Lynna Jacobs

• Creates and delivers clinical training programs for clinical staff across the enterprise to orient employees to Molina clinical methodology, along with policies, processes and systems. Ensures all Molina clinical team members are positioned to improve quality, control medical costs, and ensure compliance with state and federal regulations and guidelines. Responsible for the development, implementation, and delivery of training curriculum for Utilization Management, Case Management, and LTSS staff. Leads and manages classes, adapting to trainee skill level, specific backgrounds, changing priorities and operating environments as needed. Training includes clinical new employee orientation, development and delivery for implementations, training and partnerships on clinical initiatives, and optimization efforts.
• Process and performance development, oversight, and implementation experience to facilitate consistent, accurate, and appropriate operational execution and clinical management.
• regulatory adherence and performance improvement, and end-to-end policy and performance review with the goal of obtaining a constant state of audit readiness with zero financial penalties.
• Developed the Sickle Cell Disease Program for Molina Healthcare of South Carolina
• Intermittent Acting Director of Department
• Increased customer satisfaction by 30% over two years by ensuring exceptional service through comprehensive training programs utilizing Medicare guidelines and providing ongoing support using advanced CRM tools.

Creates and delivers clinical training programs for clinical staff across the enterprise to orient employees to Molina clinical methodology, along with policies, processes and

• Actively participated in cross-functional team meetings to discuss process improvements and share best practices within the organization.
• Responsible for Stop-Loss and reinsurance of members as it relates to different plans and States.

• Responsible for improving patient care
• Collaboration with providers
• Engagement of patients and family members impacting on delivery of quality and cost effective care
• Systemic identification of gaps in care as well as identification of high risk patients
• Analysis of performance reports and data
• Clinical Liaison for ACO
• Physician education regarding ICD 10 coding impacting on Insurance company reimbursement
• Physician education regarding EMR charting
• Patient advocate

Supervised team of registered nurses as well ancillary members

• Cross-trained existing employees to maximize team agility and performance.
• Accomplished multiple tasks within established timeframes.

• Enhanced team performance by providing regular coaching, training, and performance feedback to staff members.
• Increased customer satisfaction with timely resolution of escalated issues and proactive communication on product updates.
• Promoted a culture of continuous improvement through ongoing process reviews, employee engagement initiatives, and open channels of communication.
• Collaborated with executive leadership to establish long-term objectives, drive growth initiatives, and align regional efforts with corporate goals.
• Established and maintained operational standards for Maryland and Pennsylvania locations.
• Supervised staff to optimize brand expansion initiatives and productivity.
• Mentored and developed high-potential employees for leadership roles through individualized career development plans and opportunities for growth.

• Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
• Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
• Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
• Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.
• Responsible for all functions of utilization management and grievances
• Responsible for Stop-Loss and Reinsurance of Members
• Network development of ancillary providers
• Non-Par Contract Negotiation
• Development of Clinical Screens and Programs
• Development of Tutti Bambini Program
• Development of the Sickle Cell Disease Program
• Responsible for Training of all UM and CM staff RNs as well as non-clinical staff

Increased Network Development

Responsible for Risk Stratification and reporting

Outcomes reporting

Hedis Measures Training and Reporting

Responsible for precertification, concurrent review, retro review and post-acute services

Contract and Single Case Agreement Negotiations

Handled grievance calls and provided insight to employer and vendors to resolve matters in a timely and professional way.

Hospital and Vendor Liaison

• Researched related literature regarding issues at hand.
• Responsible for Stop-Loss and reinsurance of Medicaid MCO members.

• Responsible for overall production and service deliver for multiple buildings in the Mid Atlantic/Southern Region

• MDS at all assigned buildings

• Establish strong marketing presence in targeted hospitals within geographic area

• Responsible for Pre-admission assessments and coordination of care and services

• Responsible for obtaining precertification from insurance company case managers including negotiation of Non-Par contracts

• Consistently exceeded all sales goals

• Performed accurate documentation of patient assessments, interventions, and outcomes in compliance with regulatory standards.
• Promoted a safe and comfortable healing environment by addressing patient concerns promptly and professionally.

• Responsible for all aspects of key account management within various hospital systems

• Responsible for Pre admission assessments and obtaining pre authorization from insurance Case Managers..

• MDS

Contract negotiation with Managed Healthcare companies.

• Negotiated Non-Par contracts

• Development of Pain Management program at our facilities

• Physician recruitment of aforementioned programs

• Team leader Sales and admissions responsible for training and damage control at area hospitals and facilities with over 15 co-workers

• Consistently exceeded all sales goals

• Developed high-performing teams by providing mentorship, guidance, and opportunities for professional growth.
• Enhanced team collaboration through regular communication, goal setting, and performance evaluations.
• Established a culture of continuous improvement by fostering open communication channels and empowering employees to voice their ideas.
• Cultivated a positive work environment that fostered employee engagement, increased retention rates, and boosted overall team morale.

• Managed a staff of 12 UR nurses and Case managers

• Approving of both inpatient hospital stays and outpatient surgical procedures

• Facilitating transfers to lower levels of care when medically appropriate

• Negotiation of rates and non-par contracts

• Functioned as a secondary reviewer

• Developed and implemented policies and procedures for prospective, concurrent review and retrospective care review, clinical practice guidelines and protocols.

• Identified potential areas for improvement with appropriate plan of action

• Maintained a key role in cost containment and management and accountability

• Educated and trained the leadership staff UM plans

• HEDIS Review

Responsible for Stop-Loss and reinsurance of members when appropriate as well as the REM program of Maryland.

• Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
• Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.

• Approving of both inpatient hospital stays and outpatient surgical procedures.

• Facilitating transfers to a lower level of care when appropriate

• Negotiation of rates and non-par contracts

• Functioned as a secondary reviewer

Mentoring and Training of Nurses and Non-Clinical Team Members

• Enhanced communication between clients and providers through consistent follow-ups and progress updates.