Nicole Jones

In this position, I am responsible for authorizing services and assisting other team members in monitoring adherence of contracted providers to established site review protocols, access & service authorization criteria, and regional policy to ensure appropriate access and effective/efficient use of behavioral health and substance use disorder services.

I review the appropriateness of admissions and authorization requests, to confirm, through clinical review, the medical necessity of treatment services based on
individual client needs, service eligibility, efficacy of proposed treatment (in comparison to other available treatment options), and treatment history.

I am involved in direct client contact, respond to requests for information and general referrals, review and make determinations on authorization requests, provide care management, wait-list management and follow-up.

I am responsible for carrying out all activities of the Pre-Paid Inpatient Health Plan (PIHP) in such a manner that fulfills the organization’s mission and assure compliance with policies and procedures.

• Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
• Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
• Managed conflict resolution among team members, fostering a positive and collaborative work environment.
• Maintained an inclusive and diverse team culture, promoting respect and understanding among all members.
• Managed a busy Call center for SUD and Behavioral Health screenings

• Assisted the Team Manager and filled in for clinicians and case managers when needed, along with providing guidance and supervision.
• Set performance expectations for the team, monitoring progress towards goals and providing constructive feedback as needed.
• Empowered team members by delegating responsibilities according to individual strengths and areas of expertise.
• Managed conflict resolution among team members, fostering a positive and collaborative work environment.
• Maintained an inclusive and diverse team culture, promoting respect and understanding among all members.

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• Provided mental health services to children and their families.
• Improved patient outcomes through the implementation of evidence-based therapeutic interventions tailored to each client''s needs.
• Conducted discharge planning in collaboration with clients and their support network to ensure smooth transitions post treatment.
• Advocated for client needs within the school system and community system to ensure equitable access to appropriate treatments and resources.
• Organized workshops and groups for families of clients, fostering an environment of understanding and mutual support among loved ones impacted by mental health challenges.

• Provided therapy in the home and community environment utilizing family guided/youth driven person centered treatment plans.
• Effectively managed caseload through efficient scheduling of appointments, timely follow-ups with clients, and prioritizing urgent cases as needed.
• Provided crisis intervention services when needed, effectively de-escalating situations and ensuring client safety.
• Led psychoeducational groups covering topics such as stress management, healthy coping skills, assertiveness training, or parenting strategies that benefited multiple families simultaneously.
• Improved family dynamics through conducting in-home therapy sessions, addressing communication barriers and conflict resolution strategies.

Same as previous home-based position, except in a more rural area.

This position had challenges for assisting clients in finding needed resources in their communities, with it being more rural, but with creativity and learning/making connections with community partners, this was achieved.

• Followed classroom plans left by class teacher to continue student education and reinforce core concepts.
• Upheld classroom routines to support student environments and maintain consistent schedules.
• Developed strong rapport with students through consistent encouragement and support, fostering a positive learning atmosphere conducive to academic growth.
• Repeatedly requested as substitute teacher by teachers based on excellent past referrals and trusted performance.

• Developed strong rapport with students through empathetic listening and open communication, fostering trusting relationships conducive to growth.
• Enhanced student well-being by implementing effective social-emotional learning strategies in group sessions.
• Participated in multidisciplinary team meetings, contributing valuable insights to inform student-centered interventions.
• Participated in ongoing professional development to stay informed of current trends and best practices in school social work.

• Improved patient outcomes by conducting comprehensive psychosocial assessments and developing individualized care plans.
• Provided emotional support to patients and families, addressing their concerns related to medical conditions, treatments, and coping strategies.
• Enhanced patient satisfaction by consistently delivering compassionate, client-centered care that addressed unique needs and preferences.
• Provided information and assisted families in applying for Medicaid when children were in the NICU for over 30 days.
• completed discharge planning and placements for patients who needed physical rehabilitation or assisted living arrangements.