Clinical nurse in the quality management department at this managed care health insurance company. Includes working closely with other plan departments to perform annual QARR/HEDIS. Other responsibilities in this position included provider relations in Nassau
HCC's, CRG's, Data Extraction & Medical Record Reviews.
Private Medicaid Provider for pediatric patient in home care setting. Included performing all ADL's, G/T feeding and care, ROM, seizure precautions, administering medications and charting
GPA 4.0 - Dean's List
Internship with Suffolk County Sheriff's Dept.
SIFE- Regional champions
License current NYS
Quality management and clinical nurse in a private family practice. Responsibilities included but were certainly not limited to liaison between patient and physician, EMR configuration and training of all staff including clinicians and office managers. ACO reporting for Medicare and PQRS for Medicaid. Also reported in insurance portals for annual incentives and supplemental data throughout the year. Educated staff and providers regarding preventive health care measures and the quality of care and documentation that was required.
Onsite chart reviews and audits as a third party to health insurance companies. Projects include HEDIS, CMS Risk Adjustment
Remotely review medical records to assess quality of care and documentation of services in a managed care setting. QR and IRR for HEDIS project and supplemental data throughout the year. Working in the quality department with all of Aetna departments to ensure members receive the highest quality care.
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