Katie Jones BSN, MHA, RN, CCM
Hamilton
Summary
Seasoned Clinical Team Lead with extensive experience identifying, coordinating, and delivering appropriate levels of care across the healthcare continuum. Demonstrates exceptional leadership, professionalism, and adaptability, thriving in dynamic environments while effectively supporting evolving business and nursing needs. Known for a calm, measured approach that fosters stability, trust, and collaboration.
Brings strong expertise in clinical operations and medical management, including comprehensive assessment, planning, implementation, coordination, monitoring, and evaluation of care. Highly skilled in case management, care coordination, and medical management consultation for diverse member populations. A detail‑oriented, organized, and creative problem solver who resolves complex challenges efficiently, fairly, and effectively.
Recognized for sound clinical judgment, clear and effective communication, and the ability to navigate complex, changing environments. Applies a strategic, member‑centered approach to health education, coaching, and treatment decision support to improve patient outcomes, care quality, and overall member experience.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Clinical Team Lead
Optum
Ohio
10.2021 - Current
- Supporting National/Custom Accounts, Key Accounts, Premier Accounts Corning, Liberty Mutual, PricewaterhouseCoopers, Fresenius & V.F. Corp.
- Provided day-to-day support for Corning, Liberty Mutual, Tier 4 teams during Manager leave of absence 9/2025-3/2026.
- Coaching nursing staff to improve individual and team performance, driving measurable gains in quality, productivity, and clinical metrics.
- 2026 Liberty Mutual is in the 90th percentile PMPM, compared to sitting in the 60th percentile in previous years at this point in the year.
- Drove adoption of treatment decision support opportunities through education and coaching, achieving $83,334 in successful gap closures 1/1/2026-4/22/2026. An increase from $83,846 for all of 2025.
- Proactively monitored catastrophic case identification and coordination, ensuring appropriate opportunity alignment and effective gap closure for high‑risk members. Resulting in 146.15% increase from the first half of 2025. $454,849 for second half of 2025 up from $184,793.
- 2025 260 Heart call evaluations completed
- 2026 105 Heart call evaluations completed through 4/22/2026
- Direct nurses through high‑visibility client escalations, partnering across legal, medical, social media, and account teams while providing interim leadership. Orchestrated international care coordination and repatriation for a member following a catastrophic injury.
- 2025 Key accounts client performance stands at 77% Green up from 74% the year prior. When focusing on active performance (Green, Red, Yellow), the team achieved 92% Green, 6% Red, and 1% Yellow, reflecting strong overall outcomes. All performance guarantees met.
- 2026 State of Maryland audit, showing significant improvement in nurses performance compared to 2024 State of Maryland audit findings.
- Providing ongoing performance coaching to nurses, resulting in sustained improvement in key operational and quality indicators.
- Provide additional 1:1 coaching for quality and performance for nurses on other teams within the site at the request of leadership. Saw sustained improvement in timely documentation, improved quality of calls, and sustained improvement in nurse's metrics.
- Leading targeted coaching initiatives for nursing staff that improved performance outcomes and metric achievement.
- Successfully onboarded the Premier Team (PwC) in January 2026, providing leadership support and implementing a new weekly BCRT to strengthen workflow and clinical collaboration.
- Served as clinical lead for weekly Publicis BCRT, guiding case discussions and care coordination efforts.
- Provide consistent clinical leadership by leading two weekly BCRT meetings over a 35‑week period and delivering additional PwC BCRT coverage to ensure continuity during coverage gaps.
Employer Concierge Referral Service
Optum
01.2017 - Current
- Provide case presentations at bi-weekly rounds for eight years with Dr. Feigin, and other senior leadership of executives' cases.
- Precepts new nurse care coordinators and onboarding of social workers
- Personally assist referred executives during times of need by connecting them to top‑quality providers and health systems aligned with their individual healthcare needs. Leverage established relationships and direct contacts to facilitate expedited access to high‑quality care and specialized resources. Deliver a high‑touch, concierge‑level experience through the ECRS program, a complimentary service offered to selected clients, ensuring timely, appropriate, and member‑centered care coordination.
Complex Case Manager
Optum
Ohio
05.2011 - 10.2021
- Complex Case Management for VIP, Escalated Cases, High Cost, Claimants, &Longitudinal Case Management
- Complex Case Manager Trainer for Case Managers/Disease
- Developed & Implemented training program for Complex Case Management 2020
- SME for multiple platforms/applications
Education
Master of Science - Health Administration
Ohio University
Athens, Ohio12-2012
Bachelor's of Science in Nursing - Nursing
University of Cincinnati
Cincinnati, OH06-2009
Associate Degree in Nursing - Nursing
Good Samaritan College of Nursing And Health Sciences
Cincinnati, Ohio05-2006
Skills
- Nurse Coaching & Engagement
- Interdisciplinary Team Collaboration
- Outcome Monitoring & Quality Improvement
- Clinical Documentation & Compliance
- Performance tracking
Accomplishments
- Emerging leader's alumni 2023
- 2018 Superhero winner
- 2026 Authored and published job aid CAC provider outreach
- 2025 Clinical Sage Nominee
- 2025 Superhero Nominee
- 2025 Successful Fiserv Audit
- 2025, 2024, 2023 Exceeds Expectations for MAP as Team Lead
- 2025 Implemented and developed standardized training for SWAT support for legacy Buffalo site
- 2024 Columbus City School Successful Audit with no findings
- 2024 Kina'ole Award BTS All Star
- 2022 & 2023 State of Maryland Successful Audit
- 2022 PSCU Audit
- 2013 Aquamarine recipient
- Nursing Inspire Participant
- Manager Development Conference participant
Certification
Certification in Case Management
Timeline
Clinical Team Lead
Optum
10.2021 - Current
Employer Concierge Referral Service
Optum
01.2017 - Current
Complex Case Manager
Optum
05.2011 - 10.2021
Bachelor's of Science in Nursing - Nursing
University of Cincinnati
Associate Degree in Nursing - Nursing
Good Samaritan College of Nursing And Health Sciences
Master of Science - Health Administration
Ohio University