Shannon Jones
Lexington
Summary
Award-winning healthcare leader with a proven track record of spearheading transformative initiatives and fostering strategic partnerships. Recognized for optimizing care management, quality improvement, and regulatory compliance in managed care and inpatient health settings. Adept at driving operational efficiency and delivering exceptional outcomes through innovative programs and collaborative relationships. Skilled in strategic planning, utilization management, and team leadership. Committed to achieving organizational excellence while adhering to federal and state regulations.
Overview
14
14
years of professional experience
1
1
Certification
Work History
Case Manager
Halifax Healthcare
09.2024 - Current
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
- Coordinated services with other agencies, community-based organizations, and healthcare professionals to provide useful benefits to clients.
- Assisted clients in navigating housing, legal services and public benefits to gain access to valuable resources.
- Developed and implemented comprehensive case management plans to address client needs and goals.
Regional Director Market Liaison
CareSource
05.2023 - 08.2024
- Spearheaded oversight of operational policies, procedures, and clinical content across assigned markets. Collaborated closely with care management leadership to ensure alignment with standardized models and regulatory standards, minimizing variance within care management teams. Developed and implemented portfolio strategies to optimize resources for new and existing markets, facilitating coordination and delivery of care programs. Managed 1 Program Manager, ensuring adherence to operational policies and fostering continuous improvement. Played a key role in determining benchmarks, goals, and outcomes for programs, driving success in meeting contractual requirements, and addressing high-cost, high-volume, and high-risk conditions. Actively participated in new business activities, including RFP processes and implementation, contributing to the expansion and effectiveness of CareSource initiatives.
Senior Director, Medical Management
Centene WellCare Health Plan of Kentucky
09.2011 - 05.2023
- Developed and implemented the quality improvement plan within regional markets involves a strategic alignment with organizational goals, federal and state regulations, and accreditation standards. Established robust professional relationships with state entities, stakeholders, and community agencies, facilitating seamless quality processes internally and externally. Analyzed and enhanced Standard Operating Procedures (SOPs), elevating service delivery from the quality improvement department. Directed complex project demands and innovative approaches, ensuring effective execution of quality, case management, and utilization management initiatives. Headed and nurtured a team of management personnel and case managers consisting of 5 senior managers, 2 supervisors, 40 medical CM, and 12 BHCM.
Senior Director, Field Service Coordination, State of Kentucky
Centene WellCare Health Plan of Kentucky
03.2020 - 03.2020
- Led with visionary prowess in developing and executing operational strategies to mitigate high utilization of inpatient and ED services, setting the gold standard in member care. Helmed a multidisciplinary team of 7 managers, 2 supervisors, and 47 CMs, overseeing various facets of case management, achieving unparalleled success in member outcomes and operational efficiency.
Director of Field Service Coordination, State of Kentucky
Centene WellCare Health Plan of Kentucky
03.2013 - 03.2017
- Played an instrumental role in the launch of the WellCare Health Plan of Kentucky, setting the cornerstone for operational excellence and quality member care. Championed innovative solutions to optimize member outcomes amidst high utilization of inpatient and ED services.
Manager of Field Service Coordination, Region 8
Centene WellCare Health Plan of Kentucky
09.2011 - 03.2013
- Orchestrated groundbreaking initiatives to reduce inpatient and ED service utilization. Constructed and implemented operational plans for contract requirements, resulting in improved member outcomes and cost savings. Pioneered the Lead Assignment Warehouse, adopted statewide for targeted outreach to high-acuity members. Formed collaborative teams of 5 FTEs, reducing ED rates and strategically deployed member outreach coordinators for increased program engagement and cost savings.
Education
Associate of Science - Nursing
Eastern Kentucky University
01.1996
Skills
- Microsoft Office (Word, Excel, PowerPoint, Outlook, Teams, Visio, OneNote) Social Media Management (FB & Instagram) EMMA
- Patient support
- Utilization review
- Individualized counseling
- HIPAA compliance
- Risk assessment
- Verbal and written communication
- Care coordination
- Staff management
- Patient needs assessment
- Discharge planning
- Family education
- Resource management
- Critical thinking
Accomplishments
- Strategic Leadership & Operational Excellence:
- Led transformative initiatives to triple the number of Transition of Care (TOC) nurses, resulting in a 2% reduction in readmission rates within 90 days of implementation.
- Established specialized NICU case management teams, achieving a 24% increase in case management acceptance rates and significantly reducing inpatient LOS.
- Developed and launched innovative medical and pediatric case management programs, providing vital support to 200+ complex behavioral health and medically complex members.
- Formed strategic partnerships with the University of Kentucky, driving the development of a successful transitional care program, which led to statewide outreach initiatives.
- Operational Excellence & Process Improvement:
- Implemented measures that resulted in a 2% decrease in inpatient Emergency Department (ED) service utilization, aligning with organizational goals and optimizing resource allocation.
- Received prestigious corporate awards, including the "Excellence Award 2020" and "Health Navigation Award 2019," for outstanding leadership and innovation in member outreach and process streamlining.
- Enhanced member participation in case management by improving communication effectiveness, resulting in a significant reduction in the "unable to reach" rate from 60% to 35%.
- Acknowledged with "Associate Engagement Champion Award 2017" for achieving 96% employee engagement.
- Recognized with "Integrity Award 2017" for designing and implementing new case management programs.
- Strategic Partnership Development:
- Established key partnerships with stakeholders and community agencies, facilitating quality processes internally and externally in alignment with organizational goals.
- Negotiated strategic agreements and contracts, contributing to increased market penetration and revenue growth.
Certification
Commission for Case Manager Certification (#4218591)
CORE COMPETENCIES
Strategic Planning | Quality Improvement | Utilization Management | Case Management | Regulatory Compliance Team Leadership | Program Development | Healthcare Analytics | Partnership Building
ADDITIONAL RELEVANT EXPERIENCE
- Appalachian Regional Healthcare | Lexington, KY
- Nurse Manager, Surgical Unit, Hazard
- Nurse Manager, Psychiatric Unit, Hazard
- House Supervisor, Hazard
- Nurse, Utilization Review, Hazard
- Surgical Nurse, Hazard
- Home Health, McDowell
- Nurse, ICU Nurse, McDowell
Timeline
Case Manager
Halifax Healthcare
09.2024 - Current
Regional Director Market Liaison
CareSource
05.2023 - 08.2024
Senior Director, Field Service Coordination, State of Kentucky
Centene WellCare Health Plan of Kentucky
03.2020 - 03.2020
Director of Field Service Coordination, State of Kentucky
Centene WellCare Health Plan of Kentucky
03.2013 - 03.2017
Senior Director, Medical Management
Centene WellCare Health Plan of Kentucky
09.2011 - 05.2023
Manager of Field Service Coordination, Region 8
Centene WellCare Health Plan of Kentucky
09.2011 - 03.2013
Associate of Science - Nursing
Eastern Kentucky University
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