Quality Improvement Consultant Resume Samples
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Quality Improvement Consultant Resume Samples
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PC
P Crona
Price
Crona
2874 Kovacek Lake
Chicago
IL
+1 (555) 577 5923
2874 Kovacek Lake
Chicago
IL
Phone
p
+1 (555) 577 5923
Experience
Experience
Boston, MA
Quality Improvement Consultant
Boston, MA
Altenwerth-Batz
Boston, MA
Quality Improvement Consultant
- Deliver provider/member-specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members
- Define gaps in Humana’s service relationship with providers and facilitate resolution
- Prioritize Analyst work for PODS specific reporting
- Process improvement capabilities
- Knowledge of organizational structure, workflow, and operating procedures
- Qualify, prioritize, and concentrate Provider visit efforts on top opportunities
- Accurately define gaps in Humana’s service relationship with providers and facilitate resolution
Detroit, MI
RN Quality Improvement Consultant
Detroit, MI
Osinski-Stoltenberg
Detroit, MI
RN Quality Improvement Consultant
- Active RN license
- Design, manage and execute initiatives to drive quality measure performance for the Medicaid line of business
- Executes for Results: Effectively leverages resources to create exceptional outcomes, embraces change, and constructively resolves barriers and constraints
- Develop, enhance and maintain provider clinical relationship across product lines
- Establish and foster a healthy working relationship between practice and Humana
- Provide resources and educational opportunities to provider and staff
- Deliver provider specific metrics and coach providers on gap closing opportunities
present
San Francisco, CA
Medicaid Quality Improvement Consultant
San Francisco, CA
Heaney-Blick
present
San Francisco, CA
Medicaid Quality Improvement Consultant
present
- Entrepreneurial in thinking and acting
- Interpersonal Effectiveness: Understands oneself, effectively manages emotions, listens and communicates with respect, and builds trusting relationships
- Proven track record of managing projects and processes
- Serve as the expert in medical and health administration research for the Quality Improvement Programs
- Collaborate in the design of market level initiatives related to Quality Improvement strategies, manage and execute initiatives to drive quality measure performance for the Medicaid line of business; with market, corporate and vendor partners
- Builds Trust: Consistently models and inspires high levels of integrity in decisions, speech, and actions. Lives up to commitments, taking responsibility for the impact of one's actions. Exercises the courage to prioritize principles and values over personal or professional gain
- Establish strong working relationships with relevant stakeholders across Humana and effectively communicate quality improvement strategy and performance for the Medicaid line of business
Education
Education
Bachelor’s Degree in Healthcare
Bachelor’s Degree in Healthcare
Northwestern University
Bachelor’s Degree in Healthcare
Skills
Skills
- Strong results orientation and ability to prioritize efforts towards key results with the ability to multi-task
- Strong results orientation and ability to prioritize efforts towards key results
- Ability to use Microsoft products, computer software, run reports and maintain accurate data
- Knowledge of heart disease and/or stroke
- Demonstrated ability to effectively manage and build relationships within complex networks
- 2+ years experience in public health or a related healthcare field
- Experience in managing and building relationships to accomplish goals
- Strengths in collaboration and customer account management
- Satisfactory background and reference checks upon offer of employment
5 Quality Improvement Consultant resume templates
Read our complete resume writing guides
1
Quality Improvement Consultant Resume Examples & Samples
- Analyze data, produce reporting and generate value added recommendations that support effective decision making
- Establish strong working relationships with relevant stakeholders across Humana and effectively communicate quality improvement strategy and performance for the Medicaid line of business
- Design, manage and execute initiatives to drive quality measure performance for the Medicaid line of business
- Ensure appropriate performance to meet quality thresholds and maximize quality based payments to Humana
- Ability to interpret data generating key insights
- Excellent PC skills (including MS Excel, PowerPoint, Word)
- Strong analytical mindset with the ability to generate value added insights
- Process improvement capabilities
- Experience using one of the following: MS Access, SAS, ClickView
- Knowledge of Six Sigma, TQM or other quality improvement methodologies
- Prior experience in process improvement
- Experience in managed care or health care administration
2
Quality Improvement Consultant Resume Examples & Samples
- Qualify, prioritize, and concentrate Provider visit efforts on top opportunities
- Develop, facilitate, and/or secure opportunities to positively impact Triple Aim
- Maintain client relationships, effectively address provider needs & PODS goals
- Understand the business, industry, and industry trends and use knowledge to recommend effective solutions
- Responsible for profit and loss of the POD
- Lead and/or support collaborative business partnerships, elicit client understanding and insight to advise and make recommendations
- Clarify scope of work commitments and deliverables, and define measurable success criteria to monitor progress toward goals
- Deliver provider specific metrics and coach providers on gap closing opportunities
