Brittney Knox Peters MSN-PH RN CCM CMCN CMGT-BC

My goal is to provide health education and address health needs and trends within the local community.

Brookshire, TX 77423

ad0w7a@r.postjobfree.com

+1-850-***-****

Seeking a California. Texas, or Compact State RN position. More than 10 years of experience in providing compassionate health care to children and adults in a variety of environments. Skilled in critical thinking, patient interaction, and patient education. Passionate about helping others, adaptable, and maintains a strong reputation for achieving high levels of patient satisfaction. Well- developed skills in prioritizing, organization, decision making, time management, and verbal/written communication. Loyal and collaborative with a steadfast commitment to quality care and preventative care advocacy. I am seeking a position that involves identifying health problems and trends, settings interventions, and implementing plans to address them. My goal is to provide health education and address health needs and trends to improve the delivery of Quality Care Willing to relocate: Anywhere

Authorized to work in the US for any employer

Work Experience

Clinical Quality Auditor

The Judge Group:MRIOA contract: Kaiser Permanente Subcontractor - Houston, TX May 2023 to Present

• assigned to Kaiser Permanente sub contract

• process medical grievances and review charts to audit for quality

• write abstracts for summary of referral, chart review, criteria to report, quality summaries, and questions for peer reviewer

• conducts special clinical studies related to patient care management

• monitors compliance with standards of care, quality improvement requirements, adequate process and procedures

• Consult with service line leaders, chiefs of service, medical staff committee's physicians and department administrators in charge of special care areas to assist them in developing ongoing evaluation Programs to identify, resolve, and report opportunities to improve patient care

• Participates in risk management by investigating problems encountered by patients identifying patterns and trends in patient care issues, and developing policies and procedures to reduce risk

• assist in the preparation of quality of care reports sent to the regional office and developmemt of presentations on the quality improvement standards and medical center quality improvement plan to ensure compliance with regulatory agency standards. Clinical Quality RN

United Healthcare Contractor - Houston, TX

January 2023 to May 2023

Datamined, reviewed, over read and audited medical records to close gaps for HEDIS/STAR quality measures

Work in process improvement projects to meet annual goals with PDSA cycles Literature review smart goals root cause analysis

Working on deliverables for state and ncqa presentation to quality committee Developed recommendations for quality remediation plans and created tools for training and analytic materials

Lead weekly, monthly, bi monthly, and quarterly business review meetings related to STAR activities to summarize provider and group performance

Developed solution based, user friendly initiatives to support practice success Serve as a team lead for the group of clinical consultants in the market Provided analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups

Outreached to members to provide patient education & assessments, medication reconciliation post discharge, comprehensive diabetes care, and other quality campaign initiatives. Evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and precertification of inpatient and outpatient service request Responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests

Complex Case Manager & Utilization Manager

Community Health Choice Health Plan- Harris Health Systems - Katy, TX October 2020 to February 2023

• Case Manager for Maternal Health, Children Pregnant Women, and Complex CM, and Transplant process throughout life span programs

• Provide support to improve both maternal and infant health outcomes by providing comprehensive and coordinated prenatal and early postpartum support services

• Integrate behavioral healthcare within the OB outpatient setting with case management, psychosocial counseling and support, education and health promotion in an integrated care model

• Work in process improvement projects to meet annual goals with PDSA cycles

• Literature review smart goals root cause analysis

• Working on deliverables for state and ncqa presentation to quality comittee

• Ensure patients have access to the services and information needed

• Assist in screening for high risk factors, assessment, planning, arranging, and implementing of support programs.

• Perform reviews of complex service claims, pre-authorizations, appeals, referrals for potential fraud, etc.

• Authorize transplant evaluation and services for transplant recipients

• Use all med review and Interqual CMD NCQA and URAC guidlines

• Support HEDIS projects annually, taking part to audits and performing data extraction to close STAR gaps.

• Follow up on requested medical records required

• Collect member records and conduct reviews of records

• Contacting providers and placing the results collected into a specific data base

• Participate in staff meetings and project updates to maintain expert level of proficiency

• Serve as panelist, EMR focus group, and product testing for new Optum documentation system

• Train new hires and serve as a preceptor

• Determine medical necessity and appropriateness of services.

• Document justification of payments or denials.

• Coordinate services and provide guidance, direction, and input as needed for members care

• Provide health counseling and support, including care-planning, goal-setting, monitoring, follow-up, and care plan revision.

• Coordinate with clinical, health education, community health programs

• Provide referrals for services needed.

