quality management survey coordinator resume example

• Participated in the development of the COVID-19 Response Plan, including, monitoring CDC, WV DHHR, and OHF guidelines in order to initiate crucial adjustments to the COVID-19 Plan and providing updated education to staff members.
• Created the initial staff, vendor, and visitor COVID-19 Screening Tool and signage prior to OHF creating a standardized process for state facilities.
• Serves as part of the team that has developed, monitors, and completes revisions to the COVID-19 Pandemic Plan as changes and requirements arise.
• Served as the COVID-19 Phase IA Vaccination Coordinator, participating in the WV Hospital Association conference calls and webinars resulting in the successful vaccination of over one-hundred-fifty staff members.
• Completes the WV Hospital Association Daily COVID-19 Survey.
• Member of the COVID-19 and Infection Control Committee.
• Provide assistance to the Infection Control and Employee Health Department by participating in COVID-19 staff screening, education, vaccinations, monitoring, and regulatory entity inquiries concerning COVID-19 prevention practices, monitoring staff and employee testing, line listing, and risk mitigation.
• Infection Risk Assessment and Environmental Risk Assessments to identify potential sources, monitoring of trends, with the inclusion of planning and initiating control measures
• Completes the COVID-19 Response Summary presented to the Governing Board quarterly.
• Serves as chair of the Oversight Committee where current and up and coming regulatory requirements are discussed to ensure the facility evolves to maintain compliance, as well as identify trending issues within the hospital infrastructure.
• Investigation of adverse events, facilitating multidisciplinary review meetings, composing reports reflecting information gained during the investigation and facilitation, then development of an action plan to address identified causes, along with the mitigation of potential contributing risk factors.
• Collects and reviews monthly QAPI (Performance Improvement) and safety data to provide recommend solutions after assessing process and education needs.
• Conducts research and compiles information from multiple sources to present results for various quality improvement projects, investigations, and subjects requested to assist in preparation for presentation to the legislative audience and other delicate matters.
• Participant in multiple meetings such as committees, performance, improvement initiatives, and daily morning huddle.
• Develops and updates department goals and achievements annually.
• Reviews incident reports, actualizing appropriate corrective action plans to mitigate ongoing and potential situations.
• Completes monthly, end-of-quarter and other statistical reports, including analysis for quality improvement program outcomes studies.
• Serves as the facility survey coordinator for regulatory entities such as OHFLAC, CMS, and TJC.
• Participates in Plan of Correction composition, development, staff education, and organization of deliverables.
• Provides staff education to individual and large scale audiences as part of action plans and plans of correction to maintain regulatory standards.

• Communicated with healthcare team members to plan, implement and enhance treatment strategies to assist patients in obtaining the highest health and life potential level for each individual.
• Implemented care plans for patient treatment after assessing physician medical regimens, individual needs, and input from a multidisciplinary team.
• Administered various therapies and medications in line with physician orders and individualized treatment planning.
• Conveyed treatment options, diagnosis information and home care techniques to patients and caregivers to continue care consistency.
• Observed and documented patient factors such as diets, physical activity levels and behaviors to understand conditions and effectively modify treatment plans.
• Oversaw delivery of care for all patients on nine-chair dialysis unit, providing direct care to up to twenty patients, delegating nursing assignments and supervising team comprised of nurses, LPNs, dialysis technicians, and unit clerks.
• Maintained physical condition of facilities, applying available resources and personnel to achieve safe, clean and functional environment.
• Conducted infection risk assessments, monitored for signs and symptoms of potential infection, conducted and monitored results, and provided prescribed treatment(s).
• Served as point of contact for internal and external customers seeking support and information.
• Assisted Facilities Manager in all aspects of project implementation, including materials procurement, contract preparation and scheduling.
• Kept physical files and digitized records organized for easy updating and retrieval by authorized team members.
• Oversaw appointment scheduling and itinerary coordination for both clients and personnel.

• Prioritized and distributed staff assignments and workload based on individual teammate strengths and experience.
• Supervised staff
• Provided mediation staff conflict and disciplinary processes, such as coaching, suspension, and termination of services.
• Participated in the hiring process of staff, including reviewing resumes of, along with scheduling and interviewing potential candidates .
• Coordinated patient care with multiple medical specialists to manage acute and chronic medical conditions.
• Collaborated with a multidisciplinary team in the provision of holistic patient care, with review of effectiveness during weekly and monthly meetings with social work, nursing, and medical staff.
• Plan of Care by assessing readiness to learn, learning styles, and continuous education. Provide learning materials on not only renal care and dialysis but the vital importance of managing each individual's chronic and acute disease processes.
• Integrated logistic systems into company processes to improve operations and manage work orders and price changes.
• Developed highly-efficient administrative team through ongoing coaching and professional development opportunities.

• Medicaid Case Reviewer to support staff during six month transition to a new computer system
• Provided clinical review for medical necessity for hospital admissions.
• Completed continued stay reviews for medical necessity.
• Made referrals to case management for complex cases requiring long term acute stays.

