Quality Improvement Nurse Resume Samples
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Quality Improvement Nurse Resume Samples
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VS
V Schmeler
Vicenta
Schmeler
4710 Goodwin Plains
Houston
TX
+1 (555) 872 8533
4710 Goodwin Plains
Houston
TX
Phone
p
+1 (555) 872 8533
Experience
Experience
Boston, MA
Quality Improvement Nurse
Boston, MA
Kunde, Rolfson and Connelly
Boston, MA
Quality Improvement Nurse
- Knowledge of Medicare Risk Adjustment and billing/coding
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program
- Oversees HEDIS reporting and trend to identify opportunities for quality improvement
- Partners with cross-functional teams, including, Sr. Product/health plan Quality Management to encourage member participation in population health
- History of taking on roles of increased responsibilities with proven results
- Willing to travel within the Assigned market
- Knowledge of medical coding
Los Angeles, CA
RN Quality Improvement Nurse
Los Angeles, CA
Rippin Group
Los Angeles, CA
RN Quality Improvement Nurse
- Knowledge of Provider Rewards and MRA Coding
- Bilingual a plus
- Strong knowledge of HEDIS/Stars/CMS/Quality
- Accurately define gaps in Humana’s service relationship with providers and facilitate resolution
- RN license in state of Florida with no restrictions
- Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members
- Previous utilization management, hospital or physician
present
San Francisco, CA
Quality Improvement Nurse Consultant
San Francisco, CA
Hammes, Trantow and Nolan
present
San Francisco, CA
Quality Improvement Nurse Consultant
present
- Deliver provider specific metrics and coach providers on gap closing opportunities
- Provide resources and educational opportunities to provider and staff
- Develop, enhance and maintain provider clinical relationship across product lines
- Establish and foster a healthy working relationship between practice and Humana
- Deliver provider/member-specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members
- Develop, facilitate, and/or secure opportunities to positively impact Triple Aim
- Prioritize Analyst work for PODS specific reporting
Education
Education
Bachelor’s Degree in Nursing
Bachelor’s Degree in Nursing
Quinnipiac University
Bachelor’s Degree in Nursing
Skills
Skills
- Statistical process control basics, computer literate and understanding of Quality Management processes
- Strong attention to detail
- Highly organized
- 1-2 years of Quality Improvement experience
- 5+ years of Quality Improvement experience
- Medical knowledge
- Ability to deal with politically charged situations
- Solid assessment, clinical, and documentation skills
- Excellent communication skills (written and verbal)
- Great interpersonal skills
4 Quality Improvement Nurse resume templates
Read our complete resume writing guides
1
Lpn-quality Improvement Nurse Consultant Resume Examples & Samples
- Effectively develop, enhance and maintain provider clinical relationship across product lines
- Deliver provider/member-specific metrics (e.g., SQR reports, Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members
- Previous physician office practice experience, primary care experience or provider visit experience
- Strong knowledge of HEDIS/Stars/CMS/Quality
- Managed Care Experience
- Previous Utilization Review or Case Management experience
2
Quality Improvement Nurse 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
- 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
- Facilitate patients’ participation in clinical programs & identify opportunities member participation
- Define gaps in Humana’s service relationship with providers and facilitate resolution
- Identify specific practice needs where Humana can provide support
- 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
- Capture concerns/issues in action plans as agreed upon by Provider & PODS Owner
- Document action plans and details of visits and outcomes within CGX
- Prioritize Analyst work for PODS specific reporting
- 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 drives successful Triple Aim outcomes
- An active RN license in the designated state
- Strong interpersonal & relationship building skills
- Strong influencing, listening, and consultative skills
- Utilization management knowledge and experience
- Coding knowledge and experience
- Office practice/ hospital experience
- Bachelor’s degree in a related field
- Proven leadership/supervisory/management experience
- Experience in a state and/or federally regulated health care environment
3
Rn Quality Improvement Nurse Northeast Tn Resume Examples & Samples
- Experienced clinical background as RN
- Strong business skills, including sales and marketing objectives
- Excellent PC skills
4
Quality Improvement Nurse Resume Examples & Samples
- RN with a clinical background or previous health plan knowledge
- Strong analytic skills and ability to use data to drive improvement activities
- Strong communication, interpersonal and negotiation skills
- Willing to travel within the Assigned market
- Previous clinical or health plan operations experience
- Prior Medicare or Medicaid experience
- Previous quality or process improvement experience in a hospital, health plan or physician office practice
5
Lpn-quality Improvement Nurse Resume Examples & Samples
