Clinical Practice Consultant Resume Sample
Genevieve Mayer
36590 Dianna Corner,
New York,
NY
+1 (555) 799 0007
Work Experience
Senior Clinical Practice Consultant
03/2018
-
PRESENT
Philadelphia, PA
- Provides leadership and expert consultation on the design, development, and implementation of programs related to the expertise area. Serves as the content expert of the responsible technical area(s) and provides technical assistance and advice
- Leads a group of consultants, analysts and/or staff focused on the delivery of service/products within the responsible technical area(s). Provides leadership and direction for the technical area(s) in accordance with the overall strategic direction of the group
- Accountable for successful deployment of UHC’s Clinical Support program at the practice level, including but not limited to, introducing and educating practices on the value/use of reporting tools and delivery of reports via UHC’s Physician Portal
- Work with the practice and Optum to align and integrate Optum care/disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
- Documents and refers providers’ non-clinical/service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
- Works with providers on standards of care and advises providers on established clinical practice guidelines and appropriate documentation and billing consistent with state specific measures and technical specifications
- Supports continuum of member care by identifying members in need of health education and / or services (case management, etc.) and refers members to the appropriate internal departments per policy
Clinical Practice Consultant
07/2011
-
01/2018
San Francisco, CA
- Visit providers’ offices to educate them on clinical measures
- Documents and refers providers’ non - clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
- Works with the practice and Optum to align and integrate Optum care/disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
- Establish and maintain a supportive, collegial role with assigned PCMH practices
- Facilitate efficient, effective practice improvement meetings
- Maintain databases directly associated with role
- Assist and support leaders in summarizing and disseminating experience-related learning by way of team updates, written reports/articles, and/or presentations as called for by directors
- Educates providers and office staff on proper clinical documentation, coding and billing practices, state-mandated quality metrics specifications, provider profiling and pay for performance measurement and medical record review criteria
Hedis Clinical Practice Consultant
04/2006
-
04/2011
Philadelphia, PA
- Documents and refers providers non-clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
- If required, supports state specific medical record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection or for other focus studies as directed by the Plan Quality Director
- Works with the practice and OptumHealth to align and integrate OptumHealth care/disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
- Feedback to appropriate team members where issues are verified and monitors resolution to conclusion
- Based on medical record audit findings, provides follow-up education, practitioner intervention and measurement as needed to drive quality improvement
- Documents and refers providers’ non-clinical / service issues to the appropriate internal parties, to include Provider Relations and the Plan Chief Medical Officer
- Work with the practice and Optum to align and integrate Optum care / disease management programs and population health services to augment the practice’s capabilities, support their care management efforts and add value to the patient care experience
- Participates, coordinates and / or represents the Health Plan at community based organization events, clinic days, health department meetings, and other outreach events focused on quality improvement, member health education and disparity programs as assigned
Education
Union Institute and University
2002 - 2006
Bachelor's Degree in Science
Professional Skills
- Selling skills; Proven ability to use consultative selling approach
- Strong data management and / or project management skills
- Basic skills in PowerPoint
- Clinical experience, or other relevant experience-
- Recent HEDIS experience working with chart chasing, record abstractions, and inter-rater reliability
- Experience working with dual eligible LTC members
- Clinical experience in any setting (with at least 1 year of acute care)
How to write Clinical Practice Consultant Resume
Clinical Practice Consultant role is responsible for powerpoint, oncology, training, reporting, design, consulting, research, insurance, travel, events.
To write great resume for clinical practice consultant job, your resume must include:
- Your contact information
- Work experience
- Education
- Skill listing
Contact Information For Clinical Practice Consultant Resume
The section contact information is important in your clinical practice consultant resume. The recruiter has to be able to contact you ASAP if they like to offer you the job. This is why you need to provide your:
- First and last name
- Telephone number
Work Experience in Your Clinical Practice Consultant Resume
The section work experience is an essential part of your clinical practice consultant resume. It’s the one thing the recruiter really cares about and pays the most attention to.
This section, however, is not just a list of your previous clinical practice consultant responsibilities. It's meant to present you as a wholesome candidate by showcasing your relevant accomplishments and should be tailored specifically to the particular clinical practice consultant position you're applying to.
