BETH JONES
Bethel Park
Summary
Dedicated healthcare professional with strong patient advocacy and emotional support skills. Experienced in documentation and reporting, ensuring compliance with healthcare regulations while coordinating personalized care plans.
Overview
18
18
years of professional experience
1
1
Certification
Work History
Prior Authorization and Appeal Specialist
Panther Rare Pharmacy
Pittsburgh
05.2025 - Current
- Evaluated prior authorization requests for medical procedures and prescriptions.
- Developed workflows that improved operational efficiency.
- Communicated with healthcare providers to gather necessary documentation.
- Collaborated with pharmacy team to resolve authorization issues, ensuring timely patient access to medications.
- Reviewed and analyzed appeal documents to ensure compliance with regulatory standards and facilitate successful outcomes.
Clinical Case Manager
Gallagher Home Health Services
Pittsburgh
06.2024 - Current
- Coordinated care plans for patients based on individual health needs.
- Conducted home visits to assess patient conditions and monitor progress.
- Collaborated with interdisciplinary teams to ensure comprehensive patient care.
- Educated patients and families on disease management and treatment options.
- Documented patient interactions and care plans in electronic health records.
- Provided emotional support to patients and families during challenging times.
- Ensured compliance with healthcare regulations and quality standards in home settings.
SWAT Resource Registered Nurse
UPMC
Pittsburgh
04.2019 - 10.2024
- Assume responsibility for complex assignments with short notice -Collaborate with physician and care team to ensure quality patient care
- Guided staff and interdisciplinary team members to enhance collaboration and patient care.
- Strictly adhere to all policies and practices relative to patient care and hospital related information.
- Trained new nursing team members on hospital procedures, facilitating understanding and confidence in their roles.
- Prioritized nursing care after evaluating patients and determining severity of illnesses or injuries.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care, support and life-saving interventions.
- Assessed patient conditions and behaviors, communicating critical updates to supervising physicians to ensure timely interventions.
- Maintained strict patient data procedures to comply with HIPAA laws and prevent information breaches.
Nurse Navigator
Highmark Blue Cross Blue Shield
Pittsburgh
08.2022 - 05.2024
- Answered incoming patient calls, gathered history and symptoms to assess medical complaints' urgency.
- Analyzed symptoms according to established protocols to evaluate patient acuity and ensure appropriate care.
- Educated patients relative to health care urgency and community resources available to meet needs.
- Cultivated professional conduct operating under triage nursing care guidelines.
- Scheduled same-day or first-available appointments for urgent needs by coordinating provider availability in EPIC.
Travel Registered Nurse
Maxim Healthcare (AHN)
Pittsburgh
07.2022 - 10.2022
- Executed nursing tasks to ensure high-quality patient care while adhering to procedures and regulations.
- Performed comprehensive assessments to identify patient needs, devise care plans, modify care solutions and support patient rights.
- Collaborated with multidisciplinary healthcare professionals to administer therapies and maintain continuum of care.
- Instructed patients and families on medical and surgical procedures, medication regimens, and effective pain management strategies.
Nurse CTICU
St Clair Hospital Registered
Pittsburgh
01.2020 - 07.2022
- Assess and manage critically ill cardiothoracic patients in the postoperative phase following chest surgery such as CABG, valve repairs, post cardiac cath, VATS procedures -Manage equipment such as ventilators, chest tubes, surgical drains, cardiac output monitoring, balloon pumps, multiple vasoactive drips -Participate in daily multidisciplinary rounds and collaborate with multiple disciplines
- Facilitated recovery for patients following bypass, angioplasty, and pacemaker procedures, ensuring optimal healing and comfort.
- Communicated patient conditions, procedures, and treatment protocols to patients and families, enhancing understanding and engagement in care.
- Monitored patients' vital signs using electrocardiograms in telemetry labs.
- Provided critical nursing care to cardiac patients in post-operative recovery units, closely monitoring progress and responding to needs.
Registered Nurse Case Manager
Gallagher Hospice
Pittsburgh
02.2018 - 07.2020
- Maintaining healthy working relationship between facility’s nursing staff and administration -Communicating with interdisciplinary team and hospice nursing staff to understand the challenges faced in emergency situations for long-term patients -Establish and implement goals and outcomes to meet standards of quality care -Providing advice to patients' families on progress of the disease, symptom management, and end of life care -Capable of communicating patient's pain or comfort level to the specialist doctor, and preparing concise report based on responses after administering medicines
- Listened to patients and loved ones, offering emotional support and kindness to help with end-of-life transition.