• Coordinate care, manage caseload of 200 + members witb special health care needs

• Complete telephonic CM services remotely and also alternative shifts in local Harris Health Clinic

• Make.15 to 20 calls to follow up on services and patient outcomes Registered Nurse Case Manager/ Consultant

Aetna Insurance - Houston, TX

June 2018 to October 2020

• Responsible for managing caseload of 150-200 eligible Aetna Medicare members with complex care needs

• Evaluate the medical and psychosocial needs of the member to facilitate overall wellness and effective utilization of benefits.

• Provides long-term complex case management to support member through a collaborative process of assessment,planning, facilitation, care coordination, evaluation, and advocacy

• Completes in-person assessments on 12-15 members per week to identify problems, goals, & interventions with corresponding measurable outcomes

• Assist members in actively and knowledgeably participating with community-based organizations able to support in meeting health goal

• Responsible for entering data into a HEDIS software system

• Participation in annual HEDIS Medical Record Review Abstraction

• Received HEDIS assignment and independently contacts offices, schedules appointments, arranges to get appropriate material to the offices on a timely basis

• Collects necessary medical record information through office visits or faxes and enter into the HEDIS Software

• Complete assignment within specified time frames and follows up on missing clinical

• Case Management, Utilization Review Experience

• Uses a holistic approach assess the need for a referral to clinical resources for assistance in determining functionality.

• Partners with an interdisciplinary team to deliver comprehensive, community-based case management services focused on helping the member maximize best health outcomes

• Applies clinical judgment to the incorporation of strategies designed to reduce risk factors and barriers and address complex clinical indicators which impact care planning and resolution of member issues.

• Identify, monitor, manage, and evaluate the delivery of health services to Community members with chronic, medically complex or catastrophic conditions in both acute and non-acute settings

• Coordinate the care of a member with the involvement of the member, their PCP, Specialist and other provider

• Identify the most medically appropriate therapeutic intervention to maximize the clinical outcomes associated with chronic medically complex diseases with potentially catastrophic outcomes

• Perform a telephonic assessment and create an individualized plan of care and discharge needs assessment based on member needs utilizing available benefits and resources.

• Authorize services for active members admitted to the case management program at all levels of care, including outpatient, inpatient, and transitional levels of care.

• Ensure proper data entry of authorization in the managed care platform, and initiate the approval process for requested services/treatments utilizing nationally recognized evidenced based clinical criteria and/or internal policy's, protocols, and procedures.

• Use nursing knowledge, critical thinking and background to screen and review clinical information for the most appropriate service areas within Community; making referrals to community health workers, high risk perinatal and disease management teams as well as external resources

• Work closely with the medical directors and refer requests that do not meet medical necessity criteria.

• Initiate request for single case agreements and or letters of agreement for members requiring out of network providers.

• Responsible for meeting required performance and quality metrics and ensure reviews are completed within established regulatory, and state requirements. Advanced Public Health Nurse Consultant

University of the Incarnate Word - San Antonio, TX August 2020 to September 2020

Developed scripting for NEPTUNE CARES Telehealth Grant for Level II Undergraduate Nursing Students Served as a subject matter expert in telehealth experience Designed lesson plans, for COVID-19 and At Risk BMI outreach, focusing on seniors, vulnerable groups, mental health needs, and family dynamics.

Consulted with AHEC for development of CEU program for RNs in rural and underserved areas of South Texas

Assisted in running BTS immunization clinic, Texas Healthy womens exams, and grants for programs in lower end end for public health needs of community Registered Nurse Case Manager/Nursing Supervisor

Ageless Living Home Health

December 2017 to June 2018

• Assume responsibility for maintaining compliance according to federal state regulations

• Conduct OASIS preparation, start of care, recertification, resumption of cate, transfer and discharge for all Patients pediatric and geriatric

• Complete assessment and plan of care for private duty nursing patients and send to Medicaid Children’s Service Program and Medically Dependent Children’s Program for medical review

• Direct and supervise all RN’s and LVN’s per federal state law regulation and agency policy

• Served as alternate clinical supervisor of home health agency for overall clinical operation hiring, training/developing, and directing staff in the provision of the agency service

• Reviewed operation statistics, activity reports, performance data, chart audits for clinical compliance with agency policy and procedure, state regulations, and physician’s orders.

• Functioned as a comprehensive care coordinator for patients assigned, communicates amongst other clinicians providing care.

