A Quality Improvement Nurse works in the healthcare industry and strives to improve the quality of care that nurses provide. Other related duties are listed on the Quality Improvement Nurse Resume as – keeping a record of how quality assurance improves the way things are done in the organization; launching new life-saving strategies inpatient care and recommending upgrades that will make patient care more accurate and efficient, such as software and new equipment. Some of the nurses also act as a coordinator and handle the tasks of ensuring smooth and efficient operations in the healthcare sector.
The nature of the work demands the following skills and abilities – strong work experience in quality improvement, clinical experience, knowledge of common issues and solutions, familiarity with health care risk management, and detail-orientation. A nursing degree and relevant certification are needed to work in this capacity.
Headline : A position as a Quality Improvement Nurse in a health care facility where I can enhance my nursing education and training. In addition, utilize my prior nursing experience and interpersonal skills to provide the highest level of patient care.
Skills : Computer Skills, Instructing Skills.
Description :
Effectively supervised LVNs, CNAs, and non-clinical staff.
Processed weekly and monthly reports for the wound care and infection control programs department performance.
Managed care for post-operative patients through discharge.
Performed lab tests and communicated results.
Liaised between patients and physicians to ensure patient comprehension of treatment plans.
Instructed patients and family members on proper discharge care.
Contributed substantially to successful department JCAHO accreditation.
Experience
5-7 Years
Level
Junior
Education
Diploma
Quality Improvement Nurse Resume
Headline : Monitoring residents within state licensure regulations; may supervise and direct resident assistants where allowed by state licensure regulations. Assisting in maintaining a physical, social, and psychological environment in the best interest of residents.
Responsible for daily activities in Medicaid/Medicare Health Plan focusing on improving quality of care provided to its members, specifically to the Star, Star +, CHIP, CHIP RSA programs for all service delivery areas in Texas.
Managed Performance Improvement measurement (PIGs), ensuring goals are met, obtaining aggregate data, compiling reports, and submit to HHSC semi-annually.
Participated in HEDIS activities IRR and MRR, including training activities.
Obtained aggregate data on designated HEDIS interventions and preventive health measures to improve rates.
Timely processed of Appeals including coordinate investigation, track and trend results, and ensure compliance with NCQA standards.
Investigated all PQOC complaints and issues, track and trend results, report to MAC quarterly.
Conducted Facility-based Audits, identify deficiencies, analyze results, prepare reports and submit to MAC for trending.
Experience
5-7 Years
Level
Executive
Education
Bachelor Of Science
Quality Improvement Nurse Resume
Summary : Experienced, highly skilled Quality Improvement Nurse with excellent communication skills and 21 years of nursing and health care experience. Dedicated, caring, and motivated. Passionate about patient care and strongly devoted to family/patient advocacy. Seeking a position to utilize my nursing skills with opportunities for further growth.
High Point, NC Conducted screening, diagnostic treatment, and rehabilitative and supportive services as the senior nurse on a primary health care team.
Recorded patients' medical history, vital statistics, and test results in medical records.
Developed and maintained quality care systems and standards, including but not limited to, creating and improving medical protocols/guidelines.
Actively participated in unit-based Quality Assurance Program.
Sound, ethical and independent decision-making ability consistent with medical protocols.
Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
Provided necessary health education training for patients.
Experience
10+ Years
Level
Senior
Education
GED
Quality Improvement Nurse Resume
Objective : Supporting patients with customized patient teaching tools, Evaluating patient care needs, prioritized treatment and maintained patient flow, and also Continually updating clinical practice guidelines and monitor physician compliance with guidelines via aggregate data, prepare and submit reports to MAC.
Skills : MS Office, Coordinating Skills.
Description :
Supported health plan in achieving goals of clinical quality, cost efficiency, and member service excellence through monitoring and evaluation of the healthcare delivery system.
Assisted with the preparation and execution of accreditation (NCQA) and regulatory (CMS, AHCA, etc) health plan audits.
Coordinated quality of care complaint/resolution process.
Promoted and coordinated quality improvement activities.
Identified quality of care and quality of service issues including the management of PHI and the abstraction of medical records keeping with HIPAA regulations.
Conducted medical record case reviews on an on-going basis.
Included retrospective and ambulating reviews.
Responsible for maintenance of health plan delegates with regards to utilization management and assuring that those delegates maintain NCQA standards in-line with those of the health plan.
Drafted Memorandums of Understanding as well as pre-delegation and annual delegation audits.
Experience
2-5 Years
Level
Executive
Education
GED
Quality Improvement Nurse Resume
Summary : Professional Quality Improvement Nurse with 7 years experience in Healthcare Administration. Experienced includes InterQual criteria, EMR, HEDIS, Medicare benefits, and DRG payments, EPIC, Medical treatment Authorization Request process, Telemedicine, commercial insurance authorization, and concurrent review. Case Management: Developing and implementing care plans, managing high-risk lives, ensuring quality yet cost-effective care.
Skills : Planning Skills, Supervising Skills.
Description :
Responsible for member and provider grievances.
Reviewed potential quality Issues.
Performed clinical review of Quality of Care and Quality of Service Issues.
Utilized the QM clinical database to track and trend provider grievances, members, and IPA's for quality issues.
