Objective

To obtain a position utilizing my extensive experience as an RN Quality/Risk/Case Management and healthcare provider and educator.

Experience

January to November 2023 Garnet Health Medical Center Middletown, NY

Quality Review Nurse

Under the guidance of Quality Department leaders, the Quality Review Nurse participates in the quality management/ performance improvement program to achieve organization priority goals and strategic objectives.

Reviews medical records for quality-of-care concerns, and reports to Quality Leadership, Medical Staff Leadership, Departmental Leadership. Hospital Leadership

Develops and facilitates improvement plans where necessary, including follow up for efficacy

Participates in Hospital-wide initiatives

Ensures all state, federal and commercial payer quality reporting- pay for performance programs comply with reporting requirements and support optimal organization reimbursement

Manages patient safety activities including entry in the event reporting system, and facilitating improvement activities

Facilitates the medical staff peer review processes

Coordinates regulatory compliance and accreditation activities (DNV)

Reports to the Director of Quality, and to the VP of Quality

2015 to February 2018

Nyack Hospital

Nyack, NY

Director Risk Management

Oversight of Third-Party Administrator (TPA) activity for professional and general liability claims management and claims of fraud and abuse.

Responsible for: hospital-wide risk management activity including investigation of real or potential liability involving the hospital, its staff and physicians; educational programs involving risk management and liability avoidance; complaint management involving patients and/or families/significant others; ethics consults including those involving staff concerns/whistleblowing, and end of life discussions with patients and families/significant others.

Education/resource person for staff and physicians.

Oversight of claims and settlement activity, including mediation of settlement activity with plaintiff and defense council.

Facilitation of claims meeting including preparation of claims reviews and discussion of strategy.

Assist with preparation for Joint Commission survey.

Responsible for Department of Health and CMS surveys, including coordination of all activities involving on-site surveys.

Responsible for answering deficiency reports and creating and developing all improvement activities.

Responsible for hospital-wide incident reporting database (Verge).

Responsible for Department of Health NYPORTS reporting, including RCAs and FMEAs.

Worked closely with Corporate Compliance Department regarding claims of fraud and abuse, whistleblower claims and claims involving sexual abuse and gender discrimination.

Co-chairperson of the Ethics Committee.

Direct report to CFO.

2007 to 2013

Hudson Valley Hospital Center

Cortlandt Manor, NY

Vice President Quality Management

Oversight of departments of Quality Management/Performance Improvement, Risk Management, Case Management, Social Services, Corporate Compliance, Infection Prevention and Control, Documentation Improvement and Employee Health.

Oversight and hands-on of all quality management, performance improvement, case management and risk management activity.

Oversight of Documentation Specialist programs, including core measures and PFP.

Educator/resource person for all hospital staff and physicians involving quality improvement, risk management and changes in laws associated with both areas.

Member of, and participant in investigations and discussions involving risk and quality issues reported to Board of Directors, Executive Committee of Medical Staff, Joint Conference Committee, Corporate Compliance Committee, Ethics Committee and Peer Review Committee of the Medical Staff.

Co-chairperson of the Peer Review Committee of the Medical Staff.

Member of the Peer Review Committee of the Nursing Department.

Responsible for Ethics consultations and End-of-Life consultations.

Responsible for Compliance activities including investigations of complaints of fraud and abuse

Responsible for investigating all NY state Justice Department complaints involving Behavioral Health patients

Direct liaison for Joint Commission, Department of Health and CMS surveys, including coordinating all survey activity and participating in all surveys.

Responsible for survey presentations and for responding to survey results.

Responsible for answering deficiency reports and creating and developing and monitoring all improvement plans.

Other responsibilities as per former director’s role.

Direct report to CEO

Supervised staff of 27

Proficient in Word, Excel, Power Point and Publisher

Proficient in EMRS such as Eclipse, Cerner, Paragon and Midas.

