Liz Jones
Meridian,ID
Summary
Licensed Masters Level Social Worker (LMSW) with nearly Nineteen (19) years clinical experience working in Idaho hospitals and medical insurance industry, including Seven (7) years Clinical leadership experience. Reliable and experienced Supervisor who leads team members to take initiative and accomplish goals while developing lasting rapport. Assign tasks, train employees, and reinforce company expectations and professionalism.
Overview
17
17
years of professional experience
1
1
Certification
Work History
Supervisor Clinical Operations
Blue Cross of Idaho
01.2018 - Current
- Work alongside internal and external partners to develop processes, efficiencies, reports and safety measures
- Review, create and follow up on quality assurance reports
- Apply strong leadership talents and problem-solving skills to maintain team efficiency and optimize customer experience.
- Educate staff on organizational mission and goals to help employees achieve success.
- Leadership mentor for Summer Student internship program
- Evaluate staff performance and provide coaching
Clinical Reviewer, Senior
Blue Cross of Idaho
06.2010 - 01.2018
- Utilize clinical judgment, contract language, CMS guidelines, McKesson InterQual Decisional Support Criteria and medical policy to interpret and apply benefits for Acute Rehab, Skilled Nursing Facility, Outpatient Rehabilitation, NICU and member appeals
- Assess and present Member Pre and Post Service Medical appeals for all Lines of Business to the Medical Director and Appeals & Grievance Committee
- Highly experienced with Quality Improvement Organization appeals and processes including Administrative Law Judge Hearings
- Built relationships, gained alignment for clinical support and articulated questions to receive appropriate level of support from superiors and peers.
Medical Social Worker
St. Joseph Regional Medical Center
07.2007 - 04.2010
- Discharge planner for surgical floor
- Worked with medical teams, patients and families to create and implement effective treatment plans.
- Documented case notes daily and coordinated follow-up for seamless case management.
- Explained medical care options to help families make informed healthcare decisions.
- Completed psychosocial evaluations and needs assessments.
- Mentored BSW and MSW Practicum students
Education
Masters of Social Work -
Eastern Washington University
Cheney, WA06.2007
Bachelor of Science - Psychology
University of Idaho
Moscow, Idaho05.2004
Bachelor of Science - Sociology
University of Idaho
Moscow, Idaho05.2004
Skills
- JIVA
- FACETS
- Various hospital charting systems
- Employee development
- Staff management
- Process monitoring and improvement
- Relationship building
- Change management
Certification
- Licensed Master Social Worker - 2007- Present
- Interqual Certified Instructor (IQCI) for Blue Cross of Idaho 2018 and 2019
Timeline
Supervisor Clinical Operations
Blue Cross of Idaho
01.2018 - Current
Clinical Reviewer, Senior
Blue Cross of Idaho
06.2010 - 01.2018
Medical Social Worker
St. Joseph Regional Medical Center
07.2007 - 04.2010
Bachelor of Science - Psychology
University of Idaho
Bachelor of Science - Sociology
University of Idaho
Masters of Social Work -
Eastern Washington University
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