• Completed assigned clinical reviews for medical necessity in order to maintain time sensitive metrics.
• Review areas included acute hospitalizations, elective surgery, imaging, specialized laboratory testing, IMRT treatment, physical and occupational therapy.
• Contacted requesting providers in order to obtain documentation to support medical necessity for incomplete requests.
• Completed reviews in the system in order to generate a prior authorization number and Molina for review areas such as physical and occupational therapy, after collaboration with waiver patient case workers concerning services that may be covered by the waiver budget in order to maintain compliance with WV Traditional Medicaid requirements.
• Complete research of physical and occupational therapy visits in order to authorize the correct number of units according to WV Medicaid policy.
• Assisted out of network providers with submitting written requests, including proper clinical documentation.
• Completed reconsideration reviews by investigating the original request and comparing documentation with the new request.
• Prepared cases requiring physician medical review to ensure the lay out was conducive to efficient and timely, returning an authorization to facilities with approved requests and denial letters to cases that did not meet the physician's requirements.
• Reviewed denied requests with facility case managers in an attempt to assist and guide the submitting individual on required clinical documentation in order to provide exceptional customer service.

PROVIDED ASSISTANCE TO PROGRAM DIRECTOR BY:

1. Attending meetings with our subcontractor (WVMI) to discuss policy changes, metrics, and as a liaison between BMS, referring providers, servicing providers, and members to fulfill our contract.

2. Assisted with materials and attended Molina workshops to provide assistance to Medicaid providers statewide.

3. Investigated provider complaints and provided written reports to BMS Medical Director, Dr. Becker.

• Completed the denial or authorization upon Dr. Becker's review of my investigation findings.

4. Developed the EPSDT medical foods process by partnering with key players with WV HealthCheck and Children with Special Healthcare Needs (CSHCN) leading to the birth and evolution of the Medical Foods Data Base.

• Developed written EPSDT request process instructions and educated WV HealthCheck Specialists to provide technical assistance to WV Medicaid providers with detailed instructions concerning required clinical documentation and step by step instructions to complete a request, with the goal to prevent delays or service interruption.
• Attended meetings with CSHCN and WV Health Check to participate in the development of the medical foods data base and discuss special cases in an attempt to resolve delays with providers and members due to technical or compliance issues.
• Collaborated with CSHCN dietician(s) to obtain verification each request packet included the correct formula and amount as designated by the most recent feeding clinic visit.
• Obtained pricing, including units upon CSHCN approval of the medical food request.
• Made referrals to establish servicing providers agreeable the price and units determined by CSHCN, leading to BioScrip becoming the predominant provider for WV Medicaid members.
• Finalized approval by entering the request in the Molina system, creating a WXUTH authorization (manual authorization) allowing the service provider to obtain reimbursement.
• Emailed completion notification with the authorization number provided to BMS, WV Health Check, CSHCN, and the servicing provider.
• EPSDT requests involving non-formulary medications and supplements were completed in cooperation with BMS Pharmacy (Vickie Cunningham).
• Provided direct assistance to providers regarding pharmacy requests.

5. Instrumental with bringing clinical review in house after our subcontractor WVMI could no longer complete clinical reviews after the KEPRO acquisition within a month by hiring, onboarding, and training over 20 registered nurses, along with taking on a clinical review position myself. We were able to complete this heavy lift in less than a month while remaining within our timelines and metrics as dictated by our contract with WV BMS.

Recruited to provide my expertise by the number one hospital in the world to provide support in the expansion of Cleveland Clinic's Medical Intensive Care Unit to a 100 bed unit in a nearly two year travel nurse contract by:

• Provided targeted critical care to patients from all over the world who had exhausted all lower level care facilities.
• Assessed and managed various patient treatments for numerous complex diagnoses requiring intubation, arterial lines, central lines, quinton catheters, CRRT, continuous EEG, multiple critical drips, blood product administration, and bedside procedures for patients who did not have the stability to go to surgery.
• Performed patient treatment according to urgency of condition while multitasking and delegating treatment needs to qualified staff to ensure effective and safe care.
• Served as a charge nurse and preceptor to new hires during the expansion.
• Collaborated with assistant nurse managers to develop oncoming nurse assignments based on evaluation of staffing knowledge, skills, and strengths during charge nurse meetings each shift.
• Participated in facility survey and inspection made by JACHO and CMS during my assignment.

Level I Trauma and Stroke Center

• Assisted patients dealing with traumatic injuries or illnesses, including stroke patients, critically ill, and cardiac patients.
• Performed triage on all incoming patients brought in by EMS and private vehicle to assess physical and mental acuity to determine required level of care.
• Able to complete EKG testing and telemetry monitoring, including interpreting and identifying irregular telemetry readings.
• Assisted in care of patients undergoing various therapies, including critical and non-critical procedures.
• Provided exceptional care up to four high-acute patients needing complex care such as intubation, ventilator initiation and management, critical intravenous drips, blood product administration, TPA initiation and monitoring, resuscitation, conscious sedation for bedside procedures, from the moment the patient enters my assignment until ICU handoff.
• Delivered high level of quality care to diverse populations and ages while overseeing patient admission and triaging based on acuity and appropriate department admission.
• Performed frequent checks on life support equipment and made necessary adjustments to preserve optimal patient conditions.
• IV therapy expert, including difficult sticks, patients requiring large bore access for contrast imaging, blood product administration, traumas, and surgical prep.
• Skilled in accessing ports, set up and care for central venous lines and arterial lines.
• Accurately documented all elements of nursing assessment, including treatment, medications, and medication administration, calling report for admissions and going over instructions for individuals discharged.
• Collected blood, tissue and other laboratory specimens and prepared for lab testing.
• Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
• Implemented interventions, including medication and IV administration, catheter insertion and airway management.
• Communicated with healthcare team members to plan, implement and enhance treatment strategies.
• Explained course of care and medications, including side effects to patients and caregivers in easy-to-understand terms.