2001 to 2007

Director Quality Management

Oversight and management of all Quality Management activities including preparing for successful Department of Health, Joint Commission, and Center for Medicare/Medicaid Services validation surveys;

Oversight of, and direct involvement with all departments under Quality Management (Performance Improvement, Risk Management, Case Management, Social Services, Infection Control, Employee Health, Documentation Improvement, Core Measures)

Oversight and direct involvement in Corporate Compliance Department including review and investigation of claims of fraud and abuse, whistleblower claims, and claims involving sexual abuse and gender discrimination.

Managed all Risk Management activities including investigating cases, preparing investigative reports, preparing staff for deposition, and working with medical malpractice carrier and attorneys to prepare for trial

Reported to Department of Health for NYPORTS and to Joint Commission for Sentinel Events

Performed/facilitated RCAs and FMEAs

Developed and implemented Midas quality, risk and case management modules

Hospital liaison to Partnership for Patients initiative

Supervised staff of 20

Direct report to CEO

Proficient in Word, Excel, Power Point and Publisher

Proficient in EMRS such as Eclipse, Cerner, Paragon and Midas.

1998 to 2001

New York Presbyterian Hospital

New York, NY

Director Quality Management

Prepared staff across all campuses (four) for Joint Commission and New York State Department of Health surveys

Coordinated merger of quality management/performance improvement activities for New York Hospital Weill Cornell Campus and Colombia Presbyterian campus, NY Hospital Queens and Allen Pavilion

Initiated/facilitated performance improvement activities across the three campuses of NYP

Performed/facilitated RCAs and FMEAs based on incidents and events, NYPORTS and sentinel events

Investigated patient complaints and reported findings to nursing and clinical department heads/Chairmen

Performed medical record reviews for compliance with NYS 405 regulations

Initiated performance improvement activities as necessary

Supervised staff of 27

Direct report to Senior VP and Chief Quality Officer

Proficient in Word, Excel, Power Point and Publisher

Proficient in Eclipse.

1991 to 1998

New York Hospital – Cornell Medical Center

New York, NY

Quality Management Coordinator Department of Medicine

Coordinate all quality management and performance improvement activities for the Department of Medicine

Worked closely with Patient Advocacy and Risk Management departments to investigate incidents and occurrences, Department of Health and Joint Commission reportable, and prepared extensive investigative reports for same

Medical record review and data abstraction for various regulatory bodies

1990 to 1991

St. Vincent’s Medical Center – Harrison Div

Harrison, NY

Assistant Director Quality/Risk Management

Coordinated risk management investigations and reports in preparation for defense

Performed medical record reviews and prepared investigative reports of all incidents/occurrences, including RCAs, and reported to Department of Health and Office of Mental Health

Performed/facilitated performance improvement activities

1988 to 1990 FOJP Service Corporation New York, NY

Assistant Editor

Interviewed subjects and wrote risk management articles for Focus, FOJPs risk management newsletter for physicians and clinical staff with a circulation of 7500

1985 to 1988

Risk Control Coordinator

Investigated lawsuits, claims and events for Mount Sinai Medical Center, Orthopedic Institute, and Hospital for Joint Diseases

Prepared complete investigative reports for medical malpractice carrier and attorneys

Interview all involved parties and prepared detailed reports including assessments of witnesses

Presented cases at claims meetings for hospitals and attorneys

Participated in claims assessment meetings

1983 – 1985 Columbia Presbyterian Medical Center New York, NY

Staff RN – Critical Care ICU/CCU/Step-down units.

Educator/Preceptor for new nurses. Created extensive unit-based orientation to acquaint nurses new to critical care to such procedures as arterial lines, swan ganz catheters, ventilators support and the critical values associated with processes.

1970 to 1982 New York Hospital – Cornell Medical Center New York, NY

Licensed Practical Nurse – staff nurse general medical/surgical

1968 to 1970 Maimonides Medical Center Brooklyn, NY

Licensed Practical Nurse – staff nurse general medical surgical and step-down units

Education

1967 to1970

1982 to 1983

1982

(References available on request)

Kingsborough College of Brooklyn

Edna McConnell Clark School of Nursing of the Columbia University Medical Center

College of Mount Saint Vincent – BSN program

Brooklyn, NY

New York, NY

New York, NY

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