Tarsha Jones
Blythewood,SC
Summary
Compassionate, empathetic, caring Registered Nurse with 20 years of clinical experience delivering quality, patient-centered nursing care with cultural humility. Skilled at interpersonal relationships, care plan development, chronic disease management, patient education, discharge management, and utilization review with excellent time management and prioritization skills to meet deadlines. Case Manager accustomed to treating diverse patient needs, while managing dynamic conditions. Collaborative professional possessing excellent clinical knowledge, judgment, and strong documentation and problem-solving abilities. Well-versed in managing emergent cases with poise.
Overview
22
22
years of professional experience
Work History
Accountable Care Hybrid Case Manager
CVS
08.2024 - Current
- Utilizes a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy to meet individuals’ and families' comprehensive health needs
- Acts as a liaison with beneficiaries, families, providers, and healthcare personnel, ensuring communication and the use of available resources to promote quality, cost-effective outcomes
- Coordinates all case management activities for acute and chronically ill beneficiaries, including consultant referrals, home care visits, community resources, and alternative care levels
- Interacts with beneficiaries telephonically or in person, including home visits, physician’s offices, or CVS Health Hubs, to provide ongoing case management services
- Assesses beneficiaries' medical status and collaborates with providers to develop and implement a plan of care to optimize wellness, medical outcomes, and timely return to work
- Communicates with beneficiaries and stakeholders (e.g., medical providers, attorneys, community resources) to ensure effective care coordination
- Prepares detailed documentation of casework activities, ensuring compliance with all regulations and standards
- Collaborates with multidisciplinary teams internally to maximize health outcomes and provides educational information for optimal medical results
Registered Nurse | Utilization Review/Managed Care Coordinator
BlueCross BlueShield of SC
08.2021 - 08.2024
- Assess, review, and develop care plans for 80+ case management patients, collaborating with providers to ensure effective care coordination and positive clinical outcomes
- Provide telephonic support for members with chronic conditions and high-risk pregnancies, conducting comprehensive assessments, offering educational support, and utilizing motivational interviewing to increase member engagement
- Evaluate and update care plans based on medical necessity, eligibility, and benefit exceptions, ensuring alignment with policy guidelines
- Coordinate care with interdisciplinary teams to implement care plans and ensure accurate clinical documentation for medical necessity and contract benefits
- Advocate for patients through communication and education, guiding them on healthcare delivery, network utilization, and benefit plans to improve care outcomes
Registered Nurse | Managed Care Coordinator | Reviewer/Contractor
US Tech Solutions
07.2020 - 08.2021
- Assess, review, and develop care plans for 80+ case management patients, collaborating with providers to ensure effective care coordination and positive clinical outcomes
- Provide telephonic support for members with chronic conditions and high-risk pregnancies, conducting comprehensive assessments, offering educational support, and utilizing motivational interviewing to increase member engagement
- Evaluate and update care plans based on medical necessity, eligibility, and benefit exceptions, ensuring alignment with policy guidelines
- Coordinate care with interdisciplinary teams to implement care plans and ensure accurate clinical documentation for medical necessity and contract benefits
- Advocate for patients through communication and education, guiding them on healthcare delivery, network utilization, and benefit plans to improve care outcomes
Registered Nurse | Skin Integrity
Pruitt Health and Rehabilitation
07.2019 - 12.2020
- Provide professional nursing care to patients with alterations in skin/tissue integrity, including pressure ulcers, vascular, arterial, and diabetic ulcers, as well as skin conditions resulting from incontinence, surgical procedures, and trauma
- Manage and coordinate patient care needs, including identification, assessment, prevention, and treatment planning to achieve optimal healing outcomes in an outpatient setting
- Lead and coordinate interdisciplinary teams, including healthcare practitioners, rehabilitation therapists, social workers, and other providers, to deliver comprehensive care tailored to individual patient assessments
- Initiate and monitor the quality management program, ensuring timely and accurate documentation of patient care and billing activities in compliance with organizational and regulatory standards
- Oversee intake and discharge planning activities, ensuring patients are equipped with the education and resources needed for ongoing care and optimal outcomes after discharge
Registered Nurse | Case Manager
Kindred at Home
08.2014 - 07.2019
- Assess clinical needs and medication requirements for prospective residents, coordinating admissions to ensure rooms, equipment, and supplies are prepared for new residents
- Collaborate with nursing, therapy, and medical teams to ensure proper care planning, maintain re-certification calendars, and update EMR systems with new medications, treatment orders, and nursing assessments
- Communicate with insurance case managers to verify reimbursement rates, coordinate billing, and assist with insurance documentation for managed care and Medicare
- Participate in care meetings to provide updates on resident status, collaborate with social workers on discharge plans, and provide training on insurance requirements to staff
- Adhere to HIPAA regulations, attend mandatory training sessions, and ensure exceptional care and customer service through compassionate communication with residents and families
Registered Nurse | Medical-Surgical Nursing, GYN/Postpartum
Prisma Health Float Pool
05.2014 - 11.2014
- Provide comprehensive nursing care for antepartum, GYN, and postpartum patients, monitoring maternal and fetal well-being, and responding to labor and delivery complications as needed
- Administer pre-operative and post-operative care for GYN surgeries, including patient education, pain management, and wound care to promote recovery and minimize complications
- Educate expectant mothers and families on prenatal care, labor preparation, postpartum recovery, and newborn care, ensuring optimal outcomes and informed decision-making
