Qweotta Sims
Columbus,OH
Summary
Proficient and caring nursing team member offering over 17 years of patient-facing experience. Addresses patient needs with compassionate care and attention to detail. Diligent about maximizing satisfaction, safety and wellness while serving patients of all backgrounds.
Seasoned LPN with expertise Clinical Management. Work effectively within interdisciplinary teams to develop, implement and adjust interventions.
Tech-savvy innovator with hands-on experience in emerging technologies and passion for continuous improvement. Skilled in identifying opportunities for technological enhancements and implementing effective solutions. Adept at leveraging new tools and methods to solve problems and enhance productivity. Excels in adapting to fast-paced environments and driving technological advancements.
Overview
16
16
years of professional experience
1
1
Certificate
Work History
Licensed Practical Nurse, Continuous Care
NURSA AND NURSEIO
08.2022 - Current
- On a day to day basis traveled from facility to facility and assumed the charge nurse role
- Records a patient's medical history, symptoms, and vitals
- Updates patient charts and electronic health records (EHR)
- Performs medical tasks, including blood tests and administering shots
- Administers medication and other doctor-recommended treatment plans.
- Documented accurate and complete patient information to address patient problems and expected outcomes.
SKILLED CHARGE NURSE
CASAS ADOBES HEALTH AND REHAB
06.2024 - 09.2024
- Worked as a skilled nurse managing recently discharged hospital patients and their care
- Records a patient's medical history, symptoms, and vitals
- Updates patient charts and electronic health records (EHR)
- Performs medical tasks, including blood tests and administering shots
- Administers medication and other doctor-recommended treatment plans.
- Trained new nurses in proper techniques, care standards, operational procedures, and safety protocols.
- Supervised and managed daily scheduling, tasking, and administration.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
TRAVEL CORRECTIONS NURSE
AB Staffing
10.2022 - 02.2024
- Monitored patient progress and responded to medical emergencies
- Administered medication as ordered by physicians
- Noted signs of illness and provided updates to physicians
- Took patient blood samples according to doctor's orders
- Ensured that implementation of proper safety procedures
- Maintained a database of all patient information
- Updated the medical histories of each patient
- Provided follow-up as required.
- Advocated for and strived to protect health, safety, and rights of patient.
TRAVEL CHARGE NURSE
Snap Nurse, Maxim Health Care
06.2020 - 08.2023
- Records a patient's medical history, symptoms, and vitals
- Updates patient charts and electronic health records (EHR)
- Performs medical tasks, including blood tests and administering shots
- Administers medication and other doctor-recommended treatment plans
- During and through COVID 19 Pandemic.
- Coordinated nursing care on unit through staff assignments, assisting and rounding with physicians, monitoring patient orders, and communicating with ancillary departments.
- Supervised and managed daily scheduling, tasking, and administration.
SR MANAGER OF INTERNAL OPERATIONAL CLINICAL COMPLIANCE ADMINISTRATOR
Health Integrated Inc., an EXL Service
06.2017 - 03.2020
- Subject matter expert: Centers for Medicare and Medicaid Special Needs Programs and Utilization Management
- Monitor programs and process regarding Washington State HCA with more than 5 years of combined experience
- Evolved efficient communication of program status and future state to both operational staff as well as leadership
- Assist with new implementation of integrated health systems
- Effectively resolve any Special Needs Program client specific issues regarding the Model of Care
- Assist SNP Director and Supervisors in supporting review of documentation for meeting all regulatory requirements
- Identify and complete opportunities & gap analysis and BIA's when identified and discuss resolutions
- Analyze and interpret audit findings for all lines of business within Care Management
- Lead Care Management teams in meeting operational metrics
- Responsible for overseeing Utilization Management clinical decision making with use of nationally recognized criteria
- Assist with implementation of a new Medicare Advantage EPO plans utilization, case and care navigator program across multiple states
- Continually improving operational efficiency by utilizing More for More-Investing in the clinical staff education on product lines increases productivity and quality of work performed
- Developed a new Policy and Procedure for Inter-rater reliability as well as training matrix to support NCQA guidelines while providing feedback and re-education
- Oversee Appeals and Grievance organization
- Traveled internationally to educate US licensed nurses on US HealthCare while implementing new systems.
- Managed large-scale projects and introduced new systems, tools, and processes to achieve challenging objectives.
- Evaluated hiring, firing, and promotions requests.
