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Medical Nurse

Location:
Fletcher, NC
Posted:
January 08, 2019

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Resume:

HAROLD B. McClain, JR.

*** ********** ****

Spartanburg, SC 29301

ac75lq@r.postjobfree.com

864-***-****)

OVERVIEW

Skilled professional with excellent interpersonal and critical thinking skills developed through leadership experience in business operations and 5 years in Medical Billing, 6 years of Hedis Auditing, 2 years of Rik Adjustment, coupled with a strong science background. Also Able to consistently focus on mission and critical topics. Aggressive in researching problems and implementing strategies to meet and exceed goals. Apply logic and sound reasoning in stressful situations. Self-motivated, excellent time manager. Well-regarded for verbal and written communications in preparing and making group presentations and dealing with persons from all backgrounds, at all levels. Familiar with various software. Seeking growth opportunity in Nursing or related area.

EDUCATION

Bachelor of Science - Major: Biology/Chemistry, South Carolina State University, Orangeburg, SC, 1995

Associates of Nursing - Major: Nursing/Healthcare, Greenville Technical College, Greenville, SC, 2008

EXPERIENCES

Molina Healthcare/ Sr. Specialist/ Hedis/ Quality Dept./ Upstate of South Carolina/ Quality Feb 2017 to December 2017

• Accurately and efficiently conducted medical record reviews for hospitals and Doctors’ offices throughout

Upstate South Carolina.

• Delivered Quality Reports, Incentive programs, and Assessment tools to individual office to increase efficiency and meet Hedis Standards.

• Successfully completed chases and audits to achieve company standards, and Hedis accuracy.

• Successfully completes required training, testing and quality assessments

• Remotely audited records from home.

• Abstracted data from medical records, using web based program to determine if they were compliant with Hedis standards.

• Maintains daily communication with management, and participated in weekly meetings to improve Hedis proficiency.

• Consistently demonstrates high standards of integrity by supporting the Molina Healthcare value and adhering to the Corporate Code of Conduct.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

• Regular and reliable attendance was expected and required.

• Performed other functions as assigned by management such as following up and calling providers to retrieve additional records to meet goals.

Above and Beyond Home Healthcare/ Home Health Nurse May 2016 to Present

•Assess patients’ condition during every visit and chart your observations

•Perform evaluation tasks, including vital signs and medication review

•Administer medication as prescribed by the patient’s Physician

•Dress or redress open wounds and assess progress of healing

•Educate patients and their families on proper home health care strategies and procedures

•Coordinate with Occupational Therapists, Physical Therapists, Physicians and anyone else involved in the patient’s care plan.

Provide palliative care as needed to keep the patient comfortable

•Make recommendations for devices or tools that might improve the patient’s quality of life

• Listen to the patient and respond to concerns or requests.

Sava Senior Healthcare/ Charge Nurse, August 2016 to Present

•Plan, Direct and Manage the day-to-day functions of the nursing assistants in accordance with current rules, regulations, and guidelines that govern the long-term care facility.

•Cooperate with other resident services when coordinating nursing services to ensure that the resident's total regimen of care is maintained.

•Admit, transfer, and discharge residents as required.

•Ensure that an adequate supply of floor stock medications, supplies, and equipment is on hand to meet the nursing needs of the residents. Prepare and administer medications as ordered by the physician. Report needs to the Nurse Supervisor.

•Participate in employee performance evaluations, determining your shift's staffing requirements, and making recommendations to the Nurse Supervisor concerning employee dismissals, transfers, etc.

•Make daily rounds of your unit/shift to ensure that nursing service personnel are performing their work assignments in accordance with acceptable nursing standards. Report problem areas to the Nurse Supervisor.

•Administer professional services such as but not limited to; catheterization, tube feedings, suction, applying and changing dressings/bandages, packs, colostomy, and drainage bags, taking blood, giving massages and range of motion exercises, care for the dead/dying, etc., as required.

•Other Duties and Responsibilities are required.

Blue Choice Health Plan/Anthem Blue Cross Blue Shield of South Carolina, December 2015 to May 2016

• Accurately and efficiently conducted medical record reviews for hospitals and doctors’ offices throughout South Carolina.

• Successfully completed chases to achieve a Hedis accuracy of 93% to 95% efficiency

• Successfully completes required training, testing and quality assessments

• Remotely audited records from home.

• Abstracted data from medical records, using web based program to determine if they were compliant with Hedis standards.

• Maintains daily communication with management, and participated in weekly meetings to improve Hedis proficiency.

• Consistently demonstrates high standards of integrity by supporting the Blue Choice/Anthem mission, values and adhering to the Corporate Code of Conduct.

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

• Regular and reliable attendance was expected and required.

• Performed other functions as assigned by management such as following up and calling providers to retrieve additional records to meet goals.

Fundamental Inc, Charge Nurse, Greenville, South Carolina, June 2015 to May 2016

•Plan, Direct and Manage the day-to-day functions of the nursing assistants in accordance with current rules, regulations, and guidelines that govern the long-term care facility.

