Diane Robinson
Brooklyn
Summary
Sympathetic Clinical Liaison excited to transition to a new position where strong interpersonal skills and a passion for patient advocacy can be utilized. Successful at completing clinical assessments on patients and determining programs to improve quality of care.
Overview
25
25
years of professional experience
Work History
Clinical Liaison Registered Nurse
ODA Primary Health Care Network
Brooklyn
01.2023 - Current
- Handles incoming calls from patients and pharmacies to facilitate efficacious care and consideration to our patients.
- Receives/ returns calls from patients and addresses: lab results, medical concerns, and appropriate recommendations for provider visits.
- Serves as liaison and information source for other departments support staff, department physicians and referring providers, patients, and insurance companies.
- As directed by Clinical Liaison supervisor and Director of Nursing, will provide direct patient care support in the performance of a licensed staff functions as indicated:
- Under direction providers, review labs, diagnostic imaging and referrals and coordinate follow-up care as prescribed.
- Serves as patient advocate.
- Offers patient education, as recommended by the physician.
RN Clinical Quality Manager
Village Care Max
New York
05.2022 - Current
- Promote comprehensive understanding of HEDIS/Stars measures, barriers, and opportunities to key internal and external audiences.
- Participates in annual HEDIS chart retrieval process, such as: medical record retrieval, MMR/overreads, claims research, provider outreach, and issue resolution.
- Co-Chairperson of the Press Ganey Member-Provider Experience Workgroup to improve Member Experience and CHAPS Scores.
- Participates in Medication Adherence Workgroup. Collaborates with Care management and Pharmacy teams. Performs outreach to providers, pharmacies for prescription renewals.
- Reviews Proportion of Days Covered (PDC) reports for medication non-adherence and works with pharmacy and Care Management to assist members into compliance.
- Participates in driving MLTC Quality Measures. Reviews daily UAS reports, identifies missed quality measures and works with Assessment Quality Team to correct. Reviews gaps in care and works with outreach to bring members into care.
- Analyzes data, reports and utilize data-driven methodologies to identify opportunities for improvement.
Clinical Lead
City Block Health
New York
04.2021 - 02.2022
- Clinical lead at NYC Approved Covid Vaccination Site.
- Review all updated Covid 19 clinical details.
- Educate and supervise all Vaccinators.
- Perform Site Administrative duties as needed.
- Reconstitute and administer Covid 19 Vaccinations to the public.
- Schedule all vaccination for monthly work schedules.
Provider Relations Quality Review Specialist
Metropolitan Jewish Healthcare System
09.2018 - 01.2020
- Educate and monitor performance of the provider incentive and value-based programs.
- Serves as a clinical liaison for the Quality Management Department in educating providers on HEDIS and Stars Performance.
- Monitor gaps in care for provider groups and individual providers and provides reports/scorecards.
- Assists with navigation of the portal to increase provider knowledge and compliance of gaps in care/standardized screenings.
- Collaborate with the Business Development and Provider Relations team and keep informed of provider performance.
- Conducts onsite visits and performs medical record reviews to ensure appropriate documentation.
- Provide leadership regular reports on program participation and compliance.
- Assists the Clinical Quality Manager in the collection of medical records for designated members/ measures.
- Monitors provider's compliance with performance metrics and record retrieval.
Clinical Review Specialist Appeals and Grievances
01.2009 - 01.2020
- Good knowledge in evaluation of medical charts for Re-credentialing and quality of care concerns.
- Participate in quality improvement studies and projects, performs basic analysis of data, assist in project and program evaluation and conduct field visits/audits.
- Investigate potential quality issues including grievance and appeals and tracks trends in quality-related issues.
- Review generic charts, and other population-based studies or abstractions of medical records required by HEDIS (Health Plan Employee Data Information Sets), or the quality improvement process.
- Investigate potential quality issues including grievances and appeals-and risk related issues.
- Track and trend reported quality related issues.
- Assists in the evaluation of the annual Quality Management Program Documents and work plan.
- Participation in analysis of QARR results to facilitate the production of Root Cause Analysis and Corrective Action Plans.
- Participation in the coordination and development of goals and outcomes using QARR/HEDIS specifications for Quality Improvement.
- Performed onsite Audit of Adult Social Day Care Centers for credentialing/re-credentialing.
MDS Coordinator
Cobble Hill Nursing Home
01.2001 - 01.2009
- Competed Minimum Data Set for reimbursement.
- Conduct Comprehensive Care Plan meetings for residents.
Admission RN
01.2001 - 01.2009
- Assessed all incoming residents.
- Reviewed all medication orders and treatments.
- Demonstrate competency in nursing skills, i.e., tracheotomy care, suctioning, blood glucose testing, wound care, medication administration and IV maintenance.
Education
Borough Manhattan Community College
Skills
- HEDIS
- Nursing
- MDS
- Quality Assurance
- Medication Administration
- Quality Management
- Root Cause Analysis
- Process Improvement
- Managed Care
- ICD-10
- Medical Records
- Hospital Experience
- Case Management
- Internal Audits
- CPT Coding
Timeline
Clinical Liaison Registered Nurse
ODA Primary Health Care Network
01.2023 - Current
RN Clinical Quality Manager
Village Care Max
05.2022 - Current
Clinical Lead
City Block Health
04.2021 - 02.2022
Provider Relations Quality Review Specialist
Metropolitan Jewish Healthcare System
09.2018 - 01.2020
Clinical Review Specialist Appeals and Grievances
01.2009 - 01.2020
MDS Coordinator
Cobble Hill Nursing Home
01.2001 - 01.2009
Admission RN
01.2001 - 01.2009
Borough Manhattan Community College