Jernine R. Kanu
Owings Mills
Summary
Licensed Registered Nurse and Certified Professional Coder experienced in clinical nursing, utilization review, case management, and managed care consulting. Delivered comprehensive expertise in payer systems, including commercial plans, Medicare, and Medicaid, while ensuring compliance with UM/CM policies and medical necessity criteria. Focused on optimizing authorization workflows and enhancing patient care through effective management strategies.
Overview
21
21
years of professional experience
Work History
Patient Care Coordinator
Kaiser Permanente
Baltimore
01.2013 - Current
- Provide initial and concurrent reviews in collaboration with physicians, social workers, and case managers.
- Facilitate peer to peer reviews and denial letters for non-approved services.
Case Manager/Utilization Review Nurse
Good Samaritan Hospital
Baltimore
01.2006 - 02.2014
- Conducted initial and concurrent reviews for all insurance payers to ensure appropriate patient care and coverage.
- Acted as liaison to hospital staff, facilitating discharge planning to promote timely transitions for patients.
- Educated patients and families on alternative levels of care and treatment settings to support informed decision-making.
Clinical Quality Manager
MedAssurant
Columbia
07.2010 - 12.2012
- Led quality review teams (registered nurses and certified coders) in data abstraction and analysis, ensuring adherence to quality standards.
- Provide direct leadership and management to quality review teams (Registered Nurses and Certified Coders) in data abstraction and analysis.
- Designed, executed, and managed quality assessment procedures for all clinical review personnel to enhance accuracy and reliability of clinical data.
- Assist with the development, organization, and implementation of company-wide quality improvement efforts through project management.
Utilization/Appeals Nurse
St. Lukes Roosevelt/Continuum
New York
07.2009 - 07.2010
- Conduct onsite initial, concurrent, and retrospective reviews for inpatient admissions.
- Serve as a liaison between the physicians and insurance payors.
- Complete 1st, 2nd, and 3rd level appeals for in-house and discharge denials.
Team Lead
United HealthCare – Americhoice
Elkridge
04.2008 - 05.2009
- Built and strengthened collaborative relationships with clinical directors, hospital teams, management, and external providers, supporting coordinated care and fostering organizational alignment.
- Conducted comprehensive chart audits and quality-review evaluations for nursing personnel, ensuring compliance and driving continuous improvement.
- Facilitate appropriate medical decision-making through concurrent review processes grounded in established medical criteria and contractual requirements.
- Assessed and reported significant health-care issues and emerging trends, guiding development and implementation of educational programs for staff, providers, and the public.
Education
Certified Professional Coder - Coding
The Roxbury Institute of Medical Management
JamaicaBachelor of Science - Nursing
Villa Julie College
Stevenson, MDSkills
- Patient assessment
- Case management
- Care coordination
- Utilization review
- MCG
- Interqual
- Epic EMR
Timeline
Patient Care Coordinator
Kaiser Permanente
01.2013 - Current
Clinical Quality Manager
MedAssurant
07.2010 - 12.2012
Utilization/Appeals Nurse
St. Lukes Roosevelt/Continuum
07.2009 - 07.2010
Team Lead
United HealthCare – Americhoice
04.2008 - 05.2009
Case Manager/Utilization Review Nurse
Good Samaritan Hospital
01.2006 - 02.2014
Certified Professional Coder - Coding
The Roxbury Institute of Medical Management
Bachelor of Science - Nursing
Villa Julie College