Quality Management Coordinator Resume Samples

Description :

1. Responsible for Peer Review Committees for both campuses, Department Meetings for both campuses, preparing both campuses for JCAHO, HCFA, and Deparetment of Health surveys.
2. Handled occurrence reports for both campuses.
3. Prepared statistical reports for Department Meetings for both campuses.
4. Responsible for discharge planning/case management of the Telemetry unit.
5. Responsible for arranging for short-term care placement, long-term care placement, and short-term rehabilitation placement.
6. Arranged for care home placement for those clients who qualified for this type of care.
7. Collaborated with interdisciplinary teams to improve the elements of the surgical care improvement program.

Experience

7-10 Years

Level

Management

Education

Social Work

Description :

1. Assisted in the implementation, coordination, assessment, evaluation and development of Beacon Health Option's Quality Management and Performance Improvement program.
2. Coordinated the Quality Management Program through problem identification, development and coordination of QM studies and activities, including HEDIS, measurement and analysis of results, and recommendation of solutions.
3. Assisted leadership in the evaluation of these results contributing to the Quality Management Program Evaluation.
4. Worked with Associate Medical Director, Quality Management on development and revision of Clinical Practice Guidelines.
   
5. Assisted management with the revision of Quality Management policies related to NCQA standards.
6. Developed, maintained and enhanced reporting methods to identify trends in physician and member behavior.
7. Completed applicable physician summaries.

Experience

7-10 Years

Level

Senior

Education

AAS In Nursing

Description :

1. Integrated, troubleshot, analyzed, maintained, and cleaned all QDM correspondence in SAP System.
2. Obtained SAP QM Master Data cleansing and verification Planned, analyzed and executed creation and disbursement of Certificates of Analysis for all imported and domestically produced products.
3. Maintained specifications, layouts, errors and holds for products from business units.
4. Assisted in creation of new materials for, IPG, SCP, TRP, LEA, and TPC imports.
5. Responsible for maintaining all customers' information in Customer Master data files and additional special identification coding.
6. Established customer data to support sales and reporting.
7. Maintained customers for conglomerates and sales alignments for use in sales/accounts receivable reporting.

Experience

2-5 Years

Level

Junior

Education

Bachelors Of Science

Description :

1. Started in our Business Office as a Patient Representative, answering phones, appealing insurance and helping patients with their billing questions.
2. Promoted to Surgery Scheduling for our busiest location which included helping schedule patient appointments, verifying and authorizing insurance, etc.
3. Promoted to Surgery Coordinator for that location responsible for coordinating patient surgery schedules, flights for doctors to rural areas, nursing schedules, etc.
4. Provided analytical support and master data maintenance for SAP system through use of electronic data queries/analysis.
5. Monitored flow of data from global master data reference server to SAP system.
6. Reviewed admission and -stay cases based on hospital criteria guidelines Referred cases to the physician advisor, as necessary Performed telephone-.
7. Coordinated and maintained performance improvement program for multiple department and committees.

Experience

10+ Years

Level

Senior

Education

Infection Control

Description :

1. Oversaw clinical practice workflow, documentation, and process issues and concerns, and provides leadership and guidance to define system and process requirements that will optimize clinical and system performance to include technology utilization by clinical practitioners.
2. Supported the physicians, clinicians, health care workers, affiliates and partners by providing continuous leadership provision through structured data analysis identifying opportunities for clinical information system improvements.
3. Responsible for quality scores, increased performance and efficiencies, utilizing Lean, Six Sigma, and informatics approaches to understanding processes and data.
4. Participated in AQI data analysis.
5. Responsible for managing the uplift of the perioperative surgical home program to include modular and service line implementation of care pathways, aligned preoperative testing, and ERAS.
6. Worked knowledge of CMS and private payer matrix, PQRS requirements, MIPS, and MACRA requirements for and beyond.
7. Promoted future and present system functionality by designing, building and testing the clinical information systems.