The work experience section should be the detailed summary of your latest 3 or 4 positions.
Representative Clinical Practice Consultant resume experience can include:
- Supports efforts with clinical team to research and design educational materials and programs for members and in practitioner offices; serves as liaison with key vendors supporting HEDIS / State measures; coordinates with vendors to facilitate initiatives to improve HEDIS / State measure rates
- Coordinates and performs onsite clinical evaluations through medical / treatment record audits to determine appropriate coding and billing practices, compliance with quality metrics, compliance with service delivery and quality standards
- If required, supports state specific medical / treatment record collection and abstraction processes to drive optimum measurement and quality metric reporting during ambulatory medical record review, HEDIS data collection, or for other focus studies as directed by the Plan Quality Vice President
- Acts as strategic partner with participating practitioners and practice staff in assessing trends in quality measures and identifying opportunities for quality improvement
- Ervice delivery system or managed care setting experience
- Experience working with value based care programs such as PCMH or ACO or Population Health Programs
Education on a Clinical Practice Consultant Resume
Make sure to make education a priority on your clinical practice consultant resume. If you’ve been working for a few years and have a few solid positions to show, put your education after your clinical practice consultant experience. For example, if you have a Ph.D in Neuroscience and a Master's in the same sphere, just list your Ph.D. Besides the doctorate, Master’s degrees go next, followed by Bachelor’s and finally, Associate’s degree.
Additional details to include:
- School you graduated from
- Major/ minor
- Year of graduation
- Location of school
These are the four additional pieces of information you should mention when listing your education on your resume.
Professional Skills in Clinical Practice Consultant Resume
When listing skills on your clinical practice consultant resume, remember always to be honest about your level of ability. Include the Skills section after experience.
Present the most important skills in your resume, there's a list of typical clinical practice consultant skills:
- Experience with Dual Eligible Special Need Plans (D-SNP)
- Experience as an RN
- At least 6 months of Quality Improvement experience, HEDIS
- Experience in complex populations-Pediatrics
- HEDIS experience and / or knowledge
- Medicare / Medicaid experience
List of Typical Experience For a Clinical Practice Consultant Resume
1
Experience For Senior Clinical Practice Consultant Resume
- Analysis, review, and reporting on key metrics to assist providers in meeting quality standards, state contractual requirements, and pay for performance initiatives
- Identifies patient care opportunities and collaborates with physician practices to ensure appropriate member appointments and care
- Identifies population-based member barriers to care and works with the QMP team to identify local level strategies to overcome barriers and close clinical gaps in care Reports individual member quality of care concerns or trends of concern to the Health Plan Quality Director
- Front Facing Practice Level Leadership
- Supports medical record collection and abstraction processes to drive optimal measurement and quality metric reporting during HEDIS data collection or for other focus studies as directed by the Plan Quality Director. Based on medical record audit findings, provides follow-up education, practitioner intervention, and measurement as needed to drive quality improvement
List of Typical Skills For a Clinical Practice Consultant Resume
1
Skills For Senior Clinical Practice Consultant Resume
- Business acumen; knows how to use both formal and informal channels to get things done; is familiar with and upholds policies, practices and procedures; uses good judgment in deciding how best to achieve results within the Company
- Communication; speaks and writes clearly and succinctly to convey messages with the desired effect. Is a good listener who understands that effective communication is a two- way process that requires an understanding of the audience
- Customer focus; holds self accountable for meeting expectations and requirements of customers; actively incorporates customer feedback into practices; makes customer central to thinking and challenges others to do same; takes opportunities to build relationships with customers to gain and maintain trust and respect
- Collaborative; is a respectful and inclusive team member who works well with others. Seizes opportunities to work collaboratively to achieve shared goals. A cooperative individual who shares information and helps others
- Drive for results; can be counted on to achieve goals successfully; quickly assimilates information; regularly delivers on expectations; holds self responsible for execution; bottom-line oriented and is accountable for results
- Intermediate Microsoft skill including Word, Excel, and PowerPoint
- Health insurance industry experience, including regulatory and compliance
2
Skills For Clinical Practice Consultant Supervisor Resume
