Jessica Teiga
Aetna/CVS Health
Howard,Ohio
1
Certification
12
years of professional experience
Registered Nurse with expertise in care management, utilization management, population health, quality improvement, provider collaboration, and member engagement. Demonstrated success maintaining NCQA scores above 90% for four consecutive years, achieving MI audit scores above 2.5 on all audits, managing caseloads of 30–50 engaged members, and contributing to STAR ratings above 4 through timely initiation of care and hospitalization prevention strategies. Skilled in translating clinical insights into strategic initiatives that improve outcomes, quality performance, and healthcare resource utilization.
Work History
RN Care Manager
4 Years 7 Months- Conduct comprehensive clinical assessments and develop individualized care plans and strategies.
- Identify care gaps and support population health initiatives using data-driven interventions.
- Manage 30–50 engaged members while promoting quality outcomes and adherence.
- Maintain NCQA scores above 90% through quality-focused care management practices.
- Use motivational interviewing techniques resulting in audit scores above 2.5 on all reviews.
- Coordinate TIAA referrals and connect members with psychosocial, community, and healthcare resources.
- Address social determinants of health and barriers to care.
- Support team operations through case assignment, workflow coordination, and staff assistance.
- Collaborate with providers and interdisciplinary teams to improve member outcomes.
Utilization Management Nurse Consultant
1 Year- Conducted medical necessity reviews using CMS Medicare and MCG criteria.
- Evaluated clinical documentation, diagnoses, treatment plans, and levels of care.
- Prepared clinical summaries and referral rationales for medical director review.
- Collaborated with providers to obtain documentation and clarify clinical details.
- Supported workflow optimization, case routing, and quality-focused review activities.
RN Case Manager
4 Years- Managed complex home health caseloads and completed Medicare-compliant OASIS assessments.
Labor & Delivery RN
3 Years- Delivered maternal-newborn care throughout labor, delivery, and postpartum phases.
- Conducted assessments and escalated clinical concerns appropriately.
- Assisted with vaginal deliveries and cesarean section procedures.
- Provided patient education and maintained accurate clinical documentation.
- Responded to urgent clinical situations using evidence-based interventions.
Education
Associate of Applied Science in Nursing
Skills
Clinical Strategy
Population Health
HEDIS
NCQA
STAR Measures
Quality Improvement
Care Management
Utilization Review
Provider Collaboration
Member Engagement
Clinical Operations
Value-Based Care
Medical Necessity Review
Medicare
MCG Criteria
Workflow Optimization
Risk Stratification
Social Determinants of Health
Cross-functional team collaboration
Accomplishments
- Maintained NCQA scores above 90% for four consecutive years.
- Achieved Motivational Interviewing audit scores above 2.5 on all completed audits.
- Managed active caseloads of 30–50 engaged members.
- Contributed to STAR ratings above 4 through timely initiation of care and hospitalization prevention efforts.
- Supported TIAA referral initiatives and psychosocial resource coordination.
- Performed team-lead support duties including case assignment and workflow coordination.
Certification
- Registered Nurse
- Ohio Compact License
Timeline
Utilization Management Nurse Consultant
Aetna/CVS Health
01.2024 - 01.2025Read More
RN Care Manager
Aetna/CVS Health
01.2022 - CurrentRead More
RN Case Manager
Kindred at Home
01.2018 - 01.2022Read More
Labor & Delivery RN
Joel Pomerene Memorial Hospital
01.2015 - 01.2018Read More
Central Ohio Technical College
Associate of Applied Science in Nursing
Read More