• Mentored employees, conducted performance evaluations, counsel and provide disciplinary actions to assigned personnel, and works to facilitate individual and team development that drives positive results

• Directed day-to-day office, field staff, and clinical operation. Provided staff education and in-services for skill development and competence related to all agency policy and procedures Senior Clinical Quality RN

Wellmed United Health Care Insurance

June 2017 to December 2017

• Datamined, reviewed, and audited medical records to close gaps for HEDIS/STAR quality measures

• Developed recommendations for quality remediation plans and created tools for training and analytic materials

• Lead weekly, monthly, bi monthly, and quarterly business review meetings related to STAR activities to summarize provider and group performance

• Developed solution based, user friendly initiatives to support practice success

• Serve as a team lead for the group of clinical consultants in the market

• Provided analytical interpretation of Stars and HEDIS reporting, including executive summaries to plan and provider groups

• Outreached to members to provide patient education & assessments, medication reconciliation post discharge, comprehensive diabetes care, and other quality campaign initiatives.

• Evaluate the necessity, appropriateness, and efficiency of the use of medical services, procedures, and precertification of inpatient and outpatient service request

• Responsible for the collection, reporting, clarification and entry of bed day data and pre and post-acute certification requests

Registered Nurse and Licensed Vocational Nurse

Epic Home Health Services - San Antonio, TX

February 2014 to September 2017

• Provided skilled nursing care to pediatric and adult patients in a home setting

• Maintained ventilator and tracheostomy for respiratory dependent clients

• Administered enteral medication and nutrition

• Assessed home health patients to identify the physical, psycho-social, and environmental needs

• Developed, implemented, and evaluated the plan of care to ensure quality and continuity of care for patients

• Provided health education to patient and or caregiver

• Provided effective communication to patient/family, team members, and other health care professionals

• Provides care as ordered by the physician as outlined in the client's care plan and/or plan of care. Provides training, assistance, and demonstration to clients in learning appropriate self-care techniques.

• Promote an environment of quality and safe client care through participation, development, and adherence to the QA plan and associated activities and metrics Contract Clinical Research Nurse Coordinator

ICON plc - San Antonio, TX

August 2014 to July 2015

• Perform technical and clinical requirements of study protocols, i.e., venipuncture, specimen processing, vital signs, electrocardiograms, IV infusions, IV pump operations, Holtor monitoring, pulmonary function testing, allergy testing, urine/serum pregnancy testing, strep throat screening, injections (IM or SQ) or any procedure necessary for the protocol as ordered by the investigator.

• Attend investigator meetings, site initiation visits, and coordinator meetings to obtain training on drug preparation and administration and general knowledge about a protocol with a focus on clinical procedures.

• Obtaining knowledge about the study drugs with an emphasis on injection or intravenous infusion medications.

• Dose subjects and monitor for possible complications with the administration of study drugs with an emphasis on injections or intravenous infusions.

• Maintain accurate dispensing logs, separate from those of the coordinator, to include such information as lot number, drug vs. placebo, and information about the third party mixer or un-blinded mixer/preparer of medication.

• Document laboratory data and adverse reactions, and immediately notifying investigators, sponsors and the Institutional Review Board, if indicated, of any unexpected or serious events.

• Assist other staff members as determined by the needs and priorities of the research organization and as time and abilities permit.

Licensed Vocational Nurse

US Army Brooke Army Medical Center- Cardiac Intermediate Care Unit - San Antonio, TX May 2013 to June 2014

• Maintained sound, ethical and independent decision-making ability consistent with medical protocols.

• Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments

• Assessed, monitored and documented patient progress following surgical procedures or recovering from serious illnesses and injuries

• Assisted Registered Nurse with treatments, therapies and interventions to improve patient outcomes

• Administered medication and completed post pain and focused assessments as needed

• Monitored telemetry patients for dysthymias and reported to supervising Registered Nurse Licensed Vocational Nurse

US Army Meps Command Center - Houston, TX

May 2012 to April 2013

• Conducted patient interviews to obtain medical information

• Organized, updated and reviewed over 200 patient records daily

• Performed Quality Control and Quality Assurance review for all submitted documentation

• Chaperoned physical examinations on over 200 military recruits daily.

• Performed Orthopedic Neurological assessments for body mechanics neurological stability

• Completed audiometry and optometry screenings on enlistees

• Implemented drug, alcohol, and HCG screenings on recruits prior to transport for basic training Licensed Vocational Nurse

William Beaumont Army Medical Center- Cardiac Intermediate Care Unit - El Paso, TX January 2011 to April 2012

• Assisted patients with healing and recovery after surgery

• Provided direct and indirect nursing care of all patients ranging in age from 18 years to geriatric experiencing medically complex conditions, general medical-surgical conditions, with rehabilitation and/ or wound care needs.

