Anu Hendrikson Email & Phone Number

Chantilly, Va, Us

Activehealth Management

I manage to performance measures and standards for quality service and cost effectiveness and I coach team/individuals to take appropriate action. Ensures all complaints and feedback are reported using tracking tool to ensure reporting consistency and trend analysis and follow up completion. Serve as a content model expert and mentor to team in regards to our UM policies and procedures, regulatory and accreditation requirements. Identify trends involving non-clinical and clinical issues and reports on and recommends solutions. Direct and manage continuous quality improvement through measurement, analysis, training and consulting. Improve the quality of products, services, and processes to increase customer satisfaction and lower costs through the application of continuous quality improvement principles and practices. Maintain denial audits, appeals for all clients. Assist is accreditation process for all products such as UM, DM, ALC. Maintain reports presented at Quality Improvement Committee meetings: appeals, denials, complaints, feedback, and analysis of reporting results. Position changed to QM Project Manager and subsequently to QM Complaint And Appeal Project Manager. Analysis and reporting on complaints, appeals and other member services.

Chantilly, Va

Direct and manage continuous quality improvement through measurement, analysis, training and consulting. Improve the quality of products, services, and processes to increase customer satisfaction and lower costs through the application of continuous quality improvement principles and practices. I transitioned from the review of denial audits, and appeals for all clients. I now assist in Regulatory Compliance and Accreditation requirements and reporting for URAC/NCQA accreditation for DM, CM, UM and ALC programs. Maintain complaint logs and ensure timely resolutions while monitoring trends and implementing corrective action plans across all lines of business and departments. Select cases and conduct MD and RN inter-rater reliability testing, analysis of results and participation in ongoing quality improvements based on outcome. Maintain and prepare materials and statistics for all programs for our quarterly and yearly Quality Improvement Committee meetings.

Supervisor responsible for management of medical services staff ensuring consistency in care management interventions across membership (CM, DM, UM). Facilitated effective interfaces among team members, providers, and other departments. Responsible for day to day implementation of policies and procedures.

Provided UR/CM and ICM services to various clients within 2 databases. Also assigned responsibility as primary CM for Maternity program which involved outreach and assessments for contracted members. Duties included: obtaining necessary information from providers and facilities concerning the care being provided to members and determining medical necessity.

Responsible for complete medical, mental and emotional health of Peace Corps volunteers in Estonia. Also did volunteer health training, immunizations, counseling, and education. This was a part time position that required 24 hours/7 days per week on call. Under supervision of physician.

Managed Care of elective inpatient hospitalizations, and concurrent review of emergency admissions. Additionally, working with MD Advisor, and Case Managers to assess, and plan alternate levels of care for patients when appropriate.

Responsible for precertification and utilization review of outpatient procedures and medical appropriateness of selected inpatient procedures. Additional responsibilities included Pharmacy review, infertility procedure precert, dialysis precert, retrospective review of operative and pathology reports for selected procedures, and working with the Medical Director to determine appropriate levels of care/appeals. Promoted from Level 1 Case Manager.

Managed Care Department duties included appeals review for both inpatient cases and home care, chart review for hospitalizations never precertified, and coordination of extra contractual case management-this included negotiation of facility, pharmaceutical, and nursing charges.

Responsible for conducting HMO quality and utilization management program activities on a regional basis. These activities included service authorizations; review for medical necessity, appropriateness, and quality; data analysis; HMO provider orientation and education; provider relations; member quality of care/service complaint resolution; and working with HMO Medical Director and physician peer reviewers to identify, assess and resolve clinical issues.

Provided professional managed care guidance to those customers whose employers elected to participate in the "Managed Care Program". Interacted with customers, physicians, and/or hospitals regarding preadmission review, admission review, ambulatory surgery, concurrent review, second surgical opinion, discharge planning, benefit reductions and appeals. Required direct data entry. Other facets of responsibility included consultation with physician reviewers for cases not meeting medical criteria, updating coordination of benefits data, and directing non-managed care calls to appropriate resources.

Temporary assignments in OB/GYN and Newborn units. Included patient care, medication administration, supervision of Nurses Aides.

Full time Staff R.N. in Level I/II Newborn Nursery/Neonatal ICU. Responsibilities varied from normal newborn care, to admission, care and possible transfer of critically ill newborns to Level III nursery.

Staff R.N. on OB/GYN floor. Responsible for Labor and Delivery, Nursery, GYN, and Postpartum patient care. Duties consisted of admission/discharge of patients; exams; patient history; medication administration; charting; assisting physicians with medical procedures, and supervision of Nurses Aides. Full time for first year, and part time last 6 months while working weekend alternative position at Prince Georges General Hospital.

Responsible for patient care, medication administration, full patient documentation, supervision of LPN's and Aides. Charge Nurse for GYN/Medical Surgical Unit with average patient census of 36. Worked full time upon graduation, after working part time on same unit as Aide while attending school (see below).

Bsn (Bachelor Of Science In Nursing), Nursing, 3.8

BSN

Registered Nursing/Registered Nurse