RN Consultant Resume Samples

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B Runolfsdottir

Broderick

Runolfsdottir

544 Mayer Crossroad

Boston

+1 (555) 109 4031

544 Mayer Crossroad

Boston

Phone

p +1 (555) 109 4031

Experience Experience

Houston, TX

Clinical Program RN Consultant

Houston, TX

O'Hara-Beatty

Houston, TX

Clinical Program RN Consultant

Provide clinical updates to site management about complex cases we are providing care management for during regular site meetings
Be a resource of information to the network of CMs for all the products members are involved in: benefits, providers, responsibilities of plan
Be the subject matter expert for the network of care managers about programs and processes
Serve as a mentor and leader for contracted care management network
Serve as the key resource on complex member issues to contracted network
Solve complex problems and develop innovative solutions
Provide explanations and information to others on the most complex issues

Phoenix, AZ

Hedis Clinical Practice Consultant, RN

Phoenix, AZ

Jakubowski, Johns and Welch

Phoenix, AZ

Hedis Clinical Practice Consultant, RN

Supports effective deployment of program at the practice level through strategic partnerships with participating practitioners and practice staff while assessing trends in quality measures and identifying opportunities for quality improvement
Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state and national departments on key health related issues
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education and disparity programs as assigned
Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care
Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
Educates providers and office staff on proper clinical documentation, coding and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria, to drive quality improvement

present

San Francisco, CA

RN / LVN Regional Systems Consultant

San Francisco, CA

Franecki, Homenick and Rath

present

San Francisco, CA

RN / LVN Regional Systems Consultant

present

Present analysis and interpretation for operational and business review and planning
Conducts training sessions and serves as an IT subject matter resource for medical directors, providers, clinical staff, and support staff
Attends educational offerings to keep abreast of change and assists in the growth and development of associates by sharing knowledge with others
Systems set up and basic troubleshooting of technical components
Performs all other related duties as assigned
Manages projects as assigned with attention to detail, expected outcomes, and timelines
Acts as a consultative resource for physicians, staff and clinic leadership for projects and facilitation of change

Education Education

Undergraduate Degree in Nursing

University of California, San Diego

Undergraduate Degree in Nursing

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13 RN Consultant resume templates

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Hedis Clinical Practice Consultant Rn-houston Resume Examples & Samples

Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards, and where assigned investigation of quality of care and member complaints relative to quality of care and service. Support continuum of member care by identifying members in need of health education, case management, etc
Performs annual medical record evaluation, follow-up education, practitioner intervention, measurement (QI 13) as required
5+ years clinical experience in any setting (acute care is preferred)

Clinical Practice Consultant Supervisor, RN Resume Examples & Samples

Directly supervises the Clinical Practice Consultants to ensure the program goals are met
Acts as a liaison to the Clinical Practice Consultants, health plan and providers as necessary
Coordinate and monitor implementation of quality improvement initiatives that are undertaken as corrective action for HEDIS results, clinical studies, or other quality measures
Coordinates and trouble shoots for issues pertaining to the member and/or provider incentive programs
Provides direct supervision to evaluate, track, and coordinate corrective action plans relating to improvement of coordination of care, plan-wide provided by the QM nurses
Participate in or coordinate other department projects as needed
If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by the QM Manager
Perform/participate in assessments of the audit or review (e.g., interrater reliability of audit findings across auditors)
Perform duties as assigned
Current, unrestricted RN license for the state of residence
2+ years of managerial/supervisory experience
3+ years of HEDIS experience
Computer proficiency, including Microsoft Word, Excel, Outlook
Experience with NCQA

Hedis RN Consultant Resume Examples & Samples

Lead Weekly, Monthly, Bi-monthly, Quarterly and / or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership
Analyze and evaluate provider group structure and characteristics, provider group / provider office operations and personnel to identify the most effective approaches and strategies
Focus communications and efforts accordingly
Develop solution-based, user friendly initiatives to support practice success
Strong financial analytical background within Medicare Advantage plans (Risk Adjustment/STARS Calculation models)
Ability to solve process problems crossing multiple functional areas and business units
Undergraduate degree; post-graduate degree highly preferred

RN Consultant Resume Examples & Samples

Maintains current working knowledge of ICD-9 and ICD-10 coding principles, government regulation, protocols
3+ years Acute Inpatient Hospital Coding experience
Registered Nurse or LPN
Customer-service focused and exhibit professionalism, flexibility, dependability, desire to learn, commitment to excellence and commitment to profession
Excellent writing, editing, interpersonal, planning, teamwork, and communications skills
RHIA or RHIT or CCS credentials

