Heather Rainey
Easley,SC
Summary
Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
17
17
years of professional experience
1
1
Certification
Work History
HEDIS Data Reviewer
AmeriHealth Caritas
10.2022 - Current
- Maintained strong attention to detail while reviewing numerous medical records daily, ensuring consistent quality and accuracy.
- Stayed up-to-date on industry trends and best practices, incorporating relevant information into reviews as needed.
- Ensured consistency across multiple review projects by maintaining strict adherence to established protocols and procedures.
HEDIS Appeals Nurse - QA
Centene
01.2022 - 06.2022
- Contract position for HEDIS hybrid season.
- HEDIS Super QA team.
- Third level Overreads.
- Overreads for 11 hybrid measures.
Clinical Supervisor
Maxim Healthcare
09.2021 - 01.2022
- Oversight of nurses assigned to my pediatric patients.
- Managed caseloads effectively, ensuring timely assessments, treatment planning, and progress monitoring.
- Served as a liaison between clinical staff and administration to address concerns and optimize workflows.
- Conducted thorough assessments of clients'' needs to develop tailored treatment plans aimed at addressing specific challenges.
HEDIS Nurse
CHRISTUS Health
01.2020 - 09.2021
- HEDIS abstraction & Overreading for Commercial, Health Exchange & Medicare lines of business.
- CAHPS & HOS survey monitoring & Quality Improvement.
- Provider evaluation and clinic training to improve HEDIS & CAHPS Measures.
- Improved HEDIS metrics by efficiently reviewing medical records and identifying gaps in care.
RN
John Peter Smith Hospital
10.2019 - 01.2020
- Staff nurse on neurovascular PCU
RN Data Abstractor- HEDIS
Acclaim Physician Group
07.2018 - 10.2019
- Assisted with establishing a quality incentive program with emphasis on gap closures to meet HEDIS measures while working directly with various health plans.
- Data abstraction for various HEDIS measures.
- Program without formal director. Kept program progressing in the absence of leadership for the program.
LVN
JPS Health System
02.2017 - 07.2018
- Float Pool Staff
- Traveled to various clinics daily from specialties to family practice.
Metabolic & Bariatric Surgical Clinical Reviewer
UPMC Pinnacle
07.2015 - 12.2018
- Identified 100% of metabolic & bariatric surgical patients for inclusion in the MBSAQIP database through correct application of program criteria and protocols.
- Collected preoperative, intra-operative, 30-day, and long term follow up data components.
- Attended bi-monthly conferences to assess data on post-operative occurrences.
LPN
Penn State Milton S. Hershey Medical Center
01.2014 - 12.2015
- Float Pool Staff
- Worked in over 30 different clinics from family practice to specialties within PSHMC.
- Different assignments daily to include phone triage, prior authorizations, lab draws, etc.
LPN
Penn State Hershey Medical Group
01.2012 - 01.2014
- Family/Community Medicine and Pediatrics
- Established a process and managed pediatric Lead program after the state lost funding.
LPN
Colonial Park Care Center
10.2011 - 05.2012
- Skilled Nursing and Rehab
- Oversaw care for 15-25 residents per shift.
Dialysis Tech & LPN
Davita Dialysis
07.2007 - 05.2012
- Initiate, monitor and discontinue hemodialysis treatments.
Education
Bachelor of Science In Nursing -
Chamberlain University
08.2020
Associate of Applied Science In Nursing -
Tarrant County College, Fort Worth, TX
08.2019
Relevant Skill Set
- Over 15 years of experience as a healthcare professional, with over 4 years of experience in HEDIS.
- Experienced in HEDIS abstraction and overreading of hybrid and state measures.
- Clear and Active Multistate RN License: 976645
- Excellent verbal and written communication skills.
- Computer Knowledge: MS Office (Word, Excel, Outlook), and worked in various EMR systems and abstraction tools.
Certification
- Licensed RN - September 2019 - Current
- BLS Provider, AHA - Aug 2023 - Aug 2025
Timeline
HEDIS Data Reviewer
AmeriHealth Caritas
10.2022 - Current
HEDIS Appeals Nurse - QA
Centene
01.2022 - 06.2022
Clinical Supervisor
Maxim Healthcare
09.2021 - 01.2022
HEDIS Nurse
CHRISTUS Health
01.2020 - 09.2021
RN
John Peter Smith Hospital
10.2019 - 01.2020
RN Data Abstractor- HEDIS
Acclaim Physician Group
07.2018 - 10.2019
LVN
JPS Health System
02.2017 - 07.2018
Metabolic & Bariatric Surgical Clinical Reviewer
UPMC Pinnacle
07.2015 - 12.2018
LPN
Penn State Milton S. Hershey Medical Center
01.2014 - 12.2015
LPN
Penn State Hershey Medical Group
01.2012 - 01.2014
LPN
Colonial Park Care Center
10.2011 - 05.2012
Dialysis Tech & LPN
Davita Dialysis
07.2007 - 05.2012
Bachelor of Science In Nursing -
Chamberlain University
Associate of Applied Science In Nursing -
Tarrant County College, Fort Worth, TX