Crystal Jackson Email & Phone Number

Oklahoma City, Oklahoma, United States

Oklahoma City, Oklahoma Area

Oklahoma City, Oklahoma Area

Frisco, Texas

o Work from home position requiring efficient time management and attention to details. o Coordinate UR process for each request over multiple jurisdictions. o Conduct initial review for medical necessity against approved evidence based guidelines. o Evaluate need for continued or alternative treatment with provider.o Discuss treatment options with requesting provider. o Document utilization review components within the system per state, federal and URAC requirements. o Facilitate peer discussion during physician advisor process or for peer discussion on non-certification. o Partner with medical providers to promote best patient outcomes.o Adhere to UR, Policies and Procedures, compliance and quality standards.

Oklahoma City, Oklahoma Area

o Oversaw case management clinical activities for approximately 8 nurses, both telephonic and field. o Responsible for financial operations, including but not limited to: productivity, profitability, expenses, budgeting, billing, collections and day to day operations for case management. o Assist with new business development, including marketing and sale activities. o Responsible for quality of service provided as related case management department and additional services offered by Corvel as an integral part of claims handling. o Performed daily, weekly, and monthly reviews of various reports, invoices, logs and expenses. o Performed random file audits on approximately 10-15 open files per month, providing nurses ongoing handling recommendations as need as well as positive feedback. o Performed individual case management responsibilities in the event of nurse absences and/or appointment conflicts.o Handled select few CAT referrals at discretion of clients.

Frisco, Texas

o Work from home position requiring efficient time management and attention to details. o Coordinate UR process for each request over multiple jurisdictions. o Conduct initial review for medical necessity against approved evidence based guidelines. o Evaluate need for continued or alternative treatment with provider.o Discuss treatment options with requesting provider. o Document utilization review components within the system per state, federal and URAC requirements. o Facilitate peer discussion during physician advisor process or for peer discussion on non-certification. o Partner with medical providers to promote best patient outcomes.o Adhere to UR, Policies and Procedures, compliance and quality standards.

Oklahoma

o Oversaw approximately 50-75 files as related to on-site client. o Conduct initial 3-point contacts: Employee, Provider and Adjuster/Supervisor.o Maintain up to date files per outlined client procedures, policies and objectives. o Implement care plans specific to patient’s injury. o Educate and instruct patient in regard to diagnosis/disability and treatment plan as well as answering any questions related to same. o Collaborate with clients and medical facilities to ensure medical compliance. o Participate in qualitative analysis as well as utilization review as indicated. o Facilitate communication with all treating parties to ensure development of a treatment plan appropriate for the patient within the scope of regulatory mandate/guidelines as well as attempting cost containment for employer. o Communicate and correspond with team members at all levels to keep apprised of current/ongoing medical conditions and return to work status.

Oklahoma City, Oklahoma Area

o Monthly claim monitoring from initiation to close for 32 states. o Prepared employee injury, liability and vehicle accident claims. o Obtained verbal statements from management, employee, customers and physicians. o Obtained medical reports and enter in key information into claim system. o Handled legal correspondence as indicated for specific files. o Prepared monthly reports for review of claim activity.o Review and process billing to release payments. o Review and monitor for legislative and case law updates.

Associate Of Science - As, Registered Nursing/Registered Nurse

Bachelor Of Business Administration - Bba, Marketing