Alexandra Boland
Maricopa,AZ
Summary
Results-driven Clinical Analyst with 11 years of clinical experience in the healthcare network, information technology and clinical informatics in the healthcare setting. Experience with leveraging clinical expertise and technical skills to optimize patient care and streamline processes. Adept at analyzing clinical data, implementing Electronic Health Record (EHR) systems, and developing quality improvement strategies. Excellent communicator with a proven ability to collaborate with multidisciplinary teams and enhance clinical decision-making.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Nurse Manager
Senior Care Services LLC
01.2021 - Current
- Leverage motivational interviewing during evaluation to encourage autonomy in patient care
- Maintained compliance and enhanced clinical care by providing feedback to clinical team
- Promoted excellence in communication, interpersonal, analytical thinking, autonomous problem-solving, teamwork, care coordination, and use of clinical knowledge
- Obtained case history and gathered triage information to determine appropriate avenue for care.
- Assisted in management of patient utilization of health care system and provided patient education relative to health care needs, use of community resources and responsibilities of membership in managed care.
Lead Nurse Manager, (Nurse Case Manager & Quality Compliance Nurse)
Accolade
01.2020 - 05.2023
- Track metrics of clinical application use and conduct audits.
- Implemented compliance, system security and patient confidentiality standards.
- Build meaningful relationships with core clients in the facility including medical professionals.
- Resolved risks to ensure efficient care management by addressing social determinants of health through various procedures
- Input data into computer programs and filing systems.
- Maintained accuracy, completeness, and security for medical records and health information.
- Utilized electronic medical record systems to store, retrieve and process patient data.
- Identified care needs of individual patients and coordinated responses based on physician advice, insurance limitations, and procedural costs.
- Deliver customized care planning to identify gaps and barriers preventing patients from gaining best health outcomes
- Lead several functions, including analyzing medical records, insurance data, and other aspects of patient care using knowledge of nursing operations and care standards
- Conduct team clinical NCQA audits by utilizing representative samples of practices to verify facts and declarations
- Increased QA scores within three months by conducting clinical compliance audits for nurses to assist in Quality & Compliance training and reviewing clinical documentation to meet compliance criteria.
Nurse Manager
C&S Staffing
01.2018 - 01.2020
- Led creation and maintenance of effective care management process by establishing patient financial/medical eligibility and determining medical necessity
- Developed and deployed unique patient care plans and communicated to patients, families, and clinical staff for delivering high-quality care across healthcare continuum in compliance with set policies
- Conducted telephone follow-ups with discharged patients to ensure treatment continuity, needs assessment, and issue resolution
- Ensured compliance and better documentation within six months via training nurses to avoid future mistakes by identifying root causes and addressing problems to validate patients’ clinical records
- Reviewed intake evaluations while remaining focused on treatment interventions and monitoring quality care
- Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows.
- Influenced care outcomes by implementing improvements and optimizing health information technology.
- Researched and validated clinical data.
- Applied knowledge, data, information and workflow to develop evidence-based models for health information technology solutions.
- Implemented healthcare systems for patient status monitoring, quality tracking and home care management.
- Evaluated and optimized clinical software, applying established and end-user feedback.
Quality Improvement Nurse & HEDIS Data Analyst
Nurse Life
01.2015 - 01.2018
- Maintained HIPAA regulations and privacy of protected health information, while reporting serious incidents in prompt manner
- Examined assigned medical records to validate clinical data items for HEDIS reporting and established findings in adherence to documentation guidelines
- Promoted specialized data entry and collection, as well as comprehensive medical record review and abstraction, for HEDIS and HEDIS-like metrics
- Performed and completed MDS reviews; reviewing patient records to determine care needs, developing and implement care plans based on assessment findings as well as monitor and evaluate patients’ responses to treatments.
- Consulted professional standards of care, scientific evidence and practice to evaluate health care programs.
- Ran quality metrics reports to maintain high standards of virtual care.
- Operated computer-based systems to retrieve and store information and records.
- Provided guidance in development, implementation and maintenance of company clinical information system.
- Researched and validated clinical data.
Education
Nursing -
Wayne CC
Newark, NYBachelors of Science -
Rochester Institute of Technology
Rochester, NY2015
Skills
- Strategic Planning
- Process Improvement
- Technology Integration
- Data Collection & Abstraction
- Project Management
- Power BI
- Health Care Administration
- Managed Care
- Clinical Compliance Audits
- Microsoft Word Excel PowerPoint Qlik sense EMR/EHR Tracking Systems Access OneNote Outlook Google
- Clinical Applications VisioHIM Workflow
- User Experience
- Clinical Data Analysis
- Clinical Development and Operations
- Process Integration
- Electronic Medical Record (EMR) Systems
- Workflow Processes
- Operational Efficiency
- Web Applications
- Quality Assurance
- Utilization Review
- Case Management
Certification
HEDIS/Data Abstraction: Certificate of Completion, Remote Learning Services, LLC
Nurse-Arizona Multistate License
Timeline
Nurse Manager
Senior Care Services LLC
01.2021 - Current
Lead Nurse Manager, (Nurse Case Manager & Quality Compliance Nurse)
Accolade
01.2020 - 05.2023
Nurse Manager
C&S Staffing
01.2018 - 01.2020
Quality Improvement Nurse & HEDIS Data Analyst
Nurse Life
01.2015 - 01.2018
Nursing -
Wayne CC
Bachelors of Science -
Rochester Institute of Technology