Quality Improvement Management Analyst
Resume:
DWAN GATHERS
Columbia SC *****
***********@*****.***
GOAL
Quality Improvement Facilitator and Leader with several years of experience across the behavioral and healthcare industries. I possess excellent communication skills, verbal, written and interpersonal. I also possess strong problem-solving skills utilizing strategic thinking. My goal is to utilize my knowledge with an organization that will allow continued growth as we progress toward innovation and an ever-changing society.
EXPERIENCE
2023-Present Globe Life Liberty National Columbia, SC
Benefits Administrator Supervising Agent
Meet with clients to discuss their financial goals and insurance needs
Explain the different types of life insurance policies and recommend the most appropriate options for each client
Build and maintain relationships with clients to ensure their ongoing satisfaction and loyalty
Use various sales techniques to acquire new clients and retain existing ones
Collaborate with team members to develop and implement effective sales strategies
Keep up-to-date with industry trends and regulations to ensure compliance and provide the best possible service to clients
Market health insurance policies
Identify client needs
Advise clients on risk management
Make cold calls and develop leads
Lead a team of agents and prepare them for in the field training
2022-2023 Midlands Behavioral Health Hospital Sumter, SC
Chief Executive Officer (Interim)
Coordinated the opening of a brand new 64 bed mental health hospital for adult and geriatric patients.
Helped manage the logistics and operations of the hospital.
Worked directly with banking and securities regulators.
Also worked directly with financial internal and external audits as required.
Served as the business office manager as well to keep labor costs low until the company was able to start making a profit.
Utilized accounting and internal controls requirements under the SOX act.
Reconciled all outstanding payments.
Work on accounts receivable to apply and receive payments.
Prepare profit and loss statements, balance sheets and income statements.
Bring innovative ideas and strategies to the team.
Helped oversee business development and marketing efforts
Managed labor and HPPD effectively
Successfully completed initial accreditation survey with Joint Commission with zero deficiencies.
Effectively helped to recruit healthcare leadership as necessary
Developed policies and procedures for the hospital
Performed Tracers and audits in preparation for external surveys.
Prepared regular reports, budgets, and forecasts.
Maintain comprehensive working knowledge of regulatory compliance.
2018-2022 Prisma Health Hospital System Columbia, SC
Quality Improvement Project Manager Clinical Excellence
Facilitated and Led several system quality improvement teams including CLABSI (Central Blood stream Associated Line Infections), OUR (Opioid Utilization Review) and AIM (Alliance for Innovation for Maternal Health).
Worked with patient account services billing department to implement performance improvement ideas for budgeting.
Showed department how to balance financial reports in a more efficient manner.
Reduced report errors on income statement and balance sheets
Introduced triple check process for verification and reconciliation of financial reports.
Collaborated with Women’s Service Line to continue efforts to increase patient awareness and availability of LARCs (Long acting reversible contraception)
Participated in planning and implementation of strategic quality improvement initiatives that will advance Prisma Health objectives.
Developed and supported on-going learning that will help sustain quality. This includes coaching in facilitation and improvement methodologies.
Provided consulting and analytical support to quality improvement teams in order to achieve performance targets.
Facilitated enterprise-wide and/or entity specific quality improvement initiatives.
Designed and/or identified appropriate performance measures to evaluate effectiveness of implemented improvements.
Assisted with the development of policies, procedures and standards for compliance based on both state and national standards.
Ensured the facility remains compliant with regulations that affect the healthcare industry.
Supported service improvement by coaching and facilitating discussions to encourage creative thinking and test new ways of service delivery that are patient-centered.
Served as quality improvement lead for both HEDIS and ORYX abstraction to develop quality improvement projects whenever quality measures are not met.
2015-2018 Three Rivers Behavioral Health Columbia, SC
Director of Quality Improvement/Compliance/Risk Management
Provided leadership to the hospital committees, work groups, and task forces charged with creating and implementing a facility-wide quality assurance and performance improvement program and activities.
Directed the facility’s compliance program and served as the compliance officer.
Acted as Chief Executive Officer in their absence
Supervised the Chief Financial Officer and all of the business office staff
Utilized GAAP and SOX to ensure compliance with all accounting and business aspects for the hospital.
