Hedis Nurse Resume Example

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Jessica Claire
  • , , 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • Date of Birth:
  • India:
  • :
  • single:
Professional Summary

Highly motivated LPN with 25 years of experience in a robust variety of nursing roles and settings, most extensively in the area of clinical quality management. Excellent work ethic and exemplary time management skills, demonstrated over my many years of industry expertise. Strong leadership qualities with a passion for teaching. My ideal position is one that focuses on improving access and quality of care to consumers, as well as offers education and corroboration to providers and staff.

  • Knowledge and understanding of CMS regulations, clinical care guidelines, and HEDIS/STARS/CAHPS measures.
  • Ability to learn and retain information quickly for practical and logical application
  • Strong computer skills
  • Ability to problem solve with consideration to all role-perspectives for well-rounded solutions
  • Resourcefulness in obtaining information and accomplishing objectives
  • Ability to work autonomously, with self-regulation of efficiency and productivity
  • Courage and creativity to think outside the box when appropriate
  • Passion for teaching and ability to articulate information to align with a given population/individual's learning needs
  • Ability to elicit cooperation and lead effectively
  • Ability to think quickly and react productively in challenging situations
  • Adaptable to change
  • Desire to learn new skills and develop competencies
  • Confidence in speaking/communicating both interpersonally and publicly
Work History
HEDIS Nurse, 01/2020 to Current
Beth Israel Deaconess Medical Center Braintree, MA,
  • Requested, retrieved, abstracted medical records for annual HEDIS project
  • Gained experience and proficiency in navigating various types of EMR
  • Maintained on-going training to remain current on changes in HEDIS specs and documentation and reporting requirements
  • Developed and fostered positive working relationships with multiple providers/provider staff to ensure timely and accurate record submission
  • Collaborated with co-workers to ensure efficiency and productivity, and avoid wasted resources
  • Maintained proper handling, storage and disposal of PHI to comply with HIPPA laws
Clinical Quality Practice Consultant, 05/2016 to 12/2019
Anthem Inc. City, STATE,
  • Establish and maintain working relationships with providers (territory: northern New Jersey).
  • Communicate performance to providers and assist with setting goals for GIC, PCV and overall quality of care.
  • Provide education, support and resources to assist providers with reaching goals.
  • Request, retrieve, review and abstract medical records to facilitate year round gap in care closure.
  • Participated in 4 seasons of HEDIS project, corroborating with Medicaid team to meet regional goals.
  • Performed 3 seasons of CPG audits with a variety of provider types.
  • Began with Anthem as a temp via Populous Group and hired to FT position within 2 months.
Clinical Advisor, 11/2013 to 03/2016
Humana Insurance Company City, STATE,
  • Reviewed submitted clinical information against CMS and/or MCG to determine appropriateness of level of care provided.
  • Corroborate with both facility and internal case managers to facilitate safe discharge plans and outcomes for plan members.
  • Participate in both virtual and off-site initiatives to develop pilot programs and process enhancements.
  • Held appointed position of SME (Subject Matter Expert) within my role, providing assistance to leadership with managing reports, process changes and serving as a resource to my peers and preceptor to new hires.
  • Created and proposed ideas and tools that were subsequently adopted by my regional team to improve efficiency in tasks and communication with constituents.
  • Maintained an active role in my region's engagement committee, facilitating virtual and live activities to boost and sustain cohesiveness and morale.
  • Received both a regional STAR award by my immediate leader, as well as a nomination by senior leadership for a national SUMMIT award for exemplary performance in ensuring member safety.
Diploma: General Practical Nursing, Expected in 1996
Upper Bucks County Vocational /Technical School - Perkasie, PA
  • Graduated in the top 5 of class
  • Received written notes of gratitude from patients via clinical study settings for quality of care and patient education
  • Chosen by in-house staff at clinical settings to observe procedures, not otherwise part of curriculum
Associate of Science: Nursing Ongoing, Expected in
Excelsior College - Albany, NY

I began this continuation of my formal nursing education while raising my two daughters. I was very fortunate to have been provided professional opportunities that continued to hone my knowledge and skills and provide financial security for the three of us. My career continued to thrive and those opportunities, as well as my familial obligations had taken precedence over the time and financial requirements of completing this program. It is however without expiration and I would like to revisit completing this degree, now that my children are grown.

Additional Information

Although I am currently licensed as a LPN and not a RN, my experience and abilities well exceed my formal education. I have proven myself as a strong asset in each of my previous positions and earned the respect and praise of employers and co-workers throughout. I have been chosen for assignments, challenges and awards over many, more credentialed colleagues. I have served as a SME in a few of my roles and very much enjoy being the motivator behind a great team.

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Resume Overview

School Attended
  • Upper Bucks County Vocational /Technical School
  • Excelsior College
Job Titles Held:
  • HEDIS Nurse
  • Clinical Quality Practice Consultant
  • Clinical Advisor
  • Diploma
  • Associate of Science