Manager Quality Assurance
Resume:
debbie Dahl
Kalispell, Montana 59910
Summary of qualifications
Highly motivated, creative and versatile Health
Care professional. Extremely skilled in the
supervision of a diverse group of medical
professionals including extensive experience in
management of medical related automated systems.
People orientated person with experience in
physician contract administration, provider
education, clinic management, patient care,
community health education, fund raising
activities, public relations, quality assurance,
clinical research, preparation of various health
care statistics, laboratory management, data
analysis and public speaking.
Career Highlights
Developed comprehensive policies, standards and
procedures for patient care and clinic management.
Performed long-range strategic planning including
the SOLVAY project - a two-year, double blind
pharmaceutical study to determine the effectiveness
and side effects of post-menopausal drug therapy.
Instituted the teenage pregnancy program that
serves to educate and counsel teens and their
families - a community outreach program conducted
in local schools and churches. Organized and
presented educational workshops for providers and
staff, participated in annual community health
fairs and fundraisers.
Professional experience
2002 to 2010 Blue Cross Blue Shield of Montana
Provider Relations Network Development
Representative and Credentialing Analyst
Recruit and contract with health care providers and
facilities
Prepare analysis, reviews and financial projections
of large or complex provider contracts and contract
terms
Conduct negotiations, draft contracts and conduct
precontractual audits and surveys
Administer provider contracts and assigned programs
(CHIP, DOC, Blue Distinctions, TRICARE and Blue
Card)
Develop and conduct educational workshops for
health care providers and facilities
Credentialing and recredentialing of network
providers
Performing extensive background checks on
physicians and allied health providers
Coordinating and analyzing the completeness of
applications for compliance with credentialing
criteria
Management of malpractice case files and CME
Performing credentialing primary source
verifications and analysis of information,
compiling and presenting this information to the
Credentialing Committee, Medical Director and Board
members.
2000 - 2002 Westmont Home Health
Helena, MT
Clinical Services Supervisor
Coordinated all direct patient care services and
day to day operations
Oversaw quality assurance for client case
management
Operated services within budgetary allowances and
restrictions
Development of adequate financing, equipment and
staffing
Assigned incoming referrals, evaluating
appropriateness of referrals and coordinating
services
Assured adequate staffing, scheduling, training and
supervision
Care review for determining medical alternatives
for catastrophic illness and injuries to provide
the most cost effective utilization of services
possible
Monitored financial and operational activities to
ensure compliance of program parameters
Marketing and development of customer relations
1999 - 2000 Mercury Street Medical Center For
Women's Health
Butte, MT
Office Nurse OB GYN
Case management
Assisting in office procedures, LEEP, Cryo,
Endometrial Biopsy, etc.
Screening patient phone calls and telephone triage
Prior authorization and pre certification for
procedures and surgery
Drawing blood and collecting various samples for
testing
Reviewing lab results and advising patients of same
Tracking follow up care patient care as needed
Following abnormal test results and treatment plans
for compliance
Scheduling surgeries and doctors office visits
Patient education
1997 to 1999 Relocated to Montana/time off
1996 - 1997 Valley OB/GYN Scottsdale, AZ
Telephone Triage Nurse / Office Nurse OB GYN
Assisting in office procedures, scheduling
surgeries
OB/GYN telephone triage nurse averaging 55 calls
daily requiring crisis intervention, counseling,
referral, diagnosis and treatment
After clinic hours emergency triage nurse averaging
four weeknights and one weekend monthly
Coordinated health care enrollment services and
community outreach programs
Disability case manager
Emergency treatment nurse
Patient educator, counselor and referral
coordinator.
1991 - 1996 Women' Health Care Associates
Chandler, AZ
OB GYN and Family Health Nurse, Triage Nurse, Case
Manager, Clinic/Lab Manager
Emergency service coordinator
Triage nurse, involving crisis intervention,
counseling, referral, diagnosis and treatment
Disability case management
Supervision of a diverse staff including 7
physicians, nurses, medical assistants and clerical
staff
High risk pregnancy care planning and patient
monitoring
Referral coordinator among diverse government
community and private referral sources to provide
necessary care and patient support.
Marketing and fundraising for community health
fairs
Coordinated a project, which resulted in the
implementation of comprehensive policies for
patient care protocols, office procedures and
laboratory management
Instituted the Med-Voice Patient Information System
- an integrated telephony system that allows
patients to inquire on lab results.
Served as project coordinator for the PRESCRIBE
software implementation --a communication system
between clinics and various pharmacies throughout
the state to improve record management.
Management of several clinical drug studies funded
by state and federal agencies beginning with
obtaining funds from granting agencies, maintaining
budget, correlation / reporting of data and
interaction with hospital boards.
Public health instructor for childbirth and
parenting classes.
Instructor and coordinator of "Baby Think It Over "
Program, designed to promote teenage awareness of
the realities of motherhood.
1983 - 1991 Phoenix Community Hospital
Phoenix, AZ
University of Arizona Hospital Tuscon,
AZ
Charge Nurse / IV certified
LDRP unit
OR scrub
Medical/Surgical floor
ICU
Education
2006 - 2007 Washington Institute of Paralegal
Studies
Paralegal
1981 - 1983 Mid Suffolk School of Nursing
Nursing
1972 - 1974 Suffolk County Community
College/Excellsior College
Associate Degree in Science
Specialized training, education and experience
Current MT Nursing license and IV certification
Proficient in MS Office 2000 including Word, Excel
and Outlook
Proficient in Lotus notes, ECHO, BLUE Q and .QNXT
Experienced in MS Windows 95, 98 and NT operation
systems
Trained Paralegal
Medical equipment operation and maintenance
Member HFMA
Menber MGMA
REFERNCES
Irene Shipley, Business Office Manager, Kalispell Regional Hospital,
Kalispell Mt 59901
406=212=3274
Linda Erickson, Credentialing Dept., BCBS of MT 504 Park Ave, Helena
MT 59601
800-447=7828
Michael Frank, VP of Operations BCBS of MT 504 Park Ave, Helena MT
59601
Dr. Fred Olson, Medical Director BCBS of MT 504 Park Ave, Helena MT
59601
Donja Erdman, CFO Marcus Daly Hospital, Hamilton MT 598**-***-***-
4609
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