Summary
Overview
Work History
Education
Skills
Timeline
Generic

Paige Lockett

Aurora,CO

Summary

Diligent HEDIS Review Nurse with background in overseeing comprehensive reviews of medical records and data collection for quality improvement initiatives. Strong skill set includes knowledge of HEDIS measures, NCQA standards, and healthcare management systems. Strengths lie in process improvement, meticulous attention to detail, and ability to train and lead teams effectively. Demonstrated history of improving operational efficiency through careful review processes and implementation of effective strategies.

Overview

9
9
years of professional experience

Work History

HEDIS Review Nurse

Romack Resources - Aetna, CVS Health Company
Irving, TX
12.2020 - 05.2025
  • Prepared accurate medical documentation supporting inter-departmental information sharing.
  • Collected, organized, and entered patient data into medical systems.
  • Conducted regular maintenance on software systems inclusive of updates, upgrades, and data storage solutions.
  • Utilized various software systems to code and categorize health data for analysis.
  • Conducted consistent quality and validation audits on patient information to ensure precision.
  • Executed quality reviews to analyze data fidelity and compliance.
  • Utilized NCQA Technical Specific abstraction criteria with 98% accuracy during HEDIS medical review.
  • Analyzed information systems and applications to identify specifications for implementation projects.
  • Reviewed provider documentation to evaluate compliance with quality measure criteria.
  • Attended meetings and webinars related to Health Plan Quality Improvement initiatives.
  • Assessed accuracy of coding by performing retrospective review of members' medical records.

Clinical Review Nurse - Clinical Nurse Reviewer

One Share Health
Irving, TX
10.2021 - 10.2024
  • Evaluated past medical assessments, addressed expressed worries and examined present indicators.
  • Aggregates and logs essential details into software platforms.
  • Assessed patient needs, ensuring compliance with regulations.
  • Performed pre-ex and prior authorization assessments maintaining 98% precision.
  • Monitored data to uncover overutilization and underutilization issues.
  • Conducted utilization management activities such as pre-certification and pre-authorization requests for services rendered by health care providers.

Employee/Occupational/Correctional Health Clinical Nurse

JPS Employee Health & Wellness
Fort Worth, TX
07.2018 - 08.2021
  • Provided comprehensive health screenings and administer immunizations to dedicated patient group.
  • Adhered to company regulations while providing top-tier customer service.
  • Engaged in investigative efforts to unveil primary factors behind accidents and near-misses.
  • Coordinated with doctors and healthcare professionals to schedule additional treatments.
  • Conducted comprehensive patient assessments to establish healthcare needs and nursing care plans.
  • Counseled patients on health maintenance and disease prevention strategies.
  • Observed and reported symptoms, reactions and progress of each patient.

LVN Clinical/HEDIS Review Nurse

Manpower-Maximus Federal
Irving, TX
10.2016 - 05.2017
  • Prepared medical documentation covering admissions, treatments and discharges for departmental use.
  • Systematically gathered and recorded patient data in healthcare systems.
  • Executed software updates across systems effectively.
  • Applied diverse software solutions to process and analyze health records.
  • Conducted frequent assessments to uphold patient data accuracy.
  • Executed comprehensive over-reads to ensure reliability of medical documentation.
  • Executed NCQA Technical Specific abstraction standards achieving a 98% accuracy rate during HEDIS medical review survey timeframe.

Education

Diploma in Licensed Practical Nurse - Nursing

Louisiana Technical College
Shreveport, LA
05.2007

Skills

  • Information Analysis and Documentation
  • Data Entry Expertise
  • Autonomous Task Management
  • Resource Management Proficiency
  • Clear Written and Spoken Communication
  • Interdisciplinary Collaboration
  • Proficient in Workflow Coordination
  • Proficient in EMR Systems
  • Proficient in Adobe PDF
  • Proficient in Microsoft Office
  • HEDIS review
  • Quality assurance
  • Data analysis
  • Compliance auditing
  • Medical terminology
  • HIPAA compliance
  • HEDIS compliance

Timeline

Clinical Review Nurse - Clinical Nurse Reviewer

One Share Health
10.2021 - 10.2024

HEDIS Review Nurse

Romack Resources - Aetna, CVS Health Company
12.2020 - 05.2025

Employee/Occupational/Correctional Health Clinical Nurse

JPS Employee Health & Wellness
07.2018 - 08.2021

LVN Clinical/HEDIS Review Nurse

Manpower-Maximus Federal
10.2016 - 05.2017

Diploma in Licensed Practical Nurse - Nursing

Louisiana Technical College

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Paige Lockett