•Cooperate with other resident services when coordinating nursing services to ensure that the resident's total regimen of care is maintained.

•Admit, transfer, and discharge residents as required.

•Ensure that an adequate supply of floor stock medications, supplies, and equipment is on hand to meet the nursing needs of the residents. Prepare and administer medications as ordered by the physician. Report needs to the Nurse Supervisor.

•Participate in employee performance evaluations, determining your shift's staffing requirements, and making recommendations to the Nurse Supervisor concerning employee dismissals, transfers, etc.

•Make daily rounds of your unit/shift to ensure that nursing service personnel are performing their work assignments in accordance with acceptable nursing standards. Report problem areas to the Nurse Supervisor.

•Administer professional services such as but not limited to; catheterization, tube feedings, suction, applying and changing dressings/bandages, packs, colostomy, and drainage bags, taking blood, giving massages and range of motion exercises, care for the dead/dying, etc., as required.

•Other Duties and Responsibilities are required.

Select Health of South Carolina, Hedis Specialist, Upstate South Carolina, February 2015 to May 2015

• Accurately and efficiently conducts medical record reviews for Hospitals and Doctors office throughout the upstate of South Carolina.

• Successfully completed chases to achieve a hedis accuracy of 96% to 98% efficiency.

• Successfully completes required training, testing and quality assessments

• Travels from home to provider offices or facilities to complete reviews, if required

• Abstracts data from medical records, uses portable scanner to retrieve relevant components from medical record and upload scanned medical records daily, as required

• Maintains daily communication with management

• Consistently demonstrates high standards of integrity by supporting the Select Health of South Carolina mission and values and adhering to the Corporate Code of Conduct

• Maintains high regard for member privacy in accordance with the corporate privacy policies and procedures

• Regular and reliable attendance is expected and required

• Performs other functions as assigned by management.

Advanced Nursing, Greenville South Carolina June 2013 to Feb, 2015

*Advance Nursing provides staffing in medical facilities throughout the upstate. Duties included on- call assistances to over 20 facilities in the surrounding area including Spartanburg and Greenville Hospital systems. Duties include providing nursing assist to geriatric and skilled care facilities. Other duties include charge nursing and flu shot clinics. Specialty care includes Trachea Care, G-tube, and Hospice.

Care National, Inc (Altegra Health/ Humana Corp CA, Special Project: March 2013 to May 2013

Accurately and efficiently over-read medical record abstractions performed by the HEDIS abstraction staff. Review a sample of abstractions from each assigned abstractor on a weekly basis through the data collection tool (the “Software Application”) per HEDIS® 2013 specifications and Altegra training guidelines: Abstractions are performed on the correct member, and the correct measure. The abstractor interprets the specifications for the measure correctly. Translated the specifications for the measure to the data collection tool correctly. Completed the IRR/over-read tool in the Software Application, including comments if errors are found. Immediately corrected errors identified through over-read process, including a re-review of charts that may contain similar errors. Contacted the abstractors at least weekly to report/discuss IRR / over-read findings. Notify the appropriate abstraction supervisor of individual IRR / over-read findings. Communicate all common abstraction issues to the Director of HEDIS Abstraction and to Abstraction Supervisors. Met routinely with Director and Abstraction Supervisors to discuss IRR results and discuss any open issues. Raised questions or concerns in a timely manner via email or phone. Participated in retraining as requested by Abstraction Supervisors. Prepared routine IRR scoring reports for each client as necessary. Maintained compliance with all HIPAA and patient confidentiality requirements

Inovalon, Inc (Medical Informatics for Healthcare Solutions), Bowie, Maryland Jan 2011 to June 2013*Performed reviews (and/or quality over-reads of such reviews) of care providers, sites, facilities, medical records, and other associated medical-field materials, personnel, and documents as outlined by the Company either onsite or at remote locations as designated by the Company. Such reviews may include (amongst others): Care Provider Site Reviews, Chart Keeping Standards Reviews, HEDIS Hybrid Chart Abstractions, Medicare Risk Adjustment, Custom QI Reviews; and/or, and Care Provider Site and/or Care Provider Monitoring Reviews. Assist with the review and maintenance of policies, procedures, and training materials which reflect up-to-date NCQA, JCAHO, URAC, and related regulatory policies in as far as they relate to Med Assurant’s provision of review services. Assisted in the coordination of communication processes with Med Assurant’s administrative, management, and field staff as well as other affiliates, strategic partners, and other external individuals and organizations.

LPN (Medical Staffing Network), Spartanburg, SC May 2008 -May 2012

*Medical staffing network provides staffing in medical facilities throughout the upstate. Duties included on- call assistances to over 20 facilities in the surrounding area including Spartanburg and Greenville Hospital systems. Duties include providing nursing assist to geriatric, occupational health, psychiatric and sub-acute facilities.

