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patient care manager resume example with 12+ years of experience

Jessica Claire
  • , , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
  • H: (555) 432-1000
  • C:
  • resumesample@example.com
  • Date of Birth:
  • India:
  • :
  • single:
  • :
Summary

Experienced and reliable registered nurse with MBA in Healthcare Administration seeking to secure a long-term position in an innovative, team-focused company that offers advancement. I am passionate about providing support to clinical leaders to ensure education related to quality and compliance are woven into the organization's culture and that all team members have the resources they need to be successful and foster growth for the organization.

Skills
  • Strong verbal and written communication skills.
  • Monitor changes related to Hospice Quality Program Reporting (HQRP).
  • Experience with QIES, CASPER Reports, and SHP.
  • Focused on achieving strong outcomes on quality metrics to ensure optimal patient care.
  • I have proven expertise in response to governmental audits, conducting in-depth internal audits, and devising successful quality improvement strategies.
  • Well versed in hospice regulations, LCD guidelines, HIPAA guidelines and multiple EMR solutions.
  • Knowledgeable in methods for defensible documentation to support the medical necessity and on-going eligibility.
  • Skilled in ACHC accreditation process.
  • Proficient in MS Office software programs Word, Excel, PowerPoint, Outlook, and Teams.
Experience
Patient Care Manager, 01/2022 - Current
Curo Health Services Portland, ME,
  • Lead an interdisciplinary team of registered nurses, spiritual care coordinators, social workers, bereavement coordinator, chaplains and certified nursing assistants.
  • Assist Executive Director with ensuring quality patient care is delivered compliantly, safely and in a cost-effective manner.
  • Utilize well-developed communication, active listening and interpersonal talents when interacting with people on daily basis.
  • Facilitate communication between members of health care delivery while involving clients in decision-making processes to minimize service fragmentation.
  • Initiated training and education programs for supporting healthcare staff.
  • Implement new hire training to further develop skills and initiate discussions on task prioritization.
  • Review initial plan of care and recertification documentation prior to physician order generation for appropriateness and completeness, discusses any issues or corrections with clinician.
Director of Medical Review, 11/2014 - 01/2022
Molina Healthcare Wenatchee, WA,
  • Conducted clinical record reviews, prepared, and submitted requested records for compliance audits such as ADRS, RACs, ZIPCs, CERTs, and TPEs.
  • Lead a team of RN internal auditors and assisted in the performance of hospice agency mock surveys and monthly clinical record reviews to assess clinical outcomes, operational processes, compliance, state survey results, and PEPPER results for 16 Heart of Hospice locations.
  • Worked as part of the acquisition integration team and completed due diligence audits prior to acquisitions to promote compliance guidelines prior to and after day one of operation.
  • Developed educational curriculum and specialized training programs to enhance the understanding of compliance with hospice regulatory requirements.
  • Assisted in designing and implementing the annual QAPI plan for the organization to focus on priority areas identified in previous audits, compliance reports investigations, OIG Work Plan, PEPPER report, staff education, or regulatory changes.
  • Conducted clinical record reviews for appeals and assisted in physician preparation for peer-to-peer appeals.
  • Assisted Chief Compliance Officer in development and implementation of corporate action plans related to regulatory and ICD-10 changes.
  • Monitored SHP for HIS and CAHPS metrics, provided education related to CMS quality metrics to teams at all 16 Heart of Hospice locations.
  • Reviewed HCHB pre-billing reports for issues that impact billing release. Work with agency leaders to ensure timely release of billing holds.
  • Wrote procedures to establish medical and administrative best practices.
  • Developed focused clinical programs such as cardiac program to improve the consistency of care across all Heart of Hospice locations.
QAPI Coordinator, 05/2013 - 11/2014
Molina Healthcare Yakima, WA,
  • Conducted clinical record reviews and submitted requested records for Medicare and Medicaid compliance audits.
  • Created agency reports to monitor QAPI metrics, participated in monthly QAPI meetings, analyzed trends to improve metrics and develop relevant team educations.
  • Processed workflow in HCHB for IDG, recertification, and QI reporting.
Registered Nurse, 08/2011 - 01/2013
Priority Behavioral Health City, STATE,
  • Registered nurse for partial hospital program and outpatient mental health provider.
Registered Nurse, 06/2009 - 07/2011
Our Lady Of Lourdes Hospital City, STATE,
  • Delivered array of direct nursing care services such as assessment, medication management, cleaning and dressing wounds and coordinated discharge planning for patients on the Ortho, Neuro and Stroke floor at Our Lady of Lourdes.
Education and Training
MBA: Health Care Administration, Expected in 05/2013
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University of Louisiana at Lafayette - Lafayette, LA
GPA:
Status -
Associate of Science: Registered Nurse, Expected in 05/2009
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Louisiana State University at Eunice - Eunice, LA
GPA:
Status -
Bachelor of Arts: Psychology, Expected in 05/2004
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University of Alaska Anchorage - Anchorage, AK
GPA:
Status -

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Resume Overview

School Attended

  • University of Louisiana at Lafayette
  • Louisiana State University at Eunice
  • University of Alaska Anchorage

Job Titles Held:

  • Patient Care Manager
  • Director of Medical Review
  • QAPI Coordinator
  • Registered Nurse
  • Registered Nurse

Degrees

  • MBA
  • Associate of Science
  • Bachelor of Arts

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