Connie Temple
Danville,PA
Summary
Accomplished Quality Improvement LPN Specialist with a proven track record at Geisinger Health Plan, excelling in HEDIS/Data Abstraction and demonstrating exceptional attention to detail. Proficiant in medical documentation review and regulatory compliance, significantly enhancing clinical quality data accuracy and operational efficiency. Skilled in leveraging analytical thinking for quality assessments, ensuring top-notch healthcare delivery.
Overview
6
6
years of professional experience
Work History
Quality Improvement LPN Specialist
Geisinger Health Plan
10.2021 - Current
- Manage member case load for annual and proactive HEDIS/prenatal-postpartum (PNPP) compliant/non-compliant population.
- Retroactive medical record review to obtain clinical quality data per HEDIS/prenatal-postpartum (PNPP) specifications set forth by the National Committee for Quality Assurance (NCQA).
- Medical record data abstraction for all HEDIS measures through EMR’s and PCP to collect criteria established by CMS, NCQS and other regulatory agency standards.
- Independently reviews targeted measures and accurately document relevant medical record data into the Quality database.
- HEDIS auditor and Overreader for annual audit.
Care Gap Coordinator Nurse
Geisinger Health Plan
03.2020 - 10.2021
- Conduct medical record reviews including physican progress notes and radiology reports,
- Entered data, generated reports, and produced tracking documents.
- Enhanced operational workflows by maintaining well-organized documentation systems and updating records accurately as needed.
- Gathered and organized materials to support operations.
- Tracked records and maintained communication between clients and health care specialist.
Utilization Management Review Nurse
Geisinger Health Plan
10.2018 - 03.2020
- Performed initial, concurrent and retrospective utilization reviews for all behavior health inpatients.
- Collaborated with physicians and social workers to obtain required clinical information to support medical claim.
- Contacted insurance carriers to obtain authorizations.
- Managed physician peer review and appeal processes pertaining to denials and potential denials as outlined by insurance carriers.
- Provided ongoing reviews of patient conditions and/or improvements in accordance with insurance carrier.
- Complete coordination of benefits and bridge on discharge.
Education
Nursing License - Practical Nurse
Central Susquehanna LPN Career Center
Sunbury, PA08.2009
Skills
HEDIS/Data Abstraction
Medical Documentation Review
HIPAA Compliance
Clinical Documentation Review
Documentation accuracy Review
EMR / EHR
Behavioral assessment
Medical Records Management
Analytical Thinking
Regulatory Requirements
CPR/AED
Attention to Detail
Responsible and Dependable
Quality Assessments
Epic Systems
Timeline
Quality Improvement LPN Specialist
Geisinger Health Plan
10.2021 - Current
Care Gap Coordinator Nurse
Geisinger Health Plan
03.2020 - 10.2021
Utilization Management Review Nurse
Geisinger Health Plan
10.2018 - 03.2020
Nursing License - Practical Nurse
Central Susquehanna LPN Career Center
Similar Profiles
Tiffany EvansTiffany Evans
Licensed Practical Nurse Case Manager at Geisinger Health PlanLicensed Practical Nurse Case Manager at Geisinger Health Plan
Brianne LatshaBrianne Latsha
Nurse Case Manager at Geisinger Health PlanNurse Case Manager at Geisinger Health Plan
Shannon HackenbergShannon Hackenberg
Executive Assistant to President of GHP at Geisinger Health PlanExecutive Assistant to President of GHP at Geisinger Health Plan