Quality Improvement Nurse Resume Sample
Aliyah Zboncak
7546 Elvera Crest,
Chicago,
IL
+1 (555) 399 6265
Work Experience
Quality Improvement Nurse
12/2016
-
PRESENT
Chicago, IL
- Facilitate patients’ participation in clinical programs & identify opportunities member participation
- Define gaps in Humana’s service relationship with providers and facilitate resolution
- Maintain client relationships; effectively address provider needs & PODS goals
- Participate in Provider Engagement Strategy meetings
- Strong analytical skills, able to utilize Excel and interpret data
- Evaluate provider current state willingness to work with Humana to improve Stars performance and tailor messaging accordingly
- Identify key point of contact for each prioritized PCP and effectively develop / enhance provider clinical relationship across product lines. Accurately define gaps in Humana’s service relationship with providers and facilitate resolution through Service Alignment Manager (SAM)
Quality Improvement Nurse, RN
12/2011
-
10/2016
Detroit, MI
- Deliver provider/member-specific metrics and supporting collateral (e.g., HEDIS Summary, Patient Experience, Rx Opportunity, etc.) and coach providers on improving all aspects of Stars performance
- Educate PCP’s on Stars program, changes and best practices to enhance all aspects of Stars performance
- Identify provider best practices and needs, disseminate for sharing and / or resolution
- Maintain documentation of provider visit, including focus and performance trending (Quality Journal)
- Facilitate effective collaboration and communication with workgroup members (including operations, clinical and MRA) and Stars and Quality team members
- Identify opportunities to improve Stars and Quality processes, methods, team engagement, etc. and present resolution options / cost
- Varied clinical nursing experience
- Active RN or LPN license with no restrictions in the state(s) in which the nurse is required to practice
Lpn-quality Improvement Nurse Consultant
08/2005
-
08/2011
Detroit, MI
- Examine clinical programs information to identify members for specific Case Management / Chronic Care / Disease Management activities or interventions by utilizing established screening criteria
- Monitor practice's patient participation as well as promoting Humana's clinical programs and resources
- Facilitate member engagement
- Maintain client relationships, effectively address provider needs & team goals
- Capture concerns/issues in action plans as agreed upon by Provider
- Accountable for Provider Prioritization & communication of priorities to team
- Assess data, identify opportunities, and understand how the team drives successful Triple Aim outcomes
- Quality, Grievance and Appeals / Statistical Reporting
- Review daily grievance and appeals from health plans, providers or members and request in writing to the appropriate facility or provider for any records and a response. Review with Medical Director on each case to determine leveling
Education
University of New Mexico Valencia Campus
2000 - 2005
Bachelor's Degree in Nursing
Professional Skills
- Strong Communication and Collaborative/Teamwork Skills and abilities
- Excellent computer skills with ability to easily navigate mutliple applications
- Previous experience with Appeals, Case Management, Chart / Concurrent Review, Denials, Discharge Planning, and Enrollment
- Experience in Quality Improvement, Managed Care, Compliance and/or Accreditation
- Experienced clinical background as RN or LVN
- Experienced clinical background as an RN or LPN
- Valid drivers license and/or dependable transportation necessary (variable by region
How to write Quality Improvement Nurse Resume
Quality Improvement Nurse role is responsible for reporting, travel, messaging, health, transportation, excel, general, coding, drivers, compliance.
