Janice Napoleon MBA, RN, CCM
Castle Rock
Summary
Experienced with comprehensive client assessments, ensuring personalized care plans are in place. Utilizes strong communication and coordination skills to effectively manage client services. Track record of fostering positive client relationships and achieving measurable improvements in client well-being.
Overview
30
30
years of professional experience
Work History
Case Manager – RN
Advent Health
02.2022 - 08.2024
- Onsite Case Manager/UM for ICU, Medical/Surgical, ED, NICU, L&D, and PACU. Facilitating individualized service delivery from admission through discharge in collaboration with the patient, families, and the multidisciplinary care team to promote quality cost-effective outcomes.
- Utilizing Cortex, InterQual or Milliman Care Guidelines review the appropriateness of admission communicate to Medical Director any outliers and communicate with payer.
- Refer patients to lower level of care in a prompt manner encouraging the patient and family to take part in the individualized discharge preferences and establishing patient care goals to support patient satisfaction and HCAHP goals.
- Implement and coordinate discharge plans using appropriate community resources to facilitate timely and effective discharge planning.
- Maintain LOS (Length of Stay) benchmarks and compliance with Federal, State, and accreditation organizations.
- Use Epic to complete all patient documentation and reports.
- Attend daily multidisciplinary rounds and participate in audits.
Acting Director of Case Management – Contractor Remote
Change Healthcare
06.2022 - 11.2022
- Remotely worked with Contra Costa Health Plan in California as the Acting Director of the Case Management Division to assess the current state of the department workforce and workflows, addressed recommendations for improvement to meet business goals, increase processes using newly implemented technology and increase timely Patient contacts.
- Managed a staff of seventeen associates, fourteen licensed RN's and Social Workers and three unlicensed support team members.
- Updated all job descriptions for each skill level recommending additional education and training/certification where needed.
- Reviewed current state workflows, developed Case Management guidelines for managing and closing cases. Mentored and coached Case Managers on the new workflows.
- Updated Key Performance Metrics that increased Case Managers daily productivity by 40% in the first month of implementation.
- Increased management of the intake queues by 100% in the first month of implementation of new workflows.
- Developed best practice training materials, implemented training sessions. Created training outline for annual staff retraining.
Case Manager – RN
Sandoval Regional Medical Center
07.2021 - 02.2022
- Onsite Case Manager for ICU, Medical/Surgical, ED, and PACU. Facilitating individualized service delivery from admission through discharge in collaboration with the patient, families, and the multidisciplinary care team to promote quality cost-effective outcomes.
- Utilizing InterQual or Milliman Care Guidelines review the appropriateness of admission communicate to Medical Director any outliers and communicate with payer.
- Refer patients to lower level of care in a prompt manner encouraging the patient and family to take part in the individualized discharge preferences and establishing patient care goals to support patient satisfaction and HCAHP goals.
- Implement and coordinate discharge plans using appropriate community resources.
- Maintain LOS (Length of Stay) benchmarks.
- Mentor new team members and liaison for any IT issues related to case management needs.
- Complete all patient documentation, required reports, and attend daily multidisciplinary rounds.
Medical Record Auditor – Contractor RN Remote
Solving IT
11.2020 - 04.2021
- Clinical reviewer for HHS (Health and Human Services) ACA (Affordable Care Act) risk adjustment and Healthcare Medicaid and adjustment audits
- Reviewed medical record documentation for the validity of claims data for CMS audits.
- Identify HCC's (Hierarchical condition category)
- Contact Providers for additional information.
RN COVID-19 Tester Remote
The Judge Group
04.2020 - 06.2020
- Performed daily testing for the Arizona Public Service (APS) and Bisti Fuel employees in the Four Corners area of New Mexico.
- Performed nasopharyngeal and saliva tests for approximately one hundred employees per day.
- Followed extremely strict downing and doffing of full PPE and testing protocols established by the University of Arizona Medical School
- Performed strict daily count, packing, and chain of custody procedures of specimens.
- Charge Nurse responsibilities and patient education.
Compliance Manager UM-Senior Case Management RN - Remote
Humana Insurance
01.2017 - 01.2020
- Oversaw daily management and leadership of the telephonic Senior Case Management Department for Colorado, New Mexico, and Arizona consisting of 24 Senior Case Managers and 24 Support Team Associates
- Implemented process improvement policies, procedures, and workflow to meet metrics.
- Lead collaboration and integration of the CO/NM Senior Case Management (SCM) team with the AZ SCM team.
- Maintained Operational Excellence on a monthly average of 11.0 above 7.7 standard goal.
- Collaborated with provider risk groups to increase HEDIS, STARS, MRA, and decrease high utilizer consumption of ER and Home Health
Healthcare Consultant/Subcontractor RN - Remote
Change Healthcare Solutions, LLC
01.2013 - 01.2016
- Stood Up the Training Department for the Medical Services Department of a Managed Care Organization with over 700k members and 200 FTEs in Case Management.