- Deliver provider/member-specific metrics reports and coach providers on gap closing opportunities for Humana members
- Identify specific practice needs (e.g. use of most efficient interaction channel) to providing support
- Active RN or LPN license in FL with no restrictions
- Strong clinical experience preferably in an acute care, skilled or rehabilitation clinical setting
- Detail oriented and comfortable working with tight deadlines in a fast paced environment
- Valid drivers license and/or dependable transportation necessary (variable by region). This position requires local travel in Orlando, FL area
- 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
- Managed care experience
6
Quality Improvement Nurse Resume Examples & Samples
- Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), Member on a page, Anvita alerts) and coach providers on gap closing opportunities for Humana members
- Extensive Review of medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
- Experienced clinical background as an RN
- Previous utilization management, hospital or physician office practice experience
- Bachelor’s degree in a related field and/or work equivalent
7
RN Quality Improvement Nurse Resume Examples & Samples
- Review medical records and identify needed improvements that impact HEDIS measures or coding (i.e. identify deficiencies in data capture, use SQR to identify information and provide guidance to practice)
- Deliver provider/member-specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members
- Accurately define gaps in Humana’s service relationship with providers and facilitate resolution
8
Quality Improvement Nurse Consultant Resume Examples & Samples
- Document action plans and details of visits and outcomes
- Assess data, identify opportunities, and understand how the PODS drive successful Triple Aim outcomes
- CMS Stars/performance measures/HEDIS knowledge and/or experience
- Utilization management knowledge and/or experience
- Coding knowledge and/or experience
- Proven leadership experience
- Strong business acumen to help drive metrics
9
Quality Improvement Nurse Resume Examples & Samples
- Promote Population Health Management by educating our engaged providers on opportunities for QUALITY improvement in partnership with other functional areas
- Medical Record Reviews for Quality Opportunties, including Record Retrieval and submission where gaps are identified via the Medical Record Reviews
- Provide resources and educational opportunities to provider and staff
- Assess data, identify opportunities, and understand how to drive successful Triple Aim outcomes
- An active RN license in the designated state(s)
- Strong Organizational, Self-Starter, and Communication skillset a must
- Effective in Communication, both internally and externally to Providers as it relates to Quality findings
- Expert in Microsoft (Word, Excel, Power Point, Office, Sharepoint)
- Ability to travel to local market area provider offices for access to Medical Records when electronic retrieval is unavailable
- Savvy in Technology and Data Interpretation
- CMS Stars/performance measures/HEDIS knowledge and experience
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program
- BSN or Bachelor’s degree
- Previous Medicare/Medicaid Experience
- Fast paced, goal driven, understanding of start-up environment
10
Lpn-quality Improvement Nurse, Orlando Resume Examples & Samples
- 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)
- Knowledge of Provider Rewards and MRA coding
- Strong knowledge of HEDIS/Stars/CMS
- Previous health plan operations experience
- Strong analytical skills and ability to use data to drive improvement activities
11
RN Quality Improvement Nurse Resume Examples & Samples
- RN license in state of Florida with no restrictions
- Trong analytic skills and ability to use data to drive
- Improvement activities
- Previous utilization management, hospital or physician
- Office practice experience
- Previous experience and/or knowledge of Quality
- Improvement or process improvement
- Strong organizational and prioritization skills with ability to
- Collaborate with multiple departments
- Detail orientated and comfortable working with tight
- Deadlines in a fast paced environment
- Ability to work independently under general instructions,
- Self-directed and motivated
- Excellent PC skills (including MS Word, Excel and
- PowerPoint)
- Valid drivers license and/or dependable transportation
- Necessary (variable by region
12
Quality Improvement Nurse Resume Examples & Samples
- Develop, facilitate, and/or secure opportunities to positively impact Triple Aim (cost/quality/documentation)
- Ensure quality goals are aligned and executed effectively
- Assess and leverage provider technology to promote prospective and retrospective medical record abstraction
- Partners with cross-functional teams, including, Sr. Product/health plan Quality Management to encourage member participation in population health
- Drives STAR measures: Consumer Assessment of Healthcare Providers and Systems (CAHPS), Health Outcome Surveys (HOS), Care Management Services (CMS) and Healthcare Effectiveness Data Information Sets (HEDIS)
- Active RN or LPN license in the state(s) in which the nurse is required to practice
- Ability to travel throughout the Fort Myers, FL metro area on a daily basis
- Previous Medicare and Medicaid experience
13
