Cherish D.

Background

About Cherish D.

PROFESSIONAL EXPERIENCE Humana 11/2017- Current Manager- Clinical Validation Inpatient Audit • Manage 11 Onshore RN, 42 Offshore RN • Work collaboratively with a team of Medical Directors and Program Owners • Work with ancillary teams implementing Natural Language and Machine Processing Systems • Rethink routine every day with production and metrics Humana/Transcend Population Health Management – Fayetteville, AR 5/2015 – 11/2017 Clinical Quality Consultant • Acted as HEDIS/Quality SME; worked with clinical/non-clinical staff, CPTII coding, and proper documentation by the provider to pass NCQA audit • Original member of the start-up team, successfully launched Arkansas market • Worked with MSO leadership to develop quality processes by completing total medical record HEDIS reviews every quarter with personalized education for each provider and establishing relationships with office staff • Improved overall HEDIS STARS measures for 2015 by closing 3,023 gaps and providing education to over 127 providers • Increased STAR and patient experience survey satisfaction percentage for CAHPS and HOS in the Arkansas market • Certified OSQR nurse reviewer and project lead over 4 RNs for the nurse reviewer program Northwest Health System– Springdale, Arkansas 2007 - 2015 Manager, Corporate Health Programs 1/2014 - 5/2015 • Worked as quality consultant/case manager for three major payers: Cigna, Humana, United • Provided care coordination and member outreach for over members • Implemented strong case management by assessed and facilitating care coordination for patients and family health needs upon hospital discharge • Performed data analysis for utilization management to reduce costs for ER, admits and re-admits • Reviewed and interpreted financials for providers and staff and provided monthly “report cards.” Charge/Transport Nurse, Neonatal Intensive Care Unit 1996-2014 TECHNICAL SKILLS • Advanced with Humana systems: SCIO, Pareo, MRM, EFR, Sy True, Machinify, CCA • Microsoft Word, Excel, PowerPoint, OneNote, Office 365, Teams, Adobe Captivate • Currently working on Six Sigma Green Belt Certification