- Stood up Training Department within three ½ months detailing training plan and creating training materials in accordance with regulatory requirements of Medical Policy, HEDIS, InterQual, Milliman, and CMS guidelines for Commercial, Medicaid, and Medicare products.
- Created and delivered new hire training, testing, Preceptor training program, orientation checklists, and annual retraining guidelines to decrease staff turnover, increase staff satisfaction, and retention.
Healthcare Consultant/RFP Response Writer RN
Healthcare Consultant/RFP Response Writer RN
01.2013 - 01.2014
- Contracted to support a large Texas MCO in responding to the State of Texas on a bid to provide Care for high-risk children from birth to eighteen with physical, emotional, and mental health needs.
- Wrote responses to seven sections: Nurse Hotline, Continuity of Care, Member Complaint and Appeals, Member Education, Member Services, Behavioral Health Hotline, and Behavioral Provider Network
Manager, Delivery Leadership-RN
TriZetto Corporation
01.2012 - 01.2013
- Project Management of Care Advance Enterprise (CAE) a case management, disease management, and utilization review system and QNXT (membership, eligibility, provider, and claims processing system) for new implementations and upgrades.
- Conducted first ever integration of CAE and QNXT increasing efficiencies of care management, claims payment turnaround times, and supplied prompt membership eligibility information to providers of care.
SR. Project Director-RN
NEXTGEN Healthcare Information Systems, INC.
01.2011 - 01.2012
- Project Management of large strategic accounts in the western region, implementing electronic health records and electronic practice management information systems
- Managed strategic account implementations, conversions, integrations, Meaningful Use, ICD-10, Physician Portal, CPOE, and Claims processing based on CMS guidelines.
National Sr. Project Manager-RN
Catholic Health Initiatives
01.2006 - 01.2011
- Lead tier one initiatives for all Catholic Health Initiative (CHI) markets consisting of seventy hospitals and reporting to the VP level.
- Evidence-Based Practice (EBP) Project Manager
- Implementation of 9 EBP's within 15 months
- Developed detailed Audit and Verification tools and processes, directed the collection of metric reporting for all markets using outcomes to educate Providers on targeted payer performance levels.
- Organized formation of CHI's national EBP Steering Committee to advance clinical transformation across system increasing Medicaid and Medicare reimbursements
- Lead construction of CHI’s central Telepharmacy office in Fargo North Dakota providing Pharmacy coverage to North/South Dakota, and Minnesota markets facing a shortage of Pharmacists
- Mentored Director of Telepharmacy on establishing business practices, policies, procedures, and team organization
- Co-lead implementation of first Teleneurology program in northwestern states delivering neurology services to 5 CHI hospitals experiencing shortage of neurologists
- Lead implementations and upgrades of over 12 PACS and voice recognition systems across the country
- Boosting productivity by 95% and reduced film and transcription costs by 90%
Education
Master of Business Administration (MBA) - Business Executive Leadership
Colorado Christian University
Lakewood, COMaster Certificate - Project Management
George Washington University
Washington, DCBachelor of Arts (BA) - Healthcare Administration
Saint Joseph's College
Standish, MERegistered Nurse -
Presbyterian/Saint Luke's School of Nursing
Denver, COThe Commission For Case Manager Certification (CCM
Skills
- Effective communicator
- Experienced patient educator and advocate
- Excellent ability to formulate care plans based on patient assessments and needs
- Outstanding ability to assess patient physical, psychological, cultural, and spiritual needs
- Collaborative team management
- Excellent Problem Solving/Analytical Skills
- Over ten years of clinic experiences
Timeline
Acting Director of Case Management – Contractor Remote
Change Healthcare
06.2022 - 11.2022
Case Manager – RN
Advent Health
02.2022 - 08.2024
Case Manager – RN
Sandoval Regional Medical Center
07.2021 - 02.2022
Medical Record Auditor – Contractor RN Remote
Solving IT
11.2020 - 04.2021
RN COVID-19 Tester Remote
The Judge Group
04.2020 - 06.2020
Compliance Manager UM-Senior Case Management RN - Remote
Humana Insurance
01.2017 - 01.2020
Healthcare Consultant/Subcontractor RN - Remote
Change Healthcare Solutions, LLC
01.2013 - 01.2016
Healthcare Consultant/RFP Response Writer RN
Healthcare Consultant/RFP Response Writer RN
01.2013 - 01.2014
Manager, Delivery Leadership-RN
TriZetto Corporation
01.2012 - 01.2013
SR. Project Director-RN
NEXTGEN Healthcare Information Systems, INC.
01.2011 - 01.2012
National Sr. Project Manager-RN
Catholic Health Initiatives
01.2006 - 01.2011
Master Certificate - Project Management
George Washington University
Master of Business Administration (MBA) - Business Executive Leadership
Colorado Christian University
Bachelor of Arts (BA) - Healthcare Administration
Saint Joseph's College
Registered Nurse -
Presbyterian/Saint Luke's School of Nursing
The Commission For Case Manager Certification (CCM
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