Home Health Quality Assurance
Resume:
Maureen Buchunam, RN
ad2e3v@r.postjobfree.com
Experience:
*/**/**** – 07/29/2022 HCSC/BCBSTX
Utilization Management RN
● On-Site in Richardson Headquarter ERS/EHCM Commercial Account
● Preauth/Approvals
● On Medical Inpatient Hospitalization Admissions
● Medical Inpatient Rehabilitations/LTAC
● Medical Outpatient SNF/HHC
● Medical Outpatient procedures/Surgeries
● Medical Outpatient Consultations/Referrals
● Medical Outpatient PT/OT/SLP/SW/Chiropractor
● Medical Outpatient DME Equipment/Supplies
● Medical Outpatient Home Non-DME/PDN Approvals
● Bariatric Approvals
3/1/2016 - 8/4/2017 Cigna HealthSpring
Service Coordinator/Case Manager for Nursing Facility
● Working remotely for Cigna’s assigned Nursing Facilities and member dossier
● Completing Health assessment and coaching for Cigna HealthSpring Members
● Liaison and advocate for member’s welfare/care
6/11/2015 - 2/26/2016 MedGlobal Home Health Agency Director of Clinical Services
● Responsible for Quality Assurance/Review and Coding
● Responsible for developing/implementing of all policies/procedures,ensuring budgetary responsibility are maintained (maintaining of budgeting/accounting systems and overseeing all agency fiscal affairs), compliance with all State/Federal regulations, and day to day oversight of all clinical and clerical staff, providing ongoing staff training,education counseling,and evaluation.
● Monitoring appropriate staffing,assignment,productivity and coordination of the overall operation of the Home Health Agency to ensure quality patient care in the home.
● Responsible for the planning implementation and coordination of the Home Health Agency
● Participating in team meetings, coordinating health care services provided by ancillary personnel, initiate and conduct interdisciplinary conferences. 5/11/2015 - 6/10/2015 MedGlobal Home Health Agency Quality Review/Case Manager
● Responsible for Quality Assurance and Coding
11/2013 - 4/15/2015 AAA Home Health
Director of Nursing
● As DON, responsible for the planning, implementation and coordination of the overall operation of the Home Health Agency to ensure quality patient care in the home.
● Provided oversight for all clinical and office operations, Productivity, UR, Case Management, QI/QA, Risk, Management including incident investigations and follow up, State Federal and OSHA regulation compliance, hold in-services for all branch personnel, assist in business development.
● Other duties also include: Quality assurance Coordination, Safety Office, Compliance Officer, and Privacy Officer.
● Responsible for growing census from 45 to 75
● Responsible for Admissions, QA and Coding
1/21/2013 - 11/2013 Ebenezer Home Health
Assistant Director of Nursing
● Provided case management for clients by developing care plans, consulting with other health care providers such as physicians and social workers referring clients to other Health care resources, participating in team meetings, coordinating health care services provided by ancillary personnel, initiate and conduct interdisciplinary, conferences
● Responsible for Admissions, QA and Coding
7/12/2012 - 1/20/2013 Ebenezer Home Health
Registered Nurse Quality Assurance/Field Nurse
● Performed independent health assessments of individuals and families by evaluating their physical, mental, social, and environmental health status; and provide nursing intervention based on assessment of need.
● Responsible for making skilled nursing observations and assessments of client health care status of monitoring and documenting such things as vital signs, pulse, presence of edema, heart and lung auscultation, blood and urine laboratory values, intake and output, consciousness and orientation levels; by completing a health history/evaluation, and evaluating living arrangements.
● Intervene in emergency situations by notifying proper authorities such as police, physicians, child protection agencies and personnel in medical facilities/emergency rooms; provide information to court officials in cases of child and adult protection.
● Develop and provide health education and consultation service to community members, clients and family members on a one-to-one and group basis through home visits, responding to requests for information by phone or in person. 2011 - Present Marpe Consulting Inc, Irving TX
Consulting for Home Health Companies
● In accordance with National Women’s Entrepreneurship
● Consult for Abicare Home Health, Passion 05 Home Health Services and Advantage - A Plus Home Health care up to 2012
● Responsible for Quality Assurance and Coding
2010-2011 Ideal Home Health Services
Director of Clinical Services
● Responsible for maintaining licensure from Texas DADS, Joint Commission's accreditation, and Medicare certification.
● These responsibilities also include development/implementation of all policies/procedures, budgetary responsibility are maintained (maintaining of budgeting/accounting systems and overseeing all agency fiscal affairs), compliance with all State/Federal regulations, and day to day oversight of all clinical and clerical staff, providing ongoing staff training, counseling, disciplining, evaluating, and terminating as necessary.
● Also monitoring of appropriate staffing, productivity and coordination of the overall operation of the Home Health Agency to ensure quality patient care in the home.
● As DON, responsible for the planning implementation and coordination of the Home Health Agency to ensure quality patient care in the home. 2007 - 2010 E.S. Allstar Home Health Agency
Director of Nursing
● As DON, responsible for the planning and implementation and coordination of the Home Health Agency to ensure quality patient care in the home.
● Provided oversight for all clinical and office operations, Productivity, UR, Case Management, QI/QA, Risk Management including incident investigations and follow up, State Federal and OSHA regulation compliance, hold in-services for all branch personnel, assist in business development.
● Other duties also include: Quality Assurance Coordinator, Safety Officer, Compliance Officer, and Privacy Officer.
2005-2007 VCP Home Health Agency
Assistant Director of Nursing
● Provided case management for clients by developing care plans, consulting with other health care providers such as physicians and social workers referring clients to other Health care resources, participating in team meetings, coordinating health care services provided by ancillary personnel, initiate and conduct interdisciplinary, conferences
● Responsible for Admissions, QA and Coding
2002-2005 Dallas County Health and Human Services
Public Health Nursing and Preventative Care
● Well baby clinic and children immunization
● Foreign Vaccination Agenda
2004-2005 Kent’s Nursing Center
Weekend Supervisor Specialist
2003-2004 Vitas Hospice
Inpatient Clinical RN Supervisor
2000-2002 Irving Care Center
Acting Director of Nursing
Responsible for providing and supervising of direct patient care 1998-2000 Pioneer Rehab and Care Center
Weekend Supervisor
1997-1999 H.E.B Nursing Home
Treatment Nurse/Auxiliary Nurse
1995 - 1997 West Haven Nursing Home
Assistant Director of Nursing and Unit Coordinator 1991-1994 Baylor Medical Center
RN Medical and surgical unit
Float nurse-Telemetry unit
Lead Resource team nurse for renal oncology unit
Skills:
Home Health
Quality Utilization Management
Quality Review
Disease Management
Case Management
Public Health
Pre-Certification
Pediatrics
Care for patients with ortho-neurological deficits Wound care and treatment
Managed Care Insurance
MDS assessment, development and implementation of Nursing care plans Education:
Texas State University, San Marcos, TX
RUG Certification 2016
CCM Certification 2018
El Centro College, Dallas, TX
Associate Degree in Nursing
May 1991
Texas Compact License (#571712)
University of Nigeria Nsukka, Nsukka Enugu Campus
1980-1985
LLB (Honors) BSA
Nigerian Law School, Lagos, Nigeria
1985- 1986
LLM (Honors) BSA
Studies in British/International/American Law, May 1986
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