Kacie Jones LVN
Katy,TX
Summary
To secure a challenging position with opportunity for growth and advancement. A key position is one in which my experience and education can come together to make a direct contribution in helping the lives of others.
Overview
24
24
years of professional experience
Work History
Pror Authorization Nurse
Conflux Systems
12 2022 - Current
- Answering inbound phone calls, processing cases, loading authorizations, and making follow-up phone calls utilizing appropriate courteous and professional behavior based upon established standards
- Provide internal nurse support to the PA team and member services department
- Refer cases not meeting clinical criteria to the Pharmacist and MD team(s)
- Shift priorities while exhibiting a high level of urgency with all calls and assignments
- Follow all prior authorization procedures to guarantee an accurate process on each prior authorization.
Prior Authorization Nurse
Pharmaceutical Strategies
1 2016 - 4 2019
- Accountable for current knowledge of utilization management responsibilities, including: payer information, business rules, regulatory guidelines
- Working knowledge of drug reimbursement procedures
- Benefit investigations, prior authorizations, appeals
- Excellent understanding of EMAR/Matrix/CoverMyMeds systems
- Extensive knowledge of Med D and Medicaid coverage benefits
Charge Nurse
Arlington Villa Nursing and Rehab
08.2013 - 08.2016
- Review staffing patterns and census of nursing units, reassigning personnel when necessary
- Managing and analyzing patient care following admission/readmission; conduction initial assessment for newly admitted patients
- Creating and implement care plans to address individual resident needs
- Administer medications, IV therapy, gastronomy tube management, wound care
- Monitor for change in condition
Senior LVN/Infection Disease
UNT Health Science Center
07.2011 - 08.2013
- Triage via phone/in person nurse visits
- Educate patients on HIV/AIDS disease process, medication management, and prevention
- Assist physician with clinic visits
- Refill/fill RX orders with physician guidelines
- Obtain lab cultures, give injections, verify lab/xray and other diagnostic reports
Charge Nurse
Green Valley Nursing and Rehab
02.2011 - 07.2012
- Review staffing patterns and census of nursing units, reassigning personnel when necessary
- Managing and analyzing patient care following admission/readmission; conduction initial assessment for newly admitted patients
- Creating and implement care plans to address individual resident needs
- Administer medications, IV therapy, gastronomy tube management, wound care
- Monitor for change in condition
Claims Specialist/Team Lead
Mega Life and Health
01.2007 - 02.2011
- Provide customers with information regarding healthcare benefits and claim status
- Process/reprocess medical/mental health claims
- Follow up on member provider complains regarding payment or claim issues
- Take escalated phone calls and resolve issues promptly and proficiently
- Train new hires
Claims Specialist/Team Lead
Managed
01.2003 - 01.2007
- Health Network
- Provide accurate information regarding members mental health insurance benefits
- Process/reprocess claims as needed
- Take escalated phone calls and resolve issues accordingly
- Train new hires
Benefit Specialist/Team Lead
ValueOptions Managed
01.2000 - 01.2003
- Care
- Provide accurate information regarding members mental health policies
- Process/reprocess escalated claims
- Conduct orientation for all new hires
- Authorize out patient care for patients and providers based on member benefit plan
- Resolve escalated incoming call from members/providers Page 2 | [Type your phone number] Page 3 | [Type your e-mail address]
Education
Licensed Vocational Nurse - Nursing
Concorde Career Institute
6 . 2012
Skills
- Licensed Vocational Nurse
- Mental Health/ Medical Claims Specialist
- Mental Health/ Medical Benefit Specialist
- Certified Pharmacy Technician
- IV Certified
- Prior Authorizaton Nurse
Timeline
Charge Nurse
Arlington Villa Nursing and Rehab
08.2013 - 08.2016
Senior LVN/Infection Disease
UNT Health Science Center
07.2011 - 08.2013
Charge Nurse
Green Valley Nursing and Rehab
02.2011 - 07.2012
Claims Specialist/Team Lead
Mega Life and Health
01.2007 - 02.2011
Claims Specialist/Team Lead
Managed
01.2003 - 01.2007
Benefit Specialist/Team Lead
ValueOptions Managed
01.2000 - 01.2003
Pror Authorization Nurse
Conflux Systems
12 2022 - Current
Prior Authorization Nurse
Pharmaceutical Strategies
1 2016 - 4 2019
Licensed Vocational Nurse - Nursing
Concorde Career Institute
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