- Facilitate patients’ participation in clinical programs & identify opportunities member participation
- Coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges
- Develop, enhance and maintain provider clinical relationship across product lines
- Establish and foster a healthy working relationship between practice and Humana
- Partner with physicians/physician staff to find ways to explore new ways to encourage member clinical participation in wellness and education
- Provide resources and educational opportunities to provider and staff
- Capture concerns/issues in action plans as agreed upon by Provider & PODS Owner
- Document action plans and details of visits and outcomes within CGX
- Look beyond metrics to identify underlying issues that contribute to gaps
- Accountable for Provider Prioritization & communication of priorities to PODS team
- Facilitate regular Provider Engagement Strategy meetings
- Accountable for development of Provider specific Care Plans
- Assess data, identify opportunities, and understand how the PODS drive successful Triple Aim outcomes
- Strong interpersonal & relationship building skills
- Strong influencing, listening, and consultative skills
- Strong analytical skills, able to manipulate and interpret data
- CMS Stars/performance measures/HEDIS knowledge and/or experience
- Utilization management knowledge and/or experience
- Highly organized, analytical thinker required
- Coding knowledge and/or experience
- Bachelor’s degree in a related field
- Proven leadership/supervisory/management experience
- Six Sigma certification a plus
- Experience working in project management
- Strong business acumen to help drive metrics
3
Quality Improvement Consultant Resume Examples & Samples
- Document action plans and details of visits and outcomes
- Coding knowledge and/or experience or Office practice/ hospital experience
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program. If selected for this role, you will be required to be screened for TB
- Bachelor’s degree in a related field or an active RN/LPN license in the designated state
- Proven leadership experience
4
Quality Improvement Consultant Resume Examples & Samples
- Master’s Degree in health- or business-related field, clinical licensure
- Ten years of experience in Quality/Accreditation; five years in behavioral health preferred
- Knowledge of NCQA Accreditation, HEDIS, HOS, URAC and CMS regulatory requirements
- Leadership and motivational skills
- Integrated knowledge, interpretation and understanding of healthcare accreditation and program review practices
- Ability to manage databases and understand technical requirements
- Knowledge and understanding of accreditation planning and assessment methodologies and tools
- Skill in examining and re-engineering operations and procedures, formulating policy, and developing and implementing new strategies and procedures
- Skill in organizing resources and establishing priorities
- Knowledge of organizational structure, workflow, and operating procedures
- Ability to train associates at all levels of the organization to implement and maintain processes required for compliance to accreditation and state/federal regulations
- Strong communication skills (verbal and written) and interpersonal skills necessary in order to interact with a wide variety of individuals to obtain and exchange information
- Ability to analyze complex problems, identify operational needs, and develop integrated, creative solutions
- Working knowledge of clinical processes and case management preferred
5
Quality Improvement Consultant Resume Examples & Samples
- Must be able to travel 75% (day travel)
- Must be able to work collaboratively with cross functional teams
- Excellent communication and presentation skills, both oral and written
- Bachelor’s Degree; Graduate degree preferred
6
Quality Improvement Consultant Resume Examples & Samples
- Serve as a liaison with assigned departments in areas of reporting, Quality results and feedback
- Facilitate process improvement projects with assigned departments
- Promote data integrity and reporting timeliness
- Provide appropriate supporting evidence of assigned standards for all organizational accreditation reviews
- Identify and implement new strategies to enhance department efficiency and productivity
- Coordinate assigned task forces including agenda preparation, meeting facilitation, and minutes preparation
- Any other activities as assigned by the Quality Management
- Licensed behavioral health clinician or registered nurse
- Proficient knowledge of MS Word, Excel and PowerPoint
- Extensive quality and accreditation experience preferably in behavioral health
- Experience in utilization management preferably in behavioral health
- Metrics and report development experience
7
Quality Improvement Consultant Resume Examples & Samples
- Deliver provider/member-specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members
- Detail orientated and comfortable working with tight deadlines in a fast paced environment
- Excellent PC skills (including MS Word, Excel and PowerPoint)
- Travel with reliable transportation
- Clinical background as a RN/LPN or relevant experience working in quality and process improvements
- Knowledge of provider incentive rewards
- Previous clinical or health plan operations experience or background working in pharmaceutical sales
- MSN/MBA/BSN or Bachelor’s degree in a related field
8
RN Quality Improvement Consultant Resume Examples & Samples
- Diversified clinical experience
- Experience in quality improvement measures
- Strong communication and analysis skills
- Adaptable to changes in a dynamic environment
- Experience interacting with providers on an educational level