• Provided necessary health education for patients and their families

• Implemented total patient care through a team nursing process for 4-6 high acuity patients

• Administered prescribed oral and intravenous, and documented interventions in medical record

• Collected specimens and transported them to the laboratory

• Monitored the changing needs of patients in timely manner and respond accordingly

• Promoted teamwork with physicians and personnel of other departments Emergency Medical Technician

US Army Fort Riley - IQ

January 2008 to January 2011

• Patient assessment, triage, phlebotomy, immunizations, anthropometrics

• Researched international health threats and conducted medical threat briefings for deploying personnel

• Solely supported deployed military personnel as primary health technician in two wartime (high stress) deployments without direct Medical Doctor supervision;

• Served during the Army's transition from written medical records to electronic medical records; introduction to large scale project implementation, management, and observation

• Served as squad leader for evacuation squad with four vehicles and eight soldiers

• Conducted over 200 evacuation missions with more than 400 casualties

• Instructed U.S., coalition, Iraqi forces in, combat first-aid, and Combat Medic Advanced Skills.

• Maintained, procured and projected need of medical supply and capability for evacuation unit of eighty soldiers

• Appointed Assistant Non-Commissioned Officer in Charge of field medical operations and evacuation

• Worked in the Tactical Operations Center in Tikrit, Iraq assisting in the oversight of unit operations at 8 sites

Education

Post Masters Certificate in Health Care Quality and Patient Safety Graduate Certificate of Completion

Grand Canyon University - Phoenix, AZ

June 2022 to November 2023

Master of Science in Nursing with and Emphasis in Public Health in Nursing Grand Canyon University - Phoenix, AZ

April 2020

Bachelor of Science in Nursing

University of the Incarnate Word - San Antonio, TX 2017

Associate of Applied Science in Applied Science

Barton County College - Fort Riley, KS

2013

License in Nursing

Academy of Health Care Science - San Antonio, TX

2011

Nursing Licenses

RN

State: TX

PN

State: TX

RN

Expires: December 2024

State: CA

Skills

• Word Processing Software (Word, WordPerfect, etc)

• Typing Speed 55 Words Per MinuteGoogle Drive, Docs, Sheets, and Slides.

• Microsoft Outlook, Access. One Note

• Presentation Software (PowerPoint

• Flash

• etc)

• Spreadsheet Software (Calc

• Excel

• etc

• Case Management

• Utilization Review

• Home Health

• Hospital Experience

• RN

• Staff Nurse

• HEDIS

• Utilization Management

• Hospice Care

• Managed Care

• Primary Care Experience

• Triage

• EMR Systems

• Experience Administering Injections

• Medication Administration

• Critical Care Experience

• Quality Assurance

• QA/QC

• Employee Orientation

• Program Management

• NCQA standards

• Medical records

• Epic

Military Service

Branch: United States Army

Rank: SGT

Awards

Educational & Military Awards

Military Awards

Army Commendation Medal (2 time award recipient) Army Achievement Medal (6 time award recipient) National Defense Service Medal Iraqi Campaign Medal Global War on Terrorism Service Medal Army Service Ribbon Army Overseas Service Ribbon Good Conduct Medal (2 time award recipient)

Educational Awards

University of the Incarnate Word Nursing Peer Award for Clinical Excellence 2015 and 2016 Academy of Healthcare Science Nursing Peer Tutor Award 2011 Academy of Healthcare Science Distinguished Honor Graduate 2011 Certifications and Licenses

RN-BC ANCC Certified Case Manager

Present

CCM Certification for Case Manager

Present

BLS Certification

LVN

Secret Clearance

EMT Certification

CPR Certification

LPN

CMCN

May 2020 to Present

Certified Managed Care Nurse

Groups

Affiliations

Affiliations

The National Society of Leadership and Success

Sigma Theta Tau International Honor Society of Nursing Kappa Gamma Pi Honor Society

Florence Nightingale Society

Veterans of Foreign Wars

Oncology Nursing Society

Community Service

Catholic Charities - Volunteer Bexar County Court Monitor 2017 Haven for Hope- Volunteer Screener for HTN, Acanthosis, and Diabetes 2016

Witte Museum and Freeman Coliseum Health Fare- Vision and Hearing Screenings 2016 Converse Public Library- Volunteer Librarian 2015

New Life Fellowship- Life Changer 2015

Vitas Hospice- Respite Care 2014

City of Houston- Free Summer Lunch Program 2014

Soldiers Angels- Care Package Supplier 2014

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