Diane Jackson
Acworth
Summary
Experienced Registered Nurse with 5+ years in acute care and 20+ years as a case manager specializing in care management and utilization review. Background includes intermediate neurosensory intensive care, cardiac progressive care, home health, hospice, psychiatric nursing, and clinical trials. Skilled in telephone and email communication, Microsoft Office programs. Strong advocate for patient needs, prioritizing preventative care and health education. Organized and dependable with ability to manage multiple priorities and take on added responsibilities to achieve team goals.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Care Manager
Strategic Staffing Solutions
09.2024 - Current
- Use the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize health across the care continuum.
- Assess health, psychosocial needs, cultural preferences and support systems.
- Engage to develop an individualized plan of care, address barriers, identify gaps in care and promote improved overall health outcomes.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Post Acute Care Nurse
CareCentrix
07.2023 - 12.2023
- Maintained detailed records of patient interactions, observations, treatments performed, resulting in thorough documentation for medical reviews.
- Boosted accuracy in clinical decision-making by providing detailed analysis of medical records for physicians and nursing staff involved in utilization review processes.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Conducted utilization review to verify medically necessary care is received in correct setting.
- Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
Post Acute Care Nurse
Actalent Solutions
12.2022 - 07.2023
- Maintained detailed records of patient interactions, observations, treatments performed, resulting in thorough documentation for medical reviews.
- Boosted accuracy in clinical decision-making by providing detailed analysis of medical records for physicians and nursing staff involved in utilization review processes.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Conducted utilization review to verify medically necessary care is received in correct setting.
- Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
Medical Review Nurse
Talent Software Services
12.2021 - 10.2022
- Maintained detailed records of patient interactions, observations, treatments performed, resulting in thorough documentation for medical reviews.
- Boosted accuracy in clinical decision-making by providing detailed analysis of medical records for physicians and nursing staff involved in utilization review processes.
- Served as a liaison between healthcare providers, insurance companies, and patients for efficient resolution of coverage issues or denials following a utilization review assessment.
- Conducted utilization review to verify medically necessary care is received in correct setting.
- Reduced instances of denied claims due to insufficient documentation by meticulously verifying the accuracy of all submitted materials during the utilization review process.
- Provided accurate documentation of all utilization review findings, ensuring a clear audit trail for future reference or analysis.
- Assisted in maintaining regulatory compliance by staying up-to-date on Medicare, Medicaid, and commercial insurance requirements for utilization review activities.
Medical Review Nurse
TurningPoint Healthcare Solutions
11.2020 - 07.2021
- Determined and authorized services for patients in accordance with guidelines and regulations.
- Served as a liaison between healthcare providers and insurance companies, providing essential information to facilitate informed decision-making processes efficiently.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Collaborated with multidisciplinary teams to resolve complex clinical issues and ensure appropriate utilization of services for each patient.
- Facilitated timely claim resolution for patients by collaborating with insurance companies and healthcare providers.
Clinical Care Coordinator
Northside Hospital Forsyth
06.2018 - 11.2020
- Use the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize health across the care continuum.
- Assess health, psychosocial needs, cultural preferences and support systems.
- Engage to develop an individualized plan of care, address barriers, identify gaps in care and promote improved overall health outcomes.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Case Manager
Highmark Delaware
09.2016 - 12.2017
- Use the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize health across the care continuum.
- Assess health, psychosocial needs, cultural preferences and support systems.
- Engage to develop an individualized plan of care, address barriers, identify gaps in care and promote improved overall health outcomes.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Emergency Room Case Manager
Union Hospital of Cecil County-Christiana
10.2013 - 09.2016
- Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.
- Promoted a safe environment for vulnerable populations by reporting suspected abuse or neglect.
- Improved client outcomes by developing and implementing comprehensive case plans tailored to individual needs.
- Conducted thorough assessments to identify client needs, laying groundwork for effective case management.
- Managed crisis situations with empathy and professionalism, ensuring client safety and continuity of care.
- Coordinated with healthcare providers to ensure clients had access to necessary medical services, enhancing their overall well-being.
- Collaborated with mental health professionals to address psychological needs of clients, supporting their holistic recovery.
- Obtained authorizations from multiple insurance carriers for various levels of care.
- Performed admission reviews based on medical necessity.
Case Manager
Highmark Delaware
10.2010 - 10.2013
- Use the case management process to assess, develop, implement, monitor and evaluate care plans designed to optimize health across the care continuum.
- Assess health, psychosocial needs, cultural preferences and support systems.
- Engage to develop an individualized plan of care, address barriers, identify gaps in care and promote improved overall health outcomes.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Monitored ongoing cases closely, adjusting case management strategies as needed based on evolving circumstances or new information.
Education
Associates of Applied Science - Nursing
Cecil College
North East, MD05.1989
Skills
- Care Management
- Discharge Planning
- Utilization Review
- Knowledge of NCQA
- Knowledge of Medicare/Medicaid
- EMR Systems
- Resource Coordination
- Microsoft Office
- Medical Terminology
- Time Management
- Collaboration
- Advocacy
- Cultural Competency
- InterQual utilization
Accomplishments
Award For Clinical Excellence
'Cecil College 1997
Certification
Georgia Board of Nursing
Compact License
License Number: RN271996
Expiration Date: 2026-01-31
The Commission for Case Management Certification
Certification Number: 93449
Expiration Date: 2026-05-31
Timeline
Care Manager
Strategic Staffing Solutions
09.2024 - Current
Post Acute Care Nurse
CareCentrix
07.2023 - 12.2023
Post Acute Care Nurse
Actalent Solutions
12.2022 - 07.2023
Medical Review Nurse
Talent Software Services
12.2021 - 10.2022
Medical Review Nurse
TurningPoint Healthcare Solutions
11.2020 - 07.2021
Clinical Care Coordinator
Northside Hospital Forsyth
06.2018 - 11.2020
Case Manager
Highmark Delaware
09.2016 - 12.2017
Emergency Room Case Manager
Union Hospital of Cecil County-Christiana
10.2013 - 09.2016
Case Manager
Highmark Delaware
10.2010 - 10.2013
Associates of Applied Science - Nursing
Cecil College
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