Theresa Jones
King George,VA
Overview
20
20
years of professional experience
Work History
Manager, Clinical Health Services
CVS Health - ABHVA
Richmond, VA
02.2024 - Current
- Lead a team of up to sixteen Case Managers in care management, utilization management, and member outreach for Medicaid populations
- Provided clinical oversight for complex case management and high-risk member interventions.
- Collaborated with medical directors, providers, and community partners to improve care coordination and optimize member health outcomes.
- Supported value-based care, population health, and health equity initiatives to advance organizational goals and improve patient access to services.
- Ensured compliance with state, federal, CMS, and contractual requirements while maintaining quality standards.
- Monitored departmental performance metrics, productivity, quality scores, and member outcomes to identify areas for improvement.
- Analyzed utilization and quality data to identify trends and implement process improvements.
- Recruited, trained, mentored, and evaluated clinical staff to enhance engagement and performance.
Registered Nurse Case Manager
CVS Health - ABHVA
Richmond, VA
05.2022 - Current
- Developed and implemented individualized care plans with clients and families to address specific health needs.
- Facilitated communication between clients, families, caregivers, social services and other agencies to ensure client needs were met.
- Linked clients with social services, health care providers, and governmental agencies to support autonomy and improve service access.
- Referred patients to specialized health resources and community agencies to enhance access to care.
- Provided referrals to appropriate health care providers or other community resources.
- Counseled clients on available resources within the community that could help meet their needs.
- Participated in interdisciplinary team meetings to discuss treatment options.
Home Health Registered Nurse Case Manager
Mary Washington Healthcare
Fredericksburg, VA
04.2013 - 05.2022
- Completed initial assessments of patients and family to determine and address individual home care needs.
- Assessed patient needs and developed individualized care plans.
- Performed case management functions including referrals to community resources and other healthcare providers.
- Monitored patient condition and behavior changes to evaluate intervention effectiveness and inform care adjustments.
- Collaborated with physicians to develop treatment plans that met the needs of each patient.
- Coordinated communication among healthcare team members, including primary care providers, specialists, family members, and caregivers to ensure cohesive patient care.
- Identified and addressed potential safety hazards within home environment to enhance patient safety and care quality.
- Recognized when a change in condition warrants further evaluation or intervention and took appropriate action.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
Registered Nurse, Intermediate Care Unit (Charge)
Mary Washington Healthcare
Fredericksburg, VA
05.2006 - 04.2013
- Initiated emergency life-saving measures according to ACLS protocol guidelines.
- Maintained a safe environment for all patients by implementing infection control measures in accordance with hospital policy guidelines.
- Educated patients on conditions, disease processes, and post-discharge care to promote understanding and adherence.
- Interpreted and evaluated diagnostic tests to identify and assess patient's condition.
- Advocated for patient needs with interdisciplinary team and implemented outlined treatment plans.
- Observed strict safety measures, including checking medication dosages before administration to patients.
- Assessed patient conditions, monitored behaviors and updated supervising physicians with observations and concerns.
- Administered oral, IV and intra-muscular medications and monitored patient reactions.
- Assisted with insertion and management of central venous catheters, arterial lines, chest tubes, and other invasive devices.
- Recognized early signs and symptoms of possible complications related to cardiac conditions or treatments and reported them immediately to physician team members.
- Conducted specified laboratory tests to help detect conditions and determine diagnosis.
- Performed nursing care to acutely ill adult patients with cardiac diagnoses such as myocardial infarction, congestive heart failure, cardiomyopathy and arrhythmias.
- Trained other nurses on patient care and daily tasks, supporting growth and professional development.
- Acted as a preceptor for new nurses transitioning into specialty areas of practice.
- Coordinated daily staffing assignments for nursing staff members based on unit acuity levels.
Education
Associate of Applied Science - Nursing
Germanna Community College
Locust Grove, VA05-2006
Skills
- Care Management
- Utilization Management
- Clinical Oversight
- Regulatory Compliance
- Data Analysis
- Community Health
Timeline
Manager, Clinical Health Services
CVS Health - ABHVA
02.2024 - Current
Registered Nurse Case Manager
CVS Health - ABHVA
05.2022 - Current
Home Health Registered Nurse Case Manager
Mary Washington Healthcare
04.2013 - 05.2022
Registered Nurse, Intermediate Care Unit (Charge)
Mary Washington Healthcare
05.2006 - 04.2013
Associate of Applied Science - Nursing
Germanna Community College