Director of Risk Coding Resume VA - Hire IT People

SUMMARY

Nursing Informatics Specialist with expertise in Population Health Management to include Risk Coding, HEDIS quality, and Case Management efforts to optimize success.
Highly energetic, positive, results driven, lifelong learner with sincere passion in the triple aim of Population Health Management as the future of healthcare.
30 years experience as a professional registered nurse with various awards including Nurse of the Year, Subject Matter Speaker, rganizational presenter, and several military decorations.

WORK EXPERIENCE

Director of Risk Coding

Confidential, VA

Responsibilities:

Leader of Risk Coding group in Population Health Management with growing Medicare Advantage program Responsible for all training, strategy development.
Reporting on enterprise Risk Adjustment Factors (RAF) Implemented unique strategies to maximize RAF for 15,000+ members and several payers Significantly increased enterprise
Wide RAF, exceeding projected goals Actively contribute to Quality goals, Case Management, Operations
Training, and Membership initiatives RN Clinical Coding Nurse Educate enterprise practitioners and staff on the Risk Adjustment Process for a Medicare Advantage product Managed project to successfully map ICD-9 codes to ICD-10 codes for all managed care clients (9000+) with ptimal specificity to maximize Managed care documentation specialist for accurate quality and diagnosis requirements Perform ongoing chart and quality audits
Offering feedback to providers as needed Maintain compliance with AAPC coding standards and CMS Risk Adjustment guidelines as a Certified Professional Coder.

Confidential, VA

School Nurse

Responsibilities:

Perform thorough nursing assessments, develop plans, implement nursing and physician ordered interventions
Evaluate outcomes for well and chronically affected students Develop and offer trainings for other nurses, staff, students and families Utilized analytics to improve practice and target school and district
Wide efforts Perform vision, hearing, Acanthosis Nigricans, and scoliosis screenings, make referrals
Identify resources Provide health education, wellness, and resources for students, staff, and community Worked in multiple school settings (elementary and high school) CPR and Triage Instructor
Emergency Response Team Supervisor Coordinated School Health, Campus Chair Knowledgeable of current laws regarding student health, immunizations, medication administration, HIPAA, FERPA, 504 and IHP requirements Collect, analyze, publish data regarding student and staff health trends and effectiveness of treatment

Confidential,

US Nurse Case Manager, MA

Responsibilities:

Performed health care coordination for injured or chronically ill persons, with a focus on facilitating their return to the workplace
Obtained physician referrals, rehabilitative services and products Provided monthly monitoring and documentation

Confidential, Gottlieb, Hamilton

Legal Nurse Consultant

Responsibilities:

Reviewed medical records pertaining to a product liability case, working with a team of attorneys, physicians and other nurse consultants Produced extensive written reports regarding medical record review, timelines, symptom analysis, summaries and recommendations Performed research to interpret lab reports, medications, diagnostic studies, and physician diagnoses.
Procured expert medical opinions and reports Army Nurse Six years of service as a Commissioned Officer in the US Army Nurse Corps serving in a variety of medical surgical clinical positions in both US and forward deployed locations Served as Medical/Infectious Disease Staff Nurse and Assistant Head Nurse at Eisenhower Army Medical Center (Fort Gordon, GA).
Original Staff Nurse selected to open new Cardiac Step Down Unit Served as Clinical Staff Nurse in both Orthopedic Unit and Emergency Room at the 121 Evacuation Hospital, Seoul Korea.
Assigned to the 43rd MASH, Deployable Medical Surgical Suite; deployed to Operation Cobra Gold in Thailand Hand selected to serve as Staff Nurse on Eisenhower Executive VIP Suite, Ward 72, Walter Reed Army Medical Center.
Provided nursing care for our nation's highest level military and political leadership, as well as international heads of state, within a secured clinical setting