Tina N. Brown, BSN, RN

• Oversight and management of HEDIS vendor ensuring adherence to quality and reporting standards
• Collaborate on and ensure timely execution of HEDIS deliverables including the HEDIS Roadmap
• Led and supported all aspects of the HEDIS audit process, serving as primary point of contact for auditors and ensuring timely submission of required documentation.
• Perform medical record reviews, abstraction, and overreads for HEDIS and other quality requirements.
• Performs ongoing analysis of gaps and barriers in care, aligning interventions with HEDIS and NCQA standards
• Served as a subject matter expert on the HEDIS review team, providing guidance and support to colleagues as needed.
• Research and validate clinical data.
• Contribute to the development of training materials for new HEDIS reviewers, promoting a consistent approach to data collection.

• Conducted telephonic assessments and monitored members with chronic conditions.
• Develop and implement plan of care for patients with chronic illness or recovering from serious injuries
• Educated patients to improve self-management and reduce re-admissions.
• Collaborated with multidisciplinary teams to close gaps and align care with best practices.
• Assessed current treatment plan to identify barriers, clarify or determine realistic goals and objectives and seek potential alternatives.

• Developed and initiated individualized plan of care and assumed responsibility for ongoing development in partnership with patient, family and caregivers.
• Helped to achieve and maintain continuity of patient care by planning and exchanging information with other health professionals.
• Identified and coordinated patient and family care to support patients and families
• Initiated preventive and rehabilitative nursing procedures and provided services ordered by physician as indicated in plan of care.
• Performed triage on incoming patients and determined severity of injuries and illnesses.
• Educated family members and caregivers on patient care instructions.
• Administered medications and treatment to patients and monitored responses while working with healthcare teams to adjust care plans.
• Evaluated patient histories, complaints and current symptoms.
• Provided skilled, timely and level-headed emergency response to critically-ill patients.

● Review assigned medical records in order to abstract specified and required clinical data elements for HEDIS reporting

• ● Participate in medical record collection and inter-rater reliability process
• ● Schedule and perform on-site medical record reviews
• ● Document abstraction findings as required

● Improved HEDIS performance by conducting thorough medical record reviews and data extraction.

• Developed, implemented, coordinated, monitored, and evaluated care plans
• Conducted assessments to identify patient and caregiver needs
• Implemented care plan by facilitating referrals as appropriate
• Coordinated resources to meet patients identified needs
• Monitored and evaluated effectiveness of care plan and made modifications as needed
• Communicated with physicians to consult and develop treatment plans
• Performed nursing care such as wound care, catheter care, etc.

● Performed chart audits

● Processed prior authorizations

● Worked in various clinics such as Adult Medicine,

Pediatrics, OB/GYN, Geriatrics

● Transcribed written and verbal orders

● Managed phone and walk-in triage

● Assessed patients and documented appropriately

● Performed patient and family education

● Provided nursing care including medication administration, wound care etc.

● Performed minor procedures and other clinical nursing duties

• Administered influenza and pneumococcal vaccines
• Completed accurate patient documentation
• Monitored patients for adverse reactions
• Worked with both full and partial vials, pre-filled syringes
• Independently managed clinics of up to 80 patients
• Maintained excellent interpersonal, professional and organizational skills

• Completed facility admissions and discharges
• Performed head-to-toe assessments
• Evaluated and treated various wounds
• Completed thorough documentation
• Monitored and provided care for 23+ residents
• Performed medication administration
• Supervised team of 4 Certified Nursing Assistants

• Performed routine immunizations
• Assisted physicians as necessary
• Roomed patients and obtained vital signs