- This role is considered patient facing and is part of Humana's Tuberculosis (TB) screening program. If selected for this role, you will be required to be tested for TB
- Experience with HEDIS and Stars
9
Medicaid Quality Improvement Consultant Resume Examples & Samples
- Serve as the expert in medical and health administration research for the Quality Improvement Programs
- Provide regular, comprehensive summaries of critical literature findings, as well as state and national guidelines that will assist in the development and support of Medicaid Quality Improvement
- Complete ad hoc searches as required for development of financial models and metrics to support QI programs and initiatives
- Represent Medicaid Quality Improvement to internal and external audiences as required
- Create Quality Improvement Strategy presentations; conduct regular and as hoc online meetings with stakeholders, and present data to Division and Market leaders
- Collaborate in the design of market level initiatives related to Quality Improvement strategies, manage and execute initiatives to drive quality measure performance for the Medicaid line of business; with market, corporate and vendor partners
- Leverage reports and lead analysis to identify opportunities and assess progress to goals
- Proven facilitation skills and influencing others
- Proven track record of managing projects and processes
- Entrepreneurial in thinking and acting
- Master’s Degree in health- or business-related field
- Experience with quality improvement
- Familiarity with Medicaid and/or Medicare
- Hedis and technical specifications
10
Quality Improvement Consultant Resume Examples & Samples
- Effectively function within the quality improvement team to develop, enhance and maintain relationships with clinical and operations teams including the MRA Coding Team. Schedule and hold regular meetings with physicians and other staff to discuss strategy aimed at achieving STARS/HEDIS targets/goals
- Review provider/member-detail metrics to identify gaps in care. Utilize the data per the established workflow to drive gap closures for Humana members
- Successfully provide support of practice-patients’ participation in clinical programs - providing information on participation, Clinical Program as applicable (availability/descriptions and facilitating members with program engagement)
- Review medical records and based on guidelines, identify needed improvements that impact CMS Star measures or coding (i.e. identify deficiencies in data capture such as documentation capturing member reported data. Use available gap and performance reports to identify information and provide guidance to practice)
- Effectively coach provider office staff on best means to communicate with Senior members that may have hearing, vision, physical abilities challenges (i.e. Perfect Service orientation)
- In collaboration with leadership and the market team formulate and coordinate quality objectives to maximize quality outcomes
- Meet established standards and minimize costs when applicable through efficiency design / re-design
- Assist in driving the effective implementation of the quality improvement strategy across product lines
- Educate staff regarding quality improvement process and activities
- The role supports information management structures through knowledge of existing software to assist in the collection and analysis of data for performance patterns, trends and opportunities for improvement
- Extensive clinical background as a nurse minimum – Licensed Vocational Nurse (LVN), or Registered Nurse (RN) only
- Previous experience with HEDIS/CMS Medicare STAR program
- Must function well within a team setting but with the ability to function independently as applicable
- Experience working with clinicians and staff providing training/on-boarding, and leading discussions. Ability to present reports and data in a meeting setting
- Strong analytic skills and ability to use data to drive improvement activities. Capable of conducting chart review to identify documentation of medications and annual preventative/screenings especially for persons with chronic conditions
- Strong writing skills. Must be able to effectively communicate updates, deliver information regarding metrics/data, technical specification changes, updates regarding progress towards targets/goals via email or other medium and provide input if requested for member communication pieces brochures, posters etc
- Demonstrated communication and presentation experience
- Previous experience working with electronic medical records
- Knowledge of MRA Coding
- BSN or Bachelor’s degree in a related field
11
Quality Improvement Consultant Frontline Leader Resume Examples & Samples
- Current RN license in the state in which the nurse is/will be required to practice
- Ability to be licensed in multiple states without restrictions
- CMS Stars/performance measures/HEDIS knowledge and experience
- Office practice/ hospital experience
- Organizational and prioritization skills
- Previous management/supervisory experience
- Experience in educating new employees/continued education to employees
- Associates working in the state of Arizona must comply with the Tobacco Free Hiring Policy (see details below under Additional Information) and upon offer will be subjected to nicotine testing as part of a 10 panel drug test
- Previous clinical or health plan operations experience, including progressive leadership roles
- Prior Medicare/Medicaid experience
- Proven organizational, communication and community relations skills and the ability to communicate (oral and written) and work effectively with a diverse community
- CPHQ certification
- Utilization management knowledge and experience
