MARGARET STRICKLAND

• Successfully completed HEDIS measure training and testing with a required passing score of 95%.
• Supported year-round and hybrid HEDIS activities for Connecticut and Vermont markets, ensuring compliance, accuracy, and data integrity across measures.
• Conducted data mining across multiple EMR systems to identify clinical documentation, close care gaps, and support HEDIS and quality initiatives.
• Completed and validated overreads in QCAT to ensure accuracy and compliance with HEDIS standards.
• Provided feedback & educated abstraction team on HEDIS measure requirements through verbal coaching, screen sharing, and written communication via Outlook and Teams.
• Entered abstraction data into QMRM for over-read and quality validation.
• Datamined clinical data to support completion of IHAs and uploaded and abstracted charts in QCAT to close care gaps across multiple HEDIS measures, including BCS, CBP, COA (Pain and Medication Review), COLO, EED, and GSD.
• Collaborated with providers to request and obtain medical records to support HEDIS measure compliance.
• Delivered educational presentations and developed PowerPoint resources to support quality and gap-closure initiatives, including AWVs vs. physical exams, colorectal cancer screening, home health care, and kidney health evaluation programs; collaborated cross-functionally on provider outreach, high-risk member identification, and case management referrals.
• Maintained the required licensure for both Connecticut and my home state of Texas. Participated actively in team meetings, including CT Member Support, CT Quality Team, and one-on-one sessions with leadership.
• Subject Matter Expert (SME) on Colorectal Cancer Screening Measure.
• Assisted with member outreach campaigns, completing documented call attempts and detailed call notes to promote Annual Wellness Visits, In Home Assessments, A1C testing, and Colorectal Cancer screenings.

• Successfully completed HEDIS measure training and testing with a required passing score of 95%.
• Participated in daily stand-up meetings and weekly team and measure review sessions; experienced in Zoom and other online meeting platforms.
• Conducted independent medical record abstraction in alignment with HEDIS measure specifications as part of the clinical quality team.
• Applied critical thinking and utilized multiple reference resources to ensure accurate and compliant chart reviews.
• Navigated and used multiple software platforms to support abstraction workflows.
• Performed data entry and tracking using Excel, SharePoint, QMRM, Citrix, and other project systems.

• Utilized a variety of care management strategies and techniques to support members in managing physical, environmental, and psychosocial health needs.
• Identified and resolved barriers to care, ensuring members had access to appropriate resources and services.
• Monitored member progress through ongoing telephonic assessments and evaluations to ensure movement toward desired health outcomes.
• Developed and implemented individualized member care plans based on assessed needs and risk factors.
• Demonstrated strong understanding of departmental, organizational, and segment strategies, applying them to decision-making and daily workflows.
• Exercised sound judgment in selecting work methods, often in ambiguous situations, while following established guidelines and procedures.
• Conducted telephonic assessments for Medicare, Medicaid, Commercial, and Group Account members across seven domains of functioning.
• Evaluated member needs to support achievement or maintenance of optimal wellness and independence.
• Guided members and their families toward appropriate internal and community resources to support health and well-being.
• Collaborated with a multidisciplinary team to address member needs, employing timely interventions to manage physical, psychosocial, and environmental factors.

• Successfully completed HEDIS measure training and testing with a required passing score of 95%.
• Participated in daily stand-up meetings and weekly team and measure review sessions; experienced in Zoom and other online meeting platforms.
• Conducted independent medical record abstraction in alignment with HEDIS measure specifications as part of the clinical quality team.
• Applied critical thinking and utilized multiple reference resources to ensure accurate and compliant chart reviews.
• Navigated and used multiple software platforms to support abstraction workflows.

Performed data entry and tracking using Excel, SharePoint, QMRM, Citrix, and other project systems.

• Monitored patient conditions and assessed clinical needs to ensure high-quality care and appropriate interventions.
• Observed, interpreted, and documented patient symptoms, communicating changes promptly to physicians.
• Collaborated with physicians and interdisciplinary team members to develop and implement individualized care plans.
• Performed routine nursing procedures, including vital signs, injections, wound care, and medication administration, while completing accurate and timely documentation.
• Adjusted and administered medications and treatments in accordance with physician orders and care protocols.
• Ensured adherence to infection control standards and safety procedures in all patient care activities.
• Supervised and provided guidance to LVNs and nursing assistants to support safe and effective patient care delivery.
• Provided compassionate support to patients and families, promoting comfort, understanding, and trust.
• Expanded clinical knowledge and skills through participation in educational workshops and professional development activities.

• Provided skilled telephonic nursing support to a diverse member population, delivering culturally sensitive care and guidance.
• Performed symptom triage, clinical decision support, and chronic condition management to ensure members received appropriate and timely care.
• Connected members with relevant health plan resources, including tobacco cessation, weight management, behavioral health, physical activity programs, and community-based services.
• Participated in onboarding and training of newly hired nurses, supporting their integration and competency development.
• Consistently met or exceeded monthly productivity and service quality goals through effective collaboration with team members and leadership.
• Built strong member relationships that contributed to improved engagement, satisfaction, and overall efficiency of care delivery.