Ronee'ja James
Salem,New Jersey
Summary
Registered Nurse with experience in telephonic case management, utilization review, and chronic disease management. Proven ability to assess member needs, identify care gaps, and coordinate care plans in alignment with CMS and NCQA guidelines. Experienced in managing high-risk populations, performing remote assessments, and supporting care transitions to improve outcomes.
Overview
10
10
years of professional experience
1
1
Certification
Work History
Registered Nurse
Inspira Medical Center
10.2025 - Current
- Perform comprehensive patient assessments and develop individualized care plans
- Support care transitions and discharge planning to ensure safe continuity of care
- Collaborate with interdisciplinary teams to improve patient outcomes and reduce readmissions
- Maintain accurate EMR documentation in compliance with regulatory standards
- Apply evidence-based practice aligned with payer and quality expectations
Registered Nurse
Bayada Home Health
01.2025 - Current
- Managed chronic disease populations with focus on reducing hospital readmissions
- Coordinated care transitions, discharge planning, and follow-up care
- Delivered patient education to improve adherence and self-management
- Communicated with providers and caregivers to ensure continuity of care
- Performed independent, field-based nursing aligned with remote case management skills
RN Unit Manager
Complete Care at Hillside
07.2025 - 10.2025
- Supervised nursing staff and coordinated care for high-risk patient populations
- Managed care plans, admissions, discharges, and transitions of care
- Oversaw utilization of healthcare resources and ensured regulatory compliance
- Led interdisciplinary collaboration to improve patient outcomes and quality metrics
- Supported workflow efficiency and clinical operations
LPN HEDIS Chart Auditor
Horizon BCBS
01.2024 - 05.2024
- Conducted HEDIS chart abstraction, medical record review, and gap analysis
- Identified care gaps and supported quality improvement and gap closure initiatives
- Ensured compliance with NCQA, CMS, and payer guidelines
- Analyzed performance data and presented findings to quality improvement teams
- Strengthened knowledge of population health and payer-based care models
Licensed Practical Nurse
Various Roles
09.2016 - 09.2023
- Provided direct patient care across long-term care, OBGYN, and residential settings
- Performed medication administration, wound care, and patient monitoring
- Conducted chart reviews, audits, and EMR documentation
- Coordinated care and advocated for diverse patient populations
- Served as charge nurse, preceptor, and staff educator
- Participated in utilization review support, chronic care management, and care coordination
Education
Associate Degree in Nursing - Associate Degree In Nursing
Salem Community College
Carneys Point NJ05.2025
Diploma - Practical Nursing
Eastern Suffolk Boces School Of Practical Nursing
Islip NY 08-2016
High School Diploma -
Longwood Senior Highschool
Middle Island ,NY06-2013
Skills
- Telephonic Case Management
- Care Coordination
- Utilization Review
- Medical Necessity
- HEDIS
- NCQA
- CMS
- Chronic Disease Management
- Risk Stratification
- EMR Documentation(EPIC,Cerner ,PCC)
- Patient Advocacy
- Direct patient care
- Microsoft Office Suite
- Telehealth & Remote Documentation Platforms
- Data Tracking & Quality Reporting Systems
Certification
AHA BLS exp :11/30/2027
Timeline
Registered Nurse
Inspira Medical Center
10.2025 - Current
RN Unit Manager
Complete Care at Hillside
07.2025 - 10.2025
Registered Nurse
Bayada Home Health
01.2025 - Current
LPN HEDIS Chart Auditor
Horizon BCBS
01.2024 - 05.2024
Licensed Practical Nurse
Various Roles
09.2016 - 09.2023
Associate Degree in Nursing - Associate Degree In Nursing
Salem Community College
Diploma - Practical Nursing
Eastern Suffolk Boces School Of Practical Nursing
High School Diploma -
Longwood Senior Highschool