Experience

10+ Years

Level

Senior

Education

Doctor Of Nursing Practice

Description :

1. Worked with departments and management to develop all forms used by the agency.
2. Updated forms as rules and regulations change and kept up-to-date forms on the agency's Intranet for access by all staff.
3. Used sound judgment to independently compose all internal and external correspondence sent from the QM Department in regards to policies and procedures, corrective action plans, new procedures or forms, request for waivers or variances, request for information from other agencies/companies, applications for permits for new programs or facilities, responses to inquiries from other departments or companies, etc.
4. Worked with Program Managers to develop manuals and training materials for use by other departments.
5. Handled all consumer complaints that could not be handled at the department level and were referred to the QM Department; this included conducting investigations if necessary.
6. Effectively served on committees and task forces as management's representative as required and accurately reported information as conveyed at meetings, conferences, and/or training sessions to supervisor and/or other staff if required and in a timely manner.
7. Coordinated managerial and administrative meetings to include requesting agenda items; preparing meeting minutes, agenda, and handouts.

Experience

5-7 Years

Level

Executive

Education

Executive Secretarial Program

Description :

1. Performed clinical outcome analysis and reports for medical staff committees.
2. Reviewed physician documentation vs.
3. coded data to ensure consistency and accuracy of reported clinical and administrative data.
4. Wrote annual PI reports, made story boards to show QM improvement projects.
5. Accreditation preparation, regulatory compliance, and related special projects.
6. Served as Tumor Board Coordinator.
7. Performed root cause analysis and sentinel event reviews.
8. Trained nursing staff on how to review records for quality indicators.

Experience

2-5 Years

Level

Executive

Education

Health Information Administration

Description :

1. Provided day to day operational functions.
2. Managed timekeeping for the department.
3. Worked with Vice President, Compliance Director and Attorneys to coordinate all legal activities reviewing on-going open/closed cases.
4. Facilitated litigation cases and prepared quarterly claims meetings with Insurance Company and attorneys.
5. Developed a daily rotation system with Case Managers on calls received from our ER/Obstetrician Department.
6. Complied transfer logs and monthly statistical reports and prepared agenda for Quality Council meetings.
7. Reviewed results, demand and appeal letters from CMS (Centers for Medicare & Services) including RAC(Recovery Audit Contractors) appeal letters submission to Patient Accounts Department for further investigation.

Experience

2-5 Years

Level

Executive

Education

Bachelor's

Description :

1. Facilitated performance goal-setting, established performance indicators, coordinated improvement projects throughout agency.
2. Chaired Safety Committee and handled incident reports.
3. Followed up on patient and caregiver surveys, tracked survey response data; discussed care issues with family members and followed up with team supervisors.
4. Wrote procedure for management of HIV exposure incidents conforming to OSHA requirements; interfaced with area hospital emergency room staff to secure prompt follow up services.
5. Organized drill for response to natural disasters; coordinated fine-tuning of practices based on lessons learned from drill.
6. Established standards for chart audits based on Medical Director's pain management protocols.
7. Conducted trouble-shooting of pharmacy management software and worked with vendor for correction.

Experience

2-5 Years

Level

Executive

Education

Ph.D. In Leadership

Description :

1. Designed, implemented, and managed disease management programs for Michigan's largest HMO.
2. Conducted studies to assess program impact.
3. Presented on disease management/care management to employers and at conferences/forums.
4. Managed department staffed by registered nurses and administrative personnel with the authority to hire and terminate.
5. Initiated collaborative disease management activities involving multiple community partners.
6. Developed and operated within an annual budget of approximately $1 million.
7. Managed regional quality management activities (NCQA accreditation, HEDIS, CAHPS, focused quality studies, credentialing, peer review, and clinical practice guidelines).
8. Collaborated with Care Management, Customer Services, Provider Affairs and other departments to provide rapid and thorough identification, investigation and resolution of member, practitioner and provider quality related issues.

Experience

2-5 Years

Level

Executive

Education

MS In Progress