Quoinsetta Turner-Clark
Memphis,TN
Summary
Dynamic Regional Clinical Nurse Case Manager with over 11 years at Prestige Health Care, excelling in utilization management and compliance. Proven track record of 100% audit accuracy and over 30,000 medical necessity reviews. Strong communicator and critical thinker, adept at care coordination and enhancing patient outcomes through effective collaboration.
Overview
24
24
years of professional experience
Work History
Regional Clinical Nurse Case Manager
Prestige Health Care
04.2015 - Current
- Experienced Clinical Review Nurse with over 11 years of utilization management expertise, specializing in post-acute
concurrent review, medical necessity determination, and appeals for Medicare and Medicaid populations. Completed
over 30,000 medical necessity reviews and 10,000 expedited appeals with 100% audit accuracy. Adept at preparing
Medical Director case reviews, researching appeals, drafting denial letters and Detailed Explanations of Non-Coverage
(DENCs), and generating compliant, clear appeals resolution communications. Proven collaborator with Medical
Directors, providers, and interdepartmental teams to ensure regulatory compliance, support defensible
determinations, and streamline appeals workflows. - Conducted high-volume post-acute concurrent reviews to assess medical necessity, level of care, acuity, and
discharge readiness, ensuring compliance with Medicare, Medicaid, and health plan guidelines,
consistently meeting all
turnaround time (TAT) requirements for standard and expedited cases.
Maintained 100% audit accuracy on internal and external audits, ensuring adherence to CMS, NCQA, and utilization
management policies.
- Provided direct patient care in a fast-paced healthcare environment.
- Administered medications and monitored patient responses effectively.
- Collaborated with interdisciplinary teams to develop care plans.
Pediatric Nurse
Pediatrics East
06.2017 - 03.2019
- Administered immunizations and respiratory therapies to promote health in pediatric patients.
- Monitored vital signs and collected patient history to ensure accurate assessments.
- Supported doctors in examining pediatric patients, enhancing patient care.
LPN MDS Director/Case Manager
LTC
01.2016 - 09.2016
- Coordinated interdisciplinary assessment and care planning process to enhance resident care in nursing facilities.
- Displayed knowledge of the patient driven payment model, Case Mix Index (CMI), quality measures and overall LTC payment.
- Advocated for residents by providing support and education on their rights and care options.
- Promoted residents' quality of care and life in a skilled nursing facility.
- Initiated discharge planning, educated residents, and identified resources to support resident needs and manage diseases.
- Completed and submitted all PAEs to help residents become LTC.
- Submitted all updates to insurance companies and completed PA/Pre-Cert during resident stays.
- Entered ICD-10 codes for residents upon admission to ensure accurate documentation and compliance.
LPN Charge Nurse (LTC/Post Acute) Geriatric Unit
LTC
01.2012 - 01.2014
- Collaborated with physicians and registered nurses to ensure comprehensive patient care.
- Worked with a variety of disease management cases with the geriatric population.
- Documented and analyzed vital signs during patient assessments to identify health trends.
- Planned discharges and educated patients.
- Monitored patients and reported changes.
- Prepared and administered injections and enemas.
- Applied dressings and bandages.
- Monitored catheter placement and provided care for bedsores.
- Collected samples for testing.
- Provided patient hygiene and fed patients.
Surgery Scrub Nurse
BMC
05.2010 - 12.2012
- Prepared the operating room by setting up the equipment and sterilizing necessary tools.
- Prepared patients for surgery by washing, shaving and disinfecting areas for operation.
- Delivered instruments and supplies to the surgeon during procedures to maintain workflow and efficiency.
- Supported surgical operations by collaborating with surgeons and registered nurses to ensure seamless procedures.
Emergency Room Technician/LPN
BMC
05.2006 - 06.2011
- Monitored blood pressure, facilitated patient discharges, stocked emergency room supplies, administered oxygen, and performed catheterizations to ensure readiness for patient care.
- Supported physicians in treating lacerations and managing wound care to promote optimal patient recovery.
- Performed EKG tests to assess and document patients' heart activity for timely medical evaluation.
GI Nurse
GI Tech
05.2009 - 01.2011
- Performed colonoscopies and EGDs.
Assistant Store Manager
It’s Fashion/Metro
03.2007 - 01.2011
- Hired, worked cash register, received and put away stock/ merchandise.
- Opened and closed store.
- Inventory control and experience in sales.
EMT Basic
Bolivar Medical Center
05.2005 - 05.2010
- Responded to emergency calls.
- Transported patients to local emergency rooms.
- Developed a high level of skill in medical emergency techniques: patient assessment included taking blood pressure and pulses, wound management, splinting fractures applying oxygen, CPR, and advanced life support.
Phlebotomist
BMC
06.2004 - 05.2005
- Drew blood samples for high volume health screenings.
- Performed Venipunctures.
- Prepared blood samples for analysis or transport.
EMS 911 Dispatcher
BMC
07.2003 - 05.2005
- Answered emergency 911 calls.
- Dispatched information to emergency personnel.
Quality Management Volunteer
Bolivar Medical Center
07.2002 - 01.2003
- Input patients' names and addresses into database.
- Filled in as receptionist, handling a heavy load of incoming calls and relaying messages to staff.
Education
Bachelor of Science - Nursing
Walden University
10-2026
Bachelor of Science - Healthcare Administration
Southern New Hampshire
10-2019
Associate of Applied Science Degree - Nursing
Coahoma Community College
05-2010
Associate of Fine Arts - General Education
Mississippi Delta Community College
01-2005
Skills
- Patient assessment
- Medical charting
- Team collaboration
- Healthcare compliance
- Case management
- Care planning
- Critical thinking
- Patient relations
- Clinical judgment
- Communication skills
- Vital signs documentation
- Family education
- Resource utilization
- Geriatric care
- Care coordination
- Quality assurance
- Pediatric care
- Quality improvement
- Treatment coordination
- Patient Safety Measures
- Advanced life support
- Decision-making
- Time management abilities
- Nursing staff supervision
- Geriatric nursing
- Patient care
Timeline
Pediatric Nurse
Pediatrics East
06.2017 - 03.2019
LPN MDS Director/Case Manager
LTC
01.2016 - 09.2016
Regional Clinical Nurse Case Manager
Prestige Health Care
04.2015 - Current
LPN Charge Nurse (LTC/Post Acute) Geriatric Unit
LTC
01.2012 - 01.2014
Surgery Scrub Nurse
BMC
05.2010 - 12.2012
GI Nurse
GI Tech
05.2009 - 01.2011
Assistant Store Manager
It’s Fashion/Metro
03.2007 - 01.2011
Emergency Room Technician/LPN
BMC
05.2006 - 06.2011
EMT Basic
Bolivar Medical Center
05.2005 - 05.2010
Phlebotomist
BMC
06.2004 - 05.2005
EMS 911 Dispatcher
BMC
07.2003 - 05.2005
Quality Management Volunteer
Bolivar Medical Center
07.2002 - 01.2003
Bachelor of Science - Nursing
Walden University
Bachelor of Science - Healthcare Administration
Southern New Hampshire
Associate of Applied Science Degree - Nursing
Coahoma Community College
Associate of Fine Arts - General Education
Mississippi Delta Community College