Clinical Quality Manager Resume
Objective : As a Clinical Quality Manager, ensured timely resolution of requests. Communicated to a wide variety of audiences. Contributor to team success. Skilled in translating data into solutions. Expertised in disease management with a focus on diabetes. Reviewed completion of facility QAI activities including but not limited to adherence to the QAI calendar, and completion of QAI tools and electronic applications.
Skills : Quality Management, Analytical, and Problem-Solving.
Description :
- Maintained and prepared Reports/graphs quarterly inclusive of departmental measurements and quality management objectives.
- Developed Policies/ Procedures, Participated in committees, and Participated in Provider Education.
- Increased communications between Agency and the billing department Performed clinical reviews and managed quality assurance databases.
- Maintained GCO Clinical Trial Process Road Map tool and Acted as Process Change Manager (PCM), as applicable.
- Mentored and trained staff to collect, trend, and analyzed data on a day-to-day basis to monitor the effectiveness of their clinical and operational processes to impact patient-centered care resulting in improved patient outcomes and satisfaction and decreased morbidity and mortality.
- Worked with the on-site coordinator, delegated assignments based on low-performing measures, and time-sensitive measures, and incorporated problem-solving skills to assist hospitals with miscoding issues.
- Ensured that HNs clinical interventions within all service lines meet robust quality, compliance, and performance standards, ensuring the highest levels of patient care together with ensuring appropriate levels of compliance with all UK-wide regulatory frameworks and standards (e.g., CQC).
Experience
0-2 Years
Level
Entry Level
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager attended and participated in regional, area, facility, and team meetings as appropriate which may include quality team building and staff development and other meetings as appropriate. Collaborated with appropriate management staff as needed to achieve effective inter-disciplinary, intra-disciplinary, and clinic relationships.
Skills : Communication, Interpersonal.
Description :
- Created, distributed, and implemented improvement plans which focus on HEDIS-specific measures and member missing service lists.
- Facilitated meetings with assigned network hospitals and their off-site clinics.
- Provided education in the area of quality improvement to departments, providers, and the community and assists in ensuring compliance with regulations.
- Identified measure-specific areas of concern, and created work groups whose focus centered on access to care rates and whose end goal was to decrease gaps in care.
- Coordinated efforts with network hospitals' IT departments for proper coding and lab/encounter submissions hold education sessions on Healthfirst quality incentive programs, NCQA's HEDIS, and New York State QARR measures.
- Engaged FHQCs through monthly meetings, hands-on training, conducting root, and completing the enrollment process.
- Researched provider's status in order to evaluate/assess rate increase requests by reviewing internal systems and/or meeting with various departments for feedback, Documented findings, and recommendations for management.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Summary : Clinical Quality Manager with over 18 years in managed care with experience in case management, discharge planning, utilization review, HEDIS project management, quality studies, assisting & educating providers in utilization policies/procedures, concurrent review, assisting with IPA and component office preparation for JCAHO review, EPSDT studies, audit preparation and presentation and assisting other departments with special projects.
Skills : Case Manager, Utilization Review Nurse.
Description :
- Responsible for all clinical aspects of HEDIS, Ingenix drug study, EPSDT, credentialing, and other varied projects.
- Integrally involved in the development of a genesis DVD of training modules for the HEDIS projects utilized to train nurses nationwide.
- Performed training of nurses for medical record review, physician re-credentialing, and site visits at provider offices.
- Served as a project manager and educator for drug studies that were done in conjunction with the FDA and UHC/Inge nix.
- Worked with the CRO to conduct medical chart review and abstraction of data for various Phase III/IV drug studies.
- Provided case management services to health plan clients.
- Met with clients to give clinical perspective to our company's business performance and Prepared and participated in weekly conference calls with clients.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager, collaborated with appropriate stakeholders including but not limited to Clinical Quality leadership, Education, Clinical Services, Regulatory, and Compliance to take the appropriate steps to facilitate the achievement of quality goals and ongoing patient safety improvement.
Skills : GCP, GLP, Clinical Trials, Quality Assurance, GMP, Quality Management, SOP.
Description :
- Worked with administration, risk management, medical staff, and ancillary staff to respond to and address quality issues that arise in patient care.
