Jolene Roberts
Stanton,NE
Summary
Experienced with medical record review and quality assurance. Utilizes data abstraction and patient care coordination to support healthcare providers in meeting HEDIS measures. Track record of improving compliance and enhancing healthcare quality through collaborative efforts.
Professional healthcare professional with strong experience in quality assurance and data analysis. Skilled in medical record review, patient care evaluation, and compliance with healthcare standards. Collaborative team player with results-driven approach, adaptable to evolving healthcare needs. Known for reliability, effective communication, and problem-solving abilities.
Overview
12
12
years of professional experience
Work History
Temporary HEDIS Nurse
Optum/UHC
11.2025 - Current
- Perform comprehensive reviews of medical records to collect data for HEDIS reporting.
- Identify and report documentation deficiencies or care gaps.
- Collaborate with providers and clinical teams to ensure proper documentation.
- Assist in the coordination and execution of the annual HEDIS data collection cycle.
- Maintain knowledge of current HEDIS specifications and regulatory updates.
- Ensure HIPAA compliance and confidentiality of patient information
Care Manager
Nebraska Total Care
04.2018 - 06.2025
- Developed and implemented care plans to enhance patient outcomes and satisfaction.
- Collaborated with multidisciplinary teams to coordinate comprehensive health services for members.
- Analyzed member data to identify trends, informing strategies for improved care management.
- Mentored new staff in best practices for case management and patient advocacy.
- Enhanced communication channels between providers and members to streamline service delivery.
- Evaluated program effectiveness through regular assessments, driving continuous improvement efforts.
- Educated clients and families on community resources, treatment options and health care services to better manage conditions.
Temporary HEDIS Nurse
Through Aerotek at NTC
12.2017 - 05.2018
- Led initiatives to streamline data collection processes, improving efficiency in reporting outcomes.
- Mentored junior nurses on best practices for HEDIS data abstraction and quality assurance protocols.
- Developed training materials to support ongoing education of staff regarding HEDIS guidelines and updates.
- Facilitated interdisciplinary meetings to discuss performance results, fostering collaborative problem-solving among teams.
- Promoted a culture of quality improvement within the organization through ongoing education on HEDIS measures and best practices.
- Optimized data collection processes, utilizing advanced software tools for efficient analysis of clinical information.
Medical Review Nurse
BCBS of Nebraska
09.2016 - 12.2017
- Reviewed clinical documentation for adherence to medical policies and guidelines.
- Collaborated with healthcare providers to ensure appropriate care and treatment plans.
- Analyzed claims for accuracy, identifying discrepancies and recommending resolutions.
- Maintained up-to-date knowledge of regulatory guidelines, ensuring adherence to industry standards throughout the review process.
- Collaborated with multidisciplinary teams to resolve complex clinical issues and ensure appropriate utilization of services for each patient.
- Enhanced patient care by conducting thorough medical record reviews and identifying discrepancies or inconsistencies.
Associate Manager and Consulting
Lexicode
09.2015 - 01.2016
- Collaborated closely with senior management on strategic planning efforts, aligning departmental goals with overarching company objectives.
- Successfully managed multiple high-priority tasks simultaneously while maintaining strict deadlines ensuring optimal resource allocation.
- Supervised day-to-day operations to meet performance, quality and service expectations.
- ICD 9 and 10 coding
Program Integrity Medical Review Nurse II
Strategic Health Solutions
07.2013 - 09.2015
- Evaluated clinical documentation for compliance with regulatory standards and guidelines.
- Collaborated with interdisciplinary teams to ensure quality patient care and safety measures.
- Provided expert guidance on clinical policies and procedures to nursing staff and management.
- Analyzed data trends to identify areas for improvement in patient outcomes and operational efficiency.
- Improved overall efficiency by streamlining the review process, creating clear documentation, and developing strong communication channels.
- Supported legal and compliance teams in investigations related to medical fraud, waste, and abuse through meticulous case analysis.
- Conducted ongoing quality assurance checks on completed reviews, identifying opportunities for improvement and maintaining high levels of accuracy within the department.
Education
Associate of Science - Nursing
Iowa Western Community College
Council Bluffs, IA12-2005
Skills
- Medical record review
- Clinical documentation
- Training and mentoring
- Data collection techniques
Timeline
Temporary HEDIS Nurse
Optum/UHC
11.2025 - Current
Care Manager
Nebraska Total Care
04.2018 - 06.2025
Temporary HEDIS Nurse
Through Aerotek at NTC
12.2017 - 05.2018
Medical Review Nurse
BCBS of Nebraska
09.2016 - 12.2017
Associate Manager and Consulting
Lexicode
09.2015 - 01.2016
Program Integrity Medical Review Nurse II
Strategic Health Solutions
07.2013 - 09.2015
Associate of Science - Nursing
Iowa Western Community College