- Understanding of clinical programs
- Coding knowledge and experience
- Provider and member rewards program knowledge and experience
12
Healthcare Quality Improvement Consultant Resume Examples & Samples
- Demonstrated ability to effectively manage and build relationships within complex networks
- Strong results orientation and ability to prioritize efforts towards key results
- Strengths in collaboration and customer account management
- 2+ years clinical experience in a hospital/healthcare setting (QI, RN, EMT, Case Management); acute care nursing experience preferred
- Bachelor's degree in healthcare or a related field, Master's degree preferred
- Knowledge of heart disease and/or stroke
13
Quality Improvement Consultant, Senior Resume Examples & Samples
- 5+ years of experience with leading chronic disease improvement initiatives
- Experience with quality improvement initiatives and programs
- Knowledge of CMS improvement initiatives and activities
- Knowledge of quality improvement concepts and methods, clinical workflow, and vocabulary
- Experience with improvement initiatives within practice settings
- MSN, MPH, or MHA degree
14
Quality Improvement Consultant Resume Examples & Samples
- 10+ years of experience with leading quality improvement initiatives and programs
- Knowledge of CMS improvement or payment reform initiatives and activities
- BA, BS, or BSN degree required
- Experience with Microsoft Office at an advanced level
- Experience in a clinical environment
- Experience with federal agencies’ healthcare programs and initiatives
15
Quality Improvement Consultant Resume Examples & Samples
- Experience with federal agencies healthcare programs and initiatives
- Post
- Secondary Certification or training
16
Quality Improvement Consultant Resume Examples & Samples
- Enthusiasm and motivation essential; a confident change-agent; strong presentation skills
- Bachelor Degree or equivalent experience
- Prior experience with quality improvement tools (i.e. root cause analysis, continuous improvement)
- Experience developing policies and procedural documents
- Demonstrated critical thinking skills
- Intermediate proficiency in MS Office programs
- PMP and/or Six Sigma certification or Project Management Institute certification
- CPHQ
- Prior experience in CA Healthcare industry
17
Healthcare Quality Improvement Consultant Resume Examples & Samples
- 5+ years of experience with leading surgical or chronic disease improvement initiatives
- Experience with a broad range of quality improvement initiatives and programs
- Knowledge of quality improvement concepts and methods, clinical workflow, and vocabulary
- Experience with cardiovascular improvement initiatives
18
Healthcare Quality Improvement Consultant Resume Examples & Samples
- Experience in managing and building relationships to accomplish goals
- Experience with data analysis a plus (no experience with statistical software packages is needed (i.e. SAS or SPSS))
- Ability to use Microsoft products, computer software, run reports and maintain accurate data
- Able and willing to travel in required territory 30% of the time, with some overnight travel, and work outside standard hours as needed, including occasional evenings and weekends
- Satisfactory background and reference checks upon offer of employment
19
Healthcare Quality Improvement Consultant Resume Examples & Samples
- 5+ years of experience in the health care field
- 3+ years of experience with quality and performance improvement or project management work
- 2 years of experience in a hospital setting
- Experience with facilitating quality, safety, or performance improvement initiatives using improvement methodology, including Lean Six Sigma, FMEA, and root cause analysis
- Experience with analytics, including data analysis, statistical analysis, and using tools to display data, including control charts and Tableau software
- Experience with evidence-based clinical care practices and national benchmarking
- Knowledge of how to solve problems with clinical processes, patient flow, and departmental and system design, including achieving high reliability
- Ability to lead and facilitate effective teams and realize favorable outcomes and performance
- Experience in an RN role preferred
- Ability to support multiple initiatives and balance resources and time concurrently to meet iterative requirements and changing priorities
- Certified Professional in Healthcare Quality (CPHQ) Credential or ability to obtain certification within one year of hire
20
Healthcare Quality Improvement Consultant Resume Examples & Samples
- 5+ years of experience in the healthcare field
- 2+ years of experience in a hospital setting
- 2+ years of experience with progressive quality and performance improvement or project management responsibilities, including facilitating quality, safety, or performance improvement initiatives using improvement methodology, such as Lean Six Sigma, FMEA, and root cause analysis
- Experience with analytics, including data analysis, statistical analysis, and the tools used to display data, including control charts and Tableau software
- Experience with spreadsheets, including Excel, databases, including Access, presentations, including PowerPoint, and word processing, including Word
- Knowledge of how to solve clinical process, patient flow, and departmental and system design problems with an aim at achieving high reliability
- HS diploma or GED
- Experience in a clinical role, including working as a registered nurse, preferred
- Ability to be self-directed and show initiative
- Certified Professional in Healthcare Quality (CPHQ) credential or ability to obtain certification within one year of hire
