• Responsible for responding to client concerns related to quality• Responsible for analyzing data and developing and managing action plans related to trends• Oversight of CMS validation, measure updates, audit results and regulatory changes• Partnered with subject matter experts to develop and deploy education for clinical team members; including pre-hire testing, orientation programs, and ongoing education• Actively driving change by improving processes in support of the Quality Program

• Direct management of Team Leaders and abstraction staff, overseeing orientation and providing ongoing performance feedback. Monitoring and assessing quality and efficiency of staff providing feedback and education when necessary.• Assisted in new client implementations and collaborated with other team members to successfully start up new clients. Accountable for quality program for service line. Optimize staff utilization and team efficiency, collaboration to maintain client satisfaction.• Subject matter expert – staying up to date with regulations and abstraction changes• Identify and assist in development of processes to improve efficiency and client satisfaction,

• Responsible for monitoring and managing client satisfaction, meeting client deadlines, managing/implementation of new clients, coordinating abstractions and assignments, completing and monitoring ongoing IRR for each client• Responsible for monitoring backlog cases and implementing action plan for the completion of cases, monitoring for performance issues and developing performance improvement plans when needed, monitoring pending cases and abstractor hours, monitor and assist abstractors when needed to obtain maximum abstraction efficiency

• Responsible for all physician peer review activities within the facility. • Responsible for Coordinating and conducting the Peer Review Committee • Organize and Manage Performance Improvement Committee meeting monthly.• Day to day responsibilities include: Performing routine chart reviews for procedure complications/appropriateness/various other required indicators, mortalities, cardiac, pathology/radiology discrepancies, etc. These mentioned are only a sample of the reviews • Assist with various regulatory activities, reviews as well as risk management; Assist with Planning and implementing changes as may be required due to regulatory and risk identified items.• Oversee and assist with maintaining all performance improvement activities within the facility; Evaluation of the performance improvement activities.• Collect, aggregate and report quality data• Educate/train clinical, non-clinical and physicians on quality, performance improvement and standards of care.• Maintained facility’s registries • Developed and maintained facility’s CMS required OPPE/FPPE processes• Developed and implement the current process for electronic physician quality files.

•Responsibilities included having knowledge of all events and activities affecting the quality of care patients received and ensure that patient care outcomes are measured and monitored on a consistent and reliable basis. •Responsible for reporting to multiple medical staff committees including Medical Executive Committee and hospital administration about intervention opportunities to improve care based on the results of hospital measuring and monitoring activities. Responsible for facilitation of multiple medical staff committees including Quality Steering Council.•Coordinated the collaborative process by which medical staff and hospital administration formulate strategies and policies/procedures to ensure the delivery of high-quality, cost effective care. Responsible for daily review and analysis of case mix index reports and to report findings to the physician advisor when noted Case Mix Index exceeds geometric means.•Through the day to day operations of case management; assured that the facility: (1) Provided high-quality, cost-effective medical care services to the patients; (2) Implemented evidence-based disease management and/or clinical protocols, pathways, or order sets/initiatives; (3) Achieved and sustained compliance with the regulations of all Federal, State, local, and other regulatory bodies; (4) Continuously monitored the outcomes of medical staff and hospital operational clinical care activities, to identify opportunities for improvement; (5) Documented the results of clinical activities as required by regulatory bodies, patients, senior management, and third-party payers; and (6) Assured the Hospital Case Management activities were effective in maximizing third-party payer reimbursement.•Responsible for oversight of day to day clinical case management operations including data collection for core measures and other performance measures as set by administration and the medical staff

• Responsible for supervision of all department case managers and social workers in the day-to-day performance of case management activities, as well as performing day-to-day activities of case management. • Ensured efficient daily departmental operations by determining staffing assignments as needed for coverage of all patient care units related to patient census and continually evaluate department operations to assure departmental goals and productivity standards are met.• Facilitated Utilization Review Committee activities which focused on patients that had a LOS > 4 days. This committee was chaired by the Physician Advisor and attended by Administration, Home Health, Hospice and case management. Each case manager was responsible for discussion of patients on their units that have a LOS > 4 days and/or resource utilization issues that needed input from the physician advisor.• Responsible for day-to-day communication with case management staff and physicians regarding the continuum of care for the patients for which we rendered care.

• Responsibilities included oversight of the day-to-day activities of the nursing/nursing assistant staff, scheduling and staffing, problem solving, chart reviews, staff coaching and counseling, weekly patient care meeting, and staff performance evaluations.• Responsible for supervision in excess of 30-35 nurses and nurse assistants

• Responsible for case managing the health care of approximately 25 to 30 patients. Scheduled their visits, performed nursing skills in their homes, and administered intravenous antibiotic therapy, blood transfusions and chemotherapy in the home. I was one of 3 employees at the company who was able to place Peripherally Inserted Central Catheters. Responsible for the initial certification and re-certification of the patient’s home health care every 60 days and managed all physician orders for the caseload. Responsible for taking call two weeks out of every month.