The Resume of Lily Hunter, RN

OVERVIEW

Talented Registered Nurse skilled in Medical Record Reviews, HEDIS Chart Abstractions, Data Collections/Reviews. Dedicated to quality patient care possessing a broad spectrum of healthcare experience. Technical skills include: Microsoft Word, Excel, Powerpoint, Citrix, Macess, CRMS, .

EXPERIENCE

10/2014 to present

GENARD GROUP INC

Nurse Credentialist (long term temporary assignment)

Review physical exams of clients for appropriateness and missing criteria.

Ensure healthcare professionals and services meet all established federal and state standards, as well as NCQA (National Committee for Quality Assurance) standards.

Process applications and reappointment paperwork, checking for full completeness and accuracy collect and process significant amounts of verification and accreditation information, maintain and update accurate databases

Per diem Nurse 12/2013 to 10/2014

Accompany autistic children on community field based trips.

CURE STAFFING, Fairfield, New Jersey

EasyChoice NY 2/2012-5/2012

Contract-HEDIS Nurse Reviewer

Exec-U-Search

Conduct specific Medical reviews as necessary for HEDIS.

Analyze findings and make recommendations for corrective actions, data entry

Healthfirst 2/2008 – 6/2011

Communicate regularly with members, providers and health plan staff, Perform telephone outreach to members in the assigned registry/database.

Delivered education presentations to providers on all aspects of medical record review criteria including HEDIS, best practice methods and current health trends.

Monitored provider records and assure compliance with quality standards at all times

Coordinated and performed onsite medical record reviews at provider offices to determine appropriateness of care

Worked on projects dealing with auditing records and reviewing ICD and CPT codes as assigned

Diabetes Clinical Quality Improvement RN in the NY Office from 2/ 2008 to 1/ 2010 (MONTEFIORE assigned)

transferred to the NJ office from 1/2010 to 6/2011.

Clinical Partnership with Major hospital system in New York (MONTEFIORE)

Assist in writing member and/or provider articles in relation to HEDIS, QARR, Medicare Advantage and/or health promotions.

Outcomes Inc. Agency 10/2007-2/2008

Contract Medical Record Review

Conducted Medical Chart Audits at Provider offices in the states of NJ, NY for HEDIS Fiindings were analyzed and recommendations were made for corrective action. Data entry.

Lily Hunter, R.N.

Americhoice of NJ 7/2005-10/2007

Medical Record Review Nurse- HEDIS and Recredentialing

Collection of claims data and records, electronic and hard copy

Site audits for credentialing/recredentialing, HEDIS

Reviews for health plan QI and regulatory clinical studies.

Facilitate resolution and problem solving related to data collection

Physician office medical reviews

Foster key relationships with Providers

Nursefinders Staffing Agency 10/2003-3/2005

Nurse Reviewer for inpatient chart reviews

Amerigroup Corporation 01/2002-10/2003

Case Manager/Discharge Planner

Acquire data and evaluate medical services for cost containment using Milliman guidelines

Assess clinical data to develop treatment plans

Acquire data and evaluate medical services for cost containment

Evaluate quality of necessary medical services

Bayada Nurses 1998-2002 Case Manager, Utilization Review, Discharge Planning

Assigned on site at Valley Hospital and St Barnabas Livingston to do inpatient utilization review using Milliman guidelines

Assess clinical information collected to develop appropriate plans

Ongoing interaction with hospital personnel and physicians regarding patient hospital stays

Health Telemanagement 1997-1998

Nurse Reviewer for chart audits for various clients such as Empire Blue Cross.

Staffing Remedies 1995-1997

Agency Nurse Per diem-various hospitals, Floor Nurse and Case manager

National Healthcare Review 1994-1995

Nurse Auditor, onsite position at St Mary's Hoboken NJ

Retrospective Chart Reviews

Insurance Defense Audits

Lily Hunter, R.N.

Montclair Community Hospital 1992-1993

Quality Assurance Nurse

Data Collection of various clinical indicators

Investigation of incidents

Report preparation and agendas for Medical Staff Committee

1993-1994 2nd pregnancy time off

Palms of Pasadena Hospital 1988-1992

South Pasadena, Florida

Drug Effects Reporting.

Pharmcokinectic monitoring of selected patients

Preparation of Medications, Intravenous Solutions, Total Parenteral Nutrition

Acute patient care in Medical-surgical departments and same-day surgery

1986-1988 1st Pregnancy Time off

Riverside Hospital 1984-1985

Boonton, New Jersey

Staff Nurse Ventilator Rehabilitation Unit

Clara Maass Medical Center 1983-1984

Belleville, New Jersey

Staff Nurse Telemetry Unit

University Hospital 1981-1982

Newark, New Jersey

Acute patient care in Labor and Delivery Unit

Patient education on Birth control methods.

Role as Scrub Nurse

Education

Essex County College Newark, New Jersey

Associate in Applied Science - Nursing 1981

Licensure

NJ – ACTIVE

NY - ACTIVE

FL- ACTIVE

TX- ACTIVE

Plus other states.

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contact information:

acqb27@r.postjobfree.com 973-***-****

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