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Ipro The Quality Improvement Organiztion For The State Of Ny - Program Review Associate Resume Example

Wyatt Scott
XXX XXXXX XXXXX, West Hempstead,NY 11552
XXXXXXXXXXXXXXXXXXXX
Ph: XXXXXXXXXXXX
Professional Summary

If given an opportunity as a Professionally trained LPN, I am eager to take responsibility to practice and
advocate for quality
healthcare service, demonstrated by my experience, my high standards, strong clinical
skills, my perceived
and unseen ability
Skills
  • Adept at prioritizing/managing deadlines 
  • Analytical 
  • Proficient in all computer programs 
  • BLS certified 
  • Speak French/Haitian Creole 
  • Malpractice insurance active    
Experience
Program Review Associate: May 2011Present IPRO-The Quality Improvement Organiztion for the State of NY: Lake Success, NY
  • Reviews medical records within time constraints to determine medical necessity, appropriateness of utilization, level of care, continued stay, and/or coding and quality issues in accordance with pre-established criteria for timely Medicare case review appeals on behalf of Medicare and its beneficiaries.
  • Conducted and completed HWRDG reviews according to Milliman care guidelines
  • Able to effciently formulate final appeal determination letters to beneficiaries and providers according to the appeal and grievances policy.
  • Ensured HIPAA compliance.
  • Monitor appeal review activities to ensure compliance with protocols and with all relevant local, federal, and state regulatory and institutional polices.
LPN Field Case Coordinator: Mar 2007Mar 2011 Amedisys: Hicksville, NY
  • Work as part of a homecare healthcare team to assess patient needs, plan and modify care, and implement interventions.
  • Provided skilled nursing care to homebound clients that included taking temperatures or blood pressures, dressing wounds, treating bedsores, giving enemas or douches, or performing catheterizations.
  • Collect samples, such as blood, urine, or sputum from patients, and perform routine laboratory tests on samples.
  • Able to provide skilled teaching to homebound clients and educating them on various disease processes  including Parkinson's, Dementia, Diabetes, Cancer, Alzheimer's and Paget's disease.
LPN OnSite Medical Reviewer: Aug 2006Sep 2008 MedAssurant: NY
  • Performed onsite custom QI reviews of medical records and Hedis hybrid chart abstractions for insurance providers. Entered data, such as demographic characteristics, history and extent of disease, diagnostic procedures, or treatment scanned into laptop.
  • Assigned the patient to diagnosis-related groups (DRGs), using appropriate computer software.
  • Compiled medical care and census data for statistical reports on diseases treated, surgery performed, or use of hospital beds.
  • Coordinated Quality Improvement Activities (QIA's) to identify performance areas for improvement by maintaining quality assurance, accuracy and confidentiality
LPN Night Tour Supervior: Apr 2005Jun 2006 Maple Point Assited Living: Rockville Centre, NY
  • Directed and supervised less-skilled nursing or healthcare personnel, and supervised a building of 100 residents, including a dementia unit during the 11pm to 7am night tour
  • Consulted and coordinated with healthcare team members to assess, plan, implement, or evaluate patient care plans.
  • Monitored, recorded, and reported symptoms or changes in patients' conditions.
LPN Part Time Filed Nurse: Jan 2002Apr 2005 All Metro Home Care: Lynbrook , NY
  • Provided skilled nursing care to patients in their home, including geriatric, pediatric and hospice.
  • Promoted and restored patients' health by completing the nursing process; collaborating with physicians and multidisciplinary team members; providing physical and psychological support to patients, friends, and families
  • Observe patients, charting and reporting changes in patients' conditions, such as adverse reactions to medication or treatment, and taking any necessary action.
LPN Part Time Nurse: Oct 2001Apr 2005 Bayview Rehabilitation Center Nursing Home: Island Park, NY
  • Provided patient care or treatments, such as taking vital signs, dressing wounds, treating bedsores, performing catheterizations, trach care, g-tube care
  • Prepared patients for examinations, tests, or treatments 
  • Able to care for ventilator patients
  • Administered prescribed medications or start intravenous fluids, noting times and amounts on patients' charts.
Education
Associate of Science: Registered Nursing, Dec 2014 Excelsior College, NY
High School Diploma: Practical Nursing, Jul 1997 Nassau Tech Boces, Westbury, NY
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Resume Details

This is a real resume for a Program Review Associate in West Hempstead, New York with experience working for such companies as Ipro The Quality Improvement Organiztion For The State Of Ny, Amedisys, Medassurant. This is one of the hundreds of Program Review Associate resumes available on our site for free. Use these resumes as templates to get help creating the best Program Review Associate resume.

Previous Companies:

  • IPRO The Quality Improvement Organiztion for the State of NY
  • Amedisys
  • MedAssurant

Previous Job Positions:

  • Program Review Associate
  • LPN Field Case Coordinator
  • LPN OnSite Medical Reviewer
  • LPN Night Tour Supervior
  • LPN Part Time Filed Nurse

Schools:

  • Excelsior College
  • Nassau Tech Boces

Level of Education:

  • Associate of Science
  • High School Diploma

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