- Guided patients' loved ones and caregivers in pain management, wound care and medication dosing.
- Represented patient needs within interdisciplinary team meetings, ensuring effective implementation of treatment plans.
- Evaluated nursing notes to confirm completeness and accuracy of descriptions outlining nursing care provided and corresponding patient responses.
Hairdresser
Ultimate Hair Care
10.2008 - 12.2018
- Maintained clean and sanitary work environment to ensure customer and staff safety.
- Stayed up-to-date on current and emerging trends to increase professional value and meet diverse client needs.
- Responded to customer inquiries by phone, email and in person.
- Curated hair colors, products, and services tailored to customer preferences and personalized hair care plans.
- Advised on styles and treatments aligned with clients' needs and desired appearances.
Registered Nurse
St Clair Hospital
Pittsburgh
04.2017 - 10.2018
- Medical surgical /Telemetry/Stroke unit.
- Participated in bedside reporting and handoff at change of shift and for patient transfers.
- Assessed and prepared patients for procedures, performing initial and ongoing patient assessments.
- Updated physicians on patient test results and assisted in developing care plans.
- Collaborated with multi-disciplinary staff to improve overall patient care and response times.
Registered Nurse, Medical-Surgical Unit
UPMC Presbyterian, RN Medical, Unit
Pittsburgh
05.2016 - 05.2017
- Surgical/ Step- down
- Administered medications and treatments as directed and as appropriate for patient's medical care in collaboration with multi-disciplinary team.
- Updated physicians on patient test results and assisted in developing care plans.
- Performed blood and blood product transfusions and intravenous infusions to address patient symptoms or underlying causes.
- Collected lab specimens, ordering and interpreting diagnostic tests and lab results.
- Maintained thorough, accurate and confidential documentation in electronic medical records.
Skill Nursing Facility RN Unit Manager
Country Meadows
Bridgeville
09.2015 - 05.2016
- Applied clinical judgment and comprehensive knowledge of facility policies to assist floor nurses with patient care decisions.
- Received and investigated complaints from families, patients and clinical staff, devising solutions to multifaceted challenges.
- Evaluated patient needs and preferences to build and update tailored treatment plans.
- Supervised nurse administration of oral, intramuscular and IV medications to patients as prescribed, monitoring responses for adverse reactions.
- Monitored staff performance and provided coaching and formal counseling to staff.
- Provided case management, milieu management and emergency intervention.
- Provided strong leadership and guidance to nurses.
- Established and maintained positive relationships with residents, physicians, hospital staff, patients and families.
Education
Master of Science - Healthcare Administration
Capella University
08-2026
Bachelor of Science - Nursing
Ohio University
Athens, OH01-2020
Associate of Science - Nursing
Community College of Allegheny County
Pittsburgh, PA01-2015
Cosmetology - Cosmetology
South Hills Beauty Academy
Pittsburgh, PA09-2008
Skills
- Documentation and Reporting
- Accurate Documentation
- Data analysis
- Data compilation
- Healthcare Team Collaboration
- Patient Advocacy
- Patient communication
- Adaptable and Flexible
- Emotional Support
Certification
- Registered Nurse (Pennsylvania 2015-current) CPR certified
Child Abuse and Criminal Background Clearances
Additional Information
- Pennsylvania Cosmetology License (2008-current)
Timeline
Prior Authorization and Appeal Specialist
Panther Rare Pharmacy
05.2025 - Current
Clinical Case Manager
Gallagher Home Health Services
06.2024 - Current
Nurse Navigator
Highmark Blue Cross Blue Shield
08.2022 - 05.2024
Travel Registered Nurse
Maxim Healthcare (AHN)
07.2022 - 10.2022
Nurse CTICU
St Clair Hospital Registered
01.2020 - 07.2022
SWAT Resource Registered Nurse
UPMC
04.2019 - 10.2024
Registered Nurse Case Manager
Gallagher Hospice
02.2018 - 07.2020
Registered Nurse
St Clair Hospital
04.2017 - 10.2018
Registered Nurse, Medical-Surgical Unit
UPMC Presbyterian, RN Medical, Unit
05.2016 - 05.2017
Skill Nursing Facility RN Unit Manager
Country Meadows
09.2015 - 05.2016
Hairdresser
Ultimate Hair Care
10.2008 - 12.2018
Bachelor of Science - Nursing
Ohio University
Associate of Science - Nursing
Community College of Allegheny County
Cosmetology - Cosmetology
South Hills Beauty Academy
Master of Science - Healthcare Administration
Capella University