Yolanda Dodson

• Provided emotional support to patients and families during difficult medical situations, fostering trust and rapport.
• Improved patient outcomes by providing high-quality nursing care and closely monitoring vital signs.
• Contributed to quality improvement initiatives by identifying areas for improvement and implementing evidence-based solutions.
• Implemented evidence-based wound management techniques which promoted healing without any complications.
• Serves as Charge Nurse on rotation to effectively manage patient care assignments based on patient acuity , workload, resources and anticipated patients needs within the interprofessional team

• Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.
• Cared for wounds, provided treatments, and assisted with procedures.
• Assisted with admissions, appointments, transfers, and discharges.
• Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery.

Improved patient outcomes by administering medications, monitoring vital signs, and documenting relevant information.

Cared for wounds, provided treatments, and assisted with procedures.

Assisted with admissions, appointments, transfers, and discharges.

Collaborated with interdisciplinary healthcare teams to ensure continuous quality improvement in patient care delivery. Provided quality and safe nursing care and related services in the client's home.

• Continually evaluated the client's nursing needs and collaborated with the client/caregiver in developing ways to meet their needs and goals.

• Followed a current, individualized plan of treatment by making revisions based on original and ongoing assessments and in conjunction with the physician, nursing supervisor and client/caregiver.

• Informed the D.O.N/Nursing Supervisor and other healthcare team members of changes in the client's condition and needs.

• Conducted monthly monitoring and auditing of 120 Medicare Advantage (MA) grievance and appeal cases based on the Centers for Medicare and Medicaid Services (CMS) regulations to ensure adherence to regulatory guidelines, while achieving and maintaining a 96% quality goal
• Identified areas requiring attention and/or improvement, resulting in the training of team members for quality
• Trained, developed and coached a team of four Medicare FEHB/Resolution Analysts, in addition to a Grievance Operations Analyst on a weekly basis on CMS mandates and National Committee for Quality Assurance (NCQA) standards resulting in the enhancement of workplace performance to ensure continued accreditation status for Client Services
• Researched Medicare regulations and Medicare Advantage (MA)/Prescription Drug (PD) notifications, regulations and plan requirements on a monthly basis
• Monitored and reviewed changes/modifications on a weekly basis to the CMS operations, regulations and requirements to ensure that the Management Team and staff remained in compliance with regulatory guidelines
• Developed, maintained and revised departmental policies and procedures, in addition to work flow processes and training material based on regulatory mandates or other internal process changes
• Provided analytical and administrative support to the Grievance Team Leadership and Grievance Analysts
• Established working protocols with HAP's Compliance Office to ensure timely notification, investigation and resolution of compliance issues/activities
• Developed, improved and maintained the skills, abilities and competencies needed in areas of CMS and governmental regulations, grievance and appeal knowledge and administrative and project expertise to excel individual and department performance
• Prepared monthly summary reports of monitoring activities within the Client Services Department to identify deficiencies and trends
• Worked with the Client Services Management Team to implement process improvements
• Expedited preparation and compliance of grievance and appeal files for audit review and participated in the audit conducted by CMS for approval in 2012 and 2013, with an overall passing score

• Managed the Grievance Section work flow to ensure that cases received were stamped, assigned and distributed timely
• Served as a Subject Matter Expert on Medicare and HMO/PPO content relevant to traditional health care delivery systems
• Provided training, assistance, guidance and direction for a Grievance Team of 9 as needed
• Ensured that the Grievance Section work flow was processed within the established time frames
• Assisted the Supervisor and Manager in a variety of responsibilities, including making recommendations for applying new methods to the work flow and the updating and implementation of policies and procedures required by HAP, NCQA, CMS and OFIR, now DIFS
• Performed 48-64 audits monthly on Member Advocate grievance cases to ensure that guidelines, policies and procedures were adhered to properly and in an accurate manner
• Provided updates to Member Advocates as needed to promote service excellence
• Effectively investigated more complex grievances as well as high profile and sensitive cases and recommended resolutions in consideration of HAP's established benefit structure, policies, procedures, guidelines and cost effectiveness by coordinating with providers and internal department executives, including Medical Directors, the Vice President of Client Services, Legal, etc., while working toward service excellence and customer satisfaction
• Formulated and generated response letters for the Grievance Officers with a greater degree of tact, discretion and diplomacy
• Attended member Grievance Committee Hearings, which are heard and reviewed by HAP's Grievance Committee, which include members from the Board of Directors
• Assumed the responsibility for the collection and analysis of statistical grievance information relative to identified trends in member grievances, which included preparation, compilation and publication of the annual grievance report
• Conducted internal training for New Hires and internal support departments
• Also, provided assistance and education to non-grievance staff customers throughout the Client Services department, in addition to internal nurses and physicians, etc

• Managed the Grievance Section work flow to ensure that cases received were stamped, assigned and distributed timely
• Served as a Subject Matter Expert on Medicare and HMO/PPO content relevant to traditional health care delivery systems
• Provided training, assistance, guidance and direction for a Grievance Team of 9 as needed
• Ensured that the Grievance Section work flow was processed within the established time frames
• Assisted the Supervisor and Manager in a variety of responsibilities, including making recommendations for applying new methods to the work flow and the updating and implementation of policies and procedures required by HAP, NCQA, CMS and OFIR, now DIFS
• Performed 48-64 audits monthly on Member Advocate grievance cases to ensure that guidelines, policies and procedures were adhered to properly and in an accurate manner
• Provided updates to Member Advocates as needed to promote service excellence
• Effectively investigated more complex grievances as well as high profile and sensitive cases and recommended resolutions in consideration of HAP's established benefit structure, policies, procedures, guidelines and cost effectiveness by coordinating with providers and internal department executives, including Medical Directors, the Vice President of Client Services, Legal, etc., while working toward service excellence and customer satisfaction
• Formulated and generated response letters for the Grievance Officers with a greater degree of tact, discretion and diplomacy
• Attended member Grievance Committee Hearings, which are heard and reviewed by HAP's Grievance Committee, which include members from the Board of Directors
• Assumed the responsibility for the collection and analysis of statistical grievance information relative to identified trends in member grievances, which included preparation, compilation and publication of the annual grievance report
• Conducted internal training for New Hires and internal support departments
• Also, provided assistance and education to non-grievance staff customers throughout the Client Services department, in addition to internal nurses and physicians, etc