Registered Nurse Medical
Resume:
Michelle Yvonne Jones
RN, BSN, CCM
*** ***** ***** *************, ** 17055
**************@*******.***
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
**************@*******.***
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