Sonya Jenkins
Logan,OH
Summary
Forward-thinking team leader skilled at operating departments efficiently to meet goals. Successful background matching employees with roles for maximum performance. Proactive and hardworking individual focused on continuous operational improvement.
Overview
20
20
years of professional experience
Work History
Associate Manager; Clinical Appeals
NCAU Appeals Department
08.2022 - Current
- Hold monthly one on one meetings with staff to review production, audit results and provide feedback on performance. -Hold bi-weekly team meetings to provide department updates as well as encourage, motivate and support my team. -Audit staff appeals to ensure proper handling -Maintain proficient and accurate use of systems to meet goals and objectives as well as company and regulatory requirements -Ensure standard and expedited appeals are resolved within established timeframes, established workflows are followed, and department meets defined metrics -Onboard new staff -Participate/Manage special projects upon request
Appeals Nurse Consultant
NCAU Appeals Department
10.2013 - 08.2022
- Reviewed clinical appeals, using clinical judgement and FDA established guidelines to make a determination. -Resolved all appeals returned by a medical director prior to the case due date and/or within one business day or prior to the case due date to maintain compliance -Provide accurate and timely reporting/documentation -Complete haste/sensitive cases as needed -Commercial Member Appeals Audit Quality Results of 100% -Clinical Appeals Audit Quality Results of 100% -Assisted with the expedited appeal intake process and assign expedited appeals. -Worked as a subject matter expert on the Proton beam therapy appeals team.
Health Coach Consultant/Registered Nurse
Aetna Insurance company
10.2009 - 10.2013
- Utilize a collaborative process of assessment, planning, implementation and evaluation, to engage educate, and promote/influence members decisions related to achieving and maintaining optimal health status. - Perform initial intake assessments as well as follow up assessment on chronic conditions. - Review lab results
- Educated on normal values and ways to improve values that are out of range. - monitor all medications, check for possible drug interactions and side effects. - Encourage routine testing for prevention and early detection of chronic conditions. - Make outreach call while members were inpatient to offer educational support and assist with discharge planning. -Education members on their benefits to ensure proper utilization.
Health Coach Consultant/Registered Nurse
Aetna Insurance company
11.2007 - 10.2009
- Utilize a collaborative process of assessment, planning, implementation and evaluation, to engage educate, and promote/influence members decisions related to achieving and maintaining optimal health status. - Perform initial intake assessments as well as follow up assessment on chronic conditions. - Review lab results
- Educated on normal values and ways to improve values that are out of range. - monitor all medications, looking for possible drug interactions and side effects. - Encourage routine testing for prevention and early detection of chronic conditions. -Made outreach calls to encourage member engagement.
Licensed Practical Nurse
Fairfield medical center
07.2007 - 11.2007
- Monitor laboratory results and convey abnormal values to the doctors. - Read cardiac rhythm strips under the guidance of a Registered Nurse. - Reinforced education to patients on current illness, medications and discharge instructions. - Assess pain levels and respond promptly to insure proper pain management. - Administered medication PO, IM and subcutaneously.
Licensed Practical Nurse
Interim Health Care
10.2003 - 04.2006
- Performed pediatric and adult head to toe assessments - Administered medications and evaluated therapeutic response to the medications. - Evaluated mental health status and reported any concerns. - Suctioned patients via trach, performed trach care, changed trach tubes and monitored ventilator settings. - Performed wound care, colostomy care, and bladder irrigations. - provided education on diabetic management.
Education
Associate of Applied Science Degree in Nursing Technology -
Central Ohio Technical College
Newark, OHDiploma -
Knox County School of Practical Nursing
Mt.Vernon, OH09.2003
Skills
- Microsoft word
- Microsoft outlook
- Excel
- PowerPoint
- Teams
- Virtual phone and video meetings
Personal
- Team player
- Honest
- Empathetic
- Reliable
- Dependable
References
- Amy Duvall, RN, MSN. Senior Manager 770-346-4008
- Tammy Steele, RN, BSN. Associate Manager; Co-worker 815-275-8648
- Leigh Ciabattoni, RN. Associate Manager; Co-worker 215-775-2440
Timeline
Associate Manager; Clinical Appeals
NCAU Appeals Department
08.2022 - Current
Appeals Nurse Consultant
NCAU Appeals Department
10.2013 - 08.2022
Health Coach Consultant/Registered Nurse
Aetna Insurance company
10.2009 - 10.2013
Health Coach Consultant/Registered Nurse
Aetna Insurance company
11.2007 - 10.2009
Licensed Practical Nurse
Fairfield medical center
07.2007 - 11.2007
Licensed Practical Nurse
Interim Health Care
10.2003 - 04.2006
Associate of Applied Science Degree in Nursing Technology -
Central Ohio Technical College
Diploma -
Knox County School of Practical Nursing
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