To write great resume for quality improvement nurse job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Quality Improvement Nurse Resume
The section contact information is important in your quality improvement nurse 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
- Telephone number
Work Experience in Your Quality Improvement Nurse Resume
The section work experience is an essential part of your quality improvement nurse 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 quality improvement nurse responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular quality improvement nurse position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Quality Improvement Nurse resume experience can include:
- This role is considered patient facing and is part of Humana’s Tuberculosis (TB) screening program
- Successfully promote practice-patients’ participation in clinical programs - providing information on participation,
- Update Grievance Appeal Logs daily and report to appropriate committees monthly
- Report statistical information on quality issues tracked by health plan and report monthly to the QI Committee
- Identify and act upon any provider/vendor trends immediately and informs Medical Director and QI Committee
- Participate and provide information for QI Plan and semi-annual coalitions.Implement annual QI study approved by QI Committee with policy, process flow, and action plan and report results when completed. (Access audits / coalitions / HEDIS)
Education on a Quality Improvement Nurse Resume
Make sure to make education a priority on your quality improvement nurse resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your quality improvement nurse 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 Quality Improvement Nurse Resume
When listing skills on your quality improvement nurse 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 quality improvement nurse skills:
- Prior quality experience in a medical office or hospital
- Previous hospital RN experience or equivalent
- Strong knowledge of HEDIS
- Previous experience Quality Improvement and processes
- Office practice / hospital experience
- Pecific work experience in quality improvement or work process redesign in health care organizations
List of Typical Skills For a Quality Improvement Nurse Resume
1
Skills For Quality Improvement Nurse Consultant Resume
- Deliver provider/member specific metrics around profit and loss and coach providers on gap closing opportunities for Humana members
- TN Registered Nurse (RN) license
- This role reports to the POD Manager
- This role reports to a Strategic Consultant
- This role reports to the POD Manager/Leader
- This role reports to the Quality Improvement Director
- This role reports to the POD Front Line Leader
- This role reports to the PODS Manager
2
Skills For Quality Improvement Nurse, RN Resume
- This role reports to the department leader
- This role reports to the POD Frontline Lead
- This role reports to Director – STARS and Quality
- This role reports to the Quality Improvement Front Line Leader
- This role reports to the Frontline Leader, Manager and Quality Improvement Director
- This role reports to the Front Line Leader, Manager and Quality Improvement Director
3
Skills For RN Quality Improvement Nurse Resume
- This role reports to a Manager
- Accurately define gaps in Humana’s service relationship
- RN or LPN with a clinical background or previous health plan knowledge
- Position requires frequent day travel throughout the Cincinnati, OH area
- Position requires frequent day travel throughout the Evansville, IN area
4
Skills For Lpn-quality Improvement Nurse Consultant Resume
- Position requires frequent day travel throughout the Northwestern Indiana area
- An active RN/LPN license in the designated state
- Position requires frequent day travel throughout the Indianapolis and Southern Indiana area
- Work independently under general instructions,self-directed and motivated
- Travel throughout the Treasure Coast area on a daily basis
5
Skills For Lpn-quality Improvement Nurse Resume
- NAPNES certification or successful completion of a pharmacology exam required for all licensed practical nurses
- Knowledge of medical terminology, basic anatomy, physiology, and disease process is required
- Build relationships and gain alignment for clinical support and be able to articulate questions to receive an appropriate level of support from superiors and peers
- Interact with all members of the bariatric surgical team and administrative staff in a professional and courteous manner
- Manage data entry deadlines and center’s accreditation processes as necessary
- Business, healthcare related
6
Skills For Lpn-quality Improvement Nurse, Orlando Resume
- Knowledge of Stars and CMS
- Facilitate regular Provider Engagement Strategy team meetings
- Clinical background - RN license required
- Conduct Access and Availability audits per health plan request. Maintain departments access audits to include CSR, health plan or internal complaints
- Ensure access and availability log is updated weekly with trends reported to QI committee with follow-up and closure to be compliant
7
Skills For Rn Quality Improvement Nurse Northeast Tn Resume
- Schedule appointments with physician offices and ancillary facilities for site reviews (facility and medical charts) as requested by the Credentialing Department
- Send confirmation letter with set appointment date and the site audit tool prior to appointment to provider office
- Report within 48 hours to the Credentialing Department the provider offices that do not meet threshold requirements for the audit and provide a copy of the review and notes after site audit is completed
- Foreign Medical Graduate
- BSN or MHA/MBA
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