Quality Management Coordinator Resume
Summary : To use the skills and knowledge that have acquired in nursing and case management,
Skills : PA and NJ Workers' Compensation [?] Catastrophic/Trauma.
- Responsible for Peer Review Committees for both campuses, Department Meetings for both campuses, preparing both campuses for JCAHO, HCFA, and Deparetment of Health surveys.
- Handled occurrence reports for both campuses.
- Prepared statistical reports for Department Meetings for both campuses.
- Responsible for discharge planning/case management of the Telemetry unit.
- Responsible for arranging for short-term care placement, long-term care placement, and short-term rehabilitation placement.
- Arranged for care home placement for those clients who qualified for this type of care.
- Collaborated with interdisciplinary teams to improve the elements of the surgical care improvement program.
Sr. Quality Management Coordinator Resume
Summary : MBA nurse manager/consultant with 21 years Insurance Industry medical management experience, including 13 years workers' compensation and motor vehicle accident claim management. Experienced with third party payer regulations, utilization management standards, case management methodologies, and regulatory requirements related to utilization management and cost containment.
Skills : Quality Assurance, Behavioral Health, Credentialing.
- Assisted in the implementation, coordination, assessment, evaluation and development of Beacon Health Option's Quality Management and Performance Improvement program.
- Coordinated the Quality Management Program through problem identification, development and coordination of QM studies and activities, including HEDIS, measurement and analysis of results, and recommendation of solutions.
- Assisted leadership in the evaluation of these results contributing to the Quality Management Program Evaluation.
- Worked with Associate Medical Director, Quality Management on development and revision of Clinical Practice Guidelines.
- Assisted management with the revision of Quality Management policies related to NCQA standards.
- Developed, maintained and enhanced reporting methods to identify trends in physician and member behavior.
- Completed applicable physician summaries.
AAS In Nursing
Jr. Quality Management Coordinator Resume
Objective : Able to quickly identify user issues. Use all necessary tools and training to resolve the issues effectively and proficiently on own. Constant contact with the user, to ensure they are made aware of any progress of their issue. Willing to go above and beyond to ensure the user's issue is resolved or documented for future system update.
Skills : Supervisor, Case Management, Excel, Word, Medicare, Medicaid, Motivational Interviewing.
- Integrated, troubleshot, analyzed, maintained, and cleaned all QDM correspondence in SAP System.
- Obtained SAP QM Master Data cleansing and verification Planned, analyzed and executed creation and disbursement of Certificates of Analysis for all imported and domestically produced products.
- Maintained specifications, layouts, errors and holds for products from business units.
- Assisted in creation of new materials for, IPG, SCP, TRP, LEA, and TPC imports.
- Responsible for maintaining all customers' information in Customer Master data files and additional special identification coding.
- Established customer data to support sales and reporting.
- Maintained customers for conglomerates and sales alignments for use in sales/accounts receivable reporting.
Bachelors Of Science
Quality Management Coordinator III Resume
Summary : To obtain a position that will utilize medical and educational expertise in the health care industry. Ten years' medical and clinical experience in hospital and insurance industries. Demonstrated record of accomplishment, proficient in crises, excellent interpersonal skills, well organized, and results-driven.
Skills : Pulbic Speaking, Counseling, Clinical Trainings, CARF Clinical Support.
- Started in our Business Office as a Patient Representative, answering phones, appealing insurance and helping patients with their billing questions.
- Promoted to Surgery Scheduling for our busiest location which included helping schedule patient appointments, verifying and authorizing insurance, etc.
- Promoted to Surgery Coordinator for that location responsible for coordinating patient surgery schedules, flights for doctors to rural areas, nursing schedules, etc.
- Provided analytical support and master data maintenance for SAP system through use of electronic data queries/analysis.
- Monitored flow of data from global master data reference server to SAP system.
- Reviewed admission and -stay cases based on hospital criteria guidelines Referred cases to the physician advisor, as necessary Performed telephone-.
- Coordinated and maintained performance improvement program for multiple department and committees.
Quality Management Coordinator II Resume
Summary : To obtain employment in social services, utilizing abilities developed through experience and education, with the opportunity for professional growth based on performance.
Skills : Microsoft Office Suite, BLS, Information Technology, Newsletters, Written Communication, Oral Communication, Training, Team Building, Business Analysis, Customer Service, Change Management, Data Analysis, Documentation.
- Oversaw clinical practice workflow, documentation, and process issues and concerns, and provides leadership and guidance to define system and process requirements that will optimize clinical and system performance to include technology utilization by clinical practitioners.
- Supported the physicians, clinicians, health care workers, affiliates and partners by providing continuous leadership provision through structured data analysis identifying opportunities for clinical information system improvements.
- Responsible for quality scores, increased performance and efficiencies, utilizing Lean, Six Sigma, and informatics approaches to understanding processes and data.
- Participated in AQI data analysis.
- Responsible for managing the uplift of the perioperative surgical home program to include modular and service line implementation of care pathways, aligned preoperative testing, and ERAS.
- Worked knowledge of CMS and private payer matrix, PQRS requirements, MIPS, and MACRA requirements for and beyond.
- Promoted future and present system functionality by designing, building and testing the clinical information systems.
