JESSICA STEPHENSON MOORE
Chandler,Tx
Summary
Results-driven leader with a proven track record in guiding teams, managing complex projects, and achieving strategic objectives. Expertise in developing efficient processes and maintaining high standards while aligning efforts with organizational goals. Recognized for a collaborative approach, adaptability, and a commitment to excellence, complemented by hands-on experience in case management and strong problem-solving abilities. Dedicated to navigating challenges with creativity and a proactive mindset, consistently focused on making meaningful contributions to advance organizational success.
Overview
12
12
years of professional experience
1
1
Certification
Work History
LEAD
MOLINA MARKETPLACE CASE MANAGEMENT
04.2024 - Current
- Oversight of staffing schedules, auditing processes, and work quality of POD team members. Assists in training/educating employees on process/daily duties. Auditing of pod team cases and reviewing with case managers. Delegate tasks to team members as appropriate. Complete extra/special projects as assigned. Work with members, providers, and multidisciplinary team members to assess, facilitate, plan, and coordinate an integrated delivery of care across the continuum, including behavioral health and long-term care, for members with high need potential. Monitors Pod team workload, resource capacity to ensure Pod team’s ability to maintain high quality member engagement. Promotes multidisciplinary collaboration. Provides support, recommendations, resources, and education to Pod team members. Managing appeals/grievance cases and reviewing claims to assist in resolving member complaints.
LTSS CASE MANAGER
MOLINA HEALTHCARE OF TEXAS
01.2022 - 04.2024
- Served as a preceptor to educate/train new or existing employees on position expectations including: state guidelines/requirements, organizational skills, time management, conducting state assessments, offering problem solving assistance, adjusting/developing/managing member focused care plans, hosting interdisciplinary care team meetings, etc. Conduct necessary state assessments for HCBS Medicaid program within required time restraints, manage assigned caseloads, provide referrals for members based on assessment/needs, complete required documentation according to state and company policies/guidelines. Manage full caseload, provide guidance/assistance to other team members through assignment as ‘point’ person. Provide recommendations to increase operating efficiency and expedite workflow. Serve as mentor in problematic conflicts between other case managers and members. Ability to develop rapport with member’s who have refused other case managers.
LTSS CASE MANAGER
CIGNA CORPORATION TEXAS MEDICAID
05.2017 - 12.2021
- Conduct necessary state assessments for HCBS Medicaid program within required time restraints, manage assigned caseloads, provide referrals for members, complete required documentation according to state and company policies/guidelines.
CASE MANAGER
HUMANA MEDICARE ADVANTAGE
05.2015 - 12.2017
- Conduct necessary assessments for members Humana Medicare program within required time restraints, manage assigned caseloads, provide referrals for members, complete required documentation according to state and company policies/guidelines.
CASE MANAGER
ACUITY HEALTHCARE
11.2013 - 05.2015
- Conduct necessary assessments for members Humana Medicare program through contract within required time restraints, manage assigned caseloads, provide referrals for members, complete required documentation according to state and company policies/guidelines.
Education
Bachelor’s of Science - Nursing
University of Texas At Tyler
05.2003
Skills
- Team leadership
- Eight years of LTSS/Medicaid experience
- Committee leadership in employee engagement
- Certified case manager
- Pursuing master's degree
- Professional mentoring
- Participated in BH PPE committee
- Training facilitator
- Effective multitasking
- Reliable and accountable
- Analytical thinking
- Proficient in computer applications
- Effective organizational skills
- Molina Healthcare spotlight recipient, 2024
- Collaborative teamwork
- Supportive interpersonal skills
- Analytical problem-solving
- Effective time management
- Detail-oriented
- Adaptable to change
Certification
- Registered Nurse (TX) 2003-current
- Commission for Case Manager Certification 09/2020-Current
Timeline
LEAD
MOLINA MARKETPLACE CASE MANAGEMENT
04.2024 - Current
LTSS CASE MANAGER
MOLINA HEALTHCARE OF TEXAS
01.2022 - 04.2024
LTSS CASE MANAGER
CIGNA CORPORATION TEXAS MEDICAID
05.2017 - 12.2021
CASE MANAGER
HUMANA MEDICARE ADVANTAGE
05.2015 - 12.2017
CASE MANAGER
ACUITY HEALTHCARE
11.2013 - 05.2015
Bachelor’s of Science - Nursing
University of Texas At Tyler