Cristal Jones

Cristal J.RN

Appeals Nurse

Grievances and Appeals

How long have you worked at Neighborhood, what do you do here and what part of your job do you most enjoy?
This April marked my 14-year anniversary at Neighborhood! I currently work as an appeals nurse in the Grievances and Appeals department. I enjoy working with my coworkers and being a part of the positive energy in our department – it’s so motivating and makes me look forward to going to work every day. I also enjoy the support from my team leaders who have encouraged me and helped me with my professional development. Another aspect of my job that I find fulfilling is collaborating with other departments as this has prepared me to take on more challenging opportunities.

At Neighborhood’s 2012 Gala, Cristal flashes a smile with Yvonne Heredia (front left), senior manager of care management for the Case Management department, and Maria Monteiro (front right), medical management supervisor for the Case Management department.

What did you do before joining Neighborhood?  
Before joining Neighborhood, I worked as a staff nurse at Rhode Island Hospital for four years. Prior to this, I worked at a nursing home as a certified nursing assistant (CNA) for about 17 years. Working as a CNA was particularly helpful in preparing me for my nursing career as it taught me how to be more caring and compassionate for others who are in need. When I first joined Neighborhood in April 2008, I worked as a telephonic case manager and then transitioned to the Utilization Management department after two years. This role helped prepare me to be an effective appeals nurse as it got me acclimated to working in an intensive, fast-paced environment that ensured health care services were delivered with improved member outcome and quality. It also gave me the opportunity to improve my organizational skills and my ability to interact well with others in any situation.

Of all the projects you have worked on at Neighborhood, which one stands out as being especially meaningful to you?
Our Oncology Pathway Solutions, New Century Health program that went live about two years ago, is a project that stands out as being especially meaningful as my manager delegated this project to me before going out on leave. New Century Health is a national leader in specialty care management known for its comprehensive oncology specialty management services. Neighborhood partnered with New Century Health to ensure our members have access to evidence-based oncology and hematology care and to simplify the administrative process for providers to deliver this care. This project was very challenging and although I was initially uncomfortable with taking it on, I became comfortable with being uncomfortable and this, I believe, was important to my professional growth. Working on this project was also rewarding since the program is truly making a difference by giving our members access to the best oncology care possible and by improving efficiencies at Neighborhood. As a purpose-oriented organization, it was such a pleasure to work with leaders in other departments and develop a great partnership around this project. My manager recognized my potential and the value of my work and knew I would be able to execute our team’s deliverables for this project during her leave.

Tell us a little bit about the years you spent growing up – sharing what helped shaped your future.  
I grew up in Washington Park in Providence, Rhode Island and was fortunate to receive inspiration at an early age from my faith and from my favorite aunt. My Aunt Diana worked for years in a nursing home and was able to get me a job there as a teenager. I worked in the kitchen as a dietary aid and quickly grew close to the residents – they became like family to me and I loved being a part of taking care of them. I also enjoyed watching my aunt and other staff being so compassionate and caring to the residents and this inspired me to become a CNA. I knew that by becoming a CNA I could play a more direct role in caring for the residents so, when I was 18, I trained to become a CNA and wound up working at the nursing home for 17 years! It was such a rewarding position, especially when family members came to visit and thanked me for taking such great care of their loved ones.

I am incredibly passionate about caring for people and this passion drove me to take my career even further – especially after my daughter was born with significant health issues. It was a scary and stressful time but I somehow managed in my late twenties/early thirties to earn a nursing degree from the Community College of Rhode Island (CCRI) while caring for my daughter, going to school full time and working two 17-hour shifts on weekends. I knew I had to make certain sacrifices to make a good life for my daughter and me and, in order to do this, I wanted to stay true to my hopes and dreams. I leaned on my faith to give me the strength to get through this very challenging time and graduated from CCRI in 2004 with an Associate of Science in Nursing. I am where I am today because of my faith in God, my willingness to make sacrifices, and early inspiration from my Aunt Diana. I always saw a light at the end of the tunnel and because of this, I am who I am today – very happy at Neighborhood and incredibly thankful to have a 21-year-old daughter (the love of my life) whose health has improved greatly.

Cristal as a first-grader at Broad Street School in Providence.
Cristal’s pinning ceremony at CCRI; Cristal is joined by her mother. The pinning ceremony is a time-honored nursing school tradition that takes place prior to the commencement ceremony. 

Do not be afraid to make mistakes and stop beating yourself up because of yesterday’s mistakes. Also, never give up because giving up is not an option. Look forward and leave negative things behind. This advice helped me realize that we are human and we are not perfect. It has also shown me to rise above past mistakes and failed approaches and to stay focused on my goals and dreams. It is so important to pick ourselves up, dust ourselves off, and try again until we succeed. There is only one failure, and that is to give up on trying. I have learned how to become my best self by never giving up on my vision.

What do you like to do when you’re not working?
When I am not working, I love going to church, being involved in the ministry and hanging out with friends, going to dinner, chatting on the phone and going on 3-mile walks. And I would be remiss if I didn’t mention how much I LOVE to sing! Over the years, I have sang at events, church gatherings and, of course, at home. My daughter has picked up this gift and I really enjoy listening to her. 

Signage of a ministry Cristal is actively involved with. Through her work with this ministry, Cristal provides support to women who are or have been victims of domestic violence.
Cristal and her daughter Alexandra “Lexi” cross the finish line together at the 2017 Gloria Gemma Flames of Hope Walk.
Newspaper clipping showing Cristal and fellow members of the Holy Cross Church Gospel Choir participating in the 1997 Presidential Inaugural Parade.

What advice or recommendations would you give to someone interested in the type of career you are in?
Never stop learning, know that there will be challenges, go in the direction that makes you want to do your best, do not get behind on your work, discipline yourself, be a team player because it takes a team to do the best work. Be caring and compassionate because this will carry you through the difficult times. Last, remember why you were interested in this type of career to begin with and be assured that a career as a nurse will be fulfilling!

Posted July 22, 2022