Linda University Loma

Jacquelyn V. Neely

951-***-**** Cell

Skills:

Adult Learning Theories

Certificate for Designing Learning

Certificate for Mastery Training

Ability to multi-task, prioritize and organizational skills

Bronze Lean Training

Knowledge of Medicare, Medicaid, HMO and CMS and DHCS regulations and requirements

Problem Solving Skills’

Communication skills

Interpersonal Skills

Medical Terminology

Public Speaking Skills

Computer skills: Microsoft Word, Microsoft Power Point, Outlook

Professional Experience:

Care Management.

Long-Term Services and Support (LTSS)

03/2016-Present

Educate Internal Team Member’s regarding Long Term Service and Services (LTSS)

Educate External Partner regarding Community Base Adult Services (CBAS) and other Managed Long-Term Services and Supports Programs

Generate Job-aids that reflect Department of Health Care Services Regulations

Train new Team Members.

Quality and Training:

09/2015 – Present

Assist in the development, implementation and evaluation of the overall plan and structure

Assist with training programs for all employees, within Care Management.

Provide tools and training solutions to address gaps in knowledge, competency and

skills.

Research and evaluate adult learning programs, trends and practices in or to devise appropriate curriculums. Training implementation includes

a)Logistics preparation (rooms reservations and set-up, copies of training materials equipment needed, etc.)

b)Scheduling training for small and large groups of employees within the various units of Health Services Department.

Work closely with Director of Care Management and Managers to achieve IEHP Health Services goals and regulatory expectations.

Responsible for developing training material with guidance from CM QA and Training Nurse Manager to ensure appropriate training topics. Curriculum includes course outlines; training goals and objectives, lesson plans and Power Point presentation.

Triage Nursing Team

11/2012 – 08/2015: Inland Empire Health Plan (IEHP) – San Bernardino, CA

Research Member’s Pre-Authorization Request (PER)

Reach out to Member's regarding UM authorization

Educate Member regarding PER process.

Communicate with Members, IPA and Providers.

Communicate with Providers to advocate for Members care.

Assist Members for Continuity of Care

Educate Member’s and Provider’s

Assist with Provider Reassignment (Divorce)

Denial Coordinator

09/2012 – 11/2012: Inland Empire Health Plan (IEHP) – San Bernardino, CA

Process denials

Expedite notification to providers and members,

Educate Members about the Appeals process

Revision of denials.

UM-Coordinator

03/2012 – 09/2012: Inland Empire Health Plan (IEHP) – San Bernardino, CA

Process referral’s (Prior Auth),

Verify CPT codes, ICD-9

Approve authorizations according to UM-Outpatient Referral Guide.

Communicate with providers and various IPA.

Education

Loma Linda University – Loma Linda, CA

Bachelor of Science Degree, Wellness Management and Health Education - Public Health - 3/2006

References Available Upon Request

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