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Kimberly
kccoleman77@gmail.com
904-626-4948
43062 Thomas Creek Road
Callahan, FL 32011
Hedis Quality Nurse Reviewer
11 years experience W2
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Average rating
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Summary

Five years of experience in chronic care education at family care practice. Two years in HEDIS Quality Reviewing. Maintain strong reputation for achieving high levels of patient satisfaction. Ensure timely and complete follow-up of noncompliant medical records and multi-task with problem solving skills to ensure production and meeting daily goals.

Skill Highlights

  • Committed to chronic care management
  • Committed to compliance reporting
  • Effective policy and program development
  • Excellent telephone etiquette
  • Familiarity with disease management
  • Ability to prioritize work task to adhere to deadlines

Experience
HEDIS QUALITY NURSE REVIEWER
Insurance
Jan 2018 - May 2018
  • Computer skills including Microsoft office, Mediconnect, Members 360 and Verscend (Rapid)
  • Abstracting measures: WCC, CDC, CBP and IMA
  • Knowledge of HEDIS/Medicare guidelines
  • Work from home maintaining daily productivity and timeframes
Medicare HEDIS Nursing MS Office
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Supplemental Data Set Reviewer
Insurance
Jul 2017 - Dec 2017

  • Responsible for downloading, reviewing records from Availity for HEDIS attestation.
  • Document results in SharePoint for ABA, BCS, COL, CBP, CDC and OMW.
  • Review all data in SharePoint prior to submitting to the auditor.
  • Participation in closing measure GAPS in an effort to build compliance
HEDIS Audit Compliance
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HEDIS Quality Nurse Reviewer
Insurance
Jan 2017 - May 2017

  • Knowledge of HEDIS and Medicare guidelines
  • Knowledge of STARS program
  • Computer skill, including Microsoft office. Able to navigate through multiple systems and screens
  • Experience with maintaining daily productivity, meeting compliance standards and timeframes
  • Research and review patient records to establish meeting criteria
Compliance Medicare HEDIS Nursing MS Office
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Clinical Nurse Consultant
Professional/Consulting Services
Apr 2014 - Sep 2016
Saint Augustine, FL

  • Provides clinical insight, experience and knowledge for a variety of projects related to healthcare transformation
  • Provides education to senior leadership
  • Physician and provider support for chronic disease management
  • Facilitate processes and improve projects for training needs, plan and conduct training workshops.
Nursing
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LPN, Diabetes Educator and Health Coach
Healthcare
Feb 2011 - Oct 2015
Jacksonville, FL

  • Piloted and launched the first Health Coach position
  • Disciplined, energetic employee who quickly establishes rapport with patients and colleagues
  • Provide individualized diabetic education to patients to improve their diabetes self-management skills using current clinical guidelines adapted to patient learning style and literacy level
  • Assisted with curriculum design for Health Coach training program using evidence-based practice guidelines
  • Assisted with management of the Health Coach team who guided patients toward healthy lifestyle changes
LPN Diabetes
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Edit Skills
Non-cloudteam Skill
Education
not provided 1998
Certifications
Licensed Practical Nurse in the State of Florida
Certified Health Coach through the National Society of Health Coaches
CPR certified through American Heart Association
Certified in Honoring Choices for Advance Directives
Skills
Diabetes
2015
4
LPN
2015
4
Nursing
2018
3
HEDIS
2018
1
Audit
2017
1
Case Management
0
1
Compliance
2017
1
Medical Records
0
1
Medicare
2018
1
MS Excel
0
1
MS Office
2018
1