Thania Camilo
Bensalem
Summary
Hardworking and detail-oriented Registered Nurse with 15+ years of experience in healthcare. Proven leadership in overseeing performance improvement projects and ensuring care management compliance with state and federal regulations. Skilled in working collaboratively with healthcare teams to deliver high-quality patient care and improving service delivery in the healthcare sector.
Overview
26
26
years of professional experience
1
1
Certification
Work History
Quality Assurance RN III
NJ Department of Human Services, Division of Medical Assistance & Health Services-Office of Quality Assurance
Township of Hamilton
08.2023 - Current
- Company Overview: Temporary hire, Newkleo LLC
- Serve as a liaison between Medicaid members, Managed Care Organizations (MCOs), and/or other State agencies to assist with the prompt resolution of care concern inquiries and to ensure assistance with referral opportunities to the proper Medicaid services and/or programs is being provided.
- Follow assigned cases to ensure adherence to departmental standards for the provision of Care Management services and MCO compliance with the NJ State Managed Care Contract (N.J.S.A.).
- Review MCO Corrective Action Plans (CAPs) for quality of care and service issues.
- Team lead for internal IPRO team's Performance Improvement Projects (PIPs), monitor timely submissions of PIPs by MCOs, schedule and organize team meetings to evaluate EQRO PIP reports, prepare PowerPoint slides to present MCO PIP data during DMAHS MCO Performance Accountability Review meetings, review State Managed Care Contract to identify necessary updates to the PIPs section.
- Team participant in internal IPRO team, assist with the review of external quality review organization (EQRO) reports on MCO compliance with NJ State Managed Care Contract (N.J.S.A.) and the Centers for Medicare and Medicaid Services (CMS) guidelines for Annual Assessments, Network Adequacy, Information Systems Capabilities Assessments, Focus Studies, and Annual Technical Reports.
- Review MCO marketing material for clinical accuracy to provide feedback and requested edits to OQA supervisors.
- Temporary hire, Newkleo LLC
Registered Nurse
Capital Health System
Trenton
07.1999 - 08.2023
- Provided direct patient care to inpatients and outpatients in multiple departments including endoscopy, ambulatory care, and medical/surgical unit, utilizing extensive clinical knowledge and experience with patient assessments, administering medications, monitoring laboratory/diagnostic results, and collaborating with interdisciplinary healthcare teams to address patient needs.
- Performed admission nursing physical assessments, obtained patient medical history and medication information, inserted IV lines, and educated patients pre-procedurally.
- Facilitated smooth transfer of inpatients by reviewing laboratory and diagnostic results, and collaborating with floor nurses to assess patients' readiness for procedures.
- Assisted physicians with endoscopy procedures and collection of histology/cytology specimens.
- Provided Phase I and Phase II post-anesthesia care, monitoring vital signs, administering medications as needed, and educating patients on post-procedural discharge instructions.
- Coordinated daily nursing assignments for procedure rooms.
- Precepted new staff.
- Collected and analyzed data for the endoscopy department's Performance Improvement Project and national certification.
- Assisted in the implementation of the patients' care plans and coordination of discharge planning for medical/surgical patients.
Education
Bachelor's degree - Nursing
The College of New Jersey
Ewing, NJ05.1998
Skills
- Proficient in Microsoft Office Applications (Outlook, Teams, PowerPoint, Excel, Word)
- Navigating electronic medical records and databases
- Multi-tasking
- Increased productivity
- Maintaining patient satisfaction
Certification
- RN License
- BLS Certification
- BC/BE
- ACLS Certification
Nursing Licenses
- RN, NJ
- RN, PA
Timeline
Quality Assurance RN III
NJ Department of Human Services, Division of Medical Assistance & Health Services-Office of Quality Assurance
08.2023 - Current
Registered Nurse
Capital Health System
07.1999 - 08.2023
Bachelor's degree - Nursing
The College of New Jersey