Derrick McKnight

Experienced Healthcare Operations Supervisor with 10+ years of leadership in utilization management, prior authorization, compliance, and quality assurance. Proven ability to manage teams, improve workflows, and ensure regulatory compliance across Medicaid, Medicare, and commercial lines of business. Strong expertise in audit readiness, staff development, and process improvement within fast-paced healthcare environments.

Supervisor, Authorization Team - L.A. Care Health Plan

(2024-01)

• Supervise daily operations of Authorization Technicians, providing direction, training, and performance management across all lines of business.
• Monitor staff productivity, quality, and skillsets; implement coaching and development plans to drive consistency and improvement.
• Develop training materials, job aids, and workflow procedures to support onboarding and continuous learning.
• Recommend and implement process improvements to enhance efficiency, accuracy, and turnaround times (TAT).
• Analyze call center and operational reports to assess performance, productivity, and compliance metrics.
• Ensure adherence to regulatory and organizational requirements, including proper documentation of DX, CPT, and HCPCS codes.
• Provide technical support to Utilization Management (UM) Specialists for urgent authorizations and pre-certification requests.
• Process and distribute referrals/authorizations within 2 hours; identify duplicate requests using claims and CSIM systems.
• Ensure timely identification and prioritization of urgent requests based on TAT and compliance standards.
• Maintain accurate and secure documentation of confidential member information in compliance with HIPAA guidelines.
• Assist in preparing authorization determination communications including approvals, denials, modifications, and deferrals.
• Support retrospective reviews and appeals processes, including data entry, tracking, and communication with members and providers.
• Contribute to audit readiness and compliance reporting; ensure accuracy of departmental inventory and performance data.
• Lead employee training, onboarding, and performance improvement initiatives, including corrective action plans.
• Monitor adherence to policies including attendance, performance audits, and incentive programs.

Supervisor - CVS Health

(2014-01 - 2024-01)

• Supervised teams of up to 25 employees in healthcare operations and administrative functions.
• Managed client setup, criteria completion, and case processing for Medicaid, Medicare, and Aetna lines of business.
• Resolved administrative and system issues using SharePoint and internal tools.
• Conducted 1:1 coaching session to address performance gaps, conflict resolution, and employee development.
• Guided teams in creating and managing Salesforce cases, ensuring accurate documentation and compliance.
• Provided direction on denial reason coding and clinical letter preparation.
• Participated in leadership meetings, delivering operational updates, reporting metrics, and process improvement recommendations.

Quality Assurance Representative - Certified Payment Processing

(2007-01 - 2014-01)

• Conducted internal audits and quality reviews across departments to ensure compliance with policies and regulations.
• Evaluated training and competency programs to maintain high performance standards.
• Reviewed departmental quality records and identified opportunities for improvement.
• Delivered staff training to improve audit results, accuracy, and compliance.

Administrative Clerk - United States Marine Corps

(2002-01 - 2007-01)

• Performed administrative and clerical functions including records management, correspondence, and personnel documentation.
• Processed travel orders, pay records, and service documentation with high accuracy.
• Maintained unit diary entries and processed reporting transactions in MCTFS systems.
• Reviewed pay and allowances and maintained document tracking systems.
• Prepared official correspondence and ensured compliance with military administrative procedures.