Michelle Yvonne Jones

RN, BSN, CCM

*** ***** ***** *************, ** 17055

acet2b@r.postjobfree.com

Home Telephone: Cellular

Telephone:

717-***-**** (717)

***-****

EDUCATION: York College of Pennsylvania

York, PA

Bachelor of Science in Nursing June

1983

Thomas Jefferson University Harrisburg, PA

Masters of Science in Nursing Completed 8

credits

PROFESSIONAL

EXPERIENCE: Select Medical Corporation-113 LTACH

Mechanicsburg, PA

Corporate Utilization Management Specialist August

2005-June 2014

. Educated professionals on the Select Medical

Admission Criteria Review Process, Medicare and

Commercial UR documentation, and the Select

Precertification Process.

. Conducted review oversight for admission through

continued stay and discharge.

. Performed precertification including reviewing

clinical assessments, insurance

verification, contracted and non-contracted Payors,

billing and reimbursement forms.

. Completed high-risk reviews for accidents, workers

compensation, prisoners, and insurance defaults.

. Wrote both Medicare and Commercial medical

necessity appeal letters.

. Assisted Case Managers with the Medicare Discharge

Appeal Process.

. Accomplished duties as assigned, including projects

and counseling of Clinical Liaisons regarding their

clinical assessments through electronic means.

. Analyzed statistics and oversight of hospital

Medicare and Commercial UR.

. Managed the on-call and PTO schedules as well as

team building events.

Keystone Health Plan Central

Camp Hill, PA

Capital Blue Cross

Harrisburg, PA

Case Manager

December 1997-2005

. Accounted for the General Care Management of 50-80 patients within the

Medicare population.

. Managed 80-100 patient cases for the Congestive

Heart Failure Intensive Disease Care Management

Program.

. Coordinated treatment and discharge for members

in acute, short and long-term care.

. Completed precertification of care services for

Medicare patients utilizing Interqual criteria.

. Educated CHF patients via telephone regarding the

disease process, medications, diet and exercise.

. Coordinated care with members and their health

care providers.

. Participated in community wellness and health

care events.

Symphony Rehabilitation Services

Langhorn, PA

Rehabilitation Nurse Liaison

April 1996-Nov. 1997

. Marketed nursing and rehabilitation services to maintain Medicare

census at Sarah A.

Todd Memorial Rehabilitation Center.

. Directed communication, evaluation and planning with health care

providers, social

workers, families and staff.

Michelle Yvonne Jones

Page 2

acet2b@r.postjobfree.com

Manor Care Nursing and Rehabilitation Center

Sept. 1994-March 1996

Director of Nursing

Camp Hill, PA

. Managed nursing operations of a 121 bed facility.

. Led a 60-member team of professional staff by coordinating schedules,

providing education through training, and

personnel management.

Assistant Director of Nursing

Carlisle, PA

. Managed day-shift nursing operations of a 150 bed facility.

. Coordinated schedules, providing education through training, and

personnel

management.

Regional Nurse Trainer

Central, PA

. Developed and instructed a state-approved Nurse Aid Certification

training

program.

RELATED

EXPERIENCE: Homebound Private Patient

Mechanicsburg, PA

Private Duty Nurse July 2009-

Sept. 2012

. Performed Lymphedema massage and wrap twice a week for a home

bariatric patient.

Harrisburg Area Community College Harrisburg,

PA

Clinical Instructor: Nurse Aide Training March-

April 1996

. Taught both practical and classroom instruction for a Nurse Aide

Certification

Training Course.

Blue Ridge Haven W. Nursing and Rehabilitation Center

Camp Hill, PA

Nursing Supervisor

April-September 1994

. Supervised evening shift nursing operations of a 333-bed facility with

Sub-Acute

Unit.

. Managed a 49-member team of professional staff.

. Provided training, orientation and evaluation of personnel.

Polyclinic Medical Center Harrisburg,

PA

Floor/Charge Nurse: Teaching and ICU June 1983-

March 1994

. Supervised and provided care for complex medical patients.

. Mentored new employees on the daily execution of duties.

OTHER:

. Certified Case Manager, certificate current.

. Registered Nurse in Pennsylvania, license current.

. Possess Interqual Training Certificate.

. Educate professionals on SMVC Webinars and E-Assessments.

. Proficient in HMS Medical and Commercial UR program.

. Proficient in Microsoft Access, Excel, Outlook and Word.

. Actress, professionally filmed educational video for Select

Medical.

. Actively involved in various philanthropic

activities such as Prison Ministry and other local

volunteer and charity events.

Contact this candidate