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Online Resumes with "Qual "



Registered Nurse with 20+ years experience in the Creedmoor area

A professionally trained Registered Nurse with 20 plus years of experience ensuring high standards of culturally competent care for a wide variety of patients with diverse needs. Recently received my BSN with plans of going on to get my Master’s Degree.

Tags for this Online Resume: Creedmoor, Case management, Geriatric Psychiatry, BSN, Raleigh-Durham, InterQual, Group Therapy

Experienced Registered Nurse -EHR/ICD-9, HEDIS documentation expert

My career uniquely combines a solid understanding of medical health care practice and business management and my goal is to continue as a hospital provider advocate within the medical auditing and clinical documentation career path.

Tags for this Online Resume: Registered Nurse, Medical/Surgical, Home Health, Infusion Therapy, Director of Nurses, CCU/ICU/Telemetry, Documentation Review EHR, Quality Assurance, Telecommute, Medicare Recovery Auditor, IternQual, ICD--9 ICDCCU/ICU/Telemetry, Integrated Case Manager, Quality Assurance/HIM; Healthcare Information & Documentation Manager, Medicare Denials appeal and Managed Care Risk/ medical necessity auditor, InterQual/ICD-9/MCG;Millliman/DRGs/Lean/CMS Guidelines MS Office, telephonic/remote, CCU/ICU/Telemetry/evidence based best practice provider and physican advocate, HEDIS abstractor, internal risk auditor, EHR quality assurance, ICD-9, Interqual/Milliman, clinical coordinator

Environmental Engineer - 1 Years of Experience - Near 21515

Tags for this Online Resume: sanitary engineering, ennironmental engineering, civil engineering, CAD, GPS-X, QUAL2K, SAP2000, QS

Lead over 50 Product Qual at Intel and DEC

Help improve productivity and quality in a creative industry

Tags for this Online Resume: Qualification, Reliability, Statistics, SixSigma, Simulation, DOE

Featured Profile

Medical or Health Services Manager - 20 Years of Experience - Near 75230

Areas of Expertise & Technical Skills * Project Management * Risk Assessment * Regulatory Compliance * Audit Planning * Medical Records Review/Determination * Microsoft Tools & Internet Programs * Stakeholder Communication * Certifications & Accreditations * ICD-9-CM/ICD-10-CM * CPT/HCPCS Codes * InterQual * NCQA & Medicare

Tags for this Online Resume: Assessments, Quality, Documentation, Medical, Management, Medicare, Utilization Management, Compliance

Featured Profile

Army Mental Health Services Manager

A dedicated critical thinker with good judgement, strategic, effective in relationship building with key campus partners, community building, strong communication skills, effectively engage with students and committed advocate with 7 years of hospital and combat stress experience credited with providing compassionate support to soldiers, veterans, and their families to promote resiliency and positive mental health. Drawing ...

Ideal Companies: United States Army, Human Services, VA Hospital

Tags for this Online Resume: Integrate, Support, Cord Injury, Critical Care - Neurology, Management, Neurology, Program Management, Programming, Assessments, Behavioral Health

Case Management Manager - 20 Years of Experience - Near 60409

I am a Nurse Case Management professional with upwards of 16 experience. My experience includes but is not limited to Telephonic Complex Case Management, Occupational Health/Worker’s compensation, and Psychiatric Nursing. Additionally, my proficiency with Utilization Review software, namely InterQual criteria and guidelines as well as Epic allows me the opportunity to make determinations on admissions, prior authorization, ...

Tags for this Online Resume: Utilization Review, ICD-9, Health Care Industry, Interqual, MCG, Communication Skills, Computer Aided Software Engineering, Patient Care, Coding, ICD-9, Health Care Industry, Management, Benefits, Communication Skills, Computer Aided Software Engineering, Patient Care, Utilization Review Nurse, Allscripts, Powerchart, Epic, EMR, CPT Codes

Analyst - 20 Years of Experience - Near 06851

Extensive industry experience/expertise in telecommunications technology consumer products financial services and automotive QUALIFICATION SUMMARY Sales Experience Achievements: * Matched or exceeded budgeted revenue targets in 13 out of 14 years with P&L responsibility * Expanded telecom business by 250% in 5 year period at J.D. Power * Three-time consecutive sales award winner (highest sales totals) Two awards for largest...

Tags for this Online Resume: market research, analyst, voice of customer, customer insight, new york metro, business development, Apple, Assessments, Automotive, Best Practices

Case Management Manager - 11 Years of Experience - Near 32162

Professional Summary: I have over 17 years experience in Case Management in the provider setting as Director of Case Management, Lead Case Manager and Key account Manager for Managed Care Companies, Physicians, Hospitals and Home Health Care Agencies. Specializing in admissions and concurrent reviews using Inter-Qual Criteria and MCG on a daily basis to determine decisions of appropriateness of admissions and continued stay...

Tags for this Online Resume: Insurance, Benefits, Home Health, Health Care Industry, Referrals, Compensation, Computer Aided Software Engineering, Assessments, Management, Medication Adherence

Medical or Health Services Manager - 20 Years of Experience - Near 33534

SUMMARY * 15+ years' experience as a clinical professional with a broad range of healthcare experience, talent and expertise also in Medicaid claims reviews programs * Extensive nursing experience in multiple areas (Utilization Review/Managed Care including Inpatient/Outpatient service for Pre-Cert, Concurrent Review, Case Management, Medical Claim/Bill Review, ICD-9/ICD-10 Coding, Hedis Reviews, Home Health Care, School Nu...

Tags for this Online Resume: Medicare, Computer Aided Software Engineering, Management, Injections, Insurance, VITAL SIGNS, Medication Administration, Nursing, Wound Care, D.O.D., Case Manager, Billing, Coding, Auditing, Utilization Review, Manager, Supervisor, Health Services, Nurse, LPN, Trainer

Licensed Nurse - 20 Years of Experience - Near 33610

Healthintegrated - April 18 2016 to May 19 2017 Utilization Review Coordinator Telephonic pre-authorization of procedures over the phone for inpatient and outpatient utilizes clinical skills to support the coordination documentation and communication of medical services and/or benefit administration determinations. Critical competencies include flexibility professionalism as well as clinical knowledge with claims. InterQual...

Tags for this Online Resume: Back Office, LPN, Drug Screen, Home Health, Injections, Management, Nursing, Patient Care, Patient Education, Policies and Procedures