1. Lori A. Kramer, R.N., B.S.N.
4867 Embassy Court | Dubuque, Iowa 52002 | lorihellekr@gmail.com | 563-599-4265
OBJECTIVE
• Registered Nurse with extensive NCQA, HEDIS and Quality Improvement experience exploring
new career opportunities.
EDUCATION
• Clarke University, Dubuque, Iowa | Bachelor of Science in Nursing | 1986
CLINICAL EXPERIENCE/WORK HISTORY
Quality Improvement Coordinator and HEDIS Project Manager
Medical Associates Health Plans
1605 Associates Drive, Suite 101, Dubuque, Iowa 52002
2000—Present
Previous Titles/Positions: Quality Improvement Nurse Auditor and Compliance Coordinator
Experience: Over 14 years of HEDIS Project Management Experience
Responsibilities:
• Responsible for completion of HEDIS Roadmap as well as coordinating on-site auditors review
• Designed training manual for HEDIS data abstraction for the Health Plans
• Trained medical record review staff, data abstraction and data entry
• Conducted Inter-Rater Reliability Testing
• Conducted Clinical Quality Oversight for HEDIS
• Responsible for completion and submission of HEDIS and CMS patient level data files
• Provided oversight to the development and implementation of Quality Improvement initiatives
Electronic Data Knowledge:
• Proficient in navigating the following EMR’s for data abstraction: EPIC, eClinical Works, eMAC,
All Scripts, Greenway, Sage, Entergee, e-MD’s, HMS, Amazing Chart, Cerner Hospital and
Clinical Applications
• Proficient with Microsoft Office applications
Quality Improvement:
• Solid knowledge of NCQA and CMS
• Solid knowledge of CAHPS, MCAHPS and HOS
• Played an instrumental role in Medical Associates Health Plans achieving an “Excellent” NCQA
accreditation status for both Commercial and Medicare Plans for 14 consecutive years as well as a
5-Star rating from CMS for our Iowa/Illinois Medicare Plan and a 4.5-Star rating for our Wisconsin
Medicare Plan
Strengths:
• Strong project management and organizational skills
• Strong communication skills, written and verbal
• Strong analytical skills
• Customer service focused
• Able to prioritize, multi-task and work effectively in a deadline driven environment
• In-depth understanding of managed care, care coordination and quality improvement

2. Involvement:
• Speaker at the Third Annual HEDIS & Quality Improvement Summit for Healthcare Education
Associates in Las Vegas, Nevada
• Collaborated with Lance Lysinger Conference Producer at Financial Research Associates to
develop agenda topics for the HEDIS & Quality Improvement Summits in 2014 & 2015
Compliance & Coding:
• Developed Medical Associates Health Plans Compliance Program
• Conducted compliance audits for Evaluation & Management Coding
• Knowledgeable of ICD-9, ICD-10 and CPT coding
• Knowledgeable on CDC Immunization schedules, ACIP approval process and MMWR publications
Marketing:
• Knowledgeable on Medicare marketing guidelines
• Worked with CMS for approval of Medical Associates Health Plans marketing materials
Registered Nurse
Cottingham & Butler Insurance/Healthcorp
800 Main Street, Dubuque Iowa 52001
1999—2000
• Utilization Review/Case Management Nurse
Registered Nurse
Medical Associates Clinic, Dubuque, Iowa
1500 Associates Drive, Dubuque, Iowa 52002
1991—1999
• Developed Orthopedic Triage Nurse position and worked as the Triage Nurse until 1993
• Primary Nurse for Dr. Judson Ott, MD 1993-1997
• Developed Surgical Coordinator position for six Orthopedic surgeons and worked as
Coordinator 1997-1999
1989—1991
• Clinical Staff R.N. in the Acute Care Center walk-in clinic
Registered Nurse, 4 North Orthopedic/Neurology Surgical Unit
Mercy Medical Center, Dubuque, Iowa
250 Mercy Drive, Dubuque, Iowa 52001
1986—1989
• Staff nurse caring for adult population with acute and chronic orthopedic and neurological
diagnoses and post-surgical procedures
• Night Shift Charge Nurse, providing direction to staff to facilitate patient care flow
• Preceptor for new hires
COMMITTEES/INVOLVEMENT
• Medical Associates Continuing Education Committee—Chairperson
• Medical Associates Quality Improvement Committee
• Medical Associates Credentialing Committee
• Medical Associates Pension Committee
• Medical Associates Wellness Committee
• Medical Associates CPR Program Coordinator & Instructor
• Medical Associates Quality Metrix Committee

3. PROFESSIONAL LICENSES
Iowa—Active Status
Illinois—Inactive Status
Wisconsin—Reciprocity Status
REFERENCES
Dr. Catherine Crall, M.D.
Medical Director Clinical Coverage Review
United Healthcare
E-mail: Catherine.Crall@UHC.com
Work: 563-556-1424
Cell: 563-590-6101
*Previous Associate Medical Director Medical Associates Health Plans
Judy Riniker, R.N.
Optum Clinical Quality Oversight
*Previously Medical Associates Health Plans Quality Improvement Manager
30900 Lake Road, Guttenberg, Iowa 52052
E-mail: Judy.Riniker@optum.com
Cell: 563-599-0367
Sharon Adkins, C.M.T.
Manager Health Information Services (Retired in 2013)
Medical Associates Clinic and Health Plans
111 Crestview Drive, Potosi, Wisconsin 53820
Home: 608-763-2960
Dr. Judson Ott, M.D.
Sports Medicine and Orthopedic Trauma Surgeon
Medical Associates Clinic, P.C.
1500 Associates Drive, Dubuque, Iowa 52002
Work: 563-584-4460
Home: 563-588-2434
Kara Wessel, R.N., B.S.N.
Personal Trainer and Certified Wellness Coach
*Previously: Disease Management/Health & Wellness Nurse at Medical Associates Health Plans
37181 Colesburg Road, Garber, Iowa 52048
Home: 563-856-4754
Cell: 563-590-8472
Others available upon request