- Work closely with obstetricians, gynecologists, and interdisciplinary teams to develop and implement care plans, ensuring comprehensive treatment and support for patients and families
- Maintain accurate and timely patient records in compliance with hospital protocols and regulatory requirements, ensuring quality of care, safety, and continuity of services
Registered Nurse | Utilization Review
Care Core National
06.2013 - 05.2014
- Conducted telephonic clinical reviews of outpatient imaging requests, evaluating medical necessity and appropriateness based on established criteria
- Worked closely with healthcare providers to clarify medical information and resolve discrepancies, ensuring alignment with clinical guidelines and patient care standards
- Applied clinical knowledge and criteria to assess and approve or deny services, ensuring decisions were in line with payer policies and regulations
- Accurately documented clinical information in the electronic medical record (EMR) to support review decisions, ensuring compliance with regulatory standards and insurance requirements
- Collaborated with medical directors and case managers to address denials, facilitate appeals, and ensure appropriate care was provided based on policy coverage and medical necessity
Registered Nurse | Admission Nurse
Tri-county Home Health
08.2011 - 05.2013
- Perform detailed physical and environmental assessments for home health patients, determining medical needs, safety concerns, and appropriate care interventions
- Develop, implement, and monitor individualized care plans in collaboration with physicians, patients, and families to ensure effective treatment and care continuity
- Educate patients and caregivers on managing chronic conditions, medication administration, disease prevention, and self-care techniques to enhance health outcomes
- Provide specialized care for patients with chronic conditions and complex wound management needs, ensuring proper documentation and progress monitoring
- Maintain accurate, timely documentation in the electronic medical record (EMR), ensuring compliance with Medicare/Medicaid requirements and company policies for quality care and reimbursement
Registered Nurse | Case Manager
Gentiva | Regency Hospice
09.2007 - 10.2011
- Lead the assessment, planning, implementation, documentation, and evaluation phases of patient care, ensuring compliance with state and federal regulations
- Perform bi-weekly supervisory visits for C.N.A.s, delegating tasks as appropriate to ensure high-quality care and efficient workflow
- Contribute to the interdisciplinary plan of care (IDT), collaborating with team members to gather insights and improve patient care strategies
- Ensure timely completion of visit notes, daily logs, and payroll in adherence to Pathway procedures, while maintaining compliance with Quality Assurance and Performance Improvement (QAPI) requests
- Maintain regular communication with the attending physician, manage physician orders (including medications and durable medical equipment), and ensure timely and appropriate delivery of supplies for hospice care
- Evaluate and document changes in the level of hospice care, collaborating with the IDT to ensure patients receive the most appropriate care
Registered Nurse | Medical-Surgical Nursing
Palmetto Health Richland
12.2004 - 09.2007
- Deliver direct nursing care to a diverse patient population on the medical-surgical floor, including assessment, planning, implementation, and evaluation of care plans
- Provide post-operative and acute care for patients recovering from surgeries, ensuring timely interventions, pain management, and monitoring for complications
- Collaborate with physicians, nursing teams, and other healthcare professionals to ensure patient safety and positive outcomes through effective care coordination and treatment adjustments
- Educate patients and families on post-hospital care, medication management, and health promotion, ensuring a smooth transition from hospital to home
- Maintain accurate and up-to-date patient records in the electronic medical record (EMR) system, ensuring compliance with hospital policies and regulatory standards for quality care
Registered Nurse | Staff Nurse
South Carolina Department of Corrections
09.2003 - 12.2004
- Conduct thorough physical assessments of incoming inmates, identifying immediate health concerns, chronic conditions, and medication needs for proper intake and treatment planning
- Provide emergency nursing care and triage for incoming detainees, evaluating the severity of health conditions and coordinating with medical teams for timely interventions
- Administer prescribed medications, monitor for side effects, and maintain accurate medication records in compliance with institutional protocols
- Work closely with medical providers, security, and mental health staff to ensure appropriate care plans and referrals for specialized care when needed
- Ensure all assessments, treatments, and procedures are documented in the EMR system, adhering to correctional healthcare standards, HIPAA regulations, and institutional policies
Education
BSN -
Chamberlain College of Nursing
Chicago, IL10-2023
Associate of Science - nursing
Midlands Technical College
West Columbia, SC08-2003
Skills
- Care coordination
- Patient advocacy
- Interdisciplinary collaboration
- Electronic medical records documentation
- Chronic disease management
- Utilization criteria
- Case management
- Discharge planning
- Vulnerable population awareness
- Medication administration
- Adaptability and flexibility
- Compassionate and caring
Timeline
Accountable Care Hybrid Case Manager
CVS
08.2024 - Current
Registered Nurse | Utilization Review/Managed Care Coordinator
BlueCross BlueShield of SC
08.2021 - 08.2024
Registered Nurse | Managed Care Coordinator | Reviewer/Contractor
US Tech Solutions
07.2020 - 08.2021
Registered Nurse | Skin Integrity
Pruitt Health and Rehabilitation
07.2019 - 12.2020
Registered Nurse | Case Manager
Kindred at Home
08.2014 - 07.2019
Registered Nurse | Medical-Surgical Nursing, GYN/Postpartum
Prisma Health Float Pool
05.2014 - 11.2014
Registered Nurse | Utilization Review
Care Core National
06.2013 - 05.2014
Registered Nurse | Admission Nurse
Tri-county Home Health
08.2011 - 05.2013
Registered Nurse | Case Manager
Gentiva | Regency Hospice
09.2007 - 10.2011
Registered Nurse | Medical-Surgical Nursing
Palmetto Health Richland
12.2004 - 09.2007
Registered Nurse | Staff Nurse
South Carolina Department of Corrections
09.2003 - 12.2004
BSN -
Chamberlain College of Nursing
Associate of Science - nursing
Midlands Technical College
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