Quality Improvement Resume Profile Florida - Hire IT People

Experienced Licensed Practical Nurse, Certified Professional Coder and Medical Auditor.

Strengths

Medical arena	Chart Reviews	Diverse population
dynamics	Data Collection	communication
ICU clinical history	Report	skills
HEDIS	Development and	Organized
Medicare Risk	Presentations	Proficient
Case Management	Quality	Computer Skills
Research	Improvement	Education

Experience

Quality Improvement Nurse: Office, field and remote work. Organized and maintained assigned region. Made all calls, set appointments, onsite review and/or scanning of medical records, abstracted and completed HEDIS forms. Maintained case load according to company's policies, procedures, accuracy and time frame. Assisted with conducting secondary reviews and training of unexperienced HEDIS nurses.

Quality Management Coding/Auditor/Research Nurse: Office and Remote work. Preformed, maintained and complied reports for multiple task: internal audits, coding, coding reviews and secondary review of HEDIS, Medicare Risk and HCC data submitted by contracted companies for accuracy, quality and compliance. Data maintained and presented to Sr. Management. Developed Case Management Chronic Conditions data collecting system. Tracked condition s , treatment, non-compliance, Practitioners recommendations and other request from Sr Management. Trained new RNs, LPNs and non-clinical staff in HEDIS, Medicare Risk Adjustment, Coding and Case Management data collections.

confidential

Innovations Medicare Risk Compliance Nurse Auditor: Office, field and remote work. Organized and maintained assigned Providers. Reviewed medical records for HCC missed opportunities due to incorrect documentation, coding are other guidelines not being followed. Provided ongoing support, training, education with continued auditing of records for compliancy. My extensive nursing experience, knowledge of Medicare Risk, CMS guidelines and ICD-9 allowed easy communication which resulted in better Risk Scores
Clinical and Quality Improvement Nurse: Full and part-time. Direct care for the drug, physically and mentally handicap population. 2. Trained as a Field Responder for Pima County Department of Health, Homeland and Emergency Task Awareness. 3. Quality Improvement Leader for large Nursing Home going through Administrative changes. Conducted facility tours. Review and monitoring of treatment and outcome for targeted Dx. Reports completed within time frame and discussed with Sr Management.
Medicare Risk Nurse Auditor: Office, field and remote work. Organized and maintained assigned Providers MR scores. Reviewed medical records for HCC missed opportunities due to incorrect documentation, coding are other guidelines not being followed. Provided ongoing support, training, education with continued auditing of records for compliancy. My extensive nursing experience, knowledge of Medicare Risk, CMS guidelines and ICD-9 allowed easy communication which resulted in better Risk Scores. I was the only Nurse within the MRA Department.

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