Experienced with conducting thorough clinical reviews to ensure compliance with healthcare standards. Utilizes critical thinking and effective communication to enhance patient care and outcomes. Knowledge of regulatory guidelines and team collaboration fosters reliable and adaptable approach.
Overview
2
2
Certifications
11
11
years of professional experience
Work History
Team Lead Supervisor, RN Data Quality Reviewer
Tapestry Health
Remote
03.2024 - Current
Supervised team operations to ensure efficiency and productivity
Conducted thorough reviews of patient data to maintain accuracy
Ensure data accuracy
Documented errors and escalated to appropriate departments to facilitate timely resolution
Maintained HIPAA compliance and conducted training to uphold regulatory standards
Conducted comprehensive clinical reviews to ensure compliance with established medical guidelines.
Evaluated patient care plans, providing feedback to enhance treatment outcomes.
Collaborated with multidisciplinary teams to optimize patient management strategies.
Mentored junior nursing staff, fostering professional development and improving team performance.
Implemented quality improvement initiatives that streamlined clinical review processes.
Analyzed complex medical data to support decision-making for patient care interventions.
Led training sessions on best practices in clinical review methodologies for nursing staff.
Developed and maintained documentation standards to ensure accuracy and regulatory compliance.
Conducted regular audits of clinical documentation and provided constructive feedback to providers, leading to continuous improvement in the quality of patient care.
Streamlined workflow processes by identifying gaps in clinical documentation and providing timely feedback to providers.
Maximized efficiency within the department by organizing workload according to priority level, ensuring deadlines were met consistently.
Registered Nurse (Per Diem)
Sarah Bush Lincoln
Tuscola, IL
06.2023 - 10.2023
Performing physical assessments, taking vital signs, and documenting findings in the electronic health record (EHR)
Collecting a thorough medical history from patients and family members upon admission
Inserting intravenous catheters and collecting phlebotomy samples
Assisted with emergency procedures, administered medications, and initiated intravenous fluid replacement to stabilize patients in critical conditions
Interpreted laboratory results and communicated critical findings to a multidisciplinary team to inform patient care decisions
Collaborating with other healthcare providers to develop treatment plans and establish goals of care
Collaborated with healthcare providers to develop comprehensive treatment plans and establish patient-centered goals of care
HEDIS Nurse/Data Analyst
BCBS – IL – Remote IL
Chicago, IL
01.2023 - 05.2023
Conducted quality of care reviews to assess compliance and improve patient outcomes. Created summary thereafter based on the documented information and presented in peer review.
Performed UM, Appeals Management, and audit reviews.
Collected and analyzed medical record data for HEDIS and related projects to support quality improvement initiatives.
Evaluated practitioner compliance with documentation standards and medical record-keeping practices to ensure regulatory adherence.
Conducted comprehensive HEDIS chart reviews to ensure compliance with quality metrics and standards.
Optimized data collection processes, utilizing advanced software tools for efficient analysis of clinical information.
Effectively interpreted various types of medical documents like lab results or prescription histories which led to more accurate assessments.
Improved HEDIS metrics by efficiently reviewing medical records and identifying gaps in care.
Reduced discrepancies in medical records by performing thorough chart reviews and resolving inconsistencies through direct communication with providers.
Registered Nurse (FTE)
Memorial Health
Decatur, Illinois
04.2022 - 01.2023
Achieved optimal patient outcomes by carefully monitoring conditions and delivering comprehensive support.
Facilitated claims processing by corresponding with insurance companies to ensure timely patient reimbursements.
Delivered personalized medical care for special healthcare needs and limitations.
Maintained accurate records and charted them consistently in the EHR system.
Coordinated patient care throughout the entire hospital stay, from admission to discharge, ensuring continuity and quality of services.
Updated patient medical records with direct intake information and transcribed practitioner messages.
Maintained updated, cumulative health records in the medical system.
Identified patients referred by providers for care management in Managed Care Organizations.
