Linda Jones
RN Case Manager at Anthem- Claim this Profile
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Bio
Credentials
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CCM
Commission for Case Management CertificationMay, 2013- Oct, 2024
Experience
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Anthem
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United States
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Insurance
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700 & Above Employee
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RN Case Manager
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Jul 2014 - Present
Medicaid case manager. Telecommuting
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RN Case Manager
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Aug 2011 - Jul 2014
Case Management for Lock In Program; Medicaid clients.
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Centene Corporation
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United States
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Hospitals and Health Care
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700 & Above Employee
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RN Case Manager
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Aug 2011 - Aug 2013
Case Management NurseED Diversion Team: Reduced emergency room visits by 13% and 2.4 million dollars.Case Management: Conduct Assessments, identify problems and barriers, as well as establish member set goals. Coordinate with appropriate resources to meet members’ needs and problem solve solutions. Concurrent Review: Review medical necessity of hospital inpatient admissions and continuations per Interqual Criteria. Worked with medical director in interpreting appropriateness of care and notifications of denials. Transplant Case Management: Case management of all transplant members prior to and post transplant to evaluate and assess for medical, psychological and social needs; assess for compliance to medications, and work with transplant teams of hospitals to promote healthy outcomes.OB High Risk Case Management: Assisted with management of OB cases in absences of CM. Trainer: Trained new staff on case management, care planning and use of computer software programs affiliated with Centene’s case management. Mentored new staff.
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Anthem, Inc.
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United States
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Hospitals and Health Care
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700 & Above Employee
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Condition Care Nurse
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Mar 2006 - Jan 2011
Conducted assessments, identified problems and barriers; established member set goalsCoordinated with appropriate resources to meet member’s needs and problem solved solutions.Increased adherence to recommended healthy lifestyles. Increased participation in self management for prevention of acute events.Improved adherence to evidence-based practices for management of Diabetes, CAD, COPD, Asthma, and Heart Failure.Proficient in HMC software.HealthCoachHealth Coach to specific account: focused on smoking cessation, as well as weight loss and lifestyle changes to promote better health. Time frames and penalties with a particular account.Outreached to member to integrate health information and management tools.Increased adherence to appropriate health care services.
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Hancock Regional Hospital
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United States
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Hospitals and Health Care
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1 - 100 Employee
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Clinical Supervisor
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Jul 2000 - Mar 2006
Nursing director for hospital and homecare agency. Supervised professional and auxiliary staff rendering patient care services. Nursing Director for Hospice for 3 years in absence of a director.Reviewed charts for quality assurance and adherence to federal, state and company regulations.Established working relationship with physicians to facilitate appropriate patient care
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Director of staff
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Dec 1999 - Jun 2000
Reviewed all charts for quality assurance and followed federal, state and company regulations.Branch was taken over by Winona Health Services of Indianapolis and served as clinical Coordinator from
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Branch Director
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Jan 1995 - Jan 1999
Established successful branch of homecare agency from parent office in Indianapolis.
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Education
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1984 - 1985
Eastern Kentucky University
Associate Degree, Registered Nursing/Registered Nurse
Community
