Shannon Jones
Dytona Beach
Summary
Results driven healthcare leader with extensive experience at Centene, specializing in utilization management and integrated clinical services. Proven track record in enhancing operational efficiency and reducing inpatient length of stay by 24%. Adept at fostering teamwork while driving strategic initiatives that align with organizational goals and improve patient outcomes. Experienced in conducting thorough assessments and creating individualized care plans to meet client needs. Collaborates seamlessly with multidisciplinary teams and adapts to dynamic situations to ensure optimal client outcomes.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Case Manager
Halifax Healthcare
09.2024 - Current
- Coordinated client intake and assessment processes to identify service needs.
- Engaged in regular communication with clients to monitor progress and address concerns.
- Collaborated with multidisciplinary teams to ensure comprehensive patient support and continuity of care.
- Advocated for patients' rights, ensuring accessibility to necessary medical resources and services.
- Managed complex cases involving multiple comorbidities, requiring close monitoring and coordination of various healthcare services.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Reduced hospital readmission rates through effective case management and patient education on self-care techniques.
Regional Director Market Liasion
CareSource
05.2023 - 08.2024
- Analyzed market trends to inform program development and resource allocation.
- Spearhead oversight of operational policies, procedures, and clinical content across assigned markets.
- Developed and implemented portfolio strategies to optimize resources for new and existing markets, facilitating the coordination and delivery of care management programs.
- Played a key role in determining benchmarks, goals, and outcomes for programs, driving success in meeting contractual requirements, and addressing high cost, high volume, and high risk conditions.
- Actively participated in new business opportunities, including RFP processes and implementation, contributing to the expansion and effectiveness of initiatives.
Senior Director Medical Management
Centene
09.2011 - 05.2023
- Led cross-functional teams to implement strategic initiatives, enhancing operational efficiency across multiple departments.
- Developed and executed comprehensive business plans aligning with organizational goals and compliance standards.
- Mentored senior management, fostering leadership development and improving team performance through targeted coaching.
- Analyzed market trends to inform product development strategies, resulting in increased competitive advantage.
- Established the NICU case management program to reduce LOS and utilization. Decrease inpatient LOS and increase case management acceptance by 24%.
- Secured a strategic partnership with the University of Kentucky Hospital to develop the transitional care program, removing barriers to a safe discharge.
Education
Associate of Science - Nursing
Eastern Kentucky University
Richmond, KY05-1996
Skills
- Utilization management
- Joint commission standards
- Integrated clinical service
- InterQual admissions criteria
- HCHPS performance tracking
- Clinical quality incentives
- Teamwork and collaboration
Accomplishments
- "Excellence Award 2020" for developing one of the top case management teams nationwide, audit metrics, and the use of in-member best practices.
- "Health Navigation Award 2019" for streamlining processes, creating member outreach positions, and completing a special assignment to train the Chicago team on the best practices of the Kentucky operation.
- "Associate Engagement Champion Award 2017" for achieving a 96% employee engagement score.
- "Integrity Award 2017" for designing and implementing new case management programs to reduce recidivism.
Certification
Commission for Case Management Certification (#4218591)
Timeline
Case Manager
Halifax Healthcare
09.2024 - Current
Regional Director Market Liasion
CareSource
05.2023 - 08.2024
Senior Director Medical Management
Centene
09.2011 - 05.2023
Associate of Science - Nursing
Eastern Kentucky University