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
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
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
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
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
10.2000 - 02.2002
- Same duties as previous position
Director of Nursing
Sun Healthcare
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
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