- Facilitated event analysis and rapid response teams to address adverse and sentinel events.
- Worked specifically with medical staff and facilitated review of events directed towards medical staff.
- Involved in multiple quality improvements teams such as recruitment of case managers, and invasive line quality improvement team.
- Developed and ensured effective coordination and quality initiatives, including indications for monitoring and evaluating the quality of care, service, and satisfaction of providers and patients.
- Established Quality Management objectives and annual goals.
- Followed up dashboard reports from Centers for Medicare and Medicaid Services (CMS), and accrediting measures; analyzes the validity of quality management data/report from a clinical perspective.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager, Provided general direction, nursing and clinical guidance related to appropriate theoretical perspectives and feedback based upon professional standards and FMCNA guidelines to support facility RNs within the assigned area in achieving the desired outcomes in the following: quality, patient satisfaction, teamwork, unit culture, and employee satisfaction.
Skills : Leadership, Team management.
Description :
- Improved STAR ratings annually and Trained and managed others to obtain medical records from providers/facilities.
- Performed abstraction of medical records for HEDIS purposes and Explained HEDIS results to the medical advisory committee.
- Improved functionality of HEDIS software Created tools to train newly hired Clinical Quality Managers Helped design a better method of retrieving medical records and Used Proficient in Microsoft products Capable of working remotely Quick to learn new data software Efficient working with numerous software.
- Managed the implementation, planning, designing, and successful completion of the quality improvement program.
- Provided education to clinical staff on process improvement and related topics as it relates to quality improvement and metrics.
- Led care gap closures through Quality Improvement Interventions UDS & Metric measures.
- Maintained or improved performance upon contractual and nationally required quality performance metrics, including HEDIS and customized state measures, and Oversaw external contractors such as HEDIS to move towards a value-based payment model.
Experience
10+ Years
Level
Senior
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Objective : As a Clinical Quality Manager, developed Procedural Excellence team meeting agendas and schedules/facilitates meetings, in collaboration with the Head of Procedural Excellence. Managed Procedural Excellence SharePoint content; including various tracking tools. Prepared and Distributes Reports. Maintained the following Libraries as primary Steward: Site Training Materials Library, and Department Materials library.
Skills : Understanding of healthcare regulations.
Description :
- Identified and prioritized key quality and utilization initiatives critical for the success of performance-based payment programs.
- Prepared and presented reports and updates at internal and external provider related contracted local, state, and federal program requirements.
- Assisted Residency Program with Quality Improvement Projects and Analyzed data utilizing risk stratification tools per PCPCH requirements to maintain 5-star accreditation standards.
- Led Patient Center Primary Care Home program ensuring requirements are met.
- Worked closely with Risk Management to ensure patient safety and risk management policies and procedures are followed. Led process improvement efforts with clinical and non-clinical teams.
- Led the development of new programs and protocols that improve patient care delivery and Met with internal and external audiences to identify and problem-solve Quality Improvement issues.
- Monitored clinic practice efforts to ensure compliance with internal and external standards, set by local, state, and federal programs.
Experience
2-5 Years
Level
Executive
Education
Bachelor's In Nursing
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager, Collaborated with the provider team seeks consensus to identify evidence-based practices throughout the continuum, which are incorporated into clinical practice guidelines, protocols, and policies. Concurrently monitored compliance with evidence-based practice standards.
Skills : Planning, Nursing.
Description :
- Reviewed medical records and other documentation to ensure quality care and Evaluated variance and other data to identify Quality Improvement opportunities.
- Tracked, trended, monitored, and acted on outcomes to include identification of corrective actions that may be needed.
- Oversaw and is responsible for all state and federal quality-related audits. Ran PDSA cycles for identified care caps and projects.
- Facilitated the implementation and integration of the FKC Quality programs and initiatives into the facilities' standard operating procedures through teamwork and collaboration with area and facility clinical, interdisciplinary, and operations teams.
- Served as a subject matter expert for clinical quality matters when collaborating with other RNs and members of the Area Quality Team.
- Identified clinical quality improvement opportunities in the assigned area to achieve CMS Conditions for Coverage and FMS quality program requirements.
- Managed the tactical execution of Quality and other clinical initiatives, interventions, and standardized education materials with facility RNs within the assigned area.