Doctor Of Nursing Practice
Quality Management Coordinator I Resume
Headline : Accomplished professional with demonstrated skills in management, process improvement, and problem solving. Expertise in purchasing, inventory control, customer service, and office management. Extremely organized with acute attention to details. Talent for quickly mastering technology (Expert in Microsoft Word, Excel, and PowerPoint). Thrive in deadline-driven environments. Excellent communication, administrative, and team building skills.
Skills : Microsoft Office, Administrative Support, Administrative Assistant, Office Management, Receptionist, Employee Supervision.
- Worked with departments and management to develop all forms used by the agency.
- Updated forms as rules and regulations change and kept up-to-date forms on the agency's Intranet for access by all staff.
- Used sound judgment to independently compose all internal and external correspondence sent from the QM Department in regards to policies and procedures, corrective action plans, new procedures or forms, request for waivers or variances, request for information from other agencies/companies, applications for permits for new programs or facilities, responses to inquiries from other departments or companies, etc.
- Worked with Program Managers to develop manuals and training materials for use by other departments.
- Handled all consumer complaints that could not be handled at the department level and were referred to the QM Department; this included conducting investigations if necessary.
- Effectively served on committees and task forces as management's representative as required and accurately reported information as conveyed at meetings, conferences, and/or training sessions to supervisor and/or other staff if required and in a timely manner.
- Coordinated managerial and administrative meetings to include requesting agenda items; preparing meeting minutes, agenda, and handouts.
Executive Secretarial Program
Assistant Quality Management Coordinator Resume
Objective : To provide excellent technical and leadership services in the professional areas of Health Information Management, Coding, Quality Management and database management systems.
Skills : Resource Management, Multicultural Communication, High Risk Environments, Training, Microsoft Office, Special Projects.
- Performed clinical outcome analysis and reports for medical staff committees.
- Reviewed physician documentation vs.
- coded data to ensure consistency and accuracy of reported clinical and administrative data.
- Wrote annual PI reports, made story boards to show QM improvement projects.
- Accreditation preparation, regulatory compliance, and related special projects.
- Served as Tumor Board Coordinator.
- Performed root cause analysis and sentinel event reviews.
- Trained nursing staff on how to review records for quality indicators.
Health Information Administration
Associate Quality Management Coordinator Resume
Objective : Over 37 years combined experience in utilization review and coding. As a Medicare and Medicaid Coding Compliance Analyst for MPRO, review medical records and ensure that diagnostic and procedural coding practices are consistent with coding rules and regulations for Medicare, Medicaid, and private review contracts.
Skills : Performance Improvement, Project Management, Project Coordination, Project Development, Patient Safety, Healthcare.
- Provided day to day operational functions.
- Managed timekeeping for the department.
- Worked with Vice President, Compliance Director and Attorneys to coordinate all legal activities reviewing on-going open/closed cases.
- Facilitated litigation cases and prepared quarterly claims meetings with Insurance Company and attorneys.
- Developed a daily rotation system with Case Managers on calls received from our ER/Obstetrician Department.
- Complied transfer logs and monthly statistical reports and prepared agenda for Quality Council meetings.
- Reviewed results, demand and appeal letters from CMS (Centers for Medicare & Services) including RAC(Recovery Audit Contractors) appeal letters submission to Patient Accounts Department for further investigation.
Assistant Quality Management Coordinator I Resume
Objective : Registered Nurse. a Quality/Risk Manager for the last 25 years of nursing career. Enjoy this type of work in addition to survey, audit, and legal work, Supported Cardiology Cardiovascular and Anesthesia Subcommittees Reviewed cardiovascular records to abstract pertinent information for the Society of . Entered monthly Customer Service Surveys from Press Ganey into database to track our scores.
Skills : Computer, Analysis, Organizational, Performance Improvement, Customer Service, Supervisory.
- Facilitated performance goal-setting, established performance indicators, coordinated improvement projects throughout agency.
- Chaired Safety Committee and handled incident reports.
- Followed up on patient and caregiver surveys, tracked survey response data; discussed care issues with family members and followed up with team supervisors.
- Wrote procedure for management of HIV exposure incidents conforming to OSHA requirements; interfaced with area hospital emergency room staff to secure prompt follow up services.
- Organized drill for response to natural disasters; coordinated fine-tuning of practices based on lessons learned from drill.
- Established standards for chart audits based on Medical Director's pain management protocols.
- Conducted trouble-shooting of pharmacy management software and worked with vendor for correction.
Ph.D. In Leadership
Quality Management Coordinator Resume
Objective : To utilize skills and strengths, accept challenges, be part of a Team that will assist in enhancing the quality of people's lives, and to assist leading an organization to reach its fullest potential.
Skills : Project Management, Managed Care, Health Care Quality, Population Health Management, NCQA Accreditation, HEDIS, Microsoft Office.
- Designed, implemented, and managed disease management programs for Michigan's largest HMO.
- Conducted studies to assess program impact.
- Presented on disease management/care management to employers and at conferences/forums.
- Managed department staffed by registered nurses and administrative personnel with the authority to hire and terminate.
- Initiated collaborative disease management activities involving multiple community partners.
- Developed and operated within an annual budget of approximately $1 million.
- Managed regional quality management activities (NCQA accreditation, HEDIS, CAHPS, focused quality studies, credentialing, peer review, and clinical practice guidelines).
- Collaborated with Care Management, Customer Services, Provider Affairs and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner and provider quality related issues.
MS In Progress