Dr. Maketa Jolly
Coatesville
Summary
Highly motivated LPN with 25 years of experience in a robust variety of nursing roles and settings, most extensively in the area of clinical quality management. Excellent work ethic and exemplary time management skills, demonstrated over my many years of industry expertise. Strong leadership qualities with a passion for teaching. My ideal position is one that focuses on improving access and quality of care to consumers, as well as offers education and corroboration to providers and staff.
Overview
11
11
years of professional experience
Work History
HEDIS Nurse
IntePros Consulting
01.2020 - Current
- Requested, retrieved, abstracted medical records for annual HEDIS project
- Gained experience and proficiency in navigating various types of EMR
- Maintained on-going training to remain current on changes in HEDIS specs and documentation and reporting requirements
- Developed and fostered positive working relationships with multiple providers/provider staff to ensure timely and accurate record submission
- Collaborated with co-workers to ensure efficiency and productivity, and avoid wasted resources
- Maintained proper handling, storage and disposal of PHI to comply with HIPPA laws
Clinical Quality Practice Consultant
Anthem Inc.
05.2016 - 12.2019
- Establish and maintain working relationships with providers (territory: northern New Jersey).
- Communicate performance to providers and assist with setting goals for GIC, PCV and overall quality of care.
- Provide education, support and resources to assist providers with reaching goals.
- Request, retrieve, review and abstract medical records to facilitate year round gap in care closure.
- Participated in 4 seasons of HEDIS project, corroborating with Medicaid team to meet regional goals.
- Performed 3 seasons of CPG audits with a variety of provider types.
- Began with Anthem as a temp via Populous Group and hired to FT position within 2 months.
Clinical Advisor
Humana Insurance Company
11.2013 - 03.2016
- Reviewed submitted clinical information against CMS and/or MCG to determine appropriateness of level of care provided.
- Corroborate with both facility and internal case managers to facilitate safe discharge plans and outcomes for plan members.
- Participate in both virtual and off-site initiatives to develop pilot programs and process enhancements.
- Held appointed position of SME (Subject Matter Expert) within my role, providing assistance to leadership with managing reports, process changes and serving as a resource to my peers and preceptor to new hires.
- Created and proposed ideas and tools that were subsequently adopted by my regional team to improve efficiency in tasks and communication with constituents.
- Maintained an active role in my region's engagement committee, facilitating virtual and live activities to boost and sustain cohesiveness and morale.
- Received both a regional STAR award by my immediate leader, as well as a nomination by senior leadership for a national SUMMIT award for exemplary performance in ensuring member safety.
Education
Associate of Science - Nursing Ongoing
Rowan College At Gloucester County
Sewell, NJDiploma - General Practical Nursing
Upper Bucks County Vocational /Technical School
Perkasie, PA1996
Skills
- Knowledge and understanding of CMS regulations, clinical care guidelines, and HEDIS/STARS/CAHPS measures
- Ability to learn and retain information quickly for practical and logical application
- Strong computer skills
- Ability to problem solve with consideration to all role-perspectives for well-rounded solutions
- Resourcefulness in obtaining information and accomplishing objectives
- Ability to work autonomously, with self-regulation of efficiency and productivity
- Courage and creativity to think outside the box when appropriate
- Passion for teaching and ability to articulate information to align with a given population/individual's learning needs
- Ability to elicit cooperation and lead effectively
- Ability to think quickly and react productively in challenging situations
- Adaptable to change
- Desire to learn new skills and develop competencies
- Confidence in speaking/communicating both interpersonally and publicly
Additional Information
Formerly a Registered Nurse, my experience and abilities well exceed my formal education. I have proven myself as a strong asset in each of my previous positions and earned the respect and praise of employers and co-workers throughout. I have been chosen for assignments, challenges and awards over many, more credentialed colleagues. I have served as a Inter-Rater Reliability Supervisor in a few of my roles and very much enjoy being the motivator behind a great team.
Timeline
HEDIS Nurse
IntePros Consulting
01.2020 - Current
Clinical Quality Practice Consultant
Anthem Inc.
05.2016 - 12.2019
Clinical Advisor
Humana Insurance Company
11.2013 - 03.2016
Associate of Science - Nursing Ongoing
Rowan College At Gloucester County
Diploma - General Practical Nursing
Upper Bucks County Vocational /Technical School
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