Hedis Clinical Practice Consultant Rn-corpus Christi Resume Examples & Samples

Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria. Solicit identification of barriers the office faces in providing care to members
Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education, and disparity programs, as assigned
Current unrestricted RN licensure required in Texas

Regional UM Consultant, RN Resume Examples & Samples

Oversees adherence to quality of care and utilization standards by reviewing documentation and analysis of utilization data
Develops standards of care and quality improvement activities based on regulatory standards
Collaborates with program re-design to meet targeted utilization outcomes
Provides clinical and regulatory expertise for contractual reviews and for regional regulatory surveys
Serves as a contract liaison for regional issues pertaining to contracts and vendor, outside medical and transportation
Provides education and training to UM Directors, Physicians and Case Managers to ensure smooth operations in UM and CM
Sets the strategic direction of projects
Develops proposals for clients outlining proposed project structure, approach and work plan
Master's degree strongly preferred
Two (2) years Quality and Health Plan UM experience preferred
Good communication and writing skills

Quality RN Practice Consultant Resume Examples & Samples

Requires an AS/BS in nursing and current, unrestricted Indiana RN license required
3+ years of managed care experience or clinical experience
2 years of professional presentations to small and large audiences
Local travel up to 75% of the time within assigned territory (options include rental car, company car, mileage reimbursement)
Candidates with Quality, HEDIS, NCQA, teaching experience would be an asset

Hedis Clinical Practice Consultant, RN Resume Examples & Samples

Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS / State Specific quality measures for provider and staff education during field visits. Materials additionally include information from local, state and national departments on key health related issues
Serves as subject matter expert (SME) for assigned HEDIS / State Measures, preventive health topics, leads efforts with clinical team to research and design educational materials for use in practitioner offices; serves as liaison with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
Participates, coordinates, and / or represents the Health Plan at community based organization events, clinic days, health department meetings and other outreach events focused on quality improvement, member health education and disparity programs as assigned
Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified and monitors resolution to conclusion
Educates providers and office staff on proper clinical documentation, coding and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria, to drive quality improvement
Current unrestricted RN / LPN licensure required in state of MA or Foreign Medical School Graduate
2+ years of HEDIS or quality improvement experience
Health care and insurance industry experience
Knowledge of one or more of: clinical standards of care, preventive health standards, NCQA, governing and regulatory agency requirements and the managed care industry

Consultant for Clinical Audits RN Resume Examples & Samples

Utilizes encoders and various coding resources
Maintains strict patient and physician confidentiality and follows all federal, state and hospital guidelines for release of information
Ability to travel 10% or less of the work year for training, team meetings, possible onsite audits opportunities and implementation needs
Inpatient auditing experience
Demonstrated ability to lead process/project initiatives/ MS office proficiency
Demonstrated ability to exercise solid judgment and discretion in handling and disseminating information
Ability to work independently and manage work load
Associate's Degree in relevant field preferred
Proficient 3M Coding and Reimbursement Systems
Nurse Coder Background
ICD-10 Trainer certification from AHIMA a plus
Preferred coding skills: prospective payment methodologies, auditing experience

Hedis Clinical Practice Consultant, RN Resume Examples & Samples

Investigates gaps in clinical documentation where system variation has impact on rate calculation, provides feedback to appropriate team members where issues are verified, and monitors resolution to conclusion
Educates providers and office staff on proper clinical documentation, coding, and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
Works with providers on standards of care and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with state specific measures and technical specifications
Current, unrestricted RN or LPN license in the state of New Jersey
1+ years of HEDIS data collection experience
Managed Medicaid and / or Medicare experience
Managed care industry

Hedis Clinical Practice Consultant, RN Resume Examples & Samples

Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS/State Specific quality measures for provider and staff education during field visits
Materials additionally include information from local, state, and national departments of health on key health related issues (understanding, exploring, educating and facilitating on a local level)
Proficient in Microsoft Excel required

Quality RN Practice Consultant Resume Examples & Samples

HEDIS or NCQA accreditation experience is required
Practice administration experience preferred
Experience with persuading others is preferred

Clinical Quality Consultant RN Resume Examples & Samples

Lead Weekly, Monthly, Bi-monthly, Quarterly and/or Annual business Review meetings related to STAR activities which summarize provider group performance and market performance as requested by or required by Quality or Regional leadership
3+ years associated business experience with health care industry
Microsoft Office specialist with exceptional attention to detail
Strong communication and presentation skills
Undergraduate degree, post graduate degree highly preferred