SR. MANAGER OF COMPLIANCE AND QUALITY CLINICAL AUDIT
HEALTH INTEGRATED
09.2016 - 06.2017
- Complete and coordinate associate quality audits, focused reviews, and problem identification for Case Management (NCQA, HCA), Utilization Management (NCQA, CMS, Military), Special Needs Programs (CMS)
- Deemed subject matter expert: CMS Special Needs Programs, Utilization Management programs and Process and the Washington State HCA with more than 5 years of combined experience
- Provides coaching and feedback to associates
- Provides routine/scheduled and ad hoc audit reports, including trend identification and root cause analysis
- Coordinates development of action plans for identified issues including training programs
- Participates and assists in the development of necessary protocols, policies and procedures, and operational strategies for Clinical Services
- Responsible for the ongoing development of audit tools to meet business needs
- Participates in Quality Reviews and Inter-Rater Reliability process
- Works with management team to develop and provide individual and department-level performance improvement plans and activities as well as plan/process follow-up
- Provide monitoring performance quality with regards to customer service and regulatory KPI as provided by CMS, NCQA, & URAC
- Involved in developing and maintaining performance improvement feedback and training strategies
- Supports the education and professional development of clinical staff, auditing for clinical and process related compliance across the organization while adhering to the NCQA and URAC guideline
- As related to managed care organization, monitor corrective action plans from a regulatory and compliance standpoint
- Utilize critical thinking, communication, and documentation skills by creating the Quality Audit tool that is used throughout all Utilization Management with this company
- Attend and assist with implementation of new health care plans
- Instrumental in external audits acting as a liaison for CMS SNP MOC/ODAG-data validation, appeals and program audits.
CLINICAL TRAINING SPECIALIST/CORPORATE COMPLIANCE AUDITOR
HEALTH INTEGRATED
08.2015 - 09.2016
- Supports the education and professional development of clinical staff, auditing for clinical and process related compliance across the organization adhering to the NCQA and URAC guideline
- Audit against state and federal regulatory
- Work independently with little direction
- Utilize critical thinking, communication, and documentation skills by creating the Quality Audit tool that is used throughout all Utilization Management with this company that incorporates NCQA, URAC and clinical decision making
- Attend and assist with implementation of new health care plans.
UM TEAM LEAD/SUPERVISOR
HEALTH INTEGRATED
02.2015 - 08.2015
- Evaluation of the appropriateness, medical need for health care services and/or procedures per evidence-based criteria or guidelines, and under the provisions of the health benefit plan
- Address new clinical activities or inpatient admissions based on the analysis of a case, relate to ongoing provision of care, especially in an inpatient setting and Outpatient Procedures
- Identifying High Dollar incidence with diagnosis and event excessiveness
- Trained UM Team on MCG and InterQual guidelines integrated/Embedded in the company healthcare platform
- Offer member support with coordinating and making appropriate referrals to benefit the member e.g
- CM, DM, BH
- Work independently and met productivity expectations
- Lead a team of 16 clinician including 10 LPN's and 6 RN's for a commercial utilization management plan.
CARE COORDINATOR
HEALTH INTEGRATED
07.2014 - 02.2015
- Perform telephonic nursing, assisting in managing member's total healthcare, ensuring follow-up care from ER/Visits and IP stays
- Assisting members with being able to maintain stable health in the comfort of their own home
- Responsible for the management of care coordination for the Medicaid population served by the organization
- Decreasing High Dollar incidence with Urgent Care visits vs ER
- Responsible for the daily management of a multidisciplinary care team providing community based, care coordination to medically complex, high risk members enrolled in special government programs
- Offer member support with coordinating appointment, continuity of care, completing appropriate referrals to benefit the member e.g
- DM, BH
- Work independently and meet productivity expectations.
CHARGE NURSE SUPERVISOR
HEARTLAND VICTORIAN VILLAGE
05.2013 - 08.2014
- Provided prescribed medical treatment and personal care services to the ill, injured, convalescent and disabled persons
- Executed daily operations of Medicare charting, checking charts for new orders and maintaining a safe environment
- Managed Individual care needs of skilled patients as directed per the Medical Doctor or Nurse Practitioner
- Chart Audits and clinical training of new hires.
Travel Nurse
NURSE STAFFING
07.2011 - 01.2013
- Provided clinical support as an Optical Educator a nationally known Lasik Vision Center for 3 years greet patients, schedule and confirm appointments and provide registration assistance
- Provides pre-operative imaging and testing to determine Lasik candidacy
- Counsels patients by providing information regarding treatment, use of eye drops and any oral medication
- Ensures confidentiality by completing and safeguarding medical records
- Provide quality patient care, excellent communication and customer service
- Help generate leads towards laser vision correction surgery
- Receive and secure payments from patients
- Training provided to assist in refractive surgery
- Acted as a substitute school nurse in a school for Children with Developmental Delays and chronic health conditions
- Continuous Care Nurse with a National Hospice company to which I supported families with end of life education, comfort, and compassion
- Maintained excellent interpersonal communication and multitasking skills while providing patient care in any setting.
