Open to opportunities

Janise Dejean

@janisedejean

Message

Seasoned clinical nurse with expertise in project management and education.

United States

Message

What I'm looking for

I seek a role that allows me to leverage my clinical expertise and leadership skills while contributing to quality improvement initiatives in healthcare.

I am a seasoned clinical nurse with a strong background in project management, disease management, and clinical education. My experience spans various roles, including working as a contractor for Blue Cross/Blue Shield and Medix, where I excelled in chart auditing and HEDIS review. I take pride in maintaining a productivity level with less than a 5% error rate in record abstraction and data entry, ensuring high-quality healthcare delivery.

Throughout my career, I have demonstrated excellent leadership skills and a commitment to patient education. At Dejean Wellness, Inc., I coordinated and delivered education to patients with chronic diseases, empowering them during their health journeys. My ability to collaborate with healthcare professionals and navigate complex medical topics has been instrumental in improving patient outcomes and ensuring compliance with healthcare regulations.

Experience

Work history, roles, and key accomplishments

HEDIS Review Nurse

Medix

May 2019 - May 2023 (4 years)

Conducted structured auditing of medical records for HEDIS measures, ensuring compliance and accuracy in data entry with a productivity level of less than 5% error rate. Assisted with URAC and NCQA Accreditation.

HEDIS Production EMR Data Entry Quality Assurance Epic

Risk Adjustment Reviewer

Medix

Jun 2017 - Nov 2017 (5 months)

Reviewed and abstracted medical records for the CMS Initial Validation Audit, ensuring compliance with ACA regulations and maintaining data integrity.

CMS Abstracting Data ACA Compliance Quality Assurance Auditing

RN Consultant

Dejean Wellness, Inc.

Dec 2014 - Feb 2017 (2 years 2 months)

Coordinated patient education for chronic diseases, collaborating with healthcare professionals to enhance patient care and resource access.

Collaborative Care Communication Care Coordination

Appeals and Quality Specialist

Blue Cross/Blue Shield Illinois

Jun 2015 - Dec 2015 (6 months)

Processed medical appeals and maintained clinical quality improvement projects, ensuring compliance and effective communication with healthcare providers.

Appeals Quality Improvement Compliance Project Management

Benefits Administration Nurse

Baxter Healthcare Corporation

Oct 2008 - Apr 2014 (5 years 6 months)

Determined medical appropriateness for FMLA, maintained confidentiality, and provided training on medical processes to HR representatives.

FMLA Training Benefits Administration Communication Relationship Management

Education

Degrees, certifications, and relevant coursework

Keller Graduate School of Management

Master of Business Administration, Business Administration

Lewis University

Bachelor of Science in Nursing, Nursing

Completed a Bachelor of Science in Nursing, focusing on clinical practices and patient care. Developed skills in patient assessment, nursing interventions, and healthcare management.