1. KELLI
RIVERA
2236 W Heatherbrae Drive #3, Phoenix , AZ 85015 | H: 602-552-3319 | C: 602-303-6412 |
kelrey7492@outlook.com
Professional
Background
Experienced professional with excellent client and project management skills. Action-oriented with
strong ability to communicate effectively with technology, peers, and managerial audiences.
Skill Highlights
Client
Advocate
Accomplishments
Delivered compassionate care that exceeded department and agency requirements.
While maintaining a large caseload and daily new application, achieved employee of the
quarter as well as broke agency case completion records
Ensured accuracy of workload by having zero quality control errors per Disability Quality
Branch (DQB)reports.
Professional
Experience
Clinical Quality Coordinator -
HEDIS Project United Health Care
01/2015 to
05/2015
Phoenix ,
Arizona
In the New Mexico and Texas Markets (Commercial)
Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as
other admin temporary employees to abstract and file needed medical records to review compliance
for specific member measures assigned.
Participated in unit based Quality Assurance Program.
Contact providers and Medical records departments to ensure abstraction of any and all
records needed. Recorded and filed patient data and medical records.
Strictly followed all federal and state guidelines for release of information.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling
patient information. Created and maintained spreadsheets using advanced Excel functions and
calculations to develop reports and lists.
Clinical Quality Coordinator -
HEDIS Project United Healthcare
This is an annual contract lasting five
months.
01/2016 to
05/2016
Phoenix ,
Arizona
Working closely with Clinical Quality Managers (CQM), Hedis Program Managers (HPM) as well as
other admin temporary employees to abstract and file needed medical records to review compliance
for specific member measures assigned.
Participated in unit based Quality Assurance Program.

2. Contact providers and Medical records departments to ensure abstraction of any and all
records needed. Recorded and filed patient data and medical records.
Strictly followed all federal and state guidelines for release of information.
Demonstrated knowledge of HIPAA Privacy and Security Regulations by appropriately handling
patient information. Created and maintained spreadsheets using advanced Excel functions and
calculations to develop reports and lists.
Program Service Evaluator, Team Supervisor, Assistant Local Office Manager and Disability
Examiner
02/2004 to 06/2014
State of Arizona
Phoenix , Arizona
Managed caseload with a first in and first out policy unless a quick or expedited determination was
needed due to severity of illness.
Interviewed clients individually and with families to determine what services would best address
their needs.

3. Assessed patient and delivered comprehensive case management services.
Presented case history material for review and discussion with other staff
members.
Maintained thorough case history records and wrote detailed reports. Maintained a caseload of 100+ clients
working under strict deadlines. Educated residents and their families regarding other community resources.
Performed various administrative duties, including data entry and document preparation.
Education and Training
Nursing
Grand Canyon
University
Phoenix , Arizona , United States
Attended two years at the College of Science and Nursing until a quad accident in 2010 forced a break from
courses, will resume when time permits
Human Services Assistant : Human
Services
Rio Solado Community College
2006
Tempe , Arizona , United States
Coursework in Human Resources, Coursework in Public Health, Coursework in Community and Public
Health Coursework in Health Service Policy and Analysis
State Government Employee Management : Supervisor Academy 2007
Arizona Government Univsersity Phoenix , Arizona , United
States
Attended Supervisor Academy after a promotion into management while working for the Department of Economic
Security (DES)
Disability Examiner : Disability Claims
Disability Determination Services Administration (DDSA)
2011
Phoenix , Arizona , United States
14 week training course assessing five domains of childhood development and federal and state guidelines
regarding application and claim processing
Leadership Essentials Certificate
Employee of the Quarter
Human Services
Situational Leadership
HIPPA Annual
Certification
Annual Exams for the following HEDIS
Measures:
Certifications

4. Controlled Blood Pressure (CBP), Controlled Diabetic Care CDC), Pregnancy and Post Partum Care
(PPC), Childhood Immunization Schedule (CIS) Well Child Check up (WCC), Colorectal Screening (COL)
Affiliations
Mother's In Sympathy and Support (MISS Foundation)
July 2002 to Current -
Support Group Facilitator/Parental Bereavement Advisor Board
Dog Vacay - Host and Dog Care Provider