Educated faculty and staff on healthcare protocols for common student ailments to enhance campus health support capabilities.
Corresponded with insurance companies to process the claims of patients.
Offered knowledgeable, evidence-based health services in community-based locations.
Monitored vital signs and documented changes in patient conditions to inform treatment decisions.
Implemented quality improvement initiatives, streamlining workflows for enhanced operational efficiency.
Led training sessions for new nursing staff, enhancing onboarding efficiency and knowledge transfer.
Educated patients and families on health management, promoting informed decision-making and self-care practices.
Utilized critical thinking skills to prioritize nursing interventions based on patients'' acuity levels and individual needs.
Conducted thorough patient assessments to identify changes in condition, promptly notifying physicians and initiating appropriate interventions when necessary.
Administered medications safely according to established guidelines while closely monitoring for side effects or adverse reactions requiring intervention.
School Nurse (PRN)
Memorial Health
Decatur, Illinois
04.2022 - 01.2023
Managed direct care of patients conducted health assessments, and documented care activities.
Implemented treatment plans for acute and chronic conditions.
Educated patients on preventive care and lifestyle choices to improve overall health.
Coordinated individualized care plans with patients and healthcare team, facilitating positive outcomes during admission and discharge processes.
Oversaw patient flow in the unit, ensuring efficient admissions and discharges. for the unit, handling admissions and processing discharge paperwork.
Provided education on preventive care and lifestyle choices, enhancing patient health awareness and engagement.
Liaised with healthcare professionals in fast-paced environments using advanced medical terminology.
Provided managed care companies with clinical reviews to justify homecare services. Developed and maintained relationships and worked closely with marketing to build the managed care business
Provided managed care companies with clinical reviews to justify home care services. Developed and maintained relationships and worked closely with marketing to build the managed care business
Performed precise updates to patient charts in the electronic health record system in the computer system.
Used empathetic communication to ease patient fears about treatment, fostering a supportive care environment.
Oversaw health services for school of 1.000 students and faculty.
LPN School Nurse
Cerro Gordo School District
Cerro Gordo, IL
01.2019 - 07.2021
Responded with prompt care to injuries, accidents, or serious student illnesses.
Coordinated state-mandated yearly screenings for vision, hearing, and height to ensure compliance and promote student health.
Coordinated state-mandated yearly screenings for vision, hearing, and height.
Maintained updated, cumulative student health records to support informed healthcare decisions and track student wellness.
Managed students' health data according to HIPAA standards as well as federal and state requirements governing minors.
Trained faculty and staff in healthcare protocols for common student ailments, enhancing overall school health awareness and response.
Offered knowledgeable, evidence-based health services in community-based locations.
Delivered optimal patient outcomes by carefully monitoring conditions and delivering comprehensive support.
Oversaw health services for school of 700 students and faculty.
Prior Authorization - Licensed Practical Nurse
Springfield Clinic
Decatur, IL
04.2015 - 01.2019
Initiate, manage & appeal prior authorization in an office setting.
Initiated, managed, and appealed prior authorizations, ensuring timely approvals for patient treatments.
Corresponded with insurance companies to process the claims of patients.
Initiated and managed referral and prior authorization processes to ensure patient access to care. – initiated, generated approved referrals, and informed patients of denied referrals.
Corresponded with insurance companies to expedite processing of patient claims, facilitating quicker reimbursements.
Updated patient medical records with direct intake information and transcribed practitioner messages.
Coordinated patient admissions through proactive communication with hospital personnel.
Transcribed physician notes, detailing diagnosis or recommendations.
Compiled medical reports covering specific patient or general office data.
Scheduled x-rays and lab work for patients.
