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Click here or scroll down to respond to this candidateCandidate's Name , RNNew Port Richey, FLPHONE NUMBER AVAILABLEPROFESSIONAL SUMMARY:Over 37 years of Managed Care Experience diverse background which includes Case Management, Quality Improvement, HEDIS, Critical Care ICU/CCU, Medical/Surgical, Oncology, Hospice and Home Health CareExtended background in Case Management working in the insurance telephonic settings as well as Home Health Care, HEDIS Measures Focused on both Medicare and Medicaid/ Insurances Included: CBP, CDC, WCC, COA, CIS, Preventative Care, PPC, EDRCompetent Computer Skills with Microsoft, Excel. Adaptable with different companies individual computer software programs.PROFESSIONAL EXPERIENCE:Elevance / BC ForwardJanuary 2024 February 2024Remote Hedis Research (Contract) Researching records for potential chases forthe Hedis 2023 Measurement year.Elevance/ BCForwardNovember 2022 - March 2023Remote Hedis Care Coordinator (Contract) Requesting records from providers for measures needed. Performed chart audits and abstractions of STAR quality Hedis measures Documentation of findings into QSHR Over reading for accuracy Maintained HIPPA regulations for consumer privacy Anthem/ Supplemental HealthcareNovember 2021 - April 2022Remote Hedis Care Coordinator (Contract) Requesting records from providers for measures needed. Performed chart audits and abstractions of STAR quality Hedis measures Documentation of findings into QSHR Over reading for accuracy Maintained HIPPA regulations for consumer privacy Cigna/ Pro-UnlimitedFebruary 2021Remote RN Hedis Abstractor (Contract) Primary Measures/Encounters Focused on: CBP, Diabetes, Care of Elderly, TRC, BMI Performed chart audits and abstractions of STAR quality HEDIS measures Abstracted 40+ records daily with efficiency and accuracy Maintained 95% accuracy rating Documented findings in HEDIS database tool Conduct outreach to members/providers Maintained HIPAA regulations for consumer privacy Amedisys Homecare/ Nurse on CallSupplemental HealthcareJuly 2019 January 2020RN Staff Nurse (Contract) Performed home health visits completing assessments, care plan management. Also providing medical care, wound care and IV therapy Patient education to promote optimal health outcomes Maintained HIPAA regulations for consumer privacy Amedisys Home Care/ Cross Country NursesJuly 2020 - January 2021RN Homecare Staff Nurse (Contract) Performing home health visits, assessments, care plan management, medical care needed, wound care, including Wound VAC therapy, IV therapy and client education to promote optimal self health care results. Communicating with intra-disciplinary team Delivered patient education on disease prevention, medication management. Provided nursing care for up to 7 home health patients per day Cigna/ MedixJanuary 2016 April 2019 (Seasonal)Remote HEDIS Abstractor (Contract) Primary Measures/Encounters Focused on: CBP, Diabetes, Care of Elderly, TRC, BMI Performed chart audits and abstractions of STAR quality HEDIS measures Abstracted 40+ records daily with efficiency and accuracy Maintained 95% accuracy rating Documented findings in HEDIS database tool Conduct outreach to members/providers Maintained HIPAA regulations for consumer privacy VNAJanuary 2015 June 2017Field RN Case manager (Per Diem) Home field visits to assess patients current health status, past and present treatment plan and services, treatment and provider options Develop plan of care based upon assessment with specific objectives and goals Coordinate services between Primary Care Physician (PCP), specialists, medical providers, and non- medical staff as necessary to meet the complete medical needs of patient Provide patient and provider educationWellmed, Managed Care OrganizationJuly 2014 - September 2014HEDIS QI Nurse (Contract) Performed provider/practitioner medical record reviews, abstraction and data entry for HEDIS Chart Reviews as part of the Quality and Performance Improvement program Accurately identified findings supported by Documentation guidelines. Identified probable findings indicated by clinical documentation in the medical record Researched and provided resolution of abstraction projects as assigned for completeness and accuracy Identified, Analyzed and Collected Clinical information as it pertains to HEDIS requirements AetnaSeptember 2013 March 2014RN Case Manager Telephonically engaging members, who are triggered for the Complex Case Management Program via having new complex diagnoses, multiple hospitalizations/claims, or end of life needs Addressing Star Gaps and completed health assessments using motivational interviewing techniques Creating care plans to assist individuals to improve self-management of their health care needs. Performing discharge planning by coordinating with physicians, hospitals, skilled nursing facilities, and home health care agencies to improve coordination of care among providers and levels of care, and ensure effective use of benefits when discharged to home. WellcareMarch 2013 May 2013HEDIS QI Nurse (Contract) Performed provider/practitioner medical record reviews, abstraction and data entry for HEDIS Chart Reviews as part of the Quality and Performance Improvement program Accurately identified findings supported by Documentation guidelines Identified probable findings indicated by clinical documentation in the medical record Research and resolution of abstraction projects as assigned for completeness and accuracy Identified, Analyzed and Collected Clinical information as it pertains to HEDIS requirements HumanaFebruary 2012- January 2013RN Case Manager Telephonically engaging members, completing health assessments, addressing gaps in care, creating care plans to assist the individual to an optimal state of well-being. WellcareJuly 2011 November 2011RN Case Manager (Contract) Temporary assignment for area insurance company to perform as Complex Case Manager performing health assessments, developing care plans derived for the individuals health care goals. EDUCATION:Associate, Applied ScienceNorth Country Community College, Saranac Lake, N.Y. 1985LicenseRegistered Nurse - Multistate |
