Summary
Overview
Work History
Education
Skills
Certification
Timeline
Generic

Janice Scales

Memphis,TN

Summary

Qualified OASIS/Quality Review Specialist with solid background in review processes and quality assurance. Successfully contributed to enhancing operational efficiency and accuracy through detailed analysis. Demonstrated skill in critical thinking and communication to ensure thorough and accurate reviews.

Overview

15
15
years of professional experience
1
1
Certification

Work History

QUALITY REVIEW SPECIALIST

LHC Group
02.2021 - Current

COS-C Certified Quality Review Specialist

Patient Care Manager

Registered nurse-Field clinician

  • Collaborated with interdisciplinary healthcare team to develop and implement individualized care plans for patients
  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately in medical records
  • Managed multiple priorities effectively in a fast-paced environment while maintaining attention to detail
  • Participated in quality improvement initiatives aimed at enhancing patient outcomes and safety measures within the unit/department
  • Participated in interdisciplinary team meetings to discuss patient progress, goals, and discharge planning

Registered Nurse Case Manager

CUSTOMIZED MEDICAL NEEDS
04.2015 - 12.2023
Registered Nurse

Customized Medical Needs - Memphis, TN

April 2015 to December 2023

I was responsible for the supervision and coordination of clinical services. Provided and directed provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies.

  • Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities
  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately
  • Administered treatments and procedures as ordered by physicians, ensuring adherence to established protocols
  • Maintained accurate documentation of all nursing interventions, medications administered, and patient responses
  • Collaborated with social workers and case managers to coordinate post-hospital care for patients requiring additional support

Registered Nurse Case Manager

MY FAITH INC
04.2015 - 12.2023
Registered Nurse

My Faith Inc - Memphis,

April 2015 to December 2023

I was responsible for the supervision and coordination of clinical services. Provided and directed provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies.

  • Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities
  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately
  • Administered treatments and procedures as ordered by physicians, ensuring adherence to established protocols
  • Maintained accurate documentation of all nursing interventions, medications administered, and patient responses
  • Collaborated with social workers and case managers to coordinate post-hospital care for patients requiring additional support

Registered Nurse Case Manager

HUMANA
04.2015 - 06.2020

Registered Nurse

Humana - Northwest, Arkansas, US

April 2015 to June 2020

Arkansas Health & Wellness TN, MS, & AR

Care manager/RN that assisted, educated, & guided Humana members in improving their care in the comfort of their homes. Services included case management, referrals, community resources, and direct PCP communication.

  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately
  • Managed and prioritized multiple patient assignments effectively in a fast-paced environment
  • Monitored patient progress closely, identifying any changes in condition or potential complications
  • Collaborated with pharmacy staff to verify medication orders accuracy and resolve any discrepancies or issues promptly
  • Collaborated with healthcare team members to develop comprehensive discharge plans that met patients' needs

Registered Nurse

Quest Diagnotics
04.2015 - 03.2018

Registered Nurse

Quest Diagnostics Memphis TN - Memphis, TN

April 2015 to March 2018

Provide coverage in the field ensuring that health screenings are completed accurately and on time.  Maintain a safe and professional environment for clients and employees; perform with confidence all aspects of a health screening, including specimen collection and processing duties following established practices and procedures. Contracted Public Health Fairs for Companies to include health screenings, B/P, HT, WT, Glucose, and Cholesterol Testing.

  • Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities
  • Managed and prioritized multiple patient assignments effectively in a fast-paced environment
  • Maintained accurate documentation of all nursing interventions, medications administered, and patient responses
  • Counseled patients on lifestyle modifications necessary for managing chronic conditions such as diabetes or hypertension
  • Maintained confidentiality of patient information in accordance with HIPAA regulations

Registered Nurse

MISSISSIPPI COUNTY HOSPITAL SYSTEMS
01.2010 - 12.2015
Registered Nurse

Mississippi County Health Systems - Osceola, AR

January 2010 to December 2015

MED-SURG UNIT- Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes & treatments. Care and treatment plan provided to patients including but not limited to ADHD, Oppositional disorder, bipolar/manic disorder, depression, anxiety disorders, OCD, anxiety/panic disorders, schizophrenia, Alzheimer's, dementia, suicide, alcohol/drug abuse & antisocial personality disorders as well as chronic health diseases.

  • Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities
  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately
  • Managed and prioritized multiple patient assignments effectively in a fast-paced environment
  • Assisted in emergency situations by providing immediate medical interventions and coordinating with other healthcare professionals
  • Managed complex medication regimens for patients with multiple chronic conditions

MENTAL HEALTH PROFESSIONAL/Registered Nurse

ARKANSAS COUNSELING AND ASSOCIATES
06.2014 - 12.2014

Mental Health Professional/Registered Nurse

Arkansas Counseling & Associates - Marion, AR

June 2014 to December 2014

Outpatient Therapy Services that work in various capacities to diagnose, treat and offer medical and physical care to individuals suffering from mental illnesses and disorders. These illnesses may be mild or severe enough to require hospitalization. They include anxiety, substance abuse and addiction, depression, schizophrenia and others. I assisted, educated, & guided children & families w/ emotional and behavioral issues to successfully understand & overcome those problems. Services included Individual, Family, & Group Sessions as well as intake/interview process.

