SUMMARY OF QUALIFICATIONS

Licensed Practical Nurse with over ten years of experience in home healthcare, chart review, / case management and long-term care. Compassionate professional committed to integrating patient’s medical and emotional care within a hospital, facility office or home environment. Excellent communication and listening skills that translates to working well with doctors, colleagues, patients and

families. Outstanding interpersonal and intervention skills. Fluent In Haitian-Creole and French.

Professional Strengths

Patient safety and quality care

ICD9/CPT Coding

Patient Advocate

Basic wound care and foot care

Identifying allergic reactions

Hedis/QARR

Maintaining accurate medical records

Billing and insurance information

PROFESSIONAL EXPERIENCE

Innovage Staffing – Remote March 2022-Present

PACE Chart Auditor -

Reviewed all Medicare Member’s chart for IDT compliance

Horizon Blue Cross /Blue Shield, Pennington, NJ February 2021-February 2022

Clinical Quality Improvement Liaison-

Primary liaison for the Quality Management department and all assigned provider groups to improve HEDIS and Stars Quality Performance.

Monitored and analyzed provider Quality Performance Reports. Identified areas of improvement, provided assistance with root cause analysis, assists with developing solutions, and develop a work plan to monitor progress.

Conducted on-site visits on a regular basis to implement the work plan and to conduct provider education sessions regarding appropriate coding practices and chart documentation.

Collaborated with Value Based Programs and Provider Contracting and Services to manage provider quality performance.

During HEDIS season, assists with the retrieval of charts, chart abstraction, and chart review entries. CQM must adhere to the HEDIS guidelines for chart review abstractions and standards.

Provided HEDIS provider guidelines that highlight appropriate HEDIS codes for claims submission.

Assisted in the development of member and provider outreach, engagement, and education materials to improve Quality Performance.

Completed other assigned functions, including special projects, as requested by management.

Blue Cross/Blue Shield, Philadelphia, PA January 2015- Jan 2021

Chart Auditing / Hedis Nurse

Conduct medical records review

Collect and analyze data retrieved from hospitals and doctors’ offices.

Abstract data from medical records.

Communicated significant findings, including potential risk management issues to the Quality Performed on on-site medical record reviews.

Help/ PSI, New York, NY February 2014-January

Case Manager Nurse

Orients and educates patients and their families; explaining the role of the patient care coordinator; initiating the care plan; providing educational information in conjunction with direct care providers related to treatments, procedures, medications and continuing care requirements.

Enhances a collaborative relationship to maximize the patient’s and family’s ability to make informed decisions.

Develops interdisciplinary care plan and other case management tools by participating in meetings; coordinating information and care requirements with other care providers.

Lead case manager in working with clients in crisis as well as managing health conditions, medication monitoring and assisting with attaining housing.

Brooklyn Hospital, Brooklyn, NY August 2001- April 2014

Scheduling Coordinator / Field Nurse

Administered insulin, performed wound care and drew blood for home bound patients.

Educated care givers and clients in all the latest equipment, procedures and technics in the controlling of diabetes.

Accurately and efficiently conducted medical record chart reviews.

Collected, entered and analyzed date.

Communicated significant finding, including potential risk management issues to the Quality Management

Communicated with management regarding development within areas of assigned responsibilities

Alpine Home Health, Bronx, N.Y. April 2012 – December 2012

Intake-Nurse

Assessment of customer needs using clinical knowledge and comprehensive understanding of VNA services via hospital visits and telephone inquiries.

Developed and researched information in order to complete the referral; used assessment skills to determine that all confirmed referrals meet defined criteria for admission to the VNA. Clarify as needed.

Accepted referrals from hospitals, doctors, nursing homes, families and other agencies.

Documented complete referral information into VNA’s clinical computer system.

Provided ongoing education for all customers regarding regulations for all insurance payers in homecare.

Researched questions and collaborated with all customers to resolve problems and facilitate initiation/process of home care.

Travelled to medical facilities in specified areas to enroll patients for home care and review charts.

Bayada Nurses Home Care, Cherry Hill, NJ June 2010 - June 2012

Field Nurse

Provided excellent and direct client care as per the rules of state law.

Documented client’s tolerance, competence, and compliance according to the prescribed therapy progress and interventions.

Conducted the early stages of nursing assessments and evaluations for qualifying the clients for appropriate safety at home.

EDUCATION

Hospital for Special Nursing School, New York, N.Y Graduated June, 1993

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