clinical quality consultant ii resume example with 8+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - - : - -

Dedicated and experienced health care professional with a history of meeting company goals by utilizing consistent and organized practices pursuing new professional challenges with a growth-oriented company.

  • Ul>


  • P>Critical Thinking
  • P>Organization and Time Management
  • P>Fluent in [Language]
  • P>Customer Relations
  • P>Training and Development
  • P>Project Management
    • P>Cultural Awareness
    • P>Technical capacity
    • P>Correction action planning
    • P>Patient care
    • P>Quality improvement programs
    • P>Population health
    • P>Condition/disease management
    • P>Excellent oral and written communication
    04/2022 to Current
    Clinical Quality Consultant II Anthem, Inc. East Haven, CT,
    • Educated clinics point of contact and providers about HEDIS measures and documentation guidelines
    • Collaborated with leadership to develop user friendly strategy to improve provider's quality performance and to help practice and provider achieve 4 stars
    • Lead and presented weekly, monthly, bi-monthly, quarterly business review meetings related to STAR activities
    • Acted as liaison and primary quality support to providers and clinics staff on improving scores to 4 stars
    • Used datas and reports from tableau and various other sources to interpret scores to providers groups
    • Attended cross functional meetings to update leadership on quality performance by communicating clinics barriers and to strategize on next action plan c
    • Reviewed medical records to extract missing HEDIS measures and submit them via EPRG
    • Applied coaching techniques and tools to support provider groups and provider in improving performance.
    • Assist provider groups with identifying patients who are non adherent to medication and suggest available resources to assist patient compliance
    • Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.
    • Used excel and powerpoint to create presentations, flowcharts and graphs detailing data analysis results.
    02/2016 to 04/2022
    Clinical Quality Analyst Morgan Stephens Houston, TX,
    • Conducted medical chart review to identify risk adjustable diagnosis as established by CMS guidelines
    • Suggested risk adjustable HCC codes/diagnosis to Wellmed and contracted providers from various markets within Florida
    • Lead education sessions for several providers/ groups on identifying and documenting risk adjusted diagnosis based on ICD 10 and CMS guidelines
    • Educated providers on best practices in documentation to improve patient care, performance, reach their goals and receive highest reimbursement.
    • Collaborated with DATARAP to stay updated in latest changes in risk adjustment and provided updates and education to providers /providers groups
    • Provided regular updates to team leadership on providers performance, improvements and barriers
    • Used excel and powerpoint to create presentations, flowcharts and graphs detailing data analysis results.
    05/2014 to 05/2015
    HEDIS Specialist Central Florida Internists City, STATE,
    • Improving and managing quality of healthcare services provided to seniors and community by monitoring HEDIS interim.
    • Coordinated and designed plan within four locations of growing medical practice to ensure quality control and HEDIS measures were being met on timely manner.
    • Contributed in increasing star rating and RAF Score of medical practice and physicians.
    • Worked closely with United health care and Wellmed insurance company and its staff members to complete HEDIS measures.
    • Trained other staff members on HEDIS .
    • Developed strong professional rapport with various providers, office managers and united healthcare providers and staff members to ensure quality patient care services to all members.
    Education and Training
    Expected in to to
    M.D.: Medicine
    Universidas Iberoamericana (UNIBE) - Santo Domingo, Dominican Republic ,

    United States Medical Licensing Exam Clinical Skills (USMLE CS) : completed/Passed

    United States Medical Licensing Exam Part 1 (USMLE) –completed/Passed

    Expected in to to
    : Premedicine
    Adventist Hospital College of Health Science - Orlando, Florida ,
    Expected in to to
    : General Studies
    Valencia Community College - Orlando, Fl ,
    Expected in to to
    High School Diploma:
    Cypress Creek High School - Orlando, FL ,
    Activities and Honors

    American Red Cross

    American Heart Association

    American Medical Student association

    American Diabetes Association

    Casa Rosada

    • Helped achieved providers reach their risk adjustment goal by being very specific about the location of documentation and making it very simple for the providers to find the information needed to attest to a diagnosis.
    • Simplifying reports to make it very user friendly for providers and staff to help them achieve their goal.

    Microsoft Excel


    Microsoft powerpoint


    Microsoft word


    Service now












    Various Electronic medical records


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    Resume Overview

    School Attended

    • Universidas Iberoamericana (UNIBE)
    • Adventist Hospital College of Health Science
    • Valencia Community College
    • Cypress Creek High School

    Job Titles Held:

    • Clinical Quality Consultant II
    • Clinical Quality Analyst
    • HEDIS Specialist


    • M.D.
    • Some College (No Degree)
    • High School Diploma

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