Quality Improvement Nurse Consultant Resume Examples & Samples
- Facilitate regular Provider Engagement Strategy team meetings with ability to prioritize and interpret data through the use of strong analytical skills
- Successfully promote practice-patients’ participation in clinical programs - providing information on participation, Clinical Program availability/descriptions and facilitating members with program engagement
- Knowledge of HEDIS/Stars/CMS/Quality
- Previous quality or process improvement experience in a hospital or physician office practice
- Travel with reliable transportation
- This role is considered patient/provider 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
- MSN/MBA/BSN or Bachelor’s degree in a related field
14
Quality Improvement Nurse Resume Examples & Samples
- Minimum 2 years’ experience in Quality Management and/or LEAN experience with current knowledge of regulatory and accreditation standards highly desired
- Medical records, data analysis, business processes, facilitation experience, design, and development of performance measurement
- Medical knowledge
- Ability to deal with politically charged situations
- Negotiation and oral communication skills required
- Statistical process control basics, computer literate and understanding of Quality Management processes
- Computer skills in Word, Excel and Power Point required
15
Quality Improvement Nurse Resume Examples & Samples
- 1-2 years of Quality Improvement experience
- Current HCS-D and COS-C credentials
- CPC certification
16
Quality Improvement Nurse Resume Examples & Samples
- Deliver provider/member-specific metrics (e.g., Star Quality Reports (SQR), Member on a page, Anvita alerts) and coach providers on quality gap closing opportunities for Humana members
- Desire to consult and influence providers to improve quality of care for patients
- Strong understanding and ability to read medical charts and use EMRs in order to identify evidence of care
- Strong organizational and prioritization skills with ability to collaborate with multiple departments in a team environment
- Managed Care experience and understanding of value-based care model
- Knowledge of medical coding
17
Quality Improvement Nurse Resume Examples & Samples
- Clinical experience in a healthcare setting combined with quality improvement and administrative background
- Experience working with Core Measures, HEDIS, HOS and/or CAHPS surveys, JCAHO, NCQA, CMS or other regulatory guidelines
- Strong communication skills; ability to develop and foster relationships
- Ability to travel locally up to 75% of the time throughout the Fort Meyers and surrounding areas and to assist with other markets as needed
- High level of proficiency with MS Products, specifically Outlook and Excel as well as experience with EMRs and aptitude to learn clinical systems
- If selected for this role, you will be required to complete and pass background check/investigation for AHCA compliance
- Previous experience in quality management; population health management is a plus
18
Quality Improvement Nurse Resume Examples & Samples
- History of taking on roles of increased responsibilities with proven results
- Self-directed and motivated, with proven ability to work independently given general instructions
- Must have accessibility to high speed DSL or Cable modem for a home office (Satellite internet service is NOT allowed for this role); recommended speed for optimal performance systems if 10Mx1M
- Previous Health Insurance clinical or operations experience
19
Quality Improvement Nurse, RN Resume Examples & Samples
- Strong communication and public speaking skills; proven influencer
- Detail orientated, forward looking and comfortable working with tight deadlines in a fast paced, dynamic environment
- Demonstrated proficiency in Word, Excel and PowePoint
- If selected for this role, you will be required to be screened for TB
- Knowledge of CMS Stars Program elements, including HEDIS, Patient Experience and Patient Safety
- Physician office practice experience
- Previous Health Insurance clinical or operation experience
20
Quality Improvement Nurse Resume Examples & Samples
- Associate of Science Degree in Nursing (BSN strongly preferred)
- 3 years of clinical experience
- 3 years of acute care experience
- Knowledge of quality and process improvement principles and tools, statistics, data collection, analysis, and data presentation. Knowledge of care pathways, clinical guidelines. Ability to build and establish positive relationships with Physicians and staff. Ability to set performance goals and analyze results. Computer literacy and ability to learn new software programs and databases
21
Quality Improvement Nurse Resume Examples & Samples
- Active RN license in either or both state(s) Florida and Alabama in which the nurse is required to practice
- Ability to be licensed in multiple states without restrictions-license in both FL and AL required, only one at time of hire is needed
- 2-5 years Experience working with Core Measures, HEDIS, HOS and/or CAHPS surveys, JCAHO, NCQA, CMS or other regulatory guidelines
- Ability to travel to local provider offices 3-4 days a week in the Pensacola Florida, Mobile Alabama and surrounding areas
- BSN or Bachelor’s degree in a health Care and or business related field
- Health Plan or provider practice experience
- Previous Medicare and experience