LPN (National Healthcare Corporation), Greenville, SC Aug 2007- June 2009

*NHC is a 180 bed Healthcare Facility consisting of Geriatric care, Alhemizers,, and rehabilitation. NHC provides services to 73 long term healthcare facilities with 9,129 beds.

*Responsibilities included the care of 30 patients on a 60 bed unit. Supervised 5 to 7 CNA’s on a daily basis, ensuring that policies and procedures were followed as implemented by facility. Scheduled job assignments according to number of beds occupied to ensure quality and safety of staff and residents.

* Other duties included: Passing med’s, charting, treatments (including wound care), bowel sheets, vital sheets, suctioning, tube feedings, suprapubic Cath changes, Foley care, lab collections, calling doctors as needed and writing orders, and preparing data for the next shift.

Pediatrix (Allen Bennett Hospital) Greer, SC Jan 2006-Aug 2007

*Responsibilities included performing hearing screens on all new born infants within 8 hrs. of delivery. Other duties included downloading of all data monthly to send to supervisor for monthly reports. Scheduling infants that were unsuccessful with screening for specialist consult. Provide educational literature provided by state and local DHEC for screening purposes, and certificates for successful screeners.

Trainer (Michelin Corporation) Pindrum Staffing, Spartanburg, SC Aug 2003- Dec 2006

*Responsibilities included the training of new employees throughout production of all tasks including safety and job requirements in a proficient manner. Other duties included call-in or fill in person throughout production on an as needed bases, due to staff shortage.

MCI Sales Representative-Greenville, SC, 2002-2003

* Responsibilities included the sales and marketing of long distance packages and cellular phones throughout the United States. Calls consisted of out bound telemarketing. Average sales exceeded 200 to 340% of quota quarterly.

Senior Sales Executive- Danka Business Systems, Greenville, Spartanburg Region, SC, 1/ 2002- 8/2003

* Responsible for sales of Toshiba/ Cannon/ Heidelberg copiers, Faxes, and computers throughout the

Upstate. .

* Responsibilities include maintaining named accounts and developing new business to business. Opportunities in the area.

Supervisor G/L-Freightliner Custom Chassis Corporation, Gaffney (Daimler Chrysler Corp.), SC, 1998-2002

* Ensure quality and key processes are implemented in meeting and exceeding production levels

* Met a 40% increase in production by reorganizing assignments based on time study of employee work loads

* One of four group leaders responsible for line ranking highest out of seven with 103% efficiency

* Reduced quality issues on weekly audit from 15 to 0

* Lead employee involvement sessions and conduct weekly and monthly training classes

* Presented suggestions to management that was implemented such as using progress reports to improve

communications with temporary workers in evaluating performance for full-time employment

* Developed and implemented a program of cross training within my team to minimize the effect of absenteeism

and to improve employee performance.

* Selected as member of Kaizen Team, and have served on warranty, safety, and quality teams

* Started as temporary, hired in 1999 as group leader over 17 employees and then too larger group of 26

Science Teacher- Greenville County Schools, Greenville, SC, 1998

* Taught four high school biology and physical science classes part-time at the Carolina Academy

* Mentored problem students, focusing on basic skills to prepare for MAT 7 that resulted in higher grade levels

Quality Assurance Inspector- Pindrum Staffing, Greenville, SC, 1996-1998

* Reduced production reject rate on night shift by 98% while assigned at the BMW Manufacturing plant. Responsibilities included: Third Party inventory control of all bumpers that were shipped to BMW from P and B automotive. Duties included meeting all paint specifications set by BMW Manufacturing to ensure that all quality assurance procedure were followed in a consistent and timely manner.

Medicaid Specialist- Family Health Center, Orangeburg, SC, 1991-1996

* Directed processing and rework of over 400 Medicaid/Medicare claims weekly for center’s 9 locations,

representing 26 doctors in OB GYN, pediatrics, adult medicine, podiatry, dental, same-day surgery

* Scheduled appointments to meet with doctors regarding issues on patient charges and filing procedures

* Recruited back from Candler to reorganize center’s billing and collected over $250,000 in denied payments

* Coordinated arrangements for a customer service representative training program and conducted classes

* Reduced Medicaid errors from 250 per week to 50 as a direct result of training program

* Served on Project Cleanup management team that recaptured $750,000+ in errors on third-party claims

* Involved in medical system conversions and troubleshooting computer at main office and eight satellite

locations to ensure system stayed on-line, included system rebuilding, rebooting, and terminal repair

* Started part-time while in college as an Account Receivable Clerk/financial Advisor from 1991-1995

PERSONAL

Married with three children. Member of Big Brother Big Sister and former member of SC Primary Healthcare Association, The National Association of Community Health Centers, Association of Medical Office Managers,

E-Just Science Club, The National Institute of Science. Phi Theta Kappa National Honor Society. Who’s Who among American Junior Colleges. References available upon request.



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