quality clinical management lead analyst resume example with 12+ years of experience
JessicaClaire
, , 609 Johnson Ave., 49204, Tulsa, OK100 Montgomery St. 10th Floor
Home: (555) 432-1000
Cell:
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Summary
Driven Registered Nurse with 13 years comprehensive experience providing patient care. Seeking to leverage background and training to secure a leadership role. Skilled in delivering high-quality patient care, education and counseling. Demonstrated leadership skills that advance patient care, patient satisfaction and safety initiatives to drive holistic care approaches.
Qualifications
Highly motivated, organized and self-directed
Excellent verbal and written communication skills
Detail oriented with ability to align activities to the overall strategy/big picture
Strong work ethic with the ability to work independently
Ability to work in an interdisciplinary environment
Innovative with a desire to learn new ideas
Strong critical thinking skills
Excellent time management skills
Experience
Quality Clinical Management Lead Analyst, 07/2016 to Current Adventist Health Nw – Gresham, OR,
Review, investigate and monitor clinical and quality activities such as Quality of Care Complaints and Adverse Events
Collaboration with internal and external medical market executives and directors
Collaboration with external health care professionals and facilities
Presentation of cases to the National Peer Review Committee
Collaboration with matrix partners
Collect and analyze data for the Quality of Care and Adverse Event Aggregate Report which is reported to two committees
Lead contact for strategic alliance partners
Maintain standard operating procedures in accordance to strategic alliance and quality of care and adverse event aggregate reporting
Participate in work groups for ongoing training
Inpatient Nurse Case Manager, 11/2013 to 07/2016 Cigna – City, STATE,
Utilize Milliman Care Guidelines for inpatient reviews
Participated on the Management Operating Systems Pilot Program
Maintained Utilization Review metrics
Developed short term and long term objectives to determine case results
Collaboration with matrix partners
Identify potential Quality of Care issues and Adverse Events
Discharge planning
Maintaining URAQ and NCQA compliance
Identify new referrals for complex and specialty case management programs
Short term case management for customers that qualify
Collaboration with market medical executives to discuss inpatient reviews
Registered Nurse Emergency Department, 04/2011 to 06/2016 Central Maine Medical Center – City, STATE,
Assessed patients' overall health, identified their needs and goals for treatment and connected them with ideal practitioners and treatments.
Managed and provided leadership to deliver direct and indirect patient care, education and telemetry monitoring and interpretation.
Administered medications orally, rectally, intramuscularly, subcutaneously and via IV therapy.
Improved ED administration by compiling and analyzing data and identifying areas of improvement.
Supported patients with customized patient teaching tools.
Worked as part of team to ensure proper care of body mechanics and safety of patient.
Trained and mentored newly hired nursing personnel on policies, protocols and requirements so that they were well-prepared for their job responsibilities and duties.
Collected and properly handled specimens from patients.
Performed all tasks with a patient-centered focus while seeking opportunities for improvement of processes and treatments.
Collaborated with doctors to plan post-treatment home care.
Trained new RN hires and ancillary staff members to meet patient service goals, champion standards of care and improve patient overall satisfaction.
Registered Nurse Cardiopulmonary Unit, 11/2009 to 04/2011 Central Maine Medical Center – City, STATE,
Coordinated and managed care for patients undergoing myocardial infarction screening and anticoagulation therapies.
Served as a patient advocate by identifying insurance coverage, communicating care preferences to practitioners and ensuring interventions met patients' treatment goals.
Recorded patients' medical history, vital statistics and test results in medical records.
Planned and managed patient care in alignment with hospital standards of care.
Followed all physician orders for treatment and care and managed medication administration.
Monitored, assessed and recorded patient condition and coordinated patient discharge planning.
Completed comprehensive patient assessments to determine individual needs, formulating plans of care in collaboration with multidisciplinary healthcare professionals, including physicians, case managers and social workers.
Assisted patients with healing and recovery after surgery.
Developed and implemented successful patient care plans.
Monitored post-op vitals, set up PCA, fluids, reviewed post-op orders and assimilated patients to unit.
Administered medications orally, rectally, intramuscularly, subcutaneously and via IV therapy.
Education and Training
Master of Science: Nursing Administration and Executive Leadership, Expected in 2019 to Capella University - Minneapolis, MN GPA:
Bachelor of Science: Nursing, Expected in 2009 to University of Southern Maine - Portland, ME GPA:
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