Patricia Lee
South Brunswick,NJ
Summary
Accomplished Healthcare Nursing Professional with a strong background in acute care hospital settings, Health informatics and data analysis, Medical Record abstraction(HEDIS), and other areas of quality management. Results driven and committed to making meaningful contributions towards organizational goals
Overview
23
23
years of professional experience
Work History
QUALITY CLINICAL ANALYST (HEDIS)
Cigna Healthcare
05.2016 - 07.2025
- Managed HEDIS project including data collection, reporting, and analysis for assigned Regions and products. Extensive knowledge of the principles of HEDIS, NCQA, CMS pertaining to Health Plan accreditation.
- Subject-matter expert on measure specifications, successfully developed training materials and provided guidance to internal and external staff.
- Engaged and educated providers, physicians and office staff on HEDIS specifications to address accurate documentation and close care gaps that resulted in improved Health Plan performance ratings and measure outcomes.
- Performed analysis by gathering data from claims, pharmacy/lab, and demographics that identified trends used for internal reporting.
- Supported Quality Clinical Initiatives strategies that identified barriers resulting in opportunities for improvement.
- Reviewed clinical workflows and tools for possible automation and implementation of relevant technology for the transition to digital quality measurement to stay current with industry trends.
- Contributed to the strategic planning for HEDIS operations, ensured alignment with Enterprise goals.
- Actively participated in Health Plan Quality accreditation activities.
- Collaborated with healthcare teams to develop and implement process improvements.
REGISTERED NURSE
Princeton Medical Center
01.2011 - 01.2016
- Collaborated with physicians and healthcare teams to provide exceptional patient care.
- Triaged caseload of patients simultaneously by providing bedside care, treatments, IV therapy, and wound care.
- Monitored patient vital signs to perform thorough condition assessments.
- Utilized critical thinking skills to prioritize nursing interventions based on patient acuity levels and individual needs.
- Improved patient outcomes by implementing evidence-based nursing interventions and individualized care plans.
- Managed procedure schedules and emergency communications.
- Engaged in Quality Improvement activities for patient safety and satisfaction.
REGISTERED NURSE, BEHAVIORAL HEALTH
Monmouth Medical Center
01.2010 - 01.2011
- Provided specialized care and support to patients with mental health or acute substance use disorders by assessing their needs, developing and implementing treatment plans, medication management, therapy and counseling, and coordination of care upon discharge.
- Collaborated with interdisciplinary healthcare team, resulting in more comprehensive patient care.
- Evaluated treatment plans assessing patient progress toward established goals, adjusting interventions as needed based on clinical judgment.
- Conveyed treatment options, diagnosis information and home care support to patients and caregivers to continue care consistency.
SENIOR MANAGED CARE ANALYST
University of Medicine and Dentistry of New Jersey (formerly)
01.2003 - 01.2007
- Oversaw credentialing and re-credentialing of providers for large Faculty Practice, serving as a central point of contact, and facilitating communication between patients, providers and payers.
- Maintained up-to-date Provider data in the credentialing database and ensured compliance with governance bylaws, regulatory and accrediting bodies.
- Streamlined the credentialing process by implementing efficient tracking systems and maintaining accurate records.
- Ensured providers were accurately credentialed with Health Plans.
- Successfully resolved complex issues regarding licensing discrepancies or other concerns involving provider qualifications.
- Supported quality assurance initiatives by conducting ongoing reviews of internal procedures and making recommendations for improvements as needed.
- Conducted primary source verifications such as background checks, Medical Schools and licensing boards for incoming medical staff.
Education
Bachelor of Science - Nursing
New Jersey City University
Jersey City, NJ05.2009
Bachelor of Science - Psychology
Pennsylvania State University
Erie, PA01.1989
Skills
- Electronic Health Record Proficiency
- Strong clinical background in Acute Care
- Medical Coding knowledge
- HEDIS and Population Health strategies
- Microsoft Office
- Healthcare policies and regulations
Timeline
QUALITY CLINICAL ANALYST (HEDIS)
Cigna Healthcare
05.2016 - 07.2025
REGISTERED NURSE
Princeton Medical Center
01.2011 - 01.2016
REGISTERED NURSE, BEHAVIORAL HEALTH
Monmouth Medical Center
01.2010 - 01.2011
SENIOR MANAGED CARE ANALYST
University of Medicine and Dentistry of New Jersey (formerly)
01.2003 - 01.2007
Bachelor of Science - Psychology
Pennsylvania State University
Bachelor of Science - Nursing
New Jersey City University