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audit manager resume example with 10+ years of experience

Jessica Claire
, , 609 Johnson Ave., 49204, Tulsa, OK 100 Montgomery St. 10th Floor
Home: (555) 432-1000 - Cell: - resumesample@example.com - : - -
Professional Summary

Dedicated Clinical Audit and Quality Assurance Executive Nursing professional with a history of meeting company goals utilizing consistent and organized practices. Skilled in working under pressure and adapting to new situations and challenges to best enhance the organizational brand.

Skills
  • Quality Improvement Reports
  • Healthcare Program Planning
  • Root Cause Analysis
  • Process Mapping
  • Annual Audit Plans
  • Client Relationship Management
  • Strategic Execution
  • Risk Assessment
Work History
05/2021 to Current
Audit Manager Arrow Financial Corporation , ,


  • Lead staff of 22 employees in monitoring, analyzing, and reporting claims activity including relevant health care trends and high-cost claims to effect increased savings of $10 million during Annual fiscal year
  • Facilitated internal audits for several lines of business including Medicare under POS, line by line, DRG and NICU reviews in 4 State Region.
  • Conducted strategic and technical reviews to verify compliance with quality standards, schedule constraints and budget parameters.
  • Achieved $5 million in cost savings by discovering opportunities to amend and create policies.
  • Identified audit risks, prepared budgets and coordinated with VP and Director in preparing related reports.
07/2017 to 05/2021
RN Quality Analyst Hca , ,
  • Partnered with physicians and staff to explore new ways to encourage member clinical participation in wellness and education.
  • Led, facilitated and attended focus groups and meetings to strategize workflow issues.
  • Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows. Ran quality metrics reports to maintain high standards of virtual care.
09/2014 to 12/2022
Intensive Care Nurse Ameripride Services, Inc. , ,
  • Served as fill in charge nurse and preceptor for new hires (coaching and mentoring new hires)
  • Monitored and adjusted specialized equipment used on patients such as intracranial pressures, central venous pressures, pulmonary artery pressures, and cardiac rhythms from cardiac monitors, ventilators. Administration of acute inpatient IV medications and treatments.
  • Supervised new employees and student nurses to promote adherence to established patient care standards and practices.
05/2015 to 07/2017
Lead Drug Safety Associate Ascensus , ,


  • Supervisor and trainer of pharmacy technicians and QA nurses assisting in report adverse events
  • Point of contact of all manufactures in reporting adverse events, source date verification and reconciliation. Lead Disease state review in oncology medications for PharmD rotating students
  • Manage the triage of safety reports received into central Drug Safety workflow. Prepared and presented monthly AE data and trends to specialty pharmacies.
09/2013 to 05/2015
Case Manager/Lead QA Nurse ST. ELIZABETH HOME HEALTH , ,
  • Trained all LPNs an CNAs. Served as a liaison to all disciplines(PT, OT, ST and vendors)
  • Taught wound care classes and scheduled all in office trainings. Lead weekly case conference for all field nurses
  • Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
08/2012 to 05/2014
Quality Assurance Manager INTERIM HEALTHCARE , ,
  • Supervised QA nurses. Responsible for hiring of all QA staff and supervision of QA staff Point of contact for all audits by state and insurance providers
  • Scheduled and chaired quality review meetings to review effectiveness of performance mitigating risk, improving throughput and achieving customer satisfaction.
  • Collaborated with audit clients and action owners to apply root cause analysis guidance and establish effective corrective action plans.
  • Developed quality planning for multiple new product launches by verifying customer requirements and implementing in design and production.
09/2012 to 09/2013
Documents Specialist NORTH PHOENIX PAIN RELIEF CENTER , ,
  • Reviewed all medical assistant’s chart notes and audit charts form NPs. Responsible for verification of insurance, updating billing, auditing files, supervision of all MA’s
  • Assisted in conscious sedation for epidurals and other pain management treatment
  • Provided assistance with inbound and outbound document processes, document sorting, logging and work order creation. Worked with internal staff to process documents and sent for closing.
Education
Expected in to to
Master Of Science In Nursing : Leadership And Administration
Capella University - Minneapolis, MN
GPA:
Expected in to to
Bachelor of Science: Nursing
Aspen University - Denver, CO
GPA:
Expected in to to
Associates: Nursing
Glendale Community College - Glendale, AZ
GPA:
Websites, Portfolios, Profiles
  • https://www.linkedin.com/mwlite/in/Jessica-g-6219b5140
Skills
  • Quality Improvement Reports
  • Healthcare Program Planning
  • Root Cause Analysis
  • Process Mapping
  • Annual Audit Plans
  • Client Relationship Management
  • Strategic Execution
  • Risk Assessment
Work History
05/2021 to Current
Audit Manager
CAMBIA HEALTH SOLUTIONS ,


