Kimberly A. Mele
Southold,NY
Summary
Accomplished professional with over 30 years of experience in healthcare, offering more than 10 years of specialized experience overseeing quality management, risk oversight, regulatory compliance, and CDI. Adept at implementing quality improvement initiatives, reducing clinical risks, and ensuring regulatory compliance. Seeking to leverage my experience in a Vice President of Quality, Risk Management, Regulatory, HIPAA, and Compliance role, while continuing to advance my knowledge and strengthen my expertise in HIPAA and compliance management.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Assistant Vice President, Quality, Risk Management, and Regulatory Affairs
Stony Brook Eastern Long Island Hospital
Greenport, NY
05.2019 - Current
- Oversee the development and implementation of quality improvement programs, risk management strategies, and regulatory compliance initiatives, ensuring adherence to local, state, and federal guidelines.
- Lead multidisciplinary teams to monitor, evaluate, and improve patient safety outcomes and adverse events.
- Ensure compliance with accreditation standards (e.g., the Joint Commission, CMS, HIPAA) and regulatory requirements across the organization.
- Facilitate monthly performance improvement meetings, collaborating with clinical staff to review quality performance metrics and identify areas for improvement.
- Responsible for developing and maintaining a comprehensive risk management reporting system across the organization, facilitating early detection and prevention of potential risks (e.g., SB Safe).
- Facilitate Root Cause Analysis (RCA) discussions for adverse events and quality concerns, working with multidisciplinary teams to detect underlying systemic issues, and recommending process improvements to mitigate risks and improve quality outcomes.
- Work closely with department heads to incorporate quality improvement initiatives into daily operations, ensuring alignment with organizational objectives, and adherence to established policies and procedures.
- Retained responsibilities from the Quality Services Manager position, such as managing the patient complaint/grievance process, denial/appeal processes, and continuing to support staff in conducting PRI assessments and screenings.
- Performed data analytics to identify trends.
- Led risk assessment initiatives using FMEA methodologies.
Manager, Quality Services and Risk Management
Stony Brook Eastern Long Island Hospital
Greenport, NY
06.2013 - 05.2019
- Managed the hospital's quality services program, focusing on the enhancement of patient care, safety, and overall service delivery across departments.
- Assisted in preparing the hospital for accreditation inspections and surveys, ensuring all documentation and practices were in compliance.
- Conducted regular rounding to assess compliance with regulatory standards and hospital policies, identifying areas for improvement (e.g.). Joint Commission rounds.
- Tracked and managed patient satisfaction surveys, addressing feedback, and working with clinical teams to improve the patient experience.
- Manage and oversee patient grievance processes, addressing complaints promptly, and ensuring corrective actions are implemented to improve patient satisfaction.
- Collaborated with leadership and staff to establish quality goals, focusing on continuous improvement and patient-centered care.
- Investigated denials and submitted appeals to appropriate entities.
- Provide assistance to staff in conducting PRI assessments and screenings, ensuring compliance with care protocols.
Clinical Documentation Specialist (CDI)
Stony Brook Eastern Long Island Hospital
Greenport, NY
02.2010 - 06.2013
- Ensured that medical records were accurate, complete, and complied with coding and regulatory standards.
- Identified discrepancies or missing information that may have an effect on the quality of documentation.
- Worked closely with physicians, nurses, and other healthcare professionals to clarify documentation issues, ensure accuracy, and improve overall documentation practices.
- Educated healthcare providers on proper documentation practices, ensuring that the documentation reflects the severity of illness, the risk of mortality, and resource utilization accurately.
- Ensured that the clinical documentation supports appropriate ICD-10, CPT, and DRG codes for accurate billing and reimbursement.
- Reviewed patient charts for documentation that accurately reflects diagnoses, procedures, and patient conditions, to prevent issues with coding and billing.
- Identified areas where documentation is incomplete or unclear, and provided feedback to the medical staff for correction.
- Collaborated with coding and billing teams to ensure accurate reimbursement for services provided, preventing denials due to insufficient documentation.
- Tracked and reported metrics related to documentation quality, coding accuracy, and compliance with management, providing actionable insights for improvement.
Nurse Manager
Twin Forks Hematology Oncology
Riverhead, NY
12.2001 - 02.2010
- Managed staff and scheduling to ensure optimal workflow, consistent coverage, and operational efficiency.
- Developed, updated, and implemented policies and procedures to maintain compliance, and improve operational efficiency.
- Collaborated with the billing department to ensure accurate coding for medication administration.
- Provided direct patient care, including comprehensive assessments, and treatment planning.
- Delivered patient and family education to enhance understanding of care plans, and promote overall well-being.
Staff Nurse
East End Hematology Oncology
Riverhead, NY
10.1999 - 11.2001
- Administered chemotherapy and other oncology treatments while monitoring for adverse reactions.
- Assessed patient conditions, developed care plans, and provided ongoing patient evaluations.
- Educated patients and families on treatment protocols, side effects, and supportive care.
- Managed pain and symptom relief for patients through both pharmacologic and nonpharmacologic interventions.
- Maintained accurate medical records, and ensured adherence to safety protocols and infection control standards.
Staff Nurse
John T. Mather Memorial Hospital
Port Jefferson, NY
08.1998 - 07.1999
- Delivered comprehensive care including patient evaluations, post-op support, and intravenous therapy.
- Ensured comprehensive patient care across Medical Surgical Unit, Orthopedic Unit, and Oncology Unit.
Staff Nurse
Southampton Hospital
Southampton, NY
06.1996 - 08.1998
- Managed patient care in the medical-surgical unit.
- Performed comprehensive assessments of patients.
- Delivered patient care across obstetrics and postpartum units.
Education
Bachelor of Science - Nursing
Molloy College
NY05.1995
Skills
- Organizational planning
- Quality Improvement and Patient Safety
- Risk Analysis and Mitigation
- Regulatory Compliance
- Team Leadership and Development
- Process Improvement
Certification
- PRI (Patient Review Instrument) Certification, June, 2011
- Screen Certification, July, 2011
- BLS, December, 2023
References
References available upon request.
Timeline
Assistant Vice President, Quality, Risk Management, and Regulatory Affairs
Stony Brook Eastern Long Island Hospital
05.2019 - Current
Manager, Quality Services and Risk Management
Stony Brook Eastern Long Island Hospital
06.2013 - 05.2019
Clinical Documentation Specialist (CDI)
Stony Brook Eastern Long Island Hospital
02.2010 - 06.2013
Nurse Manager
Twin Forks Hematology Oncology
12.2001 - 02.2010
Staff Nurse
East End Hematology Oncology
10.1999 - 11.2001
Staff Nurse
John T. Mather Memorial Hospital
08.1998 - 07.1999
Staff Nurse
Southampton Hospital
06.1996 - 08.1998
Bachelor of Science - Nursing
Molloy College
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