Jacalyn Kuhlman, RN CCDS
Lady Lake,FL
Summary
Highly knowledgeable Registered Nurse in the State of Florida with a wealth of healthcare experience and expertise in many areas. Talented in maintaining complex and comprehensive databases covering patient information. Dedicated to proactive monitoring and thorough reporting using top-notch technical abilities.
Overview
34
34
years of professional experience
1
1
Certification
Work History
Clinical Documentation Improvement Specialist
TAMPA GENERAL HOSPITAL
08.2014 - 02.2016
- I was responsible for reviewing physician documentation to ensure it supported severity of illness, expected risk of mortality, and complexity of care of the patient, identifying and recording principal and secondary diagnoses, principal procedures and assigning working DRGs
- I also queried physicians for additional clarifying documentation
- I was responsible for providing information and education to physicians and ancillary staff on complete and comprehensive clinical documentation.
- Self-motivated, with a strong sense of personal responsibility
- Proven ability to learn quickly and adapt to new situations
Clinical Documentation Specialist
CENTRAL FLORIDA HEALTH ALLIANCE
04.2013 - 06.2014
- I was responsible for reviewing physician documentation to ensure it supported severity of illness, expected risk of mortality, and complexity of care of the patient, identifying and recording principal and secondary diagnoses, principal procedures and assigning working DRGs
- I also queried physicians for additional clarifying documentation
- I was responsible for providing information and education to physicians and ancillary staff on complete and comprehensive clinical documentation.
Quality Improvement Specialist
CLINIC HEALTH SYSTEM, FRANCISCAN HEALTHCARE, Tradition Health Plan
12.2005 - 04.2012
- I managed multiple projects including HEDIS (Healthcare Effectiveness Data and Information Set) and CAHPS (Consumer Assessment of Healthcare Providers and Systems)
- This included working with multiple outside vendors and oversight auditor
- I performed oversight audits of credentialing vendor, revised multiple Plan documents including Quality Management Plan, Quality Assurance/Process Improvement Work Plan and various policies and procedures
- I identified appropriate topics for study, developed and implemented member and provider focused interventions, calculated statistics and annually authored two DHS (Department of Health Services) required Performance Improvement Projects for the Wisconsin Medicaid/BadgerCare+ product.
Compliance Officer
11.2002 - 12.2005
- I was responsible for planning, implementing, monitoring, and evaluating a coordinated legislative and regulatory Corporate Compliance program that met requirements of State of Wisconsin and Federal regulators and the Health Tradition Health Plan's (Plan) Board of Directors for all products of the Plan
- I was responsible for identification of potential areas of compliance vulnerability and risk, development, and implementation of corrective action plans for resolution of problematic issues and provided general guidance on how to avoid or deal with similar situations in the future
- I performed oversight of all ongoing activities related to corporate compliance, privacy and security, and quality policies and procedures, including development and education of the workforce, implementation, maintenance of, and adherence to policies and procedures covering compliance with all Federal and State insurance and health laws, the privacy of, and access to member health information
- My responsibilities also included acting as the key compliance advisor to the Company for State insurance laws and regulations, Federal health, financial and labor laws, Health Information Portability and Accountability Act (HIPAA) privacy, security and transaction standards, including disaster recovery, Sarbanes-Oxley Act, Department of Labor (DOL) and Employee Retirement Income Security Act (ERISA) laws, contractual obligations and Department of Health Services (DHS), Office of the Commissioner of Insurance (OCI) and Health and Human Services (HHS) regulations
- I served as the key privacy advisor for members, handling disputes and managing member requests regarding health information
- Additional responsibilities included management of (planning, organizing, implementing, monitoring, and evaluating) the Plan's Quality Management program (e.g
- HEDIS, DHS required performance improvement projects and oversight of credentialing and preventive care vendors.)
Clinical Quality Specialist
PROMEDICA HEALTH SYSTEM
11.2000 - 07.2002
- I was responsible for the ProMedica Physician Group internal compliance and audit activities
- I worked directly with physicians and their staff to assure compliance with the Health Care Finance Administration and the Office of the Inspector General documentation guidelines by performing chart review audits to ensure compliance with documentation guidelines
- I developed and provided physician education through individual and group in-services
- Additionally, I developed policies and procedures as well as forms for the physicians to utilize to meet documentation requirements
- I was asked to assess the efficiency of overall clinic office function
- The work I did required that I work with ICD-9 and CPT codes to determine appropriateness of coding in the office as well as hospital settings
- I utilized multiple computer programs to compile and report data
- Our team developed and wrote the initial corporate compliance policies
- I collected and analyzed data for multiple special projects, developed and implemented action plans and was asked to be involved with our corporate HIPAA readiness.
