Shelley Jones
Nurse Case Manager
Concord,CA
Summary
I am a seasoned nursing professional, with 25 years of experience, offering knowledge, compassion and kindness to help patients transition from illness and injury to health and wellness. I have proven clinical knowledge, natural interpersonal strengths and technical abilities, and am interested in gaining understanding of a different type of nursing.
Overview
1
1
Certification
25
25
years of professional experience
Work History
Catastrophic Nurse Case Manager Workers Comp.
Gateway Health Management
Watsonville, CA
09.2019 - Current
- Communicated with healthcare team members, attorney's and adjuster's to plan, implement and enhance treatment strategies that encourage progress toward return to health and return to work.
- Collaborated with medical providers and employee's to support , educate, and participated in patient and family planning process, as well as provided instructions and addressed question and concerns.
- Effectively communicated with physicians regarding patient needs, treatment recommendations, medications and progress.
- Used first-hand knowledge and clinical expertise to advocate for patients under care and enacted prescribed treatment strategies
Telephonic Nurse Case Manager
Allied Managed Care
Sacramento, CA
10.2010 - 04.2019
- Maintained detailed records of patient progress, documentation of services and case notes.
- Interfaced with third-party payers, insurance companies and providers for utilization review activities and submitted timely reports to clients and providers.
- Assessed current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives.
- Provided patient and family education on available resources and self-care strategies
Telephonic Nurse Case Manager
Wellcomp Managed Care
Concord, CA
03.2009 - 10.2010
- Evaluated patients referred for case management to determine physical, mental, financial and psychosocial status by utilizing comprehensive, standardized criteria to identify existing and potential needs.
- Assessed current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives.
- Maintained detailed records of patient progress, documentation of services and case notes
Worker's Compensation Case Manager
Professional Dynamics
Walnut Creek, CA
06.2008 - 03.2009
- Developed and implemented comprehensive case management plans to address client needs and goals.
- Interfaced with third-party payers, insurance companies and providers for utilization review activities and submitted timely reports to clients and providers.
- Collaborated with other health care professionals regarding plan of care and variances in plan implementation to achieve outcomes.
Nurse
John Muir Medical Center
Walnut Creek, CA
08.1998 - 01.2007
- Provided direct patient care, stabilized patients, and determined next course of action.
- Assessed patients to determine individual needs and develop care plans in coordination with multidisciplinary healthcare professionals.
- Collaborated with physicians to quickly assess patients and deliver appropriate treatment while managing rapidly changing conditions.
- Remained calm during high-stress, critical situations, demonstrating sustained focus and problem-solving in real-time.
- Oversaw delivery of care for patients on medical-surgical unit, providing direct care, delegating nursing assignments and supervising team comprised of nurses, LPNs, technicians, and unit clerks.
Education
Bachelor of Science - Nursing
University of Portland
Portland, OR05.1998
Skills
- Regulatory Compliance
- Interdisciplinary Collaboration
- Utilization Review
- Accurate Documentation
- Compassionate and Caring
- Determine Medical Necessity
- Clear Patient Communication
- Electronic Recordkeeping
- RN Case Management
Certification
- Certified Case Manager - { Since 2020}
Accomplishments
- Collaborated with a team of 6 medical professionals in the development of outcome driven medical contracts aimed at monitoring, coordinating and facilitating timely, costly and medically appropriate treatment with the goal of assisting the patient return to his optimum, highest potential including return to work.
- Met with physicians, nurse practitioners and physicians assistants, face to face, to obtain necessary and accurate information to assist the treatment plan was accurate and on track with achieving the identified outcomes.
Timeline
Catastrophic Nurse Case Manager Workers Comp.
Gateway Health Management
09.2019 - Current
Telephonic Nurse Case Manager
Allied Managed Care
10.2010 - 04.2019
Telephonic Nurse Case Manager
Wellcomp Managed Care
03.2009 - 10.2010
Worker's Compensation Case Manager
Professional Dynamics
06.2008 - 03.2009
Nurse
John Muir Medical Center
08.1998 - 01.2007
Bachelor of Science - Nursing
University of Portland