- Strong operational background in Maternal Child Health
- Clinical or HEDIS experience
- Conducts targeted clinical education using approved materials related to HEDIS / State Specific quality measures for provider and staff during field visits
- Proficiency with Microsoft Office applications, including: Word, Excel and PowerPoint
- Maintains all required Vendor Credentialing requirements with assigned medical
- Participates in required sales training to maintain technical expertise related to USB portfolio as well as competitive products
- Organization agility; know ABC and industry policies, practices, technology and information
- Integrity & Trust; direct, truthful individual who upholds the highest standards for ethical and compliant behavior
3
Skills For Hedis Clinical Practice Consultant Resume
- Experience in at least one of the following: quality improvement, practice management, medical management, health care analytics, managed care contracting OR experience in a primary care or multi-specialty practice that has successfully implemented PCMH or ACO programs or quality improvement initiatives
- RN in state of Nebraska
- RN in state of Florida
- RN in state of Ohio
- An active, unrestricted RN license is required in the state where the position is located
- An active, unrestricted RN license is required in the state of residence
- Experience in quality and performance improvement working for a health plan or in a primary care or multi-specialty practice, including medical management, healthcare analytics, and/or managed care contracting in a PCMH or ACO setting
4
Skills For Senior Clinical Practice Consultant Infusion Resume
- At least 4years of experience in quality and performance improvement in a primary care or multi-specialty practice, including medical management, healthcare analytics, and/or managed care contracting in a PCMH or ACO setting
- Willingness to travel up to 50% for face to face meetings in the markets of NC and SC
- Willingness to travel up to 50 % for face to face meetings in the markets of Alabama and Louisiana
- Willingness to travel up to 50% for face to face meetings in market and nearby states to include TN, NC and SC
- Willingness to travel up to 25% for face to face client meetings
- Current unrestricted RN licensure required in state of Nevada
- RN, LPN or Foreign Medical Graduate
5
Skills For Clinical Practice Consultant Resume
- RN with an active unrestricted license in Florida or Foreign Medical Graduate
- Proficient in Word and Internet
- Reliable transportation to travel to physician offices
- Work independently and within an integrated team in a highly matrixed environment
- Current unrestricted RN licensure in the state of operation
- Proficiency in software applications that include Microsoft Word and Outlook
- Reliable transportation to travel to physician offices locally up to 75% of their time
- Role requires reliable transportation to travel to physician offices locally up to 75% of their time
- Current, unrestricted CA clinical license (LVN/LPN, RN, NP, PA, LCSW, LSW, etc.) required
6
Skills For Senior Clinical Practice Consultant Resume
- Develop and deliver written and verbal communications
- Basic statistical knowledge and application of continuous quality improvement concepts
- Reliable transportation to travel to physician offices locally up to 75% of the time
- Travel locally up to 75% to physician offices
- Current unrestricted RN licensure in the state of Wisconsin
- Travel to physician offices locally up to 75% of their time
- This is a home based position with visits to providers’ offices in the Tampa and Jacksonville Florida area
7
Skills For Clinical Practice Consultant Supervisor Resume
- Serves as subject matter expert (SME) for assigned HEDIS / State Measures and preventive health topics
- Works with key vendors supporting HEDIS / State Measures; consults with vendors to design and implement initiatives to innovate and then improve HEDIS / State Measure rates
- Identifies population-based member barriers to care and works with the team to identify strategies to overcome barriers and close clinical gaps in care
- Educates providers and office staff on proper clinical documentation, coding to close gaps in care, state-mandated quality metrics specifications, provider profiling, pay for performance measurement, and medical record review criteria
- Documents and refers providers’ non-clinical / service issues to the appropriate internal parties
8
Skills For Hedis Clinical Practice Consultant Resume
- Engage members and providers in discussions about member healthcare opportunities
- Work with others to ensure messaging to members and / or providers is appropriate to the audience, complete / accurate, and compliant (e.g., with external/internal regulations and protocols)
- Work cross-functionally, assessing trends in quality measures and identifying opportunities for quality improvement
- Collect Quality data and / or information based on applicable standards, including HEDIS, state / federal or other regulations
- Analyzes and interprets data or information (e.g., clinical, administrative) to ensure they meet standards, are compliant and / or are accurate and complete
- Work to identify and implement local level strategies to overcome barriers and close clinical gaps in care
