Simone Denniser, LPN

Bellerose, NY

954-***-****

Email: ad3j13@r.postjobfree.com

Professional Experience:

Change Health Care – Nashville, TN

HEDIS Over-reader/Quality Improvement Nurse (Remote) Jan 2023-April 2023

Over read for HEDIS measures, to include coaching and training of abstractors.

Perform, summarize and report on over-read and inter-rater reliability audit statistics in aggregate and by individual abstractor.

Ensure compliance with Medical Record Review workflow process by assuring that staff performs and applies abstraction to medical records with NCQA HEDIS specifications.

Health Care Partners – Garden City, NY

Medicaid Quality Intervention Nurse (Remote/ Hybrid) Aug 2022-Dec 2022

Gap in cares, monitor providers and policy/procedures and other sources of data for compliance with medical record standards, preventive screening guidelines, assists with coordination of the clinical review process for QARR/QSHR-HEDIS.

Strong knowledge of HEDIS and / or Medicare Stars for improving HEDIS measure performance, provider engagement, and patient experience for various markets.

Provider and member outreach by various methods.

Maintain tracking tools to log audit results including areas of non-compliance and informing what areas of improvement needed for discussion with management and / or at department team meetings.

Age Well New York – New Hyde Park, NY

HEDIS Quality Compliance Audit Nurse (Remote) Jan 2022- May 2022

Accurately and efficiently conduct medical record review for various QARR-HEDIS measures.

Assisted with collection of medical records, review, and abstractions are complete and complaint in accordance with HEDIS technical specifications and guide lines.

Assist with HEDIS audits conducted in – house and at providers’ offices; and provide feedback on documentation and medical record coding.

Emblem Health/Tandy Health – Melville, NY

HEDIS Quality Compliance Audit Nurse (Remote/Hybrid) / Utilization Manager Jan 2016 – May 2021

HEDIS Reviewer/Over-reader.

Accurately and efficiently conducted medical record review for various QARR-HEDIS measures.

Developed strategies for business performance initiatives. This includes identifying opportunities for improvements, problem prioritization, and creating performance improvements plans for non-compliant audits and / or reports.

Abstraction of data from multiple EMR Systems and site retrieval.

Identify utilization trends and potential member needs by generating reports of encounter data, pharmacy data review, and new member health assessment forms.

Communicated with the member’s primary care provider, community care manager and all other applicable providers, vendors, or agencies to facilitate health and wellness of the member in a coordinated and comprehensive manner.

AHRC of New York City, Jamaica NY Oct 2008 – Jan 2016 Quality Assurance Nurse Coordinator

Reviewed and analyzed residential consumers’ records including health care documentation, including but not limited to Medical Referrals, Medication Administration and Treatment Records, CPOPS for accuracy and completeness.

Scheduled medical appointments with various providers on behalf of consumers.

Ensured compliance per regulatory and department guidelines.

Reviewed and analyzed residential health management systems, environmental conditions, employee health compliance records, staff training, regulatory and procedural issues.

Coordinated and presented training as needed to ensure compliance in various areas.

Skills:

Ability to work collaboratively and independently. Proficient in HEDIS Measures, Medical record review, Quality management, Quality Auditing, Chart Review, QSHR, QARR, Data Abstraction, Over Reading, CARA Medicare, CRG, HHS, ICD-9 & ICD 10, Efficient in Windows 11, Exceptional customer service etiquette, various EMR systems.

Education:

McFatter Technical Center, Davie, FL LaGuardia Community College LIC, NY

License Practical Nurse (2004) A.A. Human Service Mental Health (1995)

Contact this candidate