1. MARIA ENSENAT, RN, BSN
1719 Quarry Hill Road, Louisville, KY 40213 * 502-724-3440
mariaensenat@yahoo.com
Licensure:
Kentucky:RN License #1092837
CoventryCares of Kentucky March 2012 - present
What sets me apart? My personal brand I was recognized, as the Kentucky Medicaid Nurse during
NursesWeek 2015 throughoutmyemployer’s healthcare system. Includedinthe article the Director of
the Quality Management Department comments “Maria is a key member of the Quality Management
team. Her role inthe departmentandcollaborationwithall departmentsinthe healthplanisvaluablein
so manyways.Her workimpactsday-to-dayprocesses,qualityoutcomesandenhancedmemberhealth.
Maria takesownershipanda vestedinterestinall areas of the health plan, including employee culture
and engagement.”Whatdoes other staff say about me? “I just wanted to say what a nice write up that
was and what a well deserved honor for you to be in the Aetna Medicaid Nurses Spotlight? You are a
terrific ambassador to represent the KY nurses! Congratulations!” full article available for review.
I am veryproudof the recognition.Please letme share my Career History and Key Accomplishments as
well.
Career Summary: SeasonedQualityManagementNurse experiencedinkeyplanmetrics and healthcare
analytics, Healthcare EffectivenessDataandInformationSet(HEDIS) ®,andqualityimprovementsuchas
clinical proceduresand top diagnoses. Expert to identify outliers, perform root cause analysis identify
barriers,craft andimplementinterventionsthatimprovethe qualityof results and improve outcomes. I
have a proventrack record of process improvement, team building, and technical leadership. Through
leadershipand collaboration the team resolves deficiencies that impact compliance to regulatory and
accreditationstandards. My proven record indicates I can drive key Quality Improvement projects and
the implement Quality Improvement (QI) Program and work plan activities because I work well in a
matrix environment.
Proven ability leadership and commitment to mission:
Subjectmatter expert(SME) and facilitatorforPerformance ImprovementProjects (PIPS) and focus
study interdepartmental workgroups. As facilitator I set the workgroup agenda to become an
analytical driventeamunderstanding root causes of non-compliance. Workgroup desired meeting
outcomes are based on contract and accreditation requirements. Results: improved member
antidepressantmedication managementand compliance, effortsproduced alarge improvement we
raisedfroma 2% increase overthe baseline tosurpassingthe 90th
Percentile National Committee for
Quality Assurance (NCQA) Benchmark.
HEDIS® Project: I temporarily functioned as HEDIS Outreach Supervisor in the absence of a HEDIS®
Department Manager. Results: I revised, updated, and forged the HEDIS® work plan into a “living
document”to providean all inclusive,clear snapshotof currentworkgroup activities,and a roadmap
for future opportunities for improvement. Provide support for the Quality Management
Department during annual HEDIS® project activities including medical record review and
abstraction. Results: proficient evaluation of complex data and information sets, reaching
conclusions about the data and converting the results of data analysis into meaningful business
information.
2. Quality Management Department process potential quality of care complaint/adverse event
review: I requested and performed medical record reviews and recommended actions to address
any identified improvement opportunities and trends. Results: I designed, developed, and
implemented Adverse Events (AE) templates from established, gold standard clinical resources
(CentersforDisease Controland Prevention (CDC), NationalInstituteof Health (NIH)) to expedite the
AE review process and serve as a catalyst for patient safety activity.
Prevention and Wellness Program (P&W) implementation: P&W Program is intended to educate
and informmembers,practitioners, and providers about practices and services that promote good
health and encourage members to use preventive care services and be aware of available health
promotion and health education resources. Results: I researched and identified an inventory of
potentialclinical improvementprojectsgathered from:QMMedicaid and HEDIS®, other sister health
plans, and clinical literature to create the Prevention & Wellness Program (P&W) work plan. The
work plan is a “living document” to provide an all inclusive, clear snapshot of current P&W activities
and a roadmap for future Health and Wellness topics. The P&W Coordinator provided additional,
valuable resources and successfully launched the program both internally and externally.
Participate insite visitpreparation and executionby various regulatoryand accreditationagencies
(DCH, DHR, CMS, EQRO). Results: I collaborated with the QM Project Manager to respond to
requests,comments,recommendations,and phonecallsto and madeby the External Quality Review
Organization (EQRO) relating to the PIPS and Focus Study Projects.
State report responsibilities: Results: I am responsible to and support efforts to submit monthly,
quarterly, semi-annual, and annual regulatory required performance reports.
Matters of policy: Results: My extensive knowledge based on education, experience, and research
allows me to make recommendations on matters of policy in the area of my expertise.
Health plan QI Program policies and procedures and provider clinical practice guidelines (CPGs):
The QI Program policy and procedures and CPGs are adopted to promote consistent application of
evidence-based treatment methodologies and made available to practitioners to facilitate
improvementof healthcare andreduce unnecessaryvariationsincare.These guidelines, policy and
procedures are intended to clarify standards and expectations. They do not dictate or control a
provider's clinical judgment regarding the appropriate treatment of a patient in any given case.
Results: I make a robust, constant, and earnest effort to increase provider compliance to the above
by reviewing QI policies and procedures, and CPGs as determined by plan policy, by medical record
review, updating provider website CPGs, and communicating updates via provider newsletters.
Excellence: follow through on tasks given and see the task to completion
I recommended strategies to improve member and provider compliance to QI program activities,
change knowledge, attitude and behaviors utilizing the member handbook, provider manual,
newsletters,andmember outreach interventions. Results: provider and member newsletters 2014-
2015 met all NCQA required communications and delivered prevention and wellness information.
2016 member handbook and provider manual reviewed and edited to meet NCQA requirements.
I worked 1:1 with IT to enhance the memberwebsite organizingthe Announcements/News pages;
to include updating the Immunization Schedule, adding a Behavorial Health (BH) page, adding a
QualityMatterspage and designedand developed the entire content for the Quality Matters page
http://chcmedicaid-kentucky.coventryhealthcare.com/for-members/quality-matters/index.htm
Results: the website is more user friendly for our members, added a BH page which implemented a
plan Performance Improvement Project member intervention, added the Quality Matters page to
met NCQA requirements for member communications
3. I worked 1:1 with IT to enhance the provider website adding a quality improvement page and
designed and developed the entire content for the page and the Annual QI program Summary.
Results: adding the Quality Improvement page met NCQA requirements for provider
communications. http://chcmedicaid-kentucky.coventryhealthcare.com/for-providers/document-
library/quality-improvement/index.htm
Numerous projects designing,developing,auditing,andcross-referencingdocumentsi.e. Business
audit grids, member communications crosswalks, and a QM Evidence document are only three.
Results: all documents/projectswere detailed,thorough, and a quality product delivered ahead of
or on schedule.
Courageous and innovative to provide enhanced communications to the Quality Management team:
Designed, developed, and implemented:
The Quality Management (QM) Department New Hire Learning Resource Training Program, the
program provides enhanced structure to onboarding new hires to the Quality Management
Department. Results: consistent onboarding to the QM Department for all new hires.
A personal evaluation tool to be used in conjunction with staff Talent Reward Self Assessments
Results: consistent staff self assessment.
A Performance Improvement Project Fact Sheet resource for staff and PIP workgroup participants
Results: a resource to guide staff in the development of changes that lead to favorable sustained
results which become permanent standards, practices, or procedures including understanding the
process of performance improvement projects.
Key words that declare my values and passions:
Hard work,dedication,and commitmentgive110% set goalsto complete projectaheadof schedule
I knowI am inmy elementwhenworking on multiple projects or complex projects under pressure
Adaptability I proactively adapt to change and encourage others to remain positive during
transitions
Flexible, agile, open, able to toggle between follow ship and leadership successfully
People recognize my expertise in team work and team building working with a team to find
solutionsandsolve problems.Iam accountable to myself, my team, and the organization. I quickly
realized I can accomplish far less by myself then through collaboration
Education: Degree:Bachelor’sDegree Major:Nursing
TechnologyExperiences:Highlyproficientin 2010 MicrosoftWord, Excel and Outlook
VolunteerExperiences:Coalitionforthe Homeless,SaintVincentde Paul Ministries,andSoutheast
ChristianChurch,Louisville,Kentucky
RxCrossroads Pharmacy October 2010 – March 2012
Manager Quality Improvement Department
Manger Quality Improvement Department Overview: Responsible to integrate functions and
departments for success, to plan the operation and functions of the area and accomplish department
goals, to organize and implement production of work and the workforce training and necessary
resources to direct the employees, and evaluate the success of the department goals and the
employees. QI Manager Behaviors include:
Manage and promote consistent and compliant service.
Establish and maintain systems for clinical staff to achieve high clinical core competency.
Conduct internal auditing of staff documentation to maintain compliance with regulatory standards
