Quality Assurance Manager

Career Objective

To find a position that my current skills can be used and new skills can be developed in a progressive environment.

Experience

Heartland Hospice

Director of Nursing-March 2010- April 2012

Responsibilities include meeting all state and Medicare regulatory standards. Ensured necessary services provided to meet the needs of terminal patients, their families and nursing home facilities. Proactively managing and leading the Nursing department.

Passing yearly Medicare audits. Maintaining CHAP accreditation.

Ensuring COPs are followed in clinical setting.

Developing and coordinating patient care plans from documentation and input from a team perspective which include: RN’s, LPN’s, HHA, participating therapies(PT/OT) and physicians.

Interviewed and hired RN’s, LPN’s and STNA’s to fill necessary vacancies. Evaluate RN’s, LPN’s and STNA’s on a 90-day and yearly schedule. When necessary counseled and reprimanded clinical team using progressive discipline.

Trained new staff according to job descriptions. Developed consistent plan to ensure proper staff training. Implemented performance standards to maintain quality staff and staff training.

Improved standards of care in hospice agency by keeping patient nurse ratio low. Having 24 hour staffing(on-call) to care for patient and family need. Utilizing the team approach for increased visits by all staff to patient. Maintaining individualized care for each patient and patient, family situation. Staffing crisis care with LPN’s at the bedside.

Utilized staff to stay within budget. Ensured proper staffing for all shifts. Coordinated business functions of agency with Administrator.

Lead, evaluated, and initiated standards regarding quality assurance initiatives to improve standards of care in hospice agency. Utilized performance management standards, effective leadership, appropriate and constructive delegation.

Worked with minimal supervision and organized and prioritized plans to complete multiple projects.

Managed overall operations of the Nursing Services Department in accordance with company policies, nursing standards, and governmental regulations.

MapleLeaf Home Healthcare

Director of Nursing- August 2009-March 2010

Responsibilities include meeting all state and federal regulatory standards, providing services to meet the needs of the patients, family and community, paperwork compliance and proactively leading the Nursing department.

Developing patient care plans OASISD. Managed nurses, HHA, and participating therapies and coordinated care with the patient’s physician.

Monitored, evaluated, and made recommendations regarding human resource and training procedures for nursing staff and HHAs.

Lead, evaluated, and made recommendations regarding quality assurance initiatives to improve standards of care in homecare agency.

Utilized performance management standards, effective leadership, appropriate and constructive delegation.

Working with minimal supervision and organize and prioritize to complete multiple projects. Manage overall operations of the Nursing Services Department in accordance with company policies, nursing standards, and governmental regulations.

Anthem Insurance Companies

RN Medical Mgt I/II (Precertification)- May 2009- August 2009

Telephonically collaborating with healthcare providers and members to promote quality member outcome service.

Assessing the medical necessity and appropriateness of treatment by applying the correct medical policy and industry standards by using computer software: FACETS, IMASIS, WPS, Cerner, Blue Card Directory.

Work with direction from medical directors when additional interpretation is needed.

Ensuring member access to medical necessary and quality healthcare in a cost effective setting according to contract.

Consulting with clinical reviewers to facilitate accreditation by applying accrediting and regulatory requirements and standards with the use of appropriate guidelines.

Pinnacle Senior Care

RN Case Manager- November 2008- May 2009

Evaluate and assess through Medicare and Medicaid guidelines client's appropriateness for home healthcare.

Organize and establish plan of care, goals and interventions for client's care in order for them to regain independence.

Education and teaching done for clients' family members on knowledge deficits as needed. Coordinate and manage care with a team of social workers, LPN's, and HHA. Modify and change plan of care as needed. Effectively coordinate medication care under the direction of a physician. Participate in QI/OA as needed. Share information as directed under HIPPA guidelines.

Recertification of patients for extension of services as directed under Medicare and Medicaid guidelines. Discharging client's to Physician's care as appropriate when goals are met.

Alternate Solutions Homecare

Weekend On-Call Nurse- August 2008- November 2008

Evaluate and assess through Medicare and Medicaid guidelines client's appropriateness for home healthcare.

Organize and establish plan of care, goals and interventions for client's care in order for them to regain independence.

Education and teaching done for clients' family members on knowledge deficits as needed. Coordinate and manage care with a team of social workers, LPN's, and HHA. Modify and change plan of care as needed.

Effectively coordinate medication care under the direction of a physician. Participate in QI/OA as needed. Share information as directed under HIPPA guidelines.

Recertification of patients for extension of services as directed under Medicare and Medicaid guidelines. Discharging client's to Physician's care as appropriate when goals are met.

Crossroads Hospice

RN Case Manager-November 2006 - November 2008

Evaluate and assess through Medicare guidelines patient's appropriateness for Hospice-end of life care.

Admit patients with end stage illnesses to Hospice service. Organize and establish plan of care, goals and interventions for patient care from a palliative prospective. Educate patient, family members on the end stage disease process.

Coordinate and manage care with a team of social workers, LPN's, nurse's aides, chaplains. Modify and change plan of care as needed. Effectively coordinate medication care under the direction of a physician.

Participate in QI/OA as needed. Share information as directed under HIPPA guidelines. Recertification of patients for extension of services as directed under Medicare guidelines.

Far Hills Surgical Center

Nurse RN Circulator- January 2005 - November 2006

Maintaining a sterile environment for the operative procedure.

Maintaining patient safety during procedure.

Conferring with Surgeon and Scrub Tech to asses immediate and long-term needsofpatient.

Following established procedures before, during, and after procedures in an ambulatory setting. Documenting and completing necessary paperwork to ensure continuity of care.

Education

Jones University

Still pursuing

MBA in Healthcare Management

Central State University Graduated 5/2010

Bachelor of Science in Business Administration

Kettering College of Medical Graduated 5/2003

Associates Degree of Nursing

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