Tamika Jones
Chicago,IL
Summary
Behavioral health management expert with extensive experience in electronic health records and patient education. Demonstrated success in improving patient care by collaborating with clinical teams and adhering to managed care standards.
Overview
30
30
years of professional experience
Work History
Behavioral Health Managed Care Specialist
Blue Cross Blue Shield of Illinois
Chicago, Illinois
10.2023 - 08.2026
- Managed care authorizations for behavioral health services, ensuring compliance and efficiency.
- Collaborated with clinical teams to improve patient care coordination and streamline service delivery.
- Educated members on behavioral health benefits and resources to optimize utilization of plan coverage.
- Conducted assessments of members' mental, emotional, and social functioning.
- Referred patients to community resources and specialists to ensure comprehensive support for their needs.
Phone Triage Nurse
Duly Health and Care
Lisle, Illinois
03.2023 - 08.2023
- Answered incoming patient calls to gather medical history and symptoms, facilitating accurate triage decisions.
- Analyzed discussed symptoms to assess patient acuity based on established protocols.
- Provided telephone advice per established guidelines, supporting consistent patient care delivery.
- Communicated triage information effectively to primary care team for informed decision-making.
- Collaborated with physicians and healthcare professionals to improve patient care quality through effective communication.
- Documented patient information accurately in electronic health records while adhering to HIPAA regulations.
Triage Nurse
PCC Austin Community Wellness Center
Chicago, Illinois
04.2010 - 03.2015
- Communicated triage information to primary care team for effective patient disposition discussions.
- Provided telephone advice per established guidelines and protocols to ensure patient safety and care continuity.
- Answered incoming patient calls to gather history and symptoms for medical assessments.
- Initiated treatments, including wound dressing changes and IV infusions, per physician orders.
- Reviewed medical charts and coordinated appointments, prescriptions, and consultations to address urgent care needs efficiently.
- Utilized EHR systems for accurate documentation in compliance with HIPAA regulations.
Assistant Clinical and Operations Manager/Pre-Admissions Nurse
Christ Hospital and Medical Center
Oak Lawn, Illinois
10.1996 - 01.2010
- Supervised 20 employees in 22-bed oncology/med-surg unit to ensure high-quality patient care and team cohesion.
- Performed comprehensive nursing care while managing 5 to 9 patients per shift.
- Assessed patient status and notified physicians of significant clinical changes.
- Scheduled patient admissions and discharges to ensure smooth operations.
- Coordinated staff schedules to optimize resource allocation and improve patient care.
- Collaborated with departments to enhance patient care processes and outcomes.
- Contacted patients and families regarding cardiac procedures and provided pre-op instructions.
- Oversaw medication administration according to established protocols for safety.
Education
Bachelor of Science - Nursing
Chicago State University
Chicago, IL05-1998
Skills
- Behavioral assessments
- Care coordination
- Care management
- Patient outreach
- Claims management
- Electronic health records
- EMR and diagnostic software
- Documentation and reporting strategies
- Data analysis tools
Timeline
Behavioral Health Managed Care Specialist
Blue Cross Blue Shield of Illinois
10.2023 - 08.2026
Phone Triage Nurse
Duly Health and Care
03.2023 - 08.2023
Triage Nurse
PCC Austin Community Wellness Center
04.2010 - 03.2015
Assistant Clinical and Operations Manager/Pre-Admissions Nurse
Christ Hospital and Medical Center
10.1996 - 01.2010
Bachelor of Science - Nursing
Chicago State University