Education
Associate degree - Nursing, RN
Richland Community College
Decatur, Illinois
05-2021
Licensed Practical Nursing - Nursing
Richland Community College
Decatur, Illinois
05-2014
Skills
Quality review lead
Clinical Auditing
Documentation
Clinical judgment
Process Improvement
Team Collaboration
Critical thinking
Coaching and mentoring
Deadline management
Workflow management
Work assignment delegation
Team supervision
Problem-solving
Overseeing daily activities
Giving constructive feedback
Accomplishments
Phi Theta Kappa, International Honor Society, 2014-Present
PALS from American Heart Association (AHA), 2022- Present
ACLS from American Heart Association (AHA), 2021- Present
Outstanding Achievement in Clinical Skill, 2021
Decatur Memorial Hospital Cancer Care Scholarship 2019
Edna Mae Unfer Scholarship, 2012
Mark Mull Endowment Fund, 2012
Certification
Registered Nurse IL License #041510468, Expiration Date May 2024
Junior Data Analyst/Quality Control Reviewer at Cognizant Technology SolutionsJunior Data Analyst/Quality Control Reviewer at Cognizant Technology Solutions
<ul><li>- Working in Collaboration with the Central Quality team in the development of Quantitative checklists for Aggregate reports.</li><li>- Performing QR of Safety reports i.e, PADER, DSUR, PBRER and DSURs.</li><li>- Managing QR Team for Safety reports and acting as a training lead for Safety Writing Team.</li><li>- Prepared and Performed QC of the trackers for RSI project.</li><li>- Performed Quality review of cases in Argus database for VOQR project. Created error-free reports and other outputs according to tightly defined specifications to ensure timely reporting of assigned job to program management.</li><li>- Participating in weekly meetings on a regular basis to understand the client's requirement for a particular program and ensure that the team meets or exceeds the targets in terms of quality, quantity within the scope of time constraints</li><li>- Responsible for reviewing the SOPs, job aids as per program specific requirements.</li><li>- Acting as a subject matter expert and helping the team members with day-to-day trouble shooting activities.</li><li>- Signal detection and risk management plan authoring or other assigned PV related activities for client's product(s), per the regulations and SOPs when required.</li><li>- Exhibiting a growing awareness of program strategy and thinking capability alongside independence.</li><li>- Reviewing and providing solutions for issues relating to program delivery or escalating appropriately to the Team Lead / Program Lead as required.</li><li>- Providing standards for gathering information for use in trend analysis.</li><li>- Involved in people development in partnership with PDG leads.</li><li>- Ensuring that all training (internal training and client training) are successfully completed in a timely manner.</li></ul> at Syneos Health<ul><li>- Working in Collaboration with the Central Quality team in the development of Quantitative checklists for Aggregate reports.</li><li>- Performing QR of Safety reports i.e, PADER, DSUR, PBRER and DSURs.</li><li>- Managing QR Team for Safety reports and acting as a training lead for Safety Writing Team.</li><li>- Prepared and Performed QC of the trackers for RSI project.</li><li>- Performed Quality review of cases in Argus database for VOQR project. Created error-free reports and other outputs according to tightly defined specifications to ensure timely reporting of assigned job to program management.</li><li>- Participating in weekly meetings on a regular basis to understand the client's requirement for a particular program and ensure that the team meets or exceeds the targets in terms of quality, quantity within the scope of time constraints</li><li>- Responsible for reviewing the SOPs, job aids as per program specific requirements.</li><li>- Acting as a subject matter expert and helping the team members with day-to-day trouble shooting activities.</li><li>- Signal detection and risk management plan authoring or other assigned PV related activities for client's product(s), per the regulations and SOPs when required.</li><li>- Exhibiting a growing awareness of program strategy and thinking capability alongside independence.</li><li>- Reviewing and providing solutions for issues relating to program delivery or escalating appropriately to the Team Lead / Program Lead as required.</li><li>- Providing standards for gathering information for use in trend analysis.</li><li>- Involved in people development in partnership with PDG leads.</li><li>- Ensuring that all training (internal training and client training) are successfully completed in a timely manner.</li></ul> at Syneos Health