  • Provided individual therapy sessions to clients with various mental health concerns, including anxiety, depression, and trauma
  • Conducted comprehensive assessments to determine appropriate treatment plans for clients based on their specific needs and goals
  • Utilized evidence-based therapeutic techniques such as cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and mindfulness practices
  • Facilitated group therapy sessions focused on topics such as stress management, self-esteem building, and interpersonal skills development
  • Collaborated with a multidisciplinary team of healthcare professionals to coordinate care and ensure holistic treatment approaches for clients

Registered Nurse

Arkansas Department of Health
05.2011 - 06.2014

Arkansas Department of Health

Registered Nurse

Arkansas Department of Health / Crittenden County Health Dept - West Memphis, AR

May 2012 to June 2014


Public Health Nurse with training in Communicable Diseases, STDs, WIC, Child & Adult Immunizations, Family Planning, Maternity, Well Woman, Cervical Cytology/ Pap F/U & Breast-Care Program. Use of Knowledge of professional nursing theories, concepts, and methods. Developed patient care plan and participated in diagnosis and development of treatment goals. Application of comprehensive nursing care to clients in all age groups in a clinical setting. Assigned and coordinated work activities and monitored the performance of subordinates. Instructed patients and families on self-help care. Assisted physicians with routine and emergency care.

  • Provided direct patient care, including administering medications, monitoring vital signs, and assisting with daily activities
  • Collaborated with interdisciplinary healthcare team to develop and implement individualized care plans for patients
  • Performed comprehensive assessments of patients' physical and mental health status, documenting findings accurately
  • Counseled patients on lifestyle modifications necessary for managing chronic conditions such as diabetes or hypertension
  • Coordinated diagnostic tests or procedures ordered by physicians, ensuring timely scheduling and follow-up

Arkansas Department of Health / Mississippi County Health Dept - Osceola,

2011 to May 2012

Home Health/ Case Management/PCA Supervision with travel in Northeast Region of Arkansas. Provided and directed provisions of nursing care to patients in their homes as prescribed by the physician and in compliance with applicable laws, regulations, and agency policies.

  • Coordinates total plan of care with other health care professionals involved in care and helps to achieve and maintain continuity of patient care by planning and exchanging information with physician, agency personnel, patient, family, and community resources. All done within a Point of Care setting.
  • Makes the initial and/or comprehensive nursing evaluation visit, determines primary focus of care, develops the plan of care within state specific guidelines, and submits accurate, complete, and timely documentation in collaboration with physician orders.
  • Performs patient comprehensive assessments at designated time points and develops the appropriate plan of care.
  • Ensures patients meet home health eligibility and medical necessity guidelines as defined by payer source.

Education

Associate of Applied Science - REGISTERED NURSE

Education Arkansas Northeastern College -
Blytheville, AR
12-2009

Skills

  • COS-C Certified Quality Review Specialist
  • Responsibilities
    Receives referrals and ensures appropriate clinician and/or therapist(s) assignments for timely patient evaluation by signing off after authorization and plotting start of care (SOC) visits
    Coordinates determination of patient home health benefits, medical necessity, and ongoing insurance approvals
    Ensures patient needs are continually assessed and care rendered is individualized to patient needs, appropriate and reasonable, meets home health eligibility criteria, and is in accordance to physician orders
    Oversees and assures development, implementation, and updates to the individualized patient plan of care, as appropriate
    Manages and documents phone calls from physicians, clinicians, patients, referral sources, and communicates patient updates/new orders to clinicians Uses coordination notes to document, as needed and appropriate
    Reviews assessments and plans of care daily, per assigned workflow, and consults clinicians with recommendations, as appropriate

Certification

  • [Area of certification]
  • COS-C CERTIFICATION
  • BLS

Timeline

QUALITY REVIEW SPECIALIST

LHC Group
02.2021 - Current

Registered Nurse Case Manager

CUSTOMIZED MEDICAL NEEDS
04.2015 - 12.2023

Registered Nurse Case Manager

MY FAITH INC
04.2015 - 12.2023

Registered Nurse Case Manager

HUMANA
04.2015 - 06.2020

Registered Nurse

Quest Diagnotics
04.2015 - 03.2018

MENTAL HEALTH PROFESSIONAL/Registered Nurse

ARKANSAS COUNSELING AND ASSOCIATES
06.2014 - 12.2014

Registered Nurse

Arkansas Department of Health
05.2011 - 06.2014

Registered Nurse

MISSISSIPPI COUNTY HOSPITAL SYSTEMS
01.2010 - 12.2015
  • [Area of certification]
  • COS-C CERTIFICATION
  • BLS

Associate of Applied Science - REGISTERED NURSE

Education Arkansas Northeastern College -
Janice Scales