Jody Sellers
Hudson,FL
Summary
Highly skilled, compassionate and enthusiastic professional with more than 18 years of experience in managed care and 29 years in the medical field. Successfully overseeing case managers with overseeing regulatory compliance and fostering teamwork for best quality outcomes for member health and satisfaction . Develop and lead productive and efficient office staff. Contribute to high-volume medical practices by providing exceptional customer service. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals. To seek and maintain full-time position that offers professional challenges utilizing interpersonal skills, excellent time management and problem-solving skills.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Supervisor of Care Navigators (case managers)
Healthmap Solutions
03.2022 - Current
- Specializing in kidney health and conditions leading up to kidney function decline
- Compassionate Nurse Supervisor
- Proficient in ensuring regulatory compliance
- Foster a culture of teamwork and continuous improvement
- Demonstrates strong clinical skills
- Excellent communication skills and leadership abilities
- Ensure excellent patient care and satisfaction
- Skilled in staff training, mentoring and performance evaluation
- Increased passing rates of 50% with a solid team and meeting expectations set for NCQA and LOB contractual needs
- Team average of 96% by years end
- NCQA knowledgeable for assisting in maintaining licensure/certification for organization
- Skilled in employment interviews for increasing and improving talent within the organization
- Collaboration with peers and other leadership in process changes for company growth and reduction of ED/hospital utilization, efficiency of charting times by 50% and promotion of client health
- Built CCM study group with 98% passing rate upon completion
- Proficient in Microsoft Suites (Microsoft Office, Power Point and Word), Excel, TEAMS, Adobe Acrobat and Ring Central Max.
Field Care Manager
Wellcare
04.2014 - 03.2022
- Team Lead
- Provider mentoring as subject matter expert and support to team
- Planned, assigned, and reviewed work of a group of employees, as well as select training to individual employees
- Utilized motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Comprehensive assessment of referred member’s needs/eligibility using clinical tools and review
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with SMART goals designed to meet member's needs and promote desired outcomes
- Collaboration for services between Primary Care Physician, specialists, medical providers, and non-medical staff as necessary to meet the complete medical and socio-economic needs for the clients
- Provided patient and provider education
- Facilitate member access to community-based services
- Monitored referrals made to community-based organizations, medical care and other services to support the members' overall care management plan
- Presented cases at case rounds to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes.
Field Case Manager
WellMed
03.2012 - 04.2014
- Conducted comprehensive assessment of referred member’s eligibility/needs using clinical tools and review
- Utilized motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Assess the member's current health status, resource utilization, past and present treatment plan and services, prognosis, short- and long-term goals, treatment and provider options
- Utilize assessment skills and discretionary judgment to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member's needs and promote desired outcomes
- Coordinate services between Primary Care Physician, specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of clients
- Provide patient and provider education
- Facilitate member access to community-based services
- Monitor referrals made to community-based organizations, medical care and other services to support the members overall care management plan
- Presented cases at case rounds to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes
- Closely worked with the medical director, targeted physician groups on plans of care and goals for member outcomes with those provider groups with monthly/weekly meetings
- Systems experience with InterQual, Maces, Facets, Milliman criteria as well use of Medicare and Medicaid state guidelines
- Use of Atena CPB’s for criteria standards.
Medicaid Population
Amerigroup
03.2009 - 03.2012
- Conducted comprehensive assessment of referred member’s needs/eligibility using clinical tools and review
- Utilized motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Assess the member’s current health status resource utilization, past and present treatment plan and services, prognosis, short-and-long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgement to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet member’s needs and promote desired outcomes
- Coordinate services between Primary Care Physician, specialists, medical providers, and non-medical staff as necessary to meet the complete medical socio-economic needs of the clients
- Provide patient and provider education
- Facilitate member access to community-based services
- Monitor referrals made to community-based organizations, medical care and other services to support the member’s overall care management plan
- Presented cases @ Grand Rounds to obtain multidisciplinary perspective and recommendations in order to achieve optimal outcomes
- Stabilization and chronic CM duties as telephonic CM
- Mentoring and training-Plan, assign, and review work of a group of employees, as well as select, train individual employees.
Catastrophic Telephonic Case Manager
Freedom
03.2008 - 03.2009
- Conducted comprehensive assessment of referred member’s needs/eligibility using clinical tools and review
- Utilized motivational interviewing skills to promote lifestyle/behavior changes to achieve optimum level of health
- Conducted comprehensive assessment of referred member’s needs/eligibility using clinical tools and review
- Utilized motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Assess the member’s current health status, resource utilization, past and present treatment plan and services, prognosis, short-and-long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgement to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet the member’s needs and promote desired health outcomes
- Coordinate services between Primary Care Physicians, specialists, medical providers and non-medical staff as necessary to meet the complete medical socio-economical needs of the clients
- Provide patient and provider education
- Facilitate member access to community-based organizations, medical care and other services to support the members’ overall care of the management plan
- Presented cases at case rounds to obtain a multidisciplinary perspective and recommendations in order to achieve optimal outcomes.
Utilization Management and Case Management
Health Integrated
07.2006 - 03.2008
- Conducted comprehensive assessment of referred member’s needs/eligibility using clinical tools and review
- Utilization of clinical review against state guidelines for authorization of services for medical needs
- Utilized motivational interviewing skills to ensure maximum member engagement and promote lifestyle/behavior changes to achieve optimum level of health
- Assess the member’s current health status, resource utilization, past-and-present treatment plan and services, prognosis, short-and-long term goals, treatment and provider options
- Utilize assessment skills and discretionary judgement to develop plan of care based upon assessment with specific objectives, goals and interventions designed to meet members needs and promote desired outcomes
- Coordinate services between the Primary Care Physician, specialists, medical providers and non-medical staff as necessary to meet the complete medical and socio-economical needs of the clients
- Provide patient and provider education
- Facilitate member access to community-based services
- Monitor referrals made to community-based organizations, medical care and other services to support the member’s overall care management plan.
Education
Associate in Science (A.S.) R.N. -
New Mexico Junior College
Hobbs, NM04.1995
Skills
- Healthcare Regulations
- Care Planning
- Motivational Leadership
- Staff Development
- Patient advocacy
- Problem solving
Certification
Certified Case Manager (CCM), 2009
Timeline
Supervisor of Care Navigators (case managers)
Healthmap Solutions
03.2022 - Current
Field Care Manager
Wellcare
04.2014 - 03.2022
Field Case Manager
WellMed
03.2012 - 04.2014
Medicaid Population
Amerigroup
03.2009 - 03.2012
Catastrophic Telephonic Case Manager
Freedom
03.2008 - 03.2009
Utilization Management and Case Management
Health Integrated
07.2006 - 03.2008
Associate in Science (A.S.) R.N. -
New Mexico Junior College
Certified Case Manager (CCM), 2009
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