Diane Adams
College Place,WA
Summary
Experienced Clinical Contact Center Triage Nurse specializing in emergency triage and effective communication. Enhances patient outcomes through thorough clinical assessments and collaborative teamwork. Expertise in regulatory compliance and quality assurance, ensuring timely data submissions and patient education on care processes.
Overview
26
26
years of professional experience
Work History
VISN20 Clinical Contact Center Triage Nurse
Veterans Administration
Walla Walla
04.2017 - 01.2023
- Acted as an Emergency Triage Nurse, responding to urgent and emergent Veteran calls.
- Triaged Veterans to appropriate care levels using nursing assessments and clinical algorithms
- Implemented early intervention strategies for urgent medical conditions like stroke and myocardial infarction.
- Positively impacted patient outcomes by recognizing symptoms that represent emergent conditions
- Utilized listening and communication skills to effectively engage with Veterans and their families
- Collaborated with multidisciplinary teams to coordinate patient treatment plans.
Core Measure Data Abstractor
St Mary Medical Center
Walla Walla
04.2015 - 05.2021
- Conducted medical record reviews and data abstractions for CMS, Joint Commission quality measures, and GWTG Stroke Registry Measure.
- Met all data submission deadlines and deliverables, contributing to timely reporting for quality measures.
- Trained hospital staff and patients on Performance Improvement program initiatives, enhancing engagement in quality care.
- Assisted in preparation for regulatory and accrediting surveys, ensuring compliance with established standards.
Clinical Documentation Specialist
St Mary Medical Center
Walla Walla
08.2014 - 04.2017
- Ensured accurate reflection of severity of illness and treatment through thorough review of patient medical records.
- Conducted concurrent reviews of medical records to validate diagnosis codes and identify critical missing information.
- Engaged with physicians and healthcare providers to clarify details for accurate documentation.
- Validated completeness and clinical accuracy of documentation to oversee DRG reimbursement.
Transitional Nurse Team RN
Veterans Administration
Walla Walla
07.2013 - 04.2017
- Conducted outreach to Veterans discharged from acute care within 48 hours to facilitate timely follow-up care
- Identified care gaps and assisted Veterans in scheduling provider appointments, enrolling in disease management programs, and receiving education on medications, treatment, and disease processes
Quality Coordinator
United Healthcare
Las Vegas
07.2010 - 07.2013
- Achieved established goals for Medicare Star Rating and reimbursement metrics, contributing to overall organizational performance and financial outcomes.
- Conducted medical record reviews with measure-specific data abstraction, ensuring compliance and supporting quality improvement initiatives.
- Executed inter-rater reliability testing for HEDIS team nurses, enhancing data accuracy and reliability for reporting purposes.
- Participated in internal CMS and HSAG audits, contributing to quality assurance efforts.
- Performed overreads to identify and correct data entry errors effectively.
Quality Coordinator
Kaiser Permanente
San Diego
08.2008 - 03.2010
- Conducted peer reviews of member complaints to ensure adherence to quality standards.
- Reported quarterly data to physician departments to highlight complaint resolutions and identify trends.
- Collaborated with department heads to address personnel issues and establish effective policies.
Sr Case Manager
PacifiCare of California
San Diego, California
03.2000 - 07.2007
- Coordinated care plans for diverse patient populations across multiple health systems, ensuring tailored support and continuity of care.
- Ensured comprehensive, appropriate care for members within medical groups.
- Collaborated with healthcare teams to address patient needs and improve outcomes.
- Resolved escalated member complaints, employing effective communication strategies that improved member trust and retention.
- Oversaw daily operations for assigned medical groups, enhancing service delivery and member satisfaction.
Case Manager
Scripps IPA
San Diego, California
01.1997 - 03.2000
- Coordinated client assessments to develop personalized care plans.
- Conducted daily utilization reviews to ensure clients received appropriate levels of care
- Evaluated client progress and modified care strategies.
- Provided education to clients on community resources and services to enhance their support network
- Ensured accuracy of case records and documentation to comply with agency guidelines
- Trained new staff on case management protocols and best practices.
Education
Bachelor of Science - Business Administration
University of Phoenix
San Diego, CA12-2007
Associate of Applied Science - Nursing
Walla Walla Community College
Walla Walla, WA05-1978
Skills
- Emergency triage
- Clinical assessment
- Patient documentation
- Care coordination
- Quality assurance
- Regulatory compliance
- Performance improvement
- Data abstraction
- Medical coding
- Multidisciplinary collaboration
- Effective communication
- Problem solving
- Attention to detail
- Active listening
- Educating patients
- HIPAA compliance
Timeline
VISN20 Clinical Contact Center Triage Nurse
Veterans Administration
04.2017 - 01.2023
Core Measure Data Abstractor
St Mary Medical Center
04.2015 - 05.2021
Clinical Documentation Specialist
St Mary Medical Center
08.2014 - 04.2017
Transitional Nurse Team RN
Veterans Administration
07.2013 - 04.2017
Quality Coordinator
United Healthcare
07.2010 - 07.2013
Quality Coordinator
Kaiser Permanente
08.2008 - 03.2010
Sr Case Manager
PacifiCare of California
03.2000 - 07.2007
Case Manager
Scripps IPA
01.1997 - 03.2000
Bachelor of Science - Business Administration
University of Phoenix
Associate of Applied Science - Nursing
Walla Walla Community College