol based on INR results and coordinated follow-ups to ensure patient adherence and safety.
- Administered anticoagulation therapy under physician supervision.
- Monitored patient vital signs and reported changes to the healthcare team.
- Educated patients on medication management and lifestyle modifications.
Registered Nurse
Vanderbilt Medical Center (Geriatrics)
01.2008 - 12.2011
- Provided clinical care, medication reconciliation, and follow-up to enhance geriatric patient outcomes.
- Coordinated lab and imaging processes while facilitating care coordination and optimizing patient flow.
- Administered anticoagulation therapy according to patient needs and clinical guidelines.
- Monitored patient vital signs and reported changes to healthcare team promptly.
- Educated patients on medication management and dietary adjustments for optimal care.
PACU Registered Nurse
Urology Associates, Nashville
01.2001 - 12.2008
- Administered post-anesthesia recovery care, monitoring for complications to facilitate safe patient discharge.
- Conducted post-op follow-up calls, reinforcing discharge instructions to ensure patient understanding and adherence.
- Monitored patient vital signs in post-anesthesia care unit.
- Administered medications and managed pain relief protocols.
- Collaborated with surgical teams for seamless patient transitions.
Emergency Department Registered Nurse
University of South Alabama Medical Center
01.1991 - 12.2000
- Provided emergency nursing care in Level One Trauma setting, managing high-acuity patient needs.
- Initiated treatments and coordinated admissions through collaboration with multidisciplinary teams.
- Provided direct patient care in a fast-paced medical environment.
- Administered medications and monitored patient responses effectively.
- Collaborated with healthcare teams to create personalized care plans.
Education
Bachelor of Science - Nursing
University of South Alabama
Mobile, ALSkills
- Telephonic Case Management
- Care Plans & Assessments
- Chronic disease support
- Behavioral Health Coordination
- Authorization management
- Patient assessment
- Patient education
- Quality documentation
- Chronic disease management
- Crisis management
- Referral management
- Claims review
- DME claims review
- Medicare / D-SNP / C-SNP
- Regulatory compliance
- HIPAA compliance
- Healthcare software
- Microsoft Word
- Microsoft Excel
- Case management
- Case management tracking
- Intervention plans
- Provider Outreach & Record Retrieval
- Team collaboration
- Active listening
- Interdisciplinary teamwork
- Critical thinking
- Problem solving
- Problem-solving
- Patient support
- Patient advocacy
- Referral management
Certification
Registered Nurse (RN), Tennessee Compact License
Timeline
Telephone Case Manager (RN)
Aetna
10.2025 - Current
RN Claims Reviewer
Celerian Group
07.2024 - 09.2025
RN Case Manager
Centene / WellCare Healthcare
07.2014 - 12.2023
Registered Nurse
Vanderbilt Coumadin Clinic
01.2011 - 12.2013
Registered Nurse
Vanderbilt Medical Center (Geriatrics)
01.2008 - 12.2011
PACU Registered Nurse
Urology Associates, Nashville
01.2001 - 12.2008
Emergency Department Registered Nurse
University of South Alabama Medical Center
01.1991 - 12.2000
Bachelor of Science - Nursing
University of South Alabama