Reviewed information for Peer Review meetings and follow up on all Corrective Action Plans.
Ensured that all providers and vendors were in compliance with DMHC guidelines.
Prepared Complaints, Grievances, Sentinel Events, and Potential Quality Issue reports for the Board of Directors, Management Council, and JOC meetings.
Utilized Review Nurse for Health Plan Performed Retro Review of inpatient stay using Milliman Care Guidelines.
Experience
7-10 Years
Level
Management
Education
GED
Quality Improvement Nurse Resume
Headline : Professionally, I seek a position that is both rewarding and challenging. Job duties would utilize my nursing skills and my knowledge in business/management. I strive to provide excellent care on a personal level to all patients. Therefore, it is important to me that the employer's first concern is the wellness of each individual patient.
Qualified, prioritized, and concentrated provider visit efforts on top opportunities.
Developed, facilitated, and/or secured opportunities to positively impact documentation, quality, and cost management.
Led and/or supported collaborative business partnerships, elicit client understanding, insight to advise, and make recommendations.
Maintained accountability for provider prioritization & communication of priorities to other team members.
Delivered provider-specific metrics and coach providers on gap closing opportunities.
Partnered with physicians/physician staff to explore new ways to encourage member clinical participation in wellness and education.
Provided resources and educational opportunities to providers and staff.
Experience
5-7 Years
Level
Executive
Education
Master Of Science
Quality Improvement Nurse Resume
Headline : Documenting and reviewing medication and treatment sheets for accuracy and compliance with physician orders, professional standards, federal and state regulations, and company policies. Monitors responses to treatment plans. Possesses knowledge of medication interaction and notifies Director of any occurrences.
Skills : Case Management, Disease Management, Communication Skills.
Description :
Completed Quality Improvement reports for the Medicare Agency (i.e. monthly, quarterly, year-to-date, etc.) as needed.
Attended and chaired the Interdisciplinary Review Team Meetings for the Case Management and Diversion Solution Program.
Reviewed all Medicare patient charts and files at the local level to assure proper documentation to maximize reimbursement.
Reviewed included verification of appropriate documentation, quality of care provided, visit utilization, appropriate contacts with the physician, adherence to the care plans, supplemental orders, and evidence of communication between disciplines.
Utilized data, information, and trends to identify opportunities for quality improvement and to collaborate with Home Care leadership to develop quality initiatives.
Identified learning needs, assists in education program, coordinates and trains employees on Quality Improvement Program and initiatives.
Drafted professional letters to providers and IPA's for provider response and closure letters.
Experience
5-7 Years
Level
Executive
Education
BS
Quality Improvement Nurse Resume
Headline : Planning and organizing quality control programs and activities. Maintaining a library of quality control and assessment materials necessary for complying with current standards and regulations and maintaining quality resident care.
Skills : Case Management, Disease Management.
Description :
Planned and organized site visits for providers and facilities with the Ped-I-Care provider network.
Researched and reviewed member data, reviews charts, interviews staff, and observes the facilities for safety and other quality issues.
Ensured adherence to State and Federal laws, governing agencies' guidelines, and contractual obligations.
Completed response letters and reports data on quality issues, site reviews, and data reviews.
Ensured accurate and timely documentation.
Communicated with providers, members, parents/guardians, ICS Medical Directors, CMS Nurse Care Coordinators, and ICS Third Party Administrators.
Initiated processes to correct problems and provide follow-up.
Experience
5-7 Years
Level
Executive
Education
BA
Quality Improvement Nurse Resume
Headline : A compassionate, loyal, and clearly dedicated individual who has the ambition to succeed in any given environment. Although I have extensive experience in the home health care industry, I love to learn and am always open to new educational opportunities. Work very well with others while also working efficiently independently.
Skills : Quality Improvement, Nursing.
Description :
Responsible for conducting the clinical documentation review of the case managers to assure agency policies, as well as State and Federal standards, are being met.
Conducted pre-certification and concurrent reviews with commercial insurance companies to obtain authorization for services.
Participated in the development of agency policy and procedures.
Educated clinical associates in proper clinical and OASIS documentation to assure appropriate utilization and documentation of services.
Audited medical records.
Supported quality assurance performance improvement work plan/initiatives.
Assisted in investigation and resolution of member quality of care complaints.
Experience
5-7 Years
Level
Junior
Education
Bachelor's In Nursing
Quality Improvement Nurse Resume
Headline : Overseeing the Infection Control Program of the facility and devises infection control reports for submission to the Director of Clinical Services and Quality Assurance Committee, Ensuring adherence to OSHA guidelines and infection control standards.
Skills : Medical Records, Nursing.
Description :
Investigated quality of care and service complaints.
Responsible for conducting research of clinical pathways and presenting to Medical Director for approval Review and revise existing policies and procedures as recommendations for improvement are identified.
Performed medical chart audits for specific HEDIS measures Assist with maintaining health plan regulatory and contractual compliance requirements for the organization's quality improvement program.
Presented during quarterly provider training sessions.
Prepared and presented reports to the Quality Improvement Committee.
Conducted retrospective reviews of clinical quality management cases to include adverse events and mortality reviews.
Conducted clinical record reviews to assure appropriate utilization and documentation of patient services.
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