Clinical Quality Resume Sample

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Gilberto Wunsch
762 Hermann Plains,  Dallas, TX
+1 (555) 853 5779

Work Experience

Clinical Quality Program Manager
06/2016 - PRESENT
Los Angeles, CA
  • Work in a consultative role with various departments locally and at corporate headquarters in creating effective information and analyses in order to optimize the MSO’s strategic objectives
  • Ensures Clinical pharmacists are adhering to guidelines and coaches and trains staff accordingly.
  • Consistently exhibits behavior and communication skills that demonstrate HealthCare Partners’ (HCP) commitment to superior customer service, including quality, care and concern with each and every internal and external customer
  • Uses, protects, and discloses HCP patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPPA) standards
  • Uses, protects, and discloses DaVita Medical Group patients’ protected health information (PHI) only in accordance with Health Insurance Portability and Accountability Act (HIPAA) standards
  • Collaborates with and supports nursing staff, physicians, operations, risk management, information services and other members of the health care team to achieve patient outcomes by developing, implementing, and measuring effectiveness of clinical practice guidelines across the ACO’s CIN
  • Leads and organizes the SJMLH Quality and Patient Safety Committee
  • Supports EmblemHealth’ s Quality program by conducting targeted chart review with the sole purpose of enhancing quality scores during the annual Medical Record Review project as well as throughout the year for Supplemental data collection
Clinical Quality Consultant
12/2011 - 05/2016
Houston, TX
  • Read, understand, interpret, and apply regulations, guidance for documents (e.g. study protocols, Investigator Brochure, Informed Consent Forms, and other clinical trial materials)
  • Serve as a resource regarding interpretation and application of quality requirements, and industry best practices within the company
  • Assist management joint efforts in training on company procedures, GCP regulations, and documentation systems to assure compliance with company policies and regulatory standards
  • Maintain all associated, audit findings for future trend analysis
  • Assist in development and implementation of pre-approval inspection readiness plans at the company and at investigative sites
  • Other activities as necessary
  • Opportunity to work in a Regional, Non-Profit Hospital
Clinical Quality Asst-medical Assistant Required
09/2008 - 07/2011
New York, NY
  • Involves Medical Director and department management staff as needed to resolve disputes regarding audit results
  • Reports audit results to Medical Review management monthly, includes trends or patterns noted in audit or analysis of findings
  • Assure corporate compliance with SOPs and GCP regulations and guidelines
  • Lead and coordinate diverse GCP audits
  • Initiate, perform and close internal system, CRO, Vendor, laboratory, and clinical trial site audits
  • Accountable for accuracy of audit findings, report writing and follow up to closure of audit report
  • Prepare required documentation to support audit activities including; audit plans, audit reports, audit certificates and corrective action plans
  • Conduct follow-up activities to assure that non-compliance issues are addressed with satisfactory resolution


Indiana Wesleyan University - Kokomo Campus
2003 - 2007
Bachelor's Degree in Nursing

Professional Skills

  • Strong writing and presentation skills, good organizational skills, and excellent critical thinking skills
  • Excellent Microsoft (including Access database programming and Excel) and Vizio skills. Basic statistics. Strong data analysis skills
  • Strong written and verbal communication skills. Critical thinking and problem solving skills
  • Excellent communication skills, including listening, writing and relationship development
  • Strong problem solving skills with the ability to independently develop innovative solutions
  • Effective time management skills with strong planning and organizational capabilities
  • Training or 2+ years of experience in patient engagement and experience work

How to write Clinical Quality Resume

Clinical Quality role is responsible for microsoft, computer, presentation, powerpoint, excel, organizational, interpersonal, software, analytical, outlook.
To write great resume for clinical quality job, your resume must include:

  • Your contact information
  • Work experience
  • Education
  • Skill listing

Contact Information For Clinical Quality Resume

The section contact information is important in your clinical quality resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:

  • First and last name
  • Email
  • Telephone number

Work Experience in Your Clinical Quality Resume

The section work experience is an essential part of your clinical quality resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous clinical quality responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular clinical quality position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions.

Representative Clinical Quality resume experience can include:

  • Strong oral and written communication, negotiation, and presentation skills, including well-developed customer service skills
  • Demonstrated and proven experience in data analytics and project management
  • Demonstrated and proven experience in project management and data analytics
  • Experienced computer skills in Microsoft Word, Excel, Office, Outlook and PowerPoint
  • Strong organizational and time management skills; able to research, plan, develop, implement and maintain projects to meet established goals/deadlines
  • Effective oral and written communication skills, with all levels of team and stakeholders

Education on a Clinical Quality Resume

Make sure to make education a priority on your clinical quality resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your clinical quality experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.

Additional details to include:

  • School you graduated from
  • Major/ minor
  • Year of graduation
  • Location of school

These are the four additional pieces of information you should mention when listing your education on your resume.

Professional Skills in Clinical Quality Resume

When listing skills on your clinical quality resume, remember always to be honest about your level of ability. Include the Skills section after experience.

Present the most important skills in your resume, there's a list of typical clinical quality skills:

  • Demonstrated critical thinking/analytical skills as well as strong problem-solving skills required
  • Basic project management skills and the desire to become more effective helping towards project success
  • Effective leadership, facilitation, and communication (oral, written) skills
  • Solid, documented experience in successfully preparing and submitting NCQA accreditation surveys
  • Analytical abilities and problem solving skills in a fast paced environment
  • Experience in an Good Clinical Practices (GCP) auditing role within Clinical Quality Assurance in Pharmaceutical industry

List of Typical Experience For a Clinical Quality Resume


Experience For Clinical Quality Consultant Resume

  • Excellent Microsoft and Vizio skills. Basic statistics. Strong data analysis skills
  • Understanding HEDIS/Star Measures (5 years’ experience)
  • Establish and maintain effective working relationships with others throughout the organization
  • Prioritizes quality indicators depending on severity/urgency
  • Participate as a change agent to systematically drive and implement change as prioritized by senior clinical leadership and quality / patient safety committees
  • Strong desire to make continuous improvements in all areas of responsibility
  • Review results, conduct analyses (e.g., evaluate against goals/effectiveness of interventions over time), and prepare reports on findings

Experience For Clinical Quality Auditor Resume

  • Demonstrates knowledge of DRG payer issues, documentation opportunities, clinical documentation requirements, and referral policies and procedures
  • Report inconsistencies/problems with prior authorization and/or medical claims case review to appropriate parties for resolution
  • Experience managing pharmacists, physicians, and/or mid level providers
  • Strong understanding of ISO 9001 requirements
  • Experience in Quality Management initiatives, reporting and HEDIS oversight
  • Experience managing HEDIS audits
  • Experience with production management and analytical reporting
  • Experience in a medical or clinical research setting
  • Experience in a clinical research organization/sponsoring company/biotech and/or quality department

Experience For Clinical Quality Coordinator Resume

  • Experience in a clinical trial environment working with a CRO, sponsor or investigative research site environments
  • GxP Quality Assurance Auditing experience
  • Valid driver’s license and/or dependable transportation necessary (variable)
  • Fingering: Working primarily with fingers and the whole hand or arm, as in handling, typing, etc
  • Understanding of medical terminology and EMRs as well as an understanding of measuring clinical quality and outcomes
  • Understanding of Humana's IT, claims, and coding areas
  • Hearing: Ability to receive process, understand, and act upon complex materials through spoken language
  • Including electronic Quality management System

Experience For Clinical Quality Program Manager Resume

  • Working knowledge of computers and programs (e.g., Word, Excel)
  • Training in total quality management or continuous quality improvement
  • Manages the monitoring, auditing and reporting requirements related to monthly, quarterly and annual regulatory and compliance requirements
  • Assists with quality audits, preparing documentation, reports, obtaining data, and supporting onsite audit initiatives
  • Conducts ongoing quality auditing activities of nursing staff to include appropriate and consistent application of SOPs and processes
  • Lead the planning, implementation and monitoring of the NMH Quality Plan in clinical interdisciplinary areas as assigned
  • Responsible for managing the HRA process for all health plan member groups for achieving the Medicare 5 Star ratings
  • Oversight and leadership to credentialing and re-credentialing

Experience For Clinical Quality Performance Management Associate Resume

  • Manages Special Needs Plan regulatory requirements related to health risk assessments, model of care training, and nurse monitoring requirements etc
  • Develop and maintain productive enterprise relationships while delivering value and driving successful completion of all projects
  • In-depth knowledge of problem solving and technical writing
  • Work with sponsors during monitoring visits to ensure all data questions and clarifications are answered
  • Responsible for developing and preparing documentation for NCQA, URAC and other accreditation surveys submissions

Experience For Clinical Quality Spec / Patient Adv Resume

  • Become an active participant in athenahealth’s teaching and learning culture
  • Knowledge of HEDIS, NCQA, governing and regulatory agency requirements and provider value based contracting
  • Manipulating large data sets and creating queries
  • Over 3 years and up to including 5 years of delegate/internal auditing
  • Pursues ongoing continuing education of CQI practice trends and guideline management strategies
  • Oversee the quality of vended programs including disease management, wellness, and behavioral health

Experience For Manager of Clinical Quality Performance Resume

  • Assist with development activity aligned with EMS growth strategy, such as client communications, presentations, and training
  • Support EMS deployment activities aligned with EMS growth strategy, including
  • Basic working knowledge of GCP
  • Attention to detail in performing quality data management tasks
  • Manages monthly and quarterly organizational determination reporting requirements

Experience For Clinical Quality Reviewer Resume

  • Receive, research, document, and resolve quality of care issues utilizing standardized processes and centralized databases
  • Assist with case openings and initial reviews, Incident/Accident/Death report audits, and assessing member outreach for BH accuracy
  • Enter data into the computer using the currently defined data management software
  • Maintains working knowledge of AAACN Standards and regulatory requirements as they relate to clinical tele-triage operations and protocols
  • Assess training outcomes and determine effects, such as improved retention of staff
  • Review and report audit findings to Director, Clinical Quality and Training
  • In conjunction with Quality Systems Management, identify deficiencies, root causes, opportunities for improvement, and Enterprise training needs
  • Attend Site Review and training, as needed

Experience For HS Clinical Quality Spec, Senior Resume

  • Participate in call record abstraction activities, including accuracy that support audit requirements, as needed
  • Responsible for creating a call reference library
  • Plan, develop, implement, and deliver training as requested
  • Assist in the evaluation of site training programs
  • Follow regulations and internal or external protocols for communicating information or data
  • Load completed information into relevant systems according to specifications
  • Develop an understanding of the intended audience and determine the best method to communicate data or information

Experience For Clinical Quality Associate Resume

  • Communicate Quality data or information in writing or verbally
  • Performs medical record reviews for completeness and accuracy in capturing severity of illness and risk of mortality and queries
  • Leads and develops the training and education to hospital CDI staff and physician providers
  • Develops a calendar for monitoring quality indicators for all sites
  • Assists with preparation and hosting of external audits
  • Creates training for internal staff, designs activities, job aids and audit preparation
  • Contributes to the development of goals for the department and planning efforts (budgets, operational plans, etc.)
  • Influences the performance of the business unit or related functional areas in achieving Blue Shield of California’s objectives
  • Observations, including root-cause analysis and CAPA development

List of Typical Skills For a Clinical Quality Resume


Skills For Clinical Quality Consultant Resume

  • Demonstrated excellent organizational and communication skills (written and verbal), leadership, and facilitation abilities required
  • Demonstrated strong interpersonal skills and capabilities, along with the ability to work cross-functionally with other leaders required
  • Strong computer skills, particularly Microsoft Office applications (Word, Excel, Outlook)
  • Bring leadership and communication skills to interdisciplinary quality/patient safety efforts
  • Critical thinking skills previously used in a healthcare setting

Skills For Clinical Quality Auditor Resume

  • Prior experience in analytics, SQL report writing, setup and configuring systems required
  • Communicate clearly and effectively and to foster productive dialog during audits
  • Skills in computer software, including Microsoft Word, Excel, and PowerPoint
  • High level of interpersonal skills for interacting with all levels of professional within and outside the organization
  • Prior experience utilizing electronic health records systems desired
  • Basic computer skills including knowledge of Microsoft Office and the ability to learn various programs and/or systems such as the Oracle database
  • Evaluate and monitor the transfer of training knowledge and skills to the enterprise
  • Current licensed NP, LPN or RN with 3-5 years of clinical experience in critical care or med-surgical experience required

Skills For Clinical Quality Coordinator Resume

  • Experience in quality, compliance, NCQA accreditation, HEDIS, Medicare/ Medicaid experience
  • Advanced Excel skills (Pivot Tables, Macro’s)
  • Experience in implementation of a clinical quality program, PQRS, HEDIS, and GPRO submission strongly recommended
  • HEDIS experience is required, HEDIS audit support experience required
  • 5+years’ experience with demonstrated functional knowledge of process improvement, quality improvement and change management
  • Direct clinical experience; Medicare Advantage experience

Skills For Clinical Quality Program Manager Resume

  • Communicate effectively through various medium and diverse audiences
  • Intermediate or Advanced proficiency with Microsoft Access and Excel skills
  • Microsoft Office specialist with exceptional analytical and data representation expertise; intermediate Excel, Outlook, and PowerPoint skills
  • Experience and solid knowledge of managed care and Medicare regulatory requirements related to health plan quality
  • HEDIS experience specifically with proven rate improvement results
  • High level of problem solving skills necessary to determine needs and to help facilitate changes, maintaining end-user satisfaction
  • Demonstrated experience with databases and data abstraction
  • Prior experience with Blues Plans

Skills For Clinical Quality Performance Management Associate Resume

  • Evaluating the effectiveness of athena’s services for PCMH recognition and creating strategies to drive PCMH adoption and recognition
  • Performing an annual program evaluation to determine the effectiveness of the program and opportunities for improvement
  • Demonstrated success in using data and adding knowledge-based insight when making business decisions
  • Experience in leading efforts associated with reporting of quality measures to regulatory/accrediting organizations
  • Recent experience as a staff or charge nurse working in the Critical Care, Cardiac Surgery, or Cardiac Cath Lab setting

Skills For Clinical Quality Spec / Patient Adv Resume

  • Experience leading/facilitating quality improvement activities
  • Experience coaching physicians and managers and staff in team dynamics, quality improvement and managing change. Ability to collaborate in a team environment
  • Experience defining data needs and analyzing customer and clinical data
  • Experience in project management, leading projects from beginning to end
  • Experience performing data analysis and making data-driven analytical decisions
  • Experience preparing and presenting information to executive leadership
  • Experience in auditing or training of clinical and non-clinical teams

Skills For Manager of Clinical Quality Performance Resume

  • Experience in managed care setting (handling Medicare patients from a case management or utilization management perspective)
  • Project management experience leading and managing projects
  • Over 3 years and up to and including 5 years of clinical nursing experience
  • Previous experience working with quality measures, including detailed technical specifications
  • Experience planning and managing medium to large scale projects in a fast paced environment

Skills For Clinical Quality Reviewer Resume

  • Strong quantitative background and highly analytical with a genuine interest in analyzing and interpreting data
  • Experience using Microsoft Office products, including Word, Excel, Visio and PowerPoint
  • Evaluate and prioritize new quality program development, including analysis of the clinical and financial impact to clients using these programs
  • Recent experience in the acute or medical practice care setting
  • ​Demonstrated success in managing projects with cross-functional interdependencies

Skills For HS Clinical Quality Spec, Senior Resume

  • Strong computer literacy, including advanced Excel, Word, Power Point knowledge and web/internet tools
  • Apply clinical knowledge and experience to an injured party in a non-patient contact care setting
  • Clinical experience with progressive responsibilities of conducting drug regimen reviews and therapeutic interventions
  • Experience in a managed care setting with responsibility for URAC, NCQA
  • Experience working in Managed Care Industry
  • Experience conducting GCP audits, in-house systems audits, vendors and clinical investigative sites
  • Nursing experience
  • Demonstrated knowledge and competency with quality improvement, outcomes monitoring, and/or process development in the healthcare arena required

Skills For Clinical Quality Associate Resume

  • Demonstrated knowledge of team building, both as a participant of teams and in a leadership role required
  • Experience in CDI programs in regional health systems and large academic teaching centers
  • Analyze complex systems and processes, synthesize relevant theories, principles and evidence and determine solutions challenging problems
  • Experience in quality improvement including a high level of expertise of quantitative and qualitative analysis (e.g. PDSA, Six Sigma)
  • At least two years of Performance, Process and or Quality Improvement experience in a healthcare setting
  • Experience managing deliverables and expectations to successful completion

List of Typical Responsibilities For a Clinical Quality Resume


Responsibilities For Clinical Quality Consultant Resume

  • Collaborates with Data Security Lead and Legal on the implementation of the Pearson Policies and Procedures related to Data Privacy (includes collaboration with Corporate Data Security and Privacy resources)
  • Honed interpersonal skills to interface with physicians, members of the healthcare team, residents and family members
  • Project Management experience related to intervention implementation and monitoring
  • Assure quality in education by utilization of authoritative resources and evidence based practices
  • Demonstrates the ability to send compliant queries as endorsed by AHIMA and ACDIS
  • Develops and maintains effective relationships with investigative sites and other SC departments and colleagues

Responsibilities For Clinical Quality Auditor Resume

  • Run/pull/prioritize relevant data/reports (e.g., case level data, audit trends, audit samples)
  • Prioritize services for medical chart review (e.g., high volume or high cost services)
  • Becoming an active participant in athenahealth’s teaching and learning culture
  • Point of contact for inquiries and incident reporting regarding Data Privacy
  • Responsible for developing and preparing documentation for external clients’ accreditation surveys. This includes AAAHC, URAC, and NCQA accreditations
  • Review multiple documents, and track common and differing elements to aid in harmonizing efforts
  • Fosters innovative problem solving and upholds principles of continuous quality improvement.

