Tia Strong

• Performed HEDIS data abstractions and conducted 90-100 medical record reviews daily.
• Utilized electronic health record systems to ensure accurate data entry and retrieval.
• Support QI initiatives aimed at closing care gaps (HBP, CBP, COL, BSC, CCS, KED, EED. OSTEO and WCC aligned with NCQA guidelines and entered data into the EMR.
• Data reporting related to various initiatives including chronic disease and preventative initiatives
• Maintained high accuracy and productivity metrics across assigned measures
• Participate in data validation for both internal and external Quality Intelligence reporting and projects as assigned by the leadership
• Coordinate medical records retrieval with AAH, Aligned, and outside facilities to help improve data integrity and patient outcomes

• Coordinated care plans to optimize patient outcomes and facilitate seamless communication among multidisciplinary teams.
• Assessed the patient for social determinants of health needs through comprehensive evaluations, ensuring alignment with healthcare goals and resources.
• Educate patients and develop educational materials to empower patients in managing chronic conditions effectively, to minimize hospitalization..
• Assists with scheduling annual Medicare wellness visits with PCP.P
• Educates on medication management.
• Address overdue care caps to assist with health maintenance
• Manages a monthly case load of 60 or more patients

• Coordinated interdisciplinary care plans, ensuring alignment with patient/family needs and goals.
• Facilitated patient assessments to identify unique needs and develop tailored support strategies.
• Monitored patient progress, adjusting care plans as necessary to enhance quality of life.
• Collaborated with other disciplines to educate families on hospice services, resources, and coping strategies to improve overall understanding of patient care,

• Managed and assessed behavioral health conditions for 40 or more patients.

• Conducted monthly rounds with a psychiatrist.

• Documented medication consents, behaviors, and patient progress.

• Assisted with medication management.

Reported new or worsening symptoms.