Experience
7-10 Years
Level
Management
Education
Bachelor's In Healthcare
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager, performed Quality Management related functions including facilitation of Clinical Service Quality Committees, coordination of Joint Commission certification/recertification teams (as applicable), data analysis, and management.
Skills : Data Analysis, Team Work.
Description :
- Assisted in developing work plans, timelines, and gap analyses to assess quality and safety concerns. Collaborated with the Director of Quality to identify quality metric reporting needs and generate reports for clinicians, sites including HEDIS, and regulatory required metrics.
- Utilized an organized process to assess each clinics level of clinical compliance with quality and safety standards.
- Participated in the development and distribution of the most up-to-date and pertinent information regarding clinical quality and regulatory issues.
- Assisted in obtaining PCMH recognition by analyzing current workflows, assisting with Policy & Procedure (P&P) development and updates, partnering with management to implement workflow changes, and ensuring tracking of elements needed for PCMH submission.
- Improved processes and formulate policies in support of organizational Quality goals. Participated in Quality Meetings and other committees, as assigned.
- Assisted in the transition and implementation of new clinic sites.
- Audited non-providers to ensure compliance with documentation requirements and Provided direction to Site Managers in the development of action plans to improve performance for any identified documentation issues.
Experience
7-10 Years
Level
Management
Education
Healthcare Administration
Clinical Quality Manager Resume
Headline : As a Clinical Quality Manager, Improved skills through continued education and training. Applied and sharing new knowledge, skills, and information in the workplace. Provided a positive environment for employee growth, development, and retention, with open communication. Continually improved critical thinking, and professional excellence, and recommended new services for both internal and external customers.
Skills : Technical Skills, Collaborative Skills.
Description :
- Worked with Clinical Operations in preparing for clinical survey readiness activities to comply with regulatory and contractual requirements including state and federal audits.
- Proactived identification and assist in the correction of clinical quality / regulatory issues. Collaborated and assisted in the deployment of corrective action plans with the Chief Compliance Officer to support a culture of continuous quality and safety.
- Assisted in planning responses to new, revised, or upcoming regulations or standards. Remained current and knowledgeable of all present and future clinical regulatory / quality mandates.
- Worked directly with health center site managers to Identify health center clinical efficiencies and deficiencies and aid in the development and implementation of appropriate solutions to reach stated goals and objectives.
- Collaborated with Clinic Operations Manager as a resource for site audits. Collaborated with Clinic Operations Manager as a resource for Point of Care/Waive Testing standards in the clinic setting and provides education/information.
- Provided direction to the site manager to develop an action plan to improve performance for any identified issues and follows up as appropriate to assess improvement with revision to the action plan as needed.
- Coordinated assessment, development, implementation, evaluation, and timely communication of Departmental Policies/Procedures and regulatory requirements that will appropriately guide and support the provision of the services to be provided.
Experience
5-7 Years
Level
Executive
Education
Bachelor's In Healthcare Administration
Clinical Quality Manager Resume
Summary : As a Clinical Quality Manager, I Met and remained current with organization-wide policies and procedures. Set priorities and demonstrates effective organizational skills by optimizing the use of time, meeting deadlines, and completing assigned tasks in a cost-responsible manner. Demonstrated flexibility and support changes that improve the quality of care and service.
Skills : Planning, Quality Care.
Description :
- Demonstrated an active concern for all customers (both external and internal) of the Health Center by responding to their needs and expectations in a positive, prompt, and exemplary manner, thus promoting positive interpersonal relationships.
- Identified real/potential problems affecting service and Discussed issues related to staff and physicians with the department director.
- Cooperated with co-workers and other departments and Demonstrated attention to detail, thoroughness, and accuracy of daily work.
- Completed high-quality work in accordance with outlined standards and procedures within defined time frames.
- Maintained knowledge of and compliance with all current organization policies.
- Displayed a professional appearance, consistently wears name badges, and practices good personal hygiene.
- Utilized evidenced based and best-demonstrated practices to address barriers to quality improvement and Promoted the adoption and utilization of Corporate Medical Advisory Board Recommended Algorithms and Standing Orders, clinical pathways, and clinical policies and procedures to improve care coordination and care delivery.
Experience
7-10 Years
Level
Management
Education
Healthcare Administration
