Crystal Cox

Experience

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  Capital Region Medical Center

  Jun 2005 - Sept 2016

  - Provided nursing care to a team of 5 to 7 medical-surgical patients, performing daily dressing changes, dispersing medications, administering blood products, and educating patients.- Served as a rotational charge nurse on the unit and performed tasks including assisting other nurses, determining staff numbers using staffing matrix, identifying additional staff, and maintaining an optimal, professional work environment.- Delegated tasks appropriately and communicated effectively to staff and physicians. - Cross trained in the recovery room, cardiac step down unit, rehab, PACU, and outpatient services. - Precepted new employees and nursing students with necessary educational requirements of the medical-surgical floor.- Participated in the Mentoring Program for New Nurses, Wound Care Team, and Unit Council. Show less

  • Registered Nurse

    Dec 2007 - Sept 2016

  • Nurse Extender

    Jun 2005 - Dec 2007
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  SURGICARE OF MISSOURI, P.C.

  Jan 2009 - Jan 2010

  Registered Nurse

  - Assessed patients accurately to assist physicians with determining a proper diagnosis.- Assisted general surgeons with daily clinical procedures and data collection for a national hernia study.- Effectively communicated with physicians to provide appropriate care to approximately 40 patients daily.- Acquired the ability to work under stressful conditions and developed appropriate team leading skills.

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  Columbia College

  Jan 2012 - Aug 2012

  Nursing Instructor

  - Contributed leadership and guidance as a mentor to several nursing students and guided them in appropriate nursing techniques for the medical-surgical rotation. - Instructed students primarily in the clinical setting. - Assisted with analyzing students’ abilities on a clinical and classroom level.- Provided an environment to facilitate student growth and development.

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  Missouri Department of Social Services

  Sept 2014 - Sept 2016

  Clinical Operations Registered Nurse

  - Monitored and Evaluated MO HealthNet Managed Care health plan compliance with contract requirements for Behavioral and Physical Health Case Management, Utilization Management, Appeals, Denials, and Grievances. - Provided highly skilled and complex nursing acumen on a professional and administrative level utilizing nursing theory, practices, and standards of care, in addition to working knowledge of management principles and techniques to manage daily MO HealthNet Division (MHD) functions.- Presented statistical data to Missouri Managed Care Organizations, stakeholders and other affiliated associations at the Quarterly Quality Assessment and Improvement meetings as needed.- Provided quality oversight of the three Missouri Managed Care Health Plans.- Assisted in the development of policies for the new Intensive Behavioral Therapy Program for Obesity and Asthma Education and In-Home Environmental Assessment Programs for Medicaid population.- Worked with a group of healthcare professionals to develop the State Plan Amendments and Regulation for Asthma Program and Obesity Program.- Served as the liaison for Centers for Medicare and Medicaid Services, National Committee for Quality Assurance, and Managed Care and Fee-for Service providers for MHD.- Assisted with providing clinical oversight for the Program of All-Inclusive Care for the Elderly.- Provided oversight for the Missouri Lead Program in conjunction with the Missouri Department of Health and Senior Services. Show less

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  Community Foundation of Northwest Indiana

  Oct 2016 - Oct 2018

  Nurse Care Navigator

  - Provided care management, utilization management, and disease management services to patients identified as high risk.- Identified barriers and connected patients to necessary resources to empower them to self-navigate the healthcare system and be able to self-manage their conditions.- Coordinated services between Primary Care Physicians, specialists, durable medical equipment (DME) providers, case managers, and out-of-network providers.- Assisted with starting care management programs and processes for new contracts including Medicare ACO, Transitional Care Management, Blue Cross Blue Shield of Illinois HMO, and Prairie States- Assisted with finding ways to lower costs for the health plan. - Utilized Healthcare Effectiveness Date and Information Set (HEDIS) guidelines to help guide best clinical practices amongst our providers.- Trained all new staff members on care management policies and procedures. Show less

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  WellCare Health Plans

  Oct 2018 - Jun 2019

  Field Nurse Care Manager
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  Home State Health Plan, Inc.

  Jul 2019 - now

  • Senior Manager Care Management

    Apr 2024 - now

  • Manager, Care Management

    Jul 2022 - Apr 2024

  • Case Management Supervisor

    Aug 2020 - Aug 2022

  • Case Manager II

    Jul 2019 - Aug 2020