Nurse Consultant Resume Example Security Blvd

NURSE CONSULTANT

Summary

Enthusiastic individual with superior skills in working in both team-based and independent capacities. Bringing strong work ethic and excellent organizational skills to any setting. Excited to begin new challenge with successful team.

Skills

Administrative, Safety
Agency, Strategy
CMS, Phone
Critical Care
Direction, Written
Documentation
Government
Health and safety standards
Leadership
Life support
MACs
Managing
Assisting physicians
Medication administration
Meetings

Mentor
Monitors
Nursing
Pain management
Patient advocate
Patient care
Perioperative
Policies
Post Anesthesia Care Unit (PACU)
Program implementation
Protocols
Quality
Reporting
Research

Experience

Nurse ConsultantMay 2015 to Current
Security Blvd － Baltimore, MD

Centers for Medicare and Medicaid (CMS), Hours per week: 40, (Payment, Accuracy, and Reporting Group - PARG), Lead on CERT Accuracy Project and Special Studies, as well as the subject matter expert for Medicare FFS Part A claims; responsible for creating standard operating procedures, conducting meetings, preparing issue papers/ providing technical expertise to resolve complex issues concerning local and national Medicare policies, and conducting in depth analysis of review decisions and results.
Lead on CERT Documentation Non-Compliance Accuracy Project; responsible for developing and implementing the project with the contractor and conducting complex medical reviews.
Member of the New Medicare Card Project Integrated Program Team (IPT), responsible for implementing the replacement of social security numbers with the new Medicare beneficiary identifier number on claims received and reviewed by the CERT program contractors.
Conducted research into related medical issues and care standards.
Participated in continuing education programs and [Type] workshops to enhance training and nursing knowledge.

Post Anesthesia RNAug 2007 to Apr 2015
St. Agnes Hospital － Baltimore, MD

Level III for the program's $5.5-million-dollar statistical contract, responsible for managing invoices, deliverables, evaluations, and providing direction and assessing accuracy of all completed work.
Business Function Lead (BFL) for three Medicare Administrative Contractors (MACs); responsible for reviewing deliverables, providing CERT related support, evaluating the MAC's strategy to reduce improper payments, providing additional suggested actions for the MAC to consider to reduce improper payments, and identifying any CERT concerns that need addressed.
Mentor for onboarding new staff members.
Conducted complex medical review and analysis of over 300 Medicare claims, as well as 12 claims whose review decisions were disputed to CMS, to assess the impact of program policies and requirements; worked with team to recommend policy changes to align with the agency's goal of reducing provider burden and increase savings and value of healthcare to patients.
Subsequent policy changes were made to home health that estimated Medicare savings of $5.3 billion between years 2016-2019.
Co-developed and co-implemented the Documentation Non-Compliance Project to improve reporting of payment errors related to insufficient documentation and to identify Medicare specific policy areas that have an impact on improper payments.
This project aligns with the agency's top priority of reducing provider burden, the Patients over Paperwork Initiative, by eliminating duplicative requirements that save beneficiaries and taxpayer's money and increase the value of care provided to beneficiaries.
Received the PHS Achievement Medal for exemplary role in leading this new agency initiative.
Led the program implementation of creating new CERT data files to accept the new Medicare Beneficiary Identifier as part of the agency wide effort to remove Social Security numbers from Medicare cards thus strengthening fraud protection for 58 million Americans.
Received the CMS Execution of Major Projects Award in 2018 for outstanding contributions to public service.
Provided management and oversight to the program's $5.5 million statistical contract, reviewed 200 annual deliverables and over 190 agency data requests for accuracy and timeliness.
The information from these data requests helped to address topics/policies to reduce Medicare improper payments that contribute to a CMS projected savings of nearly $5.2 billion through 2021.
Conducted in depth research and analysis on issue concerning inaccurate payment information being entered on canceled CERT claims.
Developed an issues paper and extensive timeline of events to share with upper management and recommended solutions (i.e., new data elements created to the website where payment information is entered) that allowed the CERT program to produce an accurate measurement of the national and MAC specific improper payment rates, thus maintaining the integrity of the program.
Provided in depth analysis and extensive recommendations on MAC strategies to reduce improper payments.
These review strategies provide the most impact on claim errors, thus contributing to a decrease in money lost by the government as noted by the reduction in the national improper payment dollars by $7.3 billion between 2017- 2019.
Effectively briefed senior leadership on complex statistical and data reporting topics including effective sample size calculation and enhanced stratification.
These program enhancements improve the overall CERT program and allows for improved accuracy in identification of improper payments and their causes.
Member of PCG Accuracy Review Workgroup - provide clinical nursing and program perspective in the assessment of the impact of legislation, regulations, and Agency policies and procedures; make recommendations to senior management, Hours per week: 36 Clinical Nurse II Post Anesthesia Care Unit (PACU), In a state licensed hospital, conform to health and safety requirements by utilizing the nursing process to identify patient needs for continuous assessment in the PACU.
Document and evaluate the effectiveness of nursing actions and ensure a safe environment ofcare.
Responsible and accountable for working with other departments to ensure continuity of care.
Specific duties include:.
Assessing patient conditions; planning and implementing patient care plans.
Treating wounds and providing advanced life support.
Assisting physicians in performing procedures.
Ensuring that ventilators, monitors, and other types of medical equipment function properly.
Administer intravenous fluids and medications.
Collaborate with fellow members of anesthesia and surgical team.
Act as patient advocate.
Provide education and support to patients and families.
Respond to life-saving situations, using nursing standards and protocols for treatment.
Serve as preceptor to new employees in PACU.
Serve as charge nurse providing expert care to a wide variety of patient populations.
Provide competency training and education, specifically Sure Trans Reinfusion Device and Chest Tubes, to all registered nurses in PACU.
Draft procedural instructions for implementing new computer documentation in PACU.
Created PACU assessment screens specific for PACU documentation and served as super user for training others how to perform this function.
Develop/revised written policy and procedure associated with the oversight of St Agnes hospital as a Medicare provider.
Specifically updated the criteria for discharge from the PACU to meet minimum temperature requirements prior to transfer or discharge of patient.
Develop and adhere to guidelines and procedures that interpret certification requirements for Medicare/Medicaid health and safety standards.
Specifically, utilize core measure set for the Surgical Care Improvement Project (SCIP) to improve surgical care by significantly reducing surgical complications.
These include monitoring prophylactic antibiotics for surgical patients, assessment for need of Foley catheters, verify orders for recommended venous thromboembolism prophylaxis, and perioperative temperature management.
Ensure conformity to program requirements and conduct analysis of survey data to determine effectiveness of survey policies and procedures and trends in provider services.
In the perioperative area, temperature management procedures are performed, i.e.
Warming blankets, warm intravenous fluids, wrapping of nonoperative extremities.
Research in the PACU involves monitoring of postoperative temperatures and determining need for additional warming methods.
Develop recommendations for resolving problems with program procedures.
In the PACU, it was determined to not place Foley catheters in some surgical patients.
Other measures were used to maintain integrity of surgical sites in patients receiving spinal anesthesia.
Evaluate the effectiveness of pain management and nursing care in the recovery area by performing daily phone surveys, unsupervised, to post-surgical patients.
Trained others to perform this duty.
Prepare materials for review by senior management to justify and influence the acceptance of findings from phone surveys to continue current practice of medication administration.
Utilize results to determine need for preprinted instructions specific to surgical procedure.
Consult with internal and external customers for the purpose of achieving quality health care initiatives.
Independently worked with sales representative for Build-a-Boot product.
Initial design was flawed and based on my recommendations, the product was redesigned to maximize skin integrity and promote healing for the bedridden patient.
Establish and maintain partnerships with surgeons, physicians, and anesthesia providers for the purpose of achieving survey and certification quality health care initiatives, policies, and plans by working with the SCIP core measure set.
Represent St Agnes organization at Performance and Improvement Council concerning quality of care within the unit and facility.
Work to improve unit efficiency, budget, and quality of nursing care.
Participated in research studies specific to pain and temperature management of postoperative patients in the recovery area.

