Most recently I worked as a Chart Review Nurse for Medix Staffing Solutions. I was hired to review charts for Harmony Health Plan/Wellcare members in the Southern IL. region. I worked at Scott Air Force Base as a Disease Manager, managing patient's with diabetes and asthma at the Scott Family Clinic. Prior to that I worked 3 years in Utilization Management for Workmans Comp. I worked with APS and Harmony Health Plan as a Quality improvement nurse for a period of approximately 4 years. I assisted in developing the tool for evaluating the telephonic disease management nurses and the call center at APS and taught the nurses, call center and supervisors for the Earth City location and the Jefferson City location. I set up the program for PHI protection and regular onsight inspections. I worked for Harmony Health Plan teaching the provider's about HEDIS requirements for their members and completed chart reviews annually. I particated in State of IL and MO. quarterly meetings and annual reports.
I look forward now to a future working in Quality, Performance Improvement, Training and Education.
Education
I received a Bachelor of Arts degree in Human Communication and Social Science, from Bethel College, Mishawaka, IN in 1975.
I attended Southern Illinois Univerity at Edwardsville, IL for pre-requisites for Nursing program. 1990 - 1991
I completed a Bachelors of Science Degree from St. Louis University, Accelerated Nursing program 1991-1992.
Experience
Medix Staffing Solutions
Harmony Health Plan/Wellcare
02/18/2013-04/30/2013
HEDIS Chart Review Nurse
Conducted onsite visits to different providers for HEDIS chart reviews. Sanned medicals records to Chicago, main office for IL.
InGenesis (Contract Co.)
Scott Family Clinic, Scott Air Force Base, IL.
10/29/2012-01/12/2013
Disease Manager, Contract Nurse
Followed HEDIS and ADA guidelines for scheduling diabetes patient for yearly or more often provider exams and lab work. Contacted diabetic patient to educate them on their disease and how to control their diabetes at home with diet and exercise and proper medication management. Taught on glucose monitoring and insulin pens. Advised on symptoms of hypoglycemia and hyperglycemia and response to these symptoms.
Coventry Health Care
8/2009-10/2012
Utilization Review Nurse, Workman's Comp
Received workman's compenation claims. Evaluated the medical records received by fax and determined medical necessity for the care requested. Certified surgeries, injections, diagnostics, physicsl therapy, and durable medical equipment according to Official Disability Guildelines and State guidelines. Worked closely with provider's and staff of injured workers.
APS Healthcare
12/2008-7/2009
Quality Improvement/RN
Assisted with the designing and implementation of a Documentation Audit Tool and a Silent Monitoring Audit tool used in monitoring the Telephonic Disease Management Nurses and the no clinical staff of the call center. Worked with supervisors after completing evaluations of their nurses and discussed outcomes and suggested improvements. Worked directly with each nurse and gave advice and suggestions for improvement. The audit tool was designed to meet URAC, Stae and company standards. Developed Powerpoint presentation for training of Protected Health Information, PHI, HIPAA and Compliant processes. Trained clinical and non clinical staff and set up formal program for tracking and trending PHI. Prepared a tool for tracking and trending Sentinel Events and Duty to Warn. Assisted in planning of a Quality Improvement Project.
Harmony Health Plan
12/2005-11/2008
Quality Analyst
Met regularly with network providers and staff, educating them on quality improvement initiatives, Health Effectiveness Date and Information set (HEDIS) and other state requirements as they related to our Harmony Health Plan members. Participated in local health fairs, school events and our Healthy Kids Club parties to promote healthy living and education for our members and the community on specific diseases such as diabetes, asthma and heart disease. Wrote monthty articles in the monthly newsletter focusing on disease management. Updated and took the lead on performance improvement project for asthma. Attended the National Asthma Educators Course in St. Louis, Mo. 2007. I completed on sight delegated vendor audits. Took the lead on a performance improvement project for members with asthma. Participated in External quality review organization audits in 2006 and 2008 for IL.