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Carol
carol.hirn@yahoo.com
906-428-1935
Greenville, WI 54942
Quality Improvement Coordinator (Remote)
13 years experience W2
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Summary

Experience
Quality Improvement Coordinator (Remote)
May 2015 - Mar 2020
Appleton, WI
Continuity and coordination of care for chronic patients with chronic disease and comrbidities
  • Medicare Appeals and Grievance nurse including holiday rotation
  • knowledgeable regarding Medicare LCD and NCD's, Hayes, MCMC, MCG, EviCore and Maximus.
  • Ensure compliance with NCQA, HEDIS, CMS, HIPPA, Medicare and other regulatory mandates
  • Integral HEDIS abstractor for annual quality measures including medical record review, analysis and presentation of data outcomes and brainstorm process improvements
  • Primary past Medicare utilization management coverage as needed
  • Abstraction of quality information from client records from federal and private records to ensure clients receive wellness benefits, preventative screens, disease management, and improve quality of life
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EPRP Quality Improvement Nurse (Remote)
Medical Devices
May 2009 - May 2015
Charleston, WV
Data abstraction per internet access of VHA complex veteran's computerized health record
  • Utilized review, auditing and data analysis for compliance with VHA/JACHO guidelines
  • Provided assistance with data abstraction at VA sites across the United States
  • Assessed disease management, health and wellness promotion, case management of care, health information management of veterans utilizing the VA healthcare system
  • Collaborated with VA EPRP liaison /supervisory staff to ensure that all information collected was accurate, clear and concise for monthly compiled statistical reports filed with the VHA
  • Compiled and disseminated statistical information to improve processes involving patient care at periodic exit conferences with physicians, administrators, supervisors and IT staff
  • Coordinated the development of action plans to improve processes identified deficient
  • Periodic travel for training's, to facilities and receive updates of VHA/JACHO guidelines
  • Secured governmental security clearances in order to function within the governmental system
Case Management Nursing
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Education
Nursing
Northern Michigan University
Skills
Case Management
2015
6
Nursing
2015
6