Joanicely Gonzalez
Coamo
Summary
Self-motivated professional accustomed to handling sensitive and confidential records while thriving in deadline-driven environments. Polished in developing information systems for medical establishments to provide top-quality care. Valued contributor focused on accurately capturing, storing, securing and wielding healthcare data.
Overview
11
11
years of professional experience
Work History
Quality Review Analyst - HEDIS
Triple S Salud
09.2015 - 01.2023
- Consulted professional standards of care, scientific evidence and practice to evaluate health care programs.
- Assisted in achieving compliance with NCQA standards by identifying areas for improvement in healthcare delivery.
- Utilized advanced analytical skills to identify and resolve discrepancies in reported HEDIS measure results.
- Implemented healthcare systems for patient status monitoring, quality tracking and home care management.
- Ran quality metrics reports to maintain high standards of virtual care.
- Participated in ongoing professional development opportunities to stay current with industry best practices for HEDIS review and reporting.
- Identified potential barriers to care through careful analysis of medical records, facilitating targeted interventions for at-risk populations.
- Managed digitization of paper records.
- Developed strong relationships with healthcare providers through effective communication and professional collaboration during the review process.
- Operated computer-based systems to retrieve and store information and records.
- Performed root-cause analyses on identified gaps in care, leading to targeted strategies for improving health outcomes among beneficiaries.
- Analyzed electronic health records to identify areas for care improvement and cost reduction.
- Maintained strict adherence to HIPAA regulations while handling sensitive patient information during the review process.
- Supported continuous quality improvement initiatives by analyzing trends and patterns in HEDIS measures.
- Enhanced accuracy of HEDIS reporting through meticulous documentation and validation of collected data.
- Researched and validated clinical data.
- Collaborated with healthcare providers to ensure timely submission of required documentation for HEDIS review.
- Improved HEDIS performance by conducting thorough medical record reviews and data extraction.
- Worked flexible hours across night, weekend, and holiday shifts.
- Ensured compliance with regulatory requirements by meticulously reviewing documentation and maintaining accurate records.
- Compiled and distributed weekly feedback to team leaders and managers to improve service time and quality while increasing productivity.
- Developed and maintained quality assurance procedure documentation.
- Optimized resource utilization by effectively prioritizing tasks based on project timelines and risk assessment outcomes.
- Managed competing priorities effectively, ensuring timely completion of all assigned HEDIS review tasks.
- Participated in team projects, demonstrating an ability to work collaboratively and effectively.
RN Case Manager
Torres Colon & Associates
09.2011 - 09.2015
- Increased referral rates by providing excellent service and building meaningful relationships with patients and caregivers.
- Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
- Educated patients and families on available community resources, facilitating access to necessary support services.
- Coordinated care conferences with interdisciplinary team members, ensuring all perspectives were considered in the development of comprehensive treatment plans.
- Gathered and recorded patient health information and data to assess, identify and manage characteristics that affect care outcome.
- Collaborated closely with physicians to develop individualized treatment plans, supporting optimal patient outcomes.
- Participated in quality improvement initiatives aimed at enhancing the delivery of nursing care within the organization.
- Monitored patient reactions after administering medications and IV therapies.
- Quickly responded to situations impacting safety and security to unit, actualizing crisis prevention interventions to control and de-escalate situations.
- Promoted adherence to treatment plans by conducting regular follow-up visits and providing ongoing support to patients.
- Evaluated the effectiveness of implemented interventions periodically, adjusting treatment plans as needed to promote optimal patient outcomes.
- Evaluated patient histories, complaints, and current symptoms.
- Documented treatments delivered, medications and IVs administered, discharge instructions, and follow-up care.
- Led teams in driving successful patient outcomes by prioritizing standard of care and best practices.
- Observed, monitored, and reported changes in patient condition to supervising RN or physician in accordance with policies and procedures of medical facility.
Education
Bachelor of Science - Nursing
NUC University
Ponce, Puerto Rico07.2015
Associate of Science - Nursing
Ponce Paramedical College
Ponce, Puerto Rico12.2010
Skills
- Project Planning
- Decision-Making
- Project Management
- Training and Onboarding
- Information Security
- Quality Improvement
- HEDIS Compliance
- Clinical process knowledge
- Metrics analysis
- Data collection techniques
- Medical record review
- Healthcare management
- Audit preparation
- Clinical Quality Measures
- HIPAA knowledge
- Quality Assurance
- Health plan operations
- Information Protection
- Workflow Processes
- Patient Care Coordination
- Information systems improvements
- Remote Office Availability
- Excellent Communication
- Friendly, Positive Attitude
- Organization and Time Management
- Calm Under Pressure
- MS Office
- Dependable and Responsible
- Multitasking Abilities
- Self-Directed
Affiliations
- CPEPR
Languages
English, Spanish
Native language
Timeline
Quality Review Analyst - HEDIS
Triple S Salud
09.2015 - 01.2023
RN Case Manager
Torres Colon & Associates
09.2011 - 09.2015
Bachelor of Science - Nursing
NUC University
Associate of Science - Nursing
Ponce Paramedical College
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