Regional UM Consultant, Rn-pd Resume Examples & Samples

Serves as a resource to senior management as UM and CM experts
Develops regional programs based on regulatory requirements
Provides oversight to design, develop, implement and monitor UM and Case Management programs to meet regional utilization goals while maintaining customer satisfaction
Acts as a resource to Directors, Assistant Administrators, Ambulatory Medical Staff, SCPMG and external regulatory agencies for all issues relating to UM
Analyzes and reports significant utilization trends, patterns and impact to appropriate departments
Makes significant contributions and or provides clinical and technical leadership to high visibility projects to identify and resolve issues of strategic importance to the organization
Interfaces regularly with senior management to produce timely and valuable results
Determines goals and priorities with management team sponsor
Establishes team membership and negotiates time commitments and resources
Provides staff leadership to project teams, as well as manages work of outside consultants when needed
Designs research plans for data gathering and analysis; participates significantly in interpreting analysis and developing action plans accordingly
Produces or oversees development of written materials for senior executives and other key clients
Compliance and Integrity: Models and reinforces ethical behavior in self and others in accordance to the Principles of Responsibility; adheres to organizational policies and guidelines; supports compliance initiatives; maintains confidences; admits mistakes; conducts business with honesty; shows consistency in words and actions; follows through on commitments
Minimum five (5) years of experience in a clinical setting

Clinical Consultant RN Utilization Resume Examples & Samples

Minimum five years of managed care experience in medical management and/or utilization management
Experience working in a multi-business unit environment
System implementation/support experience preferred
Consulting/large scope project leadership experience preferred

RN Hedis Clinical Quality Consultant Resume Examples & Samples

Assist in developing of training and analytical materials for Stars and HEDIS
1 years of HEDIS / Stars experience
Undergraduate degree preferred, post graduate degree

Clinical Program RN Consultant Resume Examples & Samples

Serve as a mentor and leader for contracted care management network
Be a resource of information to the network of CMs for all the products members are involved in: benefits, providers, responsibilities of plan
Serve as the internal link to UHG programs, accessing systems and services for members that external CM cannot access
Be the subject matter expert for the network of care managers about programs and processes
Provide quality assurance role in monitoring the work of the care managers: that they are delivering services according to the project protocol and provide corrective action as needed to bring the work in line
Serve as the key resource on complex member issues to contracted network
Act as an advocate for enrollees and field care advocates
Provide clinical updates to site management about complex cases we are providing care management for during regular site meetings
Focus on strategies to monitor members post hospital and to develop strategies to reduce acute admissions
Teaching our contracted partners about programs and processes
Anticipate customer needs and proactively develops solutions to meet them
Current and unrestricted RN license in the state of Minnesota
Extensive community Care Management experience - preferred 2 - 3 years
Minimum 2 years of demonstrated leadership background
Computer proficiency (Microsoft Word, Outlook, and Internet)
Exhibits strong organizational and supervisory skills
Working knowledge of Medicare, Medicaid and Special Needs Programs
Enjoy new projects and program development
Training / teaching experience in a clinical setting

RN / LVN Regional Systems Consultant Resume Examples & Samples

Supports and trains the implementation of e - Clinical Works EMR and PPMS
Engages with physicians, clinical staff and clinic leadership to enable workflow adoption, reporting and achievement of successful EMR / PPMS implementation
Acts as a consultative resource for physicians, staff and clinic leadership for projects and facilitation of change
Monitors compliance of EMR utilization, Meaningful Use, and Patient Centered Medical Home for each clinic and takes corrective actions as needed and as appropriate
Systems set up and basic troubleshooting of technical components
Coordinates and collaborates with Performance Improvement Department, Training Department, Clinic Leadership Team and other groups charged with EMR and Meaningful Use operational design
Manages projects as assigned with attention to detail, expected outcomes, and timelines
Attends educational offerings to keep abreast of change and assists in the growth and development of associates by sharing knowledge with others
Monitors compliance with new initiatives for continual process improvement
Collaborates with the Managers of Clinical Care Operations and Providers to evaluate the success of process improvement efforts and communicates findings to leadership
Drives change and EMR adoption success throughout clinics in the region
Fosters open communication with administrators and physician business partners by acting as a liaison and resource in the implementation of strategic changes to corporate policies and projects to ensure smooth transition of operations
Participates in departmental meetings and interdisciplinary team meetings as required
Undergraduate degree in related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor-s degree)
Current Registered or Vocational Nurse License in applicable state
Four years of healthcare experience to include experience in a managed care setting, or physician practice setting
Actively used or supported an electronic medical record application in a clinical setting
Must have prior training experience
Must possess strong leadership skills
Must be able to work autonomously with enthusiasm and vigor
Must possess strong critical thinking and strategic insight, written and verbal interpersonal communication skills with ability to interact with professional and non-professional staff regarding operational issues
Bachelors degree in Business, Finance, Health Administration, related field or equivalent work experience
3+ year of experience in business / finance analysis
Ability to problem solve including multiple priorities and research conflicting and / or inaccurate data Working knowledge of relational databases, database structures