Care Plan Coordinator
Nursing Home, MDS
10.1998 - 11.2000
- My duties included performing assessments of residents at Lake Park, to generate the, based on a thorough chart review, interviews with staff, residents and family members
- The position required that I coordinate the completion of the MDS in accordance with State and Federal regulations within the required time frames
- I also calculated triggers and used resident assessment protocols for development and initiation of individualized care plans
- I also coordinated interdisciplinary care conferences.
Office Nurse
03.1990 - 10.1998
- I managed office patients and routines at Family Physician Association, Family Medicine Residency Program, which included patient care during clinic hours, maintenance of patient records, assistance with various office surgeries and procedures, review of outpatient test results, triage of patient telephone calls, and participation on various committees.
Registered Nurse
02.1989 - 03.1990
- I provided bedside care for critically ill cardiac patients on the telemetry unit at Flower Hospital
- I performed assessments, provided, and documented care, administered medications, and supervised subordinate staff.
Staff Nurse, Charge Nurse and Head Nurse
Alachua General Hospital
06.1982 - 08.1988
Education
Bachelor of Arts - Interdisciplinary Studies
University of Toledo
1999
Associate of Nursing - undefined
Santa Fe Community College
1982
Skills
- SOFTWARE EXPERIENCE
- Microsoft Office including Word, Excel, Power Point, Access, and Outlook; CDR2; MIDAS
- Multitasking Skills
- Problem Resolution
- Organizational Systems
Certification
CCDS, Certified Clinical Documentation Improvement Specialist - 2015
Volunteer Service
Green Key Village, Lady Lake, FL - Activities Manager, 1/1/2023 to present; Design Team Lead - 1/1/2022 to present; Community Garden Lead - 6/1/2020 to present
Habitat for Humanity, La Crosse, WI - Member, Board of Directors, 2002 - 2008; President of the Board, 2005 - 2007; Secretary of the Board - 2007 - 2008.
Clearwater Farm Educational Farm, Onalaska, WI - Board of Directors - 2005
Licensure
State of Florida - Registered Nurse - RN9352411
Timeline
Clinical Documentation Improvement Specialist
TAMPA GENERAL HOSPITAL
08.2014 - 02.2016
Clinical Documentation Specialist
CENTRAL FLORIDA HEALTH ALLIANCE
04.2013 - 06.2014
Quality Improvement Specialist
CLINIC HEALTH SYSTEM, FRANCISCAN HEALTHCARE, Tradition Health Plan
12.2005 - 04.2012
Compliance Officer
11.2002 - 12.2005
Clinical Quality Specialist
PROMEDICA HEALTH SYSTEM
11.2000 - 07.2002
Care Plan Coordinator
Nursing Home, MDS
10.1998 - 11.2000
Office Nurse
03.1990 - 10.1998
Registered Nurse
02.1989 - 03.1990
Staff Nurse, Charge Nurse and Head Nurse
Alachua General Hospital
06.1982 - 08.1988
Bachelor of Arts - Interdisciplinary Studies
University of Toledo
Associate of Nursing - undefined
Santa Fe Community College
Similar Profiles
Shericka GraceShericka Grace
Environmental Services Housekeeper at Tampa General Hospital, St. Joseph's HospitalEnvironmental Services Housekeeper at Tampa General Hospital, St. Joseph's Hospital
Dimitri MartinezDimitri Martinez
Patient Access Specialist at Tampa General Hospital, St. Joseph's HospitalPatient Access Specialist at Tampa General Hospital, St. Joseph's Hospital
Alyvia YoungAlyvia Young
Volunteer at Tampa General Hospital, St. Joseph's HospitalVolunteer at Tampa General Hospital, St. Joseph's Hospital
Dimitri MartinezDimitri Martinez
Patient Access Specialist at Tampa General Hospital, St. Joseph's HospitalPatient Access Specialist at Tampa General Hospital, St. Joseph's Hospital
DHANWANTIE TILAKDHANWANTIE TILAK
RN Case Manager at Aetna CVSRN Case Manager at Aetna CVS