Janice Knight
Griffin,GA
Summary
Clinical professional eager to bring talent and expertise to growing department.
Committed to building a strong team where staff is compliant with all regulatory and accreditation standards. Focused on developing teams' clinical knowledge, decision-making skills and performance standards. Proficient in conducting data analysis to identify opportunities for improvement.
Overview
26
26
years of professional experience
Work History
Clinical Program Coordinator
Cambia
Tacoma, WA
05.2004 - Current
- Conducted case audits to verify accuracy and compliance with regulations and accreditation.
- Analyzed data to identify risk of non compliance within the Utilization Management process.
- Collaborated with business owners to apply root cause analysis guidance and establish effective corrective action plans.
- Liaised with Medicare Compliance to ensure CMS Program audit preparedness.
Quality Program Clinician
Cambia Health Solutions
Tacoma, WA
01.2011 - 04.2018
- Updated and maintained documentation of the Quality-of-Care Complaint program.
- Recorded findings from quality audits of utilization timeliness and collaborated with business owners to resolve issues.
- Educated employees on specific URAC and NCQA standards and confirmed maintenance of standards.
- Developed and administered the Interrater reliability survey
Clinical Nurse Liaison
Kindred Hospital, LTAC
Seattle, WA
01.2003 - 04.2004
- Coordinated with interdisciplinary professionals to develop plans of care.
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Effectively communicated with health insurance case manager regarding patient needs, performance, and condition changes.
RN Utilization/Nurse Case Manager
Cigna
Seattle, WA
02.2002 - 09.2002
- Advocated for patients by communicating care preferences to practitioners, verifying interventions met treatment goals and identifying insurance coverage limitations.
- Effectively communicated with physicians regarding patient needs, performance, medications and changes.
- Evaluated healthcare needs, goals for treatment, and available resources of each patient and connected to optimal providers and care.
RN Utilization/Nurse Case Manager
PacMed Clinics
Seattle, WA
10.2000 - 02.2002
- Same duties as previous position
Director of Nursing
Sun Healthcare
Bellevue, WA
06.1997 - 01.2001
- Evaluated work performance of 50 nursing personnel to determine wage increases and implement discipline.
- Built and maintained positive working relationships with physicians and staff to support seamless healthcare operations.
- Oversaw and approved recruitment, hiring and orientation of new nursing staff.
Education
Bachelor of Science - Nursing
Kaplan University
Davenport, IAAssociate of Science - Nursing
Seattle Central Community College
Seattle, WASkills
- Clinical Quality Improvement
- Utilization Management
- Accreditation Coordination
- Regulatory and Statutory Compliance
- Critical Thinking
- Data Compilation
- Medicare Compliance
- Process improvements
Accomplishments
- Collaborated with team of 6 in the development of Annual Interrater reliability survey.
- Successfully navigated multiple Annual Data Validation audit without findings
- Achieved an average of 98% compliance with Medicare turnaround time through effectively working with business owners to identify opportunities for for improvements in UM process.
Timeline
Quality Program Clinician
Cambia Health Solutions
01.2011 - 04.2018
Clinical Program Coordinator
Cambia
05.2004 - Current
Clinical Nurse Liaison
Kindred Hospital, LTAC
01.2003 - 04.2004
RN Utilization/Nurse Case Manager
Cigna
02.2002 - 09.2002
RN Utilization/Nurse Case Manager
PacMed Clinics
10.2000 - 02.2002
Director of Nursing
Sun Healthcare
06.1997 - 01.2001
Bachelor of Science - Nursing
Kaplan University
Associate of Science - Nursing
Seattle Central Community College