DCM, RMS, Microsoft Teams, Microsoft Word, Excel
Beth Parks
Lansdale
Summary
Dynamic Quality Analyst Lead with expertise in project management and quality audits. Demonstrated ability to lead initiatives that drive team development and operational excellence, while mentoring junior analysts in best practices.
Overview
29
29
years of professional experience
1
1
Certification
Work History
Quality Analyst Lead
Optum Insight
Eden Prairie, MN
09.2017 - Current
- Created and implemented a quality tool to evaluate the work of the Nurse Case Coordinator
- Led the initiative to revamp the quality tool for physicians who perform concurrent reviews to establish the Optum standard for quality across all work groups
- Led and participated in calibration sessions to ensure interrater reliability
- Performed quality audits at a set metric for both concurrent reviews and denials
- Provided educational feedback to the Nurse case coordinator, physicians and support staff
- Mentored junior analysts on best practices for test case design and execution, fostering team development.
- Created auditor's guidance aligning with the quality tool for both nurses and physicians to serve as a job aide to current auditors and newly hired auditors
- Collaborated with cross-functional teams to identify process improvements, resulting in enhanced operational efficiency.
- Participant in Review Partners to review newly implemented guidance and OCG revisions
- Participated in a fast-tracked training program to learn Clinical appeal based on the company's needs for auditors and trainers to perform Transition QA for onboarding of new clinical appeals nurses
- Provided written and verbal feedback to new trainees learning the Clinical Appeals process
- Participated in daily calibrations to ensure consistency in feedback to maintain the integrity of the Training and Quality program for Clinical appeals
- Complete transition QA for new Clinical Appeals nurses
- Extensive knowledge of MCG application, InterQual criteria and the Book of arguments (internal appeals support)
- Extensive understanding of appeals documents that includes billing, coding, and client-specific requests
Nurse Letter Writer and Nurse Case Coordinator
Optum Insight
Eden Prairie, MN
12.2011 - 09.2017
- Cross-trained in Nurse letter writing when there was a high letter queue, in order ot meet client demands and product deadlines
- Wrote and edited client letters with physician advisor recommendations
- Performed quality checks on determination letters to ensure client satisfaction
- Piloted the nurse case coordinator program, which was a proposed solution to high physician advisor caseload. I was one of 4 RNs selected to embody the role of a physician advisor and perform concurrent review
- Worked closely with physician advisors to evaluate cases for inpatient appropriateness based on internal care guidelines
- Evaluated concurrent cases based on my own medical knowledge along with internal care guidelines to assess for severity of illness and service intensity.
Intake RN
Executive Health Resources
Newtown Square, PA
11.2007 - 12.2011
- Performed live telephonic concurrent case reviews for over 2000 hospitals countrywide
- Worked closely with physician advisors to triage high-priority clients and performed follow-up client calls to streamline the workflow
- Surpassed the standard metric for intake calls per hour, assisting with meeting client expectations and turnaround time
- Escalated client inquiries and issues as needed to enhance client satisfaction
- Served as a weekend Intake RN supervisor, managing 20 live telephonic nurses in a high volume queue
Registered Nurse, Medical-Surgical Unit, Telemetry
Our Lady of Lourdes Medical Center
Camden, NJ
06.1997 - 06.2007
- Charge nurse for 10 nurses in a high acuity telemetry monitored unit, involved with managing staff assignments based on patient acuity, along with reallocation of staff, equipment, and resources based on patient needs
- Administered medications and treatments per physician orders, ensuring patient safety and compliance with protocols.
- Assessed patient conditions, providing timely interventions to enhance recovery outcomes.
- Collaborated with interdisciplinary teams to develop care plans tailored to individual patient needs and preferences.
- Educated patients and families on health management, promoting understanding of treatment options and self-care practices.
- Mentored junior nurses through hands-on training, enhancing their clinical skills and confidence in delivering care.
Education
Bachelor of Science - Nursing
University of Delaware
Newark, DE05-1996
Skills
- Quality management systems
- Auditing techniques
- Standards of care criteria analysis
- Quality Calibration Lead
- Project management
Certification
InterQual certified reviewer in Behavioral Health
InterQual certified reviewer in Acute Medical
Software
Interests
- Cooking
- Gardening
- Mindfulness Practices
- Enjoy hobbies that combine physical activity with outdoor exploration
- Passionate about balancing physical health with mental and emotional wellness
Timeline
Quality Analyst Lead
Optum Insight
09.2017 - Current
Nurse Letter Writer and Nurse Case Coordinator
Optum Insight
12.2011 - 09.2017
Intake RN
Executive Health Resources
11.2007 - 12.2011
Registered Nurse, Medical-Surgical Unit, Telemetry
Our Lady of Lourdes Medical Center
06.1997 - 06.2007
Bachelor of Science - Nursing
University of Delaware
Awards
2019 Optum SuperHero award for exemplifying the core values of Optum