Clinical Advisor (Rn)
CurrentCarePlus Health Plans – Miramar, FL / Doral, FLClinical Advisor – RN (03/2011 – Present)This position is responsible for conducting audits of member’s medical records; researching, evaluating and recommending appropriate health care service solutions; working with Medical Affairs and provider partners to develop appropriate action plans; and managing the Peer Review process.• Participated in the HEDIS process collecting and entering data from March to June • Participated in the… Show more CarePlus Health Plans – Miramar, FL / Doral, FLClinical Advisor – RN (03/2011 – Present)This position is responsible for conducting audits of member’s medical records; researching, evaluating and recommending appropriate health care service solutions; working with Medical Affairs and provider partners to develop appropriate action plans; and managing the Peer Review process.• Participated in the HEDIS process collecting and entering data from March to June • Participated in the MRD process for the months of July and August• Managing the CarePlus side of the monthly Peer Review Committee meetings• Provided 4 in-services to employees at the Doral office on the Referral Process to the Quality Department• Text Mining Committee Member• Provides comprehensive reviews of quality of care cases within the 90-day guidelines• Proficient with medical record reviews Show less