Jeanette Israel
Spartanburg
Summary
Dedicated and results-driven Registered Nurse (MSN) and Certified Case Manager with over 10 years of diverse clinical and leadership experience. Expertise in Complex Care Management, Care Coordination, Behavioral Health, Diabetes, and Transitions of Care. Proven ability to supervise multidisciplinary teams, maintain regulatory compliance (State, NCQA, CMS), oversee daily unit operations, drive reporting, and deliver exceptional patient-centered care. Proficient in Microsoft Office Suite, excel, and PowerPoint with excellent organizational, decision-making, and communication skills.
Overview
14
14
years of professional experience
Work History
RN-Corporate Clinical and Delegate Auditor
AmeriHealth Caritas
01.2017 - Current
- Corporate Clinical and Delegate Auditor (2022–Present)
- Develop and implement audit tools; conduct internal and external audits for Medicare and Medicaid delegates in alignment with CMS, State, and NCQA standards.
- Review clinical documentation for compliance, identify deficiencies, and initiate corrective action plans to address performance gaps.
- Educate delegates on contract and regulatory requirements, serving as a subject matter expert on compliance expectations.
- Collaborate with interdisciplinary teams and management to enhance operational performance and ensure quality standards are met.
- Care Coordinator / Case Manager (2017–2022)
- Served as primary point of contact for members and their care teams to coordinate medical, behavioral, and social services across the continuum of care.
- Conducted health risk assessments and developed individualized, person-centered care plans addressing clinical and social determinants of health.
- Managed transitions of care and long-term support services, ensuring continuity and quality outcomes.
- Mentored new staff, created job aids, supported leadership with data analysis, and assisted with caseload assignments.
- Recognized as a subject matter expert in Transitions of Care, Home & Community-Based Services, and Plan of Care processes.
Wound Care & Cardiovascular Surgery RN
Greenville Health System
06.2013 - 03.2016
- Specialized in chronic disease management including diabetic wounds and surgical wound care; conducted staff education on pressure injury prevention and treatment.
- Provided pre-op and post-op care for cardiovascular surgical patients, managing complex clinical interventions (chest tubes, critical drips).
Case Manager and Wound Care Nurse
Regency Hospital LTACH, Select Medical Corporation
01.2011 - 01.2015
- Managed complex case management, discharge planning, and insurance updates; led interdisciplinary team meetings to coordinate long-term acute care.
- Served as wound care resource nurse; collaborated with surgeons during bedside wound debridement procedures.
- Precepted new staff and student nurses, contributing to staff development and training initiatives.
Education
MSN -
Capella University
02.2025
Skills
- Staff Supervision & Mentoring
- Unit Operations Oversight
- Clinical Risk Identification and Management
- NCQA, CMS, and State Regulatory Compliance
- Care Management for to include Diabetes and Behavioral Health
- Problem Solving and Process Improvement
- Interdisciplinary Collaboration and Advocacy
- Reporting and Data Analysis
- Member and Family Empowerment
- Microsoft Word
- Microsoft Excel
- Microsoft PowerPoint
- Microsoft Access
- Case Management Systems
- Typing Speed: 50 WPM
Commitment To Diversity Equity And Inclusion
Dedicated to fostering an inclusive environment where members, families, and staff feel valued, respected, and empowered to succeed. Advocate for breaking down barriers to care through culturally sensitive coordination and communication.
Degree
BSN, RN, CCM
Leadership And Core Competencies
- Staff Supervision & Mentoring
- Unit Operations Oversight
- Clinical Risk Identification and Management
- NCQA, CMS, and State Regulatory Compliance
- Care Management for to include Diabetes and Behavioral Health
- Problem Solving and Process Improvement
- Interdisciplinary Collaboration and Advocacy
- Reporting and Data Analysis
- Member and Family Empowerment
Licensure And Certification
- Registered Nurse, Unrestricted, South Carolina
- Certified Case Manager (CCM), 01/01/19
- MSN, Capella University, 02/01/25
Timeline
RN-Corporate Clinical and Delegate Auditor
AmeriHealth Caritas
01.2017 - Current
Wound Care & Cardiovascular Surgery RN
Greenville Health System
06.2013 - 03.2016
Case Manager and Wound Care Nurse
Regency Hospital LTACH, Select Medical Corporation
01.2011 - 01.2015
MSN -
Capella University
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