Wanda Boyd
Wesley Chapel,FL
Summary
Experienced HEDIS Review Nurse with a strong background in clinical advisory, quality review coordination, and improvement. Proven track record in enhancing healthcare delivery through rigorous quality audits and compliance evaluations. Identified areas for improvement to drive high standards of patient care and operational efficiency. Collaborated with multidisciplinary teams and optimized processes to ensure adherence to HEDIS measures and regulatory compliance.
Overview
34
34
years of professional experience
Work History
Quality Audit Professional II
Humana, Inc
Tampa, FL
01.2019 - 01.2024
- Conducted chart reviews to investigate quality issues and improve patient care standards
- Managed record request responses with precision, ensured regulatory compliance, and maintained exceptional documentation standards.
Clinical Advisor and QIO Coordinator
Humana, Inc
Tampa, FL
12.2001 - 01.2019
- Conducted chart reviews to identify quality issues, collected annual HEDIS data, and educated providers on best practices.
- Handled record requests and quality discussion letters from Florida Medical Quality Assurance Inc., the Medicare Quality Improvement Organization (QIO) for Florida.
Manager and Pro Coordinator
Humana, Inc
Tampa, FL
05.1996 - 12.2001
- Coordinated and actively participated in various committees including Peer Review, Credentialing and Continuous Quality Management.
- Requested records for Random Quarterly PRO Sample, Beneficiary Complaints, and Special PRO Projects.
Quality Improvement Specialist/PRO Coordinator
Humana, Inc
Tampa, FL
02.1995 - 05.1996
- Succeeded in fulfilling a range of FMQAI duties, including record retrieval for the Random Quarterly PRO Sample, conducting comprehensive record reviews, responding to inquiry letters received from FMQAI promptly and handling select HCFA correspondences.
- Investigated quality issues through chart review.
R.N. Review Coordinator
Florida Medical Quality Assurance
Tampa, FL
08.1993 - 02.1995
- Reviewed inpatient, ambulatory, and chart to assess utilization, quality, and medical necessity of procedure.
- Reviewed single admissions, transfers, and re-admissions.
- Conducted specialty reviews on rehabilitation stays.
- Reviewed beneficiary complaints and issued hospital notice of non-coverage (HINN) for continued stay in hospital and pre-admission.
- Conducted online reviews using a compass system.
- Conducted HMO reviews.
Healthy Start Nurse/ Community Health Nurse (full-time)
HRS Hillsborough County Public Health Unit
Lee Davis Health Center, Tampa
10.1990 - 08.1993
- Managed health care and psychological needs of high-risk pregnant women and infants up to one year old
- Conducted home visits for clients in private and public sectors.
Registered Nurse
Interim Health Care (part time, PRN)
Tampa, FL
- 08.1993
- Provided direct care to patients
- Initiated and revised peripheral lines
- Administered full range of IM medications, PO medications, IV medications, Subq medications
- Performed venipunctures
- Implemented effective instructional techniques for teaching insulin self-administration.
- Performed nurse assessments and executed dressing changes.
Staff Nurse: Medical Surgical/Orthopedic Unit
Tampa General Hospital
Tampa, FL
02.1990 - 10.1990
- Administered direct patient care and prepared patients for surgery, including administering IM, PO, IV Subq medications and blood as well as starting and changing peripheral lines.
University of South Florida Student Preceptor
- Assisted with clinical rotation and provided Public Health education to nursing students; Trained and oriented Healthy Start Nurses, focusing on responsibilities such as home visits and follow-up of substance-exposed infants; Conducted comprehensive physical assessments and delivered preventive education for healthy infants
- Coordinated interagency referral and patient services as a Community Health Nurse for OSAP Project Support. Case managed pregnant substance-using women, ensuring their comprehensive care and support. Counseled substance-using women to encourage them to enter drug treatment, while also supervising paraprofessional outreach workers.
Education
Bachelor of Science in Nursing -
Florida A & M University
Tallahassee, Florida08.1989
Skills
- Decision-Making
- Organizational Skills
- Analytical Thinking
- Critical Thinking
- Attention to Detail
- Problem Resolution
- Data Management
- QMS Software Proficiency
- Excellent Communication
- Self-Directed
- Active Listening
- Relationship Building
References
Available upon Request
Timeline
Quality Audit Professional II
Humana, Inc
01.2019 - 01.2024
Clinical Advisor and QIO Coordinator
Humana, Inc
12.2001 - 01.2019
Manager and Pro Coordinator
Humana, Inc
05.1996 - 12.2001
Quality Improvement Specialist/PRO Coordinator
Humana, Inc
02.1995 - 05.1996
R.N. Review Coordinator
Florida Medical Quality Assurance
08.1993 - 02.1995
Healthy Start Nurse/ Community Health Nurse (full-time)
HRS Hillsborough County Public Health Unit
10.1990 - 08.1993
Staff Nurse: Medical Surgical/Orthopedic Unit
Tampa General Hospital
02.1990 - 10.1990
Registered Nurse
Interim Health Care (part time, PRN)
- 08.1993
University of South Florida Student Preceptor
Bachelor of Science in Nursing -
Florida A & M University
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