Mystal Jackson, MSN, RN, CCM
Weatherford,TX
Summary
Dedicated registered nurse with with 24 years of functional case management to include leadership experience. Enacts strong and collaborative approach across care continuum and manages workflow to support dynamic teams. Spearheads operational effectiveness and efficiencies to develop quality improvement activities and achieve financial goals. Experience with Medicare, Medicaid and Medicare Advantage programs to include SNP and state waiver programs.
Overview
13
13
years of professional experience
1
1
Certification
Work History
Director of Case Management
WellMed- United Health Group
11.2021 - Current
- Collaborated with interdisciplinary teams to optimize patient outcomes and ensure seamless transitions between care settings for Medicare Advantage patient population
- Maintained compliance with regulatory requirements through rigorous quality assurance processes and timely reporting mechanisms.
- Championed culture of teamwork overseeing 75-100 staff members, to improve collaboration, and innovation within the department to drive positive change across the organization, increasing productivity for optimal outcomes
- Reduced healthcare costs by streamlining case management protocols, leveraging technology and maximizing resource utilization.
- Proactively addressed complex cases or escalated issues, working closely with stakeholders to devise effective resolution strategies.
- Managed budgets effectively, ensuring optimal allocation of resources while reducing waste and inefficiency.
- Established clear objectives for 7 direct reports and 75 indirect reports, fostering an environment that encouraged professional growth while aligning with organizational goals.
- Conducted regular performance evaluations to identify strengths, areas for improvement, and opportunities for growth among team members.
- Integrated population health management principles into daily practice, promoting preventative care measures among patients as well as streamlined interventions when needed.
- Spearheaded initiatives aimed at reducing readmissions, improving discharge planning, and enhancing overall continuity of care.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle while complying with regulatory standards .
- Collaborated with internal and external multidisciplinary teams to facilitate client care and reduce case management barriers and improve access to care.
- Served as corporate resource for compliance and audits to facilitate legal process and appeals.
Manager of Case Management
United Healthcare Group
06.2020 - 11.2021
- Collaborated with cross-functional teams to resolve complex cases, ensuring timely resolution and efficiency by streamlining processes and implementing time-saving technologies.
- Facilitated internal and external meetings focused on interdisciplinary care planning, promoting collaboration between various service providers involved in each client''s care plan.
- Implemented data-driven strategies to identify areas for improvement in case management processes, leading to increased productivity and better client outcomes.
- Conducted regular audits of case files to ensure compliance with regulatory requirements and company policies.
- Achieved high levels of employee retention by implementing targeted recruitment strategies aimed at attracting qualified candidates with relevant experience in case management roles.
- Developed and maintained comprehensive policies and procedures for case management department, ensuring consistency in practice across all team members.
- Streamlined, standardized and implemented case management processes and techniques to maximize revenue cycle.
- Served as corporate resource for compliance and audits to facilitate legal process and appeals.
- Developed and implemented training programs for staff.
Quality Assurance RN
Crest Home Health
06.2016 - 11.2021
- Perform daily, quarterly and yearly audits of multidisciplinary team members documentation to ensure compliance with CMS & internal business policies and operating procedures
- Identify trends in documentation and clinical practice and communicate potential issues to leadership
- Develop and provide health education and consultation services to community members, clients and family members on a one-to-one and group basis and respond to requests for information by phone or in person.
- Streamlined documentation processes to ensure accurate record-keeping and compliance with regulatory standards.
- Championed quality improvement initiatives within the team by identifying areas for improvement and implementing evidence-based strategies.
RN Case Manager/ Clinical Quality RN
United Health Care
06.2016 - 06.2020
- Independently perform audits as assigned by director/manager using multiple documentation systems to ensure alignment with state LTSS requirements
- Analyze documentation and data to identify non-compliance with policies, process guidelines and report potential issues to leadership as identified and offered potential solutions
- Provide testing of chosen solution to identify any potential gaps in new implemented processes to improve overall clinical outcomes
- Prepare and provide instruction that align with current business process guidelines to implement change within teams
- Identify practice trends with potential negative business impact and communicate findings to leadership
- Provide additional support to multidisciplinary team members to ensure processes are being followed and daily activities align with state regulated waiver program requirements
- Provide Assistance and support with various roles within the prior authorization and secondary review teams
- Coordinated care conferences with interdisciplinary team members, patients and families ensuring all perspectives were considered in the development of comprehensive treatment plans.
- Mentored new nursing staff, facilitating a faster learning curve and increased overall team efficiency.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
- Optimized resource utilization by identifying opportunities for cost containment while maintaining quality of care.
- Assisted in the development of policies and procedures that improved the efficiency of case management processes within the organization.
RN Field Case Manager
Klarus Homecare –Fort Worth, Texas
05.2011 - 01.2017
- Participate in team meetings, coordinating health care services provided by ancillary personnel
- Utilized advanced clinical skills such as wound care management or IV therapy administration, leading to faster recovery times for patients treated under my supervision.
- Served as a liaison between physicians and patients'' families to facilitate clear communication regarding treatment options and progress updates.
- Coordinated discharge planning efforts with social workers, case managers, and other multidisciplinary team members for smooth transitions posthospitalization.
- Develop and provide health education and consultation services to community members, clients and family members on a one-to-one and group basis through home visits, responding to requests for information by phone or in person.
- Assessed patient conditions promptly upon admission to determine appropriate interventions and prioritize care needs.
- Collaborated with interdisciplinary teams for comprehensive patient care plans, resulting in better health outcomes.
Education
Master of Science - Nursing
Capella University
06.2020
Associates Degree in Nursing -
Cisco Junior College
Abilene, TX12.2004
Licensed Vocational Degree in Nursing - Licensed Vocational Degree in Nursing
Cisco Junior College
Cisco, TX08.2000
Skills
- Readmission reduction
- Care Coordination
- Quality Improvement
- Staff Development
- Transitions of care
- Utilization & Case Management
- Interdepartmental Collaboration
- Self Motivated with Analytical Thinking skills
Certification
- Certified Case Manager - December 2021
- Intermediate to Advanced knowledge in using Community Care, ECCA, ICUE, TruCare, IKA, ECG, EPRG, Zephyr, NaviHealth Coordinate
- Advanced knowledge in Microsoft Office Suite to include Sharepoint, Teams, Power Automate
- Familiar with utilization of Power BI, HCE and Tableau reporting
References
Available Upon Request
Timeline
Director of Case Management
WellMed- United Health Group
11.2021 - Current
Manager of Case Management
United Healthcare Group
06.2020 - 11.2021
RN Case Manager/ Clinical Quality RN
United Health Care
06.2016 - 06.2020
Quality Assurance RN
Crest Home Health
06.2016 - 11.2021
RN Field Case Manager
Klarus Homecare –Fort Worth, Texas
05.2011 - 01.2017
Master of Science - Nursing
Capella University
Associates Degree in Nursing -
Cisco Junior College
Licensed Vocational Degree in Nursing - Licensed Vocational Degree in Nursing
Cisco Junior College
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