DIRECTOR OF RESIDENT CARE
MEDLOCK GARDENS ASSISTED LIVING
08.2010 - 07.2011
- Directed a team of 26, coordinated the staff scheduling, process improvement and facilitated interviewing, hiring, performance improvement, separation of employment as well as evaluations
- Maintained/facilitated all training utilizing state regulations for adherence
- Coordinated all resident care from ADL's to dietary needs
- Oversee the management and daily operations of the ALF
- Ensures department staff is in full compliance with all federal, state, and local licensing regulations
- Ensures the individual service plans and general program for each resident are being followed
- Oversee staff operations, business planning and budget development
- Ensure services are in compliance with boarding home regulations, state and federal regulatory requirements
- Act as liaison for conflict resolution between staff, patients, family members and physicians
- Directs the staff in quality and caring support of elderly patients
- Plan and direct the assisted living program.
CHARGE NURSE/UR
SELECT SPECIALTY HOSPITAL
01.2009 - 08.2010
- Receiving admissions and/or transfers to the unit
- Initial and on-going systematic patient assessment
- Communicate with UM/CM clinicians regarding patient's stays
- Timely and accurate documentation
- Interpreting assessment/diagnostic data including labs, telemetry
- Ensuring medical orders are transcribed and processed accurately
- Competence in Rapid Response and code events
- Promoting continuous quality improvement
- Teaching and counseling patients/families
- Managing patients on ventilators and with high acuity under the supervision of a RN.
Education
Practical Nursing
COLUMBUS STATE COMMUNITY COLLEGE
12.2006
Skills
- Compassionate communication
- EMR Software-EPIC, PCC, MediTech, Cerner, Allscripts
- HIPAA Compliance
- Pediatric Care
- End of life care
- Cultural competency
- Documentation accuracy
- Postoperative care
- Elderly Care
- Diabetes management
- Tracheostomy Care
- Emergency Response
- Wound Care
- EMR / EHR
- FL, OH Licensed Practical Nurse
- HIPAA protocols
- Medical Records Management
- Psychotropic medication knowledge
- Behavioral assessment
Certification
Florida, PN 5215359, Active Compact
Ohio, PN 126120, Active single state
Timeline
SKILLED CHARGE NURSE
CASAS ADOBES HEALTH AND REHAB
06.2024 - 09.2024
TRAVEL CORRECTIONS NURSE
AB Staffing
10.2022 - 02.2024
Licensed Practical Nurse, Continuous Care
NURSA AND NURSEIO
08.2022 - Current
TRAVEL CHARGE NURSE
Snap Nurse, Maxim Health Care
06.2020 - 08.2023
SR MANAGER OF INTERNAL OPERATIONAL CLINICAL COMPLIANCE ADMINISTRATOR
Health Integrated Inc., an EXL Service
06.2017 - 03.2020
SR. MANAGER OF COMPLIANCE AND QUALITY CLINICAL AUDIT
HEALTH INTEGRATED
09.2016 - 06.2017
CLINICAL TRAINING SPECIALIST/CORPORATE COMPLIANCE AUDITOR
HEALTH INTEGRATED
08.2015 - 09.2016
UM TEAM LEAD/SUPERVISOR
HEALTH INTEGRATED
02.2015 - 08.2015
CARE COORDINATOR
HEALTH INTEGRATED
07.2014 - 02.2015
CHARGE NURSE SUPERVISOR
HEARTLAND VICTORIAN VILLAGE
05.2013 - 08.2014
Travel Nurse
NURSE STAFFING
07.2011 - 01.2013
DIRECTOR OF RESIDENT CARE
MEDLOCK GARDENS ASSISTED LIVING
08.2010 - 07.2011
CHARGE NURSE/UR
SELECT SPECIALTY HOSPITAL
01.2009 - 08.2010
Practical Nursing
COLUMBUS STATE COMMUNITY COLLEGE
Skillsabilities
Excellent critical thinking and Problem-Solving Skills, Strong team building skills, Proficient in Policy and Procedure writing, Proficient in MS Office, Power point, Access, Outlook, Intermediate to expert in Excel and Adobe Acrobat. Strategic Management and Business Planning, very strong business sense in health care. Skilled in utilizing and interpreting criteria used in Utilization and Care Management, Solid Leadership Skills, Vast knowledge of Commercial HMO, PPO, EPO, POS as well as Medicaid and Medicare lines of business. Build and develop strong working relationships at all levels in the organization.
Manage internal and external open communication while utilizing effective listening/speaking practices. Maintain a positive feedback loop. Provide confident and assertive leadership with effective directives and expectations
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