  • Lead staff of 22 employees in monitoring, analyzing, and reporting claims activity including relevant health care trends and high-cost claims to effect increased savings of $10 million during Annual fiscal year
  • Facilitated internal audits for several lines of business including Medicare under POS, line by line, DRG and NICU reviews in 4 State Region.
  • Conducted strategic and technical reviews to verify compliance with quality standards, schedule constraints and budget parameters.
  • Achieved $5 million in cost savings by discovering opportunities to amend and create policies.
  • Identified audit risks, prepared budgets and coordinated with VP and Director in preparing related reports.
07/2017 to 05/2021
RN Quality Analyst
LASH GROUP, AMERISOURCE BERGEN ,
  • Partnered with physicians and staff to explore new ways to encourage member clinical participation in wellness and education.
  • Led, facilitated and attended focus groups and meetings to strategize workflow issues.
  • Integrated decision support, clinical pathways and best practices into health information technology to enhance delivery of care and workflows. Ran quality metrics reports to maintain high standards of virtual care.
09/2014 to 12/2022
Intensive Care Nurse
St Joseph Hospital ,
  • Served as fill in charge nurse and preceptor for new hires (coaching and mentoring new hires)
  • Monitored and adjusted specialized equipment used on patients such as intracranial pressures, central venous pressures, pulmonary artery pressures, and cardiac rhythms from cardiac monitors, ventilators. Administration of acute inpatient IV medications and treatments.
  • Supervised new employees and student nurses to promote adherence to established patient care standards and practices.
05/2015 to 07/2017
Lead Drug Safety Associate
AVELLA SPECIALTY PHARMACY ,


  • Supervisor and trainer of pharmacy technicians and QA nurses assisting in report adverse events
  • Point of contact of all manufactures in reporting adverse events, source date verification and reconciliation. Lead Disease state review in oncology medications for PharmD rotating students
  • Manage the triage of safety reports received into central Drug Safety workflow. Prepared and presented monthly AE data and trends to specialty pharmacies.
09/2013 to 05/2015
Case Manager/Lead QA Nurse
ST. ELIZABETH HOME HEALTH ,
  • Trained all LPNs an CNAs. Served as a liaison to all disciplines(PT, OT, ST and vendors)
  • Taught wound care classes and scheduled all in office trainings. Lead weekly case conference for all field nurses
  • Partnered with physicians, social workers, activity therapists, nutritionists and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
08/2012 to 05/2014
Quality Assurance Manager
INTERIM HEALTHCARE ,
  • Supervised QA nurses. Responsible for hiring of all QA staff and supervision of QA staff Point of contact for all audits by state and insurance providers
  • Scheduled and chaired quality review meetings to review effectiveness of performance mitigating risk, improving throughput and achieving customer satisfaction.
  • Collaborated with audit clients and action owners to apply root cause analysis guidance and establish effective corrective action plans.
  • Developed quality planning for multiple new product launches by verifying customer requirements and implementing in design and production.
09/2012 to 09/2013
Documents Specialist
NORTH PHOENIX PAIN RELIEF CENTER ,
  • Reviewed all medical assistant’s chart notes and audit charts form NPs. Responsible for verification of insurance, updating billing, auditing files, supervision of all MA’s
  • Assisted in conscious sedation for epidurals and other pain management treatment
  • Provided assistance with inbound and outbound document processes, document sorting, logging and work order creation. Worked with internal staff to process documents and sent for closing.

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Resume Overview

School Attended

  • Capella University
  • Aspen University
  • Glendale Community College

Job Titles Held:

  • Audit Manager
  • RN Quality Analyst
  • Intensive Care Nurse
  • Lead Drug Safety Associate
  • Case Manager/Lead QA Nurse
  • Quality Assurance Manager
  • Documents Specialist

Degrees

  • Master Of Science In Nursing
  • Bachelor of Science
  • Associates

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