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outsourcing quality manager resume example with 15+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Summary

Health Care Professional with over 30 years of experience in a wide variety of fields. Excellent reputation for resolving problems, improving customer satisfaction, and driving overall operational improvements.

Education
Northwest Junior College Senatobia, MS, Expected in 01/1981 Associate of Science : Nursing - GPA :
Highlights
  • Vendor procurement
  • Contracting policies and regulations
  • SOP proficiency
  • Process Improvement
  • Operational Improvement
  • Histology
  • Phlebotomy
  • Abstracting
Work History
Deloitte - Outsourcing & Quality Manager
Indianapolis, IN, 09/2012 - 07/2020

Ensure all Conifer assigned services for domestic or international outsourced vendor(s) remains compliant with Conifer/Client RCS policies, procedures, budget/expense. Service Level Agreements and Performance metrics.

Manage Processes (including process mapping, policies & procedures, design sessions, Inventory, inventory management, Training/Refreshers, Vendor Scope Management. Activities within timeless (transitions and projects) and reconciliation of vendor(s) invoice payment., as relates to assigned portfolio of vendors.

Drive efficiencies - expense and revenue as it relates to the assigned portfolio of vendors, including negotiations of overall contractual terms, service level agreements and pricing for the vendor management.

Manage relationships and effectively communicate with Clients, C&G, Transitions, Product line operations. Client performance / Delivery and other partner organizations.

Manager effectiveness of overall services within the vendor portfolio, propose changes in placement volumes/processes as needed and ensure business needs or inventory liquidation rates are within accepted guidelines.

Manage and communicate quality audits, improvement plan and operational processes to ensure compliance with Conifer and Client requirements.

  • Maintained excellent attendance record, consistently arriving to work on time.
  • Resolved conflicts and negotiated mutually beneficial agreements between parties.
  • Drove operational improvements which resulted in savings and improved profit margins.
  • Resolved problems, improved operations and provided exceptional client support.
Johns Hopkins Bayview Medical Center - Consultant
Baltimore, MD, 06/2006 - 09/2012
  • Drafted and analyzed complex medical data.
  • Developed and maintained electronic record management systems to analyze and process data.
  • Abstracting experience in Cancer Tumor Registry
  • Managed onsite personnel and liaised between team and senior management.
  • Release of Patient Information
  • Chart Completion -Vital Record Completion
  • Prepping, Scanning, Indexing Medical Record Documentation
  • Evaluated diverse organizational systems to identify workflow, communication and resource utilization issues.
  • