Clinical Quality RN Resume Sample

11 votes

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Haylee Leffler
715 Fausto Square,  San Francisco, CA
+1 (555) 767 8224

Work Experience

Senior Clinical Quality Rn-hedis Rn-dade County
02/2018 - PRESENT
Philadelphia, PA
  • Applies advanced knowledge to conduct multispecialty subjective assessments to evaluate the skills of nurses and other allied health professionals
  • Collate all data available to illustrate a full picture of an individual staff members performance (Work Force Management data, phone metrics, other)
  • Assist the Clinical Management team, as needed, to determine areas that require immediate remediation and assist Optum’s employees to stay ahead of changing information while improving the quality and effectiveness of clinicians and consumer engagement
  • Work with colleagues across business units to ensure that process and procedural changes are reflected in staff member’s documentation such as job aids and policies
  • Self-motivated, flexible person who can flourish in an office setting with colleagues as well as in a self-structured independent setting
  • Accept constructive feedback for continual improvement
  • Add to a team atmosphere where a team approach is highlighted and valued
  • Thrives in a process based transactional work environment
  • Visit providers’ offices to educate them on clinical measures
Clinical Quality RN
05/2015 - 12/2017
Phoenix, AZ
  • Supports continuum of member care by identifying members in need of health education and / or services (case management, etc.) and refers members to the appropriate internal departments per policy
  • 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
  • Serves as subject matter expert (SME) for assigned STARS 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 STARS Measures; consults with vendors to design and implement initiatives to innovate and then improve STAR Measure rates
  • Generate reports / findings of reviews for the Clinical Management Teams: in a clear, concise manner that is understandable and actionable
  • Designs practice level quality transformation through targeted clinical education and approved materials related to HEDIS/STARS 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)
  • Works with providers on standards of care, and advises providers on established clinical practice guidelines, and appropriate documentation and billing consistent with STARS measures and technical specifications
  • Collaborate with appropriate department to document, investigate and resolve formal or informal member complaints and appeals in accordance with plan and state policies and procedures and requirements
Clinical Quality Rn-telecommute
12/2007 - 12/2014
Boston, MA
  • Review and analyze reports, records, and medical documents/charts
  • Prepare reports and records on work function activities and projects
  • Coordinate quality management and HEDIS related programs and activities as required
  • Supports quality improvement programs requesting records from providers, maintaining databases, and researching to identify members' provider encounter history
  • Performs, provider and/or member outreach as required
  • 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
  • Coordinates and performs offsite clinical evaluations through medical record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards


Everest University - Clearwater Campus
2001 - 2006
Master's Degree in Healthcare

Professional Skills

  • In a Clinical Contact Center environment required with proven customer service skills and experience
  • Prior experience demonstrating the ability to work with minimal supervision, prioritize and organize work, and analyze data
  • Excellent interpersonal and communication skills, both oral and written are necessary
  • Strong organizational skills, self-motivated and ability to interact with company staff at all levels
  • Strong communication skills and presentation abilities
  • Experience of quality improvement experience
  • Experience developing and delivering training to front line clinic staff

How to write Clinical Quality RN Resume

Clinical Quality RN role is responsible for health, clinical, software, events, travel, insurance, research, design, reporting, database.
To write great resume for clinical quality rn job, your resume must include:

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

Contact Information For Clinical Quality RN Resume

The section contact information is important in your clinical quality rn 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 RN Resume

The section work experience is an essential part of your clinical quality rn 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 rn 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 rn position you're applying to. The work experience section should be the detailed summary of your latest 3 or 4 positions. Representative Clinical Quality RN resume experience can include:

  • Demonstrated current knowledge of program development and adult learning theory
  • Experience in Managed Health Care / Insurance environment
  • Quality improvement experience
  • Experience with maternal health
  • Experience with Medicaid and/or Medicare
  • Clinical quality experience

Education on a Clinical Quality RN Resume

Make sure to make education a priority on your clinical quality rn 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 rn 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 RN Resume

When listing skills on your clinical quality rn 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 rn skills:

  • Effectively compile and analyze complex data and reporting metrics to drive program strategy at both population and individual level
  • Demonstrated ability to research and develop evidence-based clinical guidelines and protocols
  • Experience working in Medicaid and/or Medicare health care and insurance industry, including regulatory and compliance requirements
  • Experience working with providers’ offices
  • Previous experience educating Physicians, RNs or other clinical and / or non-clinical employees
  • Skilled in use of computers including MS Windows, Excel, Word and PowerPoint

List of Typical Skills For a Clinical Quality RN Resume


Skills For Tricare Med / Surge Clinical Quality RN Resume

  • Experience working with Grievance and Appeals
  • Possession of, or ability to obtain, an appropriate and valid license to practice as a Registered Nurse by the State of Oregon
  • Knowledge and proficiency in current, evidenced based methods and practices of primary care delivery with an emphasis on health promotion and risk reduction
  • Knowledge of principles, methods and techniques of project management and effective organization change management and/or willingness and ability to learn
  • Experience with Epic Electronic Health Records

Skills For Senior Clinical Quality Rn-hedis Rn-dade County Resume

  • Knowledge and proficiency in current, evidence based methods and practices of primary care delivery with an emphasis on health promotion and risk reduction
  • Participates in and represents the Clinical Quality Team by collaborating with internal business partners focusing on quality improvement
  • Knowledge regarding program development, implementation, and evaluation
  • Utilize PC based software for word processing, spreadsheet, database and statistics is required
  • Working in Quality Management in managed care or in the insurance industry

Skills For Clinical Quality Rn-telecommute Resume

  • Knowledge base of clinical standards of care, preventive health standards, HEDIS, NCQA, governing and regulatory agency requirements
  • Working in managed care or in the insurance industry
  • Do formal presentations in different settings- internal/external auditors, reporting on projects and reports that have been created and analyzed
  • Assist with report preparation and records regarding work function activities and projects
  • Current unrestricted RN licensure in state of Delaware
  • Specialized training with demonstrated expertise in the clinical specialty area with emphasis on nursing process, research principles, hospital policies and nursing standard development
  • Effective as a change agent with the ability to influence practice for positive patient outcomes without direct accountability

Skills For Clinical Quality RN Auditor Resume

  • Present clinical information to a wide variety of audiences
  • Clinical RN with current licensure
  • Proficiency in software applications that include, but are not limited to, Microsoft Word, Excel and PowerPoint
  • Travel to physician offices locally up to 75% of the time
  • Clinical RN with current, unrestricted license in PA
  • Current unrestricted RN licensure
  • Clinical RN with current, unrestricted license in state of residence

Skills For Senior Clinical Quality Rn-new Castle County Resume

  • Evaluate medical records with attention to detail to perform quality audits
  • Subject matter expert for CMS Special Needs Plans Models of Care (SNP MOC)
  • Effective program/project management skills to administer and manage a variety of program activities. and competing priorities while collaborating closely with diverse stakeholders
  • ?Knowledge of adult education principles and approaches
  • Proficiency in the use of computer hardware, software, particularly in Microsoft Word, Excel, and PowerPoint

Skills For Senior Clinical Quality Rn-philadelphia Resume

  • Review and audit medical documentation/charts and records
  • Coordinate quality management and Special Needs Plans Models of Care (SNP MOC) related programs and activities as required
  • Supports quality improvement programs

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