Jessica Williams, MSN, RN, CCM

Responsible for the daily supervision and clinical oversight of the case management and utilization review nurses and assigned workload. Assists in operational oversight including interviewing, training, and supervision of clinical staff. Ensures that all clinical services are delivered in accordance with currently policies and procedures aligning with URAC, federal, and state regulatory requirements. Provides case coverage as needed for case management and utilization review clinical staff. Completes quality audits and delivery of metric results to staff monthly. Serves as liaison for case activity questions between the groups/clients and medical management program. Promotes interdisciplinary interactions while communicating and documenting patient outcomes with key stakeholders on an ongoing basis depending on level of risk stratification. Ensures appropriate utilization management of services for medical necessity of services as specified by the member's benefit plan. Participates in Quality Management activities which include patient satisfaction, patient safety and clinical and financial outcomes Maintain compliance with Health Plan, URAC, Regulatory Agencies and HIPAA rules and regulations.

Senior Registered Nurse Case Manager and Team Lead responsible for supporting the Behavioral Health and Transplant Care Management Teams. Supports leadership with training and education of staff, assists with implementation of workflow changes. Also offers guidance and support to Case Management Team through mentoring, coaching, and performance audits. Collaborates with leadership to address policy and procedure changes, assist with project development and implementation. Responsible for managing catastrophic and high-cost members on the Transplant, Medical/Oncology, and Behavioral Health/Substance Use Disorder Care Management Teams. Provides continuity of quality care through telephonic communication with members and their providers. Coordinates transplant contracts with Centers of Excellence including solid organs, hematopoietic stem cells, CAR-T, and LVADs. Initiates extra-contractual agreements with non-designated facilities or provides steerage where applicable. Initiates medical director reviews for transplant and clinical trial approvals. Provides utilization reviews of transplant admissions, chemotherapy, behavioral health admissions, and related services including DME and supplies, concurrent reviews, and clinical trials utilizing MCG and UnitedHealthcare Guidelines. Supports members with education regarding diagnoses and treatment plans. Provides medication reviews, skills for condition management, connections to resources within the community, and other various recommendations to improve health and wellness. Assists members with their transition from a healthcare facility back to their home. Coordinates post discharge needs with members and their providers. Provides assistance to members in interpreting their benefits and coverage with third-party administrator. Coordinates care and benefit coverage with key stakeholders including primary care providers, specialists, and pharmacy benefit managers.

Registered Nurse working on a Medical-Surgical/Telemetry Unit. Educate patients and their families on disease processes, medical-surgical procedures and other aspects of therapeutic regimens, including medication and pain management techniques. Administer oral, intravenous, intramuscular and subcutaneous medications. Closely monitor patients for acute changes and collaborate with multidisciplinary team, including physicians, social workers, case managers, physical and occupational therapists, to diagnosis and treat patient effectively. Responsible for collaborating with telemetry monitor technician to identify any acute or critical changes in patient cardiac or respiratory status.

Registered Nurse working on Intermediate Care/Step-down Unit. Educate patients and their families on disease processes, medical-surgical procedures and other aspects of therapeutic regimens, including medication and pain management techniques. Administer oral, intravenous, intramuscular and subcutaneous medications. Closely monitor patients for acute changes and collaborate with multidisciplinary team including physicians, social workers, case managers, physical and occupational therapists, to diagnosis and treat patient effectively. Experience with various titratable drips and full disclosure telemetry monitoring. Responsible for collaborating with telemetry monitor technician to identify any acute or critical changes in patient cardiac or respiratory status. Exercised leadership skills as unit charge nurse during assigned shifts. Supervised performance of 6 or greater staff nurses while delegating nursing assignments, preparing schedules, overseeing admissions and discharges, and monitoring and ordering medicines and supplies.

Registered Nurse at women's correctional facility. Work sick-call and infirmary, triaging and monitoring inmates. Work in the lab obtaining lab specimens per physician orders. Assess and treat chronic and acute wounds during bath and bandage and respond to all declared emergencies within the facility. Functioned as RN Team Lead during each shift and oversaw performance of approximately 2-3 staff nurses. Coordinated with Medical Director as needed to ensure appropriate treatment and follow-up of inmates.

Registered Nurse at OB/GYN practice. Assist physicians with exams and in-office procedures. Administer IM injections, including vaccines and other prescribed medications. Educate patients on various women's health issues, including disease processes and procedures or planned surgeries. Phone Triage Nurse responsible for triaging phone calls and assessing post-op complaints, medication questions, and giving clinical instructions to both gynecological and obstetrical patients. Responsible for documenting effectively and appropriately to ensure proper communication between patients and physicians. Experience in Electronic Medical Records/EMR.

Registered Nurse on Medical-Surgical/Oncology floor. Educate patients and their families on disease processes, medical- surgical procedures and other aspects of therapeutic regimens, including medication and pain management techniques. Administer oral, intravenous, intramuscular and subcutaneous medications.