Ph.D. Candidate - Graduate Assistant

• Sep 2019 - Present

Quality Auditor, Registered Nurse – Federal Employee Program (FEP), Clinical Operations

• 2019 - 2019

Conducted quality review of claims, correspondence, FEP membership, and telephone inquiries to ensure accuracy and efficiency across multi-disciplinary lines. ◆ Analyzed claims submitted to determine compliance with the Healthcare Effective Data and Information Set (HEDIS), a widely used set of performance measures in the managed care industry, which was developed and maintained by the National Committee for Quality Assurance (NCQA).◆ Performed comprehensive audits on claims, correspondence, membership, and telephone to determine the accuracy levels and assess the efficiency of the operations areas.◆ Collaborated with stakeholders in the national, regional, and corporate level to analyze discrepancies in compliance to ensure and enhance high-quality standards for patient care.◆ Evaluated quality audit procedures, including quality scorecards, matrixes, audit point sheets (MTM), trending, and reporting. Conducted follow-up reviews to ensure that deficiencies have been corrected. ◆ Root Cause Analysis – Identified coding problem between the internal documentation at Horizon and the federal program using data mapping to recognize the error, leading to a coding fix rather than a practice change. ◆ Data Analysis – Evaluated claims using IBM Advanced Analytics 2.0 (IBM Watson) and Microsoft Excel to write queries on demand to determine the current health of the membership and ways to improve the population health for the FEP.

Registered Nurse Case Manager, Federal Employee Program, Clinical Operations and Integration

• 2018 - 2019

Coordinate the delivery of high quality, cost-effective care supported by clinical practice guidelines addressing the entire continuum of care. ◆ Interact and communicate with multidisciplinary teams, either telephonically and/or in-person striving for continuity and efficiency of care.◆ Evaluate care by problem-solving, analyzing variances and participating in the quality improvement program toenhance member outcomes. ◆ Contribute to special projects and to the curriculum in collaboration with Rutgers University Out of Hospital Nurse Residency Program.◆ Quality Improvement – Evaluate function and impact of a newly created non-clinical personal health assistant to engage members in better understanding how to best access medical care and community resources with a referral to a nurse case manager when needed.◆ Utilization Review – Reduce re-admissions and emergency room use by coordinating with existing providers and finding alternative methods of care.

Cancer Registrar, Cancer Registry, Division of Health Informatics

• 2011 - 2017

As Cancer Registrar, read pathology reports and medical records from multiple institutions to create patient care narrative. Translated into standard coding language to accurately compare national data. Maintained strict confidentiality for patients, clinicians, and institutional information. ◆ Monitored and applied up-to-date medical terminology, anatomy, and physiology, ICD-0, SEER Stage, AJCC TNM Staging, FORDS, Collaborative Staging, and Hematopoietic classification systems.◆ Analyzed clinical, pathological, therapeutic, and epidemiologic data using guidelines from the American College of Surgeons, Commission on Cancer, New York State Department of Health, and MSKCC.◆ Integrated prior and current databases within the client systems to provide a single data point of access.

Research Study Assistant, Disease Management System, Telecommuter

• Oct 2008 - 2011

As Research Study Assistant, abstracted information from electronic health records for the Gynecology Team. Maintained cancer-related statistics and explanatory narratives for Gynecology medical staff and administration.◆ Analyzed cancer survivor rates and identified clinical drug trial candidates.◆ Followed up with pathologists, physicians, clinical, and administrative staff to ensure pathology presentations and patient treatment information was current and accurate.