Critical Care RNJan 1998 to Aug 2007
St. Agnes Hospital － Baltimore, MD

Hours per week: 36, As a critical care RN, used advanced skills to care for patients who were critically ill and at high risk for life threatening problems.
Specific duties included:.
Assessing patient conditions and planning/implementing patient care.
Acted as patient advocate.
Provided education and support to patients and families as recommended by initiatives from CMS.
Collaborated with fellow members of critical care team.
Served on Critical Care Divisional Council through which policies and procedures were revised and created.

Education and Training

Bachelor of Science, Nursing1995University of Maryland － Baltimore, MD, United StatesGPA: 3.63, GPA: 4.0, Inducted into Sigma Theta Tau - International Honor Society of Nursing BLS certified

Accomplishments

2019 - HHS Gears of Government Award for exemplary performnace and exceptional leadership in the achievements of the CERT program

2019 - HHS Secretary's Award for Meritorious Service for exemplary performance and exceptional leadership in the achievements of the CERT program

2019 - Public Health Service Achievement Medal for exemplary role in leading the agency's new initiative, the Documentation Non-Compliance Project that refines reporting of Medicare payment errors

2019 - CMS Office of Financial Management Unsung Hero Award for outstanding work as COR for the CERT Statistical Contractor, managing all data requests, for reliability and constant willingness to take on tasks, and for providing great support to fellow team and leads

2018 - CMS Internal Service Award for outstanding work achieved in the CERT team

2018 - CMS Execution of Major Projects Award for outstanding work achieved in the New Medicare Card Project

Resume Overview

Companies Worked For:

Security Blvd
St. Agnes Hospital

School Attended

University of Maryland

Job Titles Held:

Nurse Consultant
Post Anesthesia RN
Critical Care RN

Degrees

Bachelor of Science , Nursing 1995

Nurse Consultant Resume Example

Resume Score: 80%

DISCLAIMER

Resume Overview

Create a job alert for [job role title] at [location].

Similar Resumes