- Conducts clinical quality audits and support NCQA requirements
9
Skills For Senior Clinical Practice Consultant Infusion Resume
- Educates prescriber offices on competitive advantages to USB approach, to include products, clinical benefits, capabilities and drug techniques
- Onboards new prescriber offices to USB services; educates staff on technical aspects of products, applications of USB Portal, and builds capabilities to administer and prescribe USB products
- Responsible for account management of prescriber offices by developing long-term relationships and influencing prescriber offices to switch to USB drugs based on clinical benefits
- Reduces complexity and burden on prescriber offices of referring a patient, stays connected to patients via real-time updates and ensures patient issues are resolved in real- time
- For assigned accounts, understands key stakeholders within prescriber offices, including who are the clinical, financial and other key decision makers, their key issues/concerns, including challenges and opportunities for the oncology portfolio
- Aligns communication and messages with prescriber staff, pharmacy staff, and patients to ensure seamless communication and superior service for the patient
10
Skills For Clinical Practice Consultant Resume
- Develops and maintains productive cross-functional relationships inside and outside USB to share knowledge and leverage synergies within the organization
- Works collaboratively with local Sales team, Clinical Director, internal Operations team, and additional internal departments to meet financial objectives and allocate resources within the geographical area
- Utilizes USB reporting Portal to comply with corporate direction, expand/track current customer business, track and document sales leads and for other purposes as defined by management
- Responsible for ongoing management of provider practice and community education on state specific quality measures
- Works with provider practices to develop action plans to drive quality improvement Educates providers and office staff on proper clinical documentation, coding, and billing practices, CMS mandated quality metrics specifications, provider profiling and pay for performance measurement, and medical record review criteria, to drive quality improvement
Related to Clinical Practice Consultant Resume Samples
Clinical Appeals Reviewer Resume Sample
Work Experience
• This is an office position
• Own problem through to resolution on behalf of the member / provider / facility in real time or through comprehensive and timely follow - up with the member / provider / facility
• Provides expertise or general support in reviewing, researching, i...
Professional Skills
• Experience working in a Telecommuting/Virt...
• Experience working with Insurance Clinical...
• Previous Data entry experience entering la...
Clinical Consultant Resume Sample
Work Experience
• Utilizes Express Scripts’ multiple data analytics programs and tools to monitor and analyze trends in clients’ pharmacy utilization, and collaborates with client and client’s ESI account team to optimize clinical and financial outcomes
• Work experience, preferably with Health Plan experience
...
Professional Skills
• Demonstrated ability to effectively educat...
• Proven success with organization and time ...
• Well-developed interpersonal skills in ord...
Clinical Practice Resume Sample
Work Experience
• Direct all aspects of satellite/department operations
• Responsible for implementation and evaluation of ongoing daily management system including regular attendance at huddles to role model and coach
• Direct work of teammates, including supervision, hiring, and terminations...
Professional Skills
• Demonstrates that he/she has the analytica...
• Work autonomously in managing projects and...
• Interpersonal and leadership skills suppor...
Medicine Resume Sample
Work Experience
• As prescribed by Physician, performs diagnostic studies on patients using scanners or scintillation cameras to detect radiation emitted and to produce image of organ on photographic film
• Manage the Chair’s calendar of meetings, appointments, travel and special events with limited or no consultati...
Professional Skills
• Demonstrate effective written and spoken c...
• Demonstrate appropriate social skills
• Demonstrates knowledge of various Nuclear ...
Emergency Dept Resume Sample
Work Experience
• Provides basic patient care within established guidelines. Assists professional staff with patient care under direct supervision of a Professional Registered Nurse. Documents appropriate and pertinent information on patient care record
• Performs phlebotomy, specimen collection/processing and "...
Professional Skills
• Proven organizational skills. Ability to w...
• Computer skills (IDX). Able to communicate...
• Experience in an emergency services or rel...
Associate Clinical Resume Sample
Work Experience
• Coordinates the processing of ARAMARK’s vendor service contracts from field inception through approvals, purchase order release, annual renewals and expirations
• Establishes or ensures the establishment of work priorities and provides daily supervision and support to all assigned staff
...
Professional Skills
• Strong organizational skills, attention to...
• Excellent verbal, written and communicatio...
• Excellent verbal, written & communication ...