Responsibilities For Clinical Quality Coordinator Resume

  • Detail oriented, with careful attention to work processes and focus on delivering high-quality results
  • Strategy for improving areas of low performance
  • Knowledge of medical terminology for reviewing clinical documentation and health care quality measures (e.g. HEDIS and Five stars measures)
  • Work in a fast-paced environment, flexible, and capable of handling constant change and multiple new processes
  • Pain Management training or certification
  • Knowledge of medical record coding processes and medical record terminology
  • Knowledge of data collection and analyses methodologies including statistical process control charts
  • Availability to travel up to 20% for auditing purposes and member safety oversight
  • Proficiency in database, spreadsheet, and word processing software applications essential.Microsoft Office proficiency required

Responsibilities For Clinical Quality Program Manager Resume

  • Working with Medicaid Waiver programs
  • Graduation from an accredited four-year college with a major in nursing (BSN) required
  • Successfully complete clinical quality improvement training within one year of hire or transfer date required
  • Knowledge of Centers for Medicare and Medicaid, Transforming Clinical Practice Initiative (TCPI)
  • Unrestricted Registered Nursing License
  • Current unrestricted license, certification in applicable field (i.e. CPHQ) and/or a MS in the health field (i.e. Nursing)
  • Current State of Texas RN license to practice professional nursing
  • Flexibility and adaptability; comfortable with defining structure for complex projects
  • Maintain focus on strategic objectives while understanding the business needs

Responsibilities For Clinical Quality Performance Management Associate Resume

  • Monitors Data Privacy regulatory changes and Pearson Corporate Data Privacy Updates
  • Reviews with Legal and Data Security any matter that needs to be addressed regarding Data Privacy (contract language, special requests regarding data handling, incidents or issues, internal or external inquiries and implementation items)
  • Participates in special projects, surveys and audits regarding Data Privacy
  • Computer proficiency with the ability to learn programs and educate others to functionality and purpose of the application
  • Respond to Sponsor’s written data queries in a timely manner
  • Strong time management, organizational, and prioritization skills with the ability to balance multiple priorities, track and manage requests and deliverables, and meet deadlines
  • Multi-task in a dynamic setting and work well under pressure

Responsibilities For Clinical Quality Spec / Patient Adv Resume

  • Takes ownership of issues with ability to follow through and be resourceful on all responsibilities
  • Direct supervision is received from the CSC Operations Director
  • Data extraction of patients’ medical history from paper chart/Electronic Health Record consisting of but not limited to, past medical histories, medications, allergies, social history, immunizations, and clinical indicators into appropriate data collection tool
  • Organizes and/or participates in readiness assessments in preparation for clients’ accreditation survey submissions
  • Communicate regularly with interdisciplinary team members to coordinate/update a patient’s care

Responsibilities For Manager of Clinical Quality Performance Resume

  • Works in partnership across all NIBR early development processes and other Novartis cross-functional clinical areas to ensure alignment, coordination and delivery of applicable clinical quality strategy/ goals including required changes, appropriate remediation programs, and quality/compliance activities
  • Setting the quality strategy
  • Articulating the program to implement the strategy
  • Develop, document and implement the BSC Quality Program
  • Lead the organization's HEDIS, CAHPS, and Medicare Stars’ Clinical Performance improvement to include

Responsibilities For Clinical Quality Reviewer Resume

  • Interventions to implement the strategy
  • HEDIS pursuit and data collection
  • Oversee the development, implementation and operations of data and analytics for HCQA
  • Review and approve quality related clinical guidelines
  • Lead the Potential Quality Issues (PQI) program

Responsibilities For HS Clinical Quality Spec, Senior Resume

  • Lead the efforts to host and respond to Regulatory oversight
  • Lead the accreditation efforts for National Committee for Quality Assurance (NCQA) and Utilization Review Accreditation Commission (URAC). Provide support to the organization in order to meet the standards
  • Staff the Board Quality Improvement Committee
  • Represent BSC in external quality collaborations e.g. PBGH
  • Quality Product Performance Management
  • Responds to requests in a timely manner.

Responsibilities For Clinical Quality Associate Resume

  • Resource expert for ISO 9001 standards, their interpretation, and their application to business areas
  • Works closely with the Health Plan Chief Medical Director(s) and other appropriate stakeholders implementing and monitoring the quality performance of value based provider contracts and reporting of findings at joint operations meetings
  • Working under the direction of the Quality Director, maneuvers multiple tasks independently with a fast-paced proactive vs. reactive approach to changing priorities
  • Assists in assuring regulatory compliance requiring Clinical RN oversight and review
  • Investigates all potential quality of care issues reported in coordination with the Medical Director and Peer Review Committee

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