Conducted monthly P&L meetings with corporate staff
Coordinated initiatives to measure effectiveness, performance and quality of the hospital quality and compliance programs including tools for tracking and trending.
Provided guidance for implementation and coordination of inpatient/outpatient services including CQI studies, CQI tools, monitoring and sustaining results.
Directed and provided leadership for compliance with National Committee for Quality Assurance (NCQA) standards.
Conducted risk assessments throughout the facility and logged and responded to all level of incidents.
Collected and submitted Performance Indicator data in accordance with the facility's Performance Improvement Services Plan
Served as a resource for the design and evaluation of process improvement plans/quality improvement plans and ensures they meet Continuous Quality Improvement (CQI) methodology and state contractual requirements.
Managed and supervised Medical Records, the Infection Control Program and all Risk Management Departments as well as all expense and capital budgets.
Directed and provided leadership for implementing, monitoring and evaluating the Quality Management Program for the health plan
Coordinated and monitored Risk Management program to maintain compliance with JCAHO, CMS, State Department of Human Resources, and State Department of Mental Health requirements.
Worked with business office in the absence of the chief financial officer to reconcile and balance financial reports.
Worked with medical records with billing and applying appropriate CPT and ICD-10 codes.
Ensured providers coded charts with correct diagnosis codes for accurate reimbursement.
Coded and billed charts for both inpatient and outpatient services.
Used EMR to facilitate billing with triple check.
Served as HEDIS abstractor and sometimes as an over-reader to ensure facility was compliant with the current quality of care measures.
Used HEDIS abstraction information to help set Quality Improvement initiatives.
2012-2015 Columbia Regional Care Center (Correct Care) Columbia, SC
Performance Improvement and Compliance Administrator
Served as the facility’s subject matter expert in the area of interpreting the compliance and accreditation criteria based on organization, contracting client or outside party requirements, 374 bed licensed infirmary.
Supervised and managed the medical records department, infection control and the unit clerks as well as operational budgets.
Ensured all accounts were balanced to prepare for reconciliation.
Performed billing for all contracted clients.
Prepared financial reports and served as the second level reviewer for corporate billing.
Negotiated contracts; Calculated yearly CPI Increases based on the bureau of labor standards and built that increase into contract rates.
Facilitated and prepared facility for audits from accrediting bodies such as National Commission of Correctional Health Care, Joint Commission, OFDT, OSHA, CARF and DHEC.
Performed facility level operational reviews and audits.
Developed annual Continuous Quality Improvement Plan, facilitated annual strategic plan and developed strategic management plan.
Performed ORYX measure abstractions.
2003-2012 Blue Cross/Blue Shield of SC Columbia, SC
Accounting Associate Manager/Quality Consultant
Balanced and prepared financial reports such as Accounts Receivable, Cash Management, Bank Analysis and Monthly Reconciliations.
Performed on TQM and Performance Improvement Committee.
Applied debits and credits to financial accounts.
Applied refunds to accounts for health insurance claims.
Balanced 4 different service line accounts totaling $27 million dollars.
Performed Financial Analyses to reconcile bank statements with internal reports. (Accounts Receivables)
Supervised employees in manager’s absence and performed assessments and reviews based on QC reports.
Developed expense and capital reports with manager.
Utilized SAP, GAAP and SOX to ensure compliance with accounting services.
EDUCATION
Southern Wesleyan University (conferred) Columbia, SC
Bachelor’s in Business Administration (Accounting)
Southern Wesleyan University (conferred) Columbia, SC
M.A in Business Administration (Ethics & Finance)
Strayer University Columbia, SC
M.A. in Healthcare Administration
CERTIFICATIONS
Microsoft Access Advanced Certificate,
Certified Six Sigma Series-Green Belt,
Change Acceleration Process (CAP Certification)
Microsoft Advanced Certification in Excel, Word, Access, Powerpoint, All MS Suite
Member of NAHQ, currently in preparation to take CPHQ exam
ACCOLADES
National Publication in the July/August 2021 issue of the American Journal of Medical Quality for work on reducing C Diff SIR (Standard Infection Ratio)
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