Quality & Utilization Consultant, RN Resume Examples & Samples

Serves as a consultant in all areas of quality assessment, improvement, demonstration, and utilization management to regional staff and medical center physicians and staff
Leads and develops work teams or participates as a member of a quality/utilization work team
Projects will range from developing internal quality programs to responding to internal or external regulatory requirements
Regulatory requirements may include a review by a state or national organization
Selects and uses appropriate data and information from DOQU as it applies to each individual project
Oversees the following components of studies: definition of population, sample selection, data collection, chart review, data analysis, and statistical adjustment
Prepares Kaiser as a whole for specific regulatory reviews or audits
This also applies to special projects requiring collaboration with the other entities
Insures that the study plans have identified and adequately addressed the potential pitfalls that may be caused by data problems
Educates physicians and staff regarding regional projects or regulatory reviews, i.e., the interpretation of regulatory requirements and the methods of compliance when preparing for a review or the interpretation of project goals
Reviews the work of quality and utilization analysts for purposes of quality control
Minimum three (3) years of experience in quality/utilization management and/or accreditation
Minimum one (1) year of experience providing consultative services, analytical studies and project management experience which may be included in the aforementioned experiential requirement
Current California RN License preferred
Experience for Quality/Utilization Management may include working with the Quality/Utilization department in your area, leading your team in Quality/Utilization Management, or direct experience in the Quality/Ulitization department

Hedis Clinical Practice Consultant RN-& Surrounding Areas Resume Examples & Samples

Coordinates and performs onsite medical record reviews at provider offices to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards and where assigned investigation of quality of care and member complaints relative to quality of care and service
Support continuum of member care by identifying members in need of health education, case management, etc
Educates providers and office staff on proper coding and billing practices, HEDIS and state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
Supports quality improvement program studies requesting records from providers, maintaining databases and researching to identify members' provider encounter history
Participates in and represents plan at community, health department, collaborative and other organizational meetings focusing on quality improvement, member education and disparity programs, as assigned
Enter documentation of findings in identified database
Bachelors degree in Science or equivalent work experience
2+ years of quality improvement experience (chart review, compliance, HEDIS, investigation, etc.)

Clinical Quality Hedis Consultant RN Resume Examples & Samples

Strong financial analytical background within Medicare Advantage plans (Risk Adjustment / STARS Calculation models)
Strong knowledge of the Medicare market, products and competitors
Strong problem-solving skills; the ability to analyze problems, draw relevant conclusions and devise and implement an appropriate plan of action
Medical / clinical background
Undergraduate degree; post-graduate degree

RN / LVN Regional Systems Consultant Resume Examples & Samples

Supports and trains the implementation of e-Clinical Works EMR and PPMS, Meaningful Use, Patient Centered Medical Home and other operational business strategies
Engages with physicians, clinical staff and clinic leadership to enable workflow adoption, reporting and achievement of successful EMR/PPMS, Meaningful Use, and Patient Centered Medical Home implementation
Leads or assists in the development of IT communication and business training materials, processes, and procedures related to reporting packages and reporting systems
Conducts training sessions and serves as an IT subject matter resource for medical directors, providers, clinical staff, and support staff
Uses strong critical thinking skills along with managed care, or physician office business knowledge to have insight and understanding of business concepts, tools and processes that are needed for making sound decisions in the contact of the company’s business
Undergraduate degree in related field (4 additional years of comparable work experience beyond the required years of experience may be substituted in lieu of a Bachelor’s degree)
Four years of healthcare experience to include experience in a managed care setting, or physician practice setting required
HEDIS/STAR experience
Informatics or data analytics experience
Experience with major systems implementation experience

Practice Performance Consultant Rn-telecommute From TN Resume Examples & Samples

Functioning independently, connect with providers to discuss Optum tools and programs focused on improving the quality of care for Medicare Advantage Members
Establish positive, long - term, consultative relationships with physicians, medical groups, IPAs and ACOs
Training will include Stars measures (HEDIS / CAHPS / HOS / med adherence), and Optum program administration, use of plan tools, reports and systems
Facilitate / lead monthly or quarterly meetings, as required by plan leader, including report and material preparation
1+ year experience working with HEDIS measures
Microsoft Office specialist with exceptional analytical and data representation expertise; Advanced Excel, Outlook, and PowerPoint skills
Bachelor’s Degree or higher level of education
Knowledge of Medicare guidelines
Medicare Star Rating experience (clinical standards of care, preventive health, and Stars measures)
Experience in managed care working with network and provider relations / contracting
Knowledge of electronic medical record systems