Quality Assurance Management
Resume:
Tammy J. Stewart
Glenville, WV 26351
********@*****.***
Education:
Master of Science Psychology, Organizational Psychology and Development, May 2010
Walden University, Minneapolis, Minnesota
Bachelor of Science Behavioral Science, August 2001
Glenville State College, Glenville, WV
o Psychology/Sociology concentration
o Criminal Justice minor
Work Experience:
February 2007 to October 2008 and then August 2011 to Present
Compliance/Quality Assurance/UM Coordinator, United Summit Center, Inc.
o Reviewed and work with Utilization Management Committee in regards to
changes/implementation on policies and procedures.
o Maintained a thorough knowledge of Medicaid and the requirements for authorizations for
service that can be provided to medically and socially necessary clients.
o Daily review and analysis of request for authorizations that are submitted to the Medicaid
managed care entity. Daily contacts with the Medicaid management care entities to
review submission and resolve problems.
o Disseminates changes, including developing and delivering the training necessary to
maintain the agency’s managed care systems as needed.
o Consults daily with clinicians to resolve clinician inconsistencies.
o Consults, collaborates and works with other managers to plan, develop and define
required indications of quality, both clinically and managerially to monitor and correct care
management issues.
o Perform internal documentation compliance audits.
o Participate and aids external entities in Quality Assurance Audits
o Performs daily electronic submission of Medicaid authorization requests when needed.
o Appropriately respond to common inquiries or complaints from customers, regulatory
agency of members or the business community.
o Coordinates and performs ongoing clinical and compliance trainings for staff.
o Maintains a working knowledge of OHFLAC regulations and licensing requirements.
o Member of Utilization Management Committee, meeting weekly to resolve UM issues.
o Member of Credentialing Committee, reviewing new hire information to determine if they
can be credentialed to bill insurances.
o Prepares and send clinical data for review and authorization.
October 2008 to August 2011
Case Management Coordinator, United Summit Center, Inc
o Responsible for ensuring that employees are providing exceptional patient care.
o Responsible for the recruitment and hiring of case managers.
o Aids in determining salaries of incoming staff.
o Responsible for the development and implementation of training for all clinical staff.
o Responsible for performance evaluations, rewarding, disciplining and terminating staff.
o Member of the credentialing committee responsible for credentialing incoming staff.
o Assist Case Managers in attaining established productivity and compliance standards.
o Addresses complaints both internally and externally and resolving problems.
o Conducts quarterly meetings and trainings to ensure compliance with regulatory
guidelines.
o Promotes professional development of the Case Management staff.
o Monitors and coordinates the activities of staff internally and externally.
o Ensures compliance with human resource guidelines for all staff.
o Provides direct supervision to all Case Managers and Care Coordinators in all county
sites.
o Provides training and mentoring related to the core function of case management.
o Assist Case Managers in providing quality case management services.
o Maintains a thorough knowledge of Medicaid and the requirements set forth to provide
medically necessary services.
o Consults daily with clinicians to resolve clinical inconsistencies.
o Plans, assigns and directs work to staff.
o Maintains a working knowledge of OHFLAC regulations and licensing requirements.
o Appropriately respond to common inquiries or complaints from customers, regulatory
agency of members or the business community.
September 2001 to February 2007
Case Manager and Community Liaison, Adult Psychiatric Disability Services Program,
Untied Summit Center, Inc.
o Conduct clinical evaluations and provide clinical diagnostic impression through DSM-IV
manual.
o Conduct and report mental status.
o Access and provide crisis support services and interventions.
o Conduct supportive therapy as needed.
o Develop comprehensive individualized service plan based on client’s strengths, needs,
resources and life goals.
o Participate/facilitate interdisciplinary team meeting to discuss client’s individualized
service plans with other care providers.
o Advocate on behalf of client in order to ensure the continuity of services, system flexibility,
integrated services, proper utilization of facilities, and resources and accessibility to
services.
o Reporting and overseeing client’s progress and performance in field placement and/or
employment.
o Administer and score ABS-RC:2 and Adult Severity Index (substance abuse).
o Ensure that requested services meet criteria for diagnosis.
o Participates in clinical supervision monthly.
o Meet with individuals admitted to an inpatient or residential facility on a daily basis or as
needed to coordinate provisions for treatment, medication, behavior challenges, co-
occurring conditions, living arrangements, support services, etc.
o Established and maintained close working relationships with the inpatient and residential
treatment facilities in West Virginia for assistance in providing appropriate treatment
options for clients.
o Work with inpatient and residential treatment facility social workers in regards to current
treatment and discharge planning for continuation of care as well as attending unit
staffing.
o Attend quarterly linkage meetings and all scheduled liaison activities.
o Was the direct link between inpatient and outpatient care.
Volunteer Experience:
October 2010 to May 2010, United Summit Center, Inc.
o Consultation provided to United Summit Center, Inc. to investigate the factors influencing
turnover among Case Managers
March 2010 to Present
Family Resource Network, Inc., Glenville, WV
o Serves as President of the Board of Directors, 2010-2012
o Serves as Community Mental Health Representative
Glenville State College, Glenville, WV
o Member of Internal Review Board
City of Glenville, Glenville, WV
o City Council Member 2012 to present
Skills:
o High level of organizational and attention to detail
o Exceptional written, oral and interpersonal communications
o Demonstrates ability to acquire and apply knowledge rapidly
o Proficiency in computer and word processing
o High level of clinical skills related to mental health
o Ability to read, analyze and interpret common scientific, technical and final reports as well
as legal documents
o Ability to define problems, collect data and establish facts drawing valid conclusions.
Contact this candidate