Dori Traina

- Performed annual HEDIS reviews with high accuracy level.

- Performed annual Continuity of Care reviews, including communication with providers regarding results and areas for improvement.

- Performed accurate and thorough quality of care (QOC) medical record reviews utilizing strong clinical judgement for QOC-related referrals from members, clinicians and other departments, (i.e. Risk Management, Special Investigations Unit, etc.).

- Prepared and presented cases to the Peer Review Committee based on review findings and policy.

- Collaborated with the Grievance & Appeals Department (G&A) when clarification and/or additional information was necessary for a complete and thorough review of all member concerns.

- Communicated with state reporting agencies when potential abuse was identified.

- Mentored, oriented and supported new associates.

• Stayed current on emerging trends in patient education best practices through regular professional development activities.
• Assisted healthcare providers in designing patient education programs tailored to individual needs.
• Developed slide presentations for group sessions.
• Utilized multimedia tools such as videos, pamphlets, and interactive presentations to engage patients in the learning process effectively.
• Participated in community outreach events and seminars focused on raising public awareness about various health issues and preventive measures.
• Served as a liaison between patients, families, and healthcare providers, advocating for optimal patient education opportunities and resources.
• Established trusting relationships with patients and families, ensuring open lines of communication for ongoing support and guidance.
• Identified knowledge gaps among patients, creating targeted interventions to address their specific concerns.
• Maintained thorough documentation of each patient''s educational progress, providing feedback to healthcare providers as needed.
• Evaluated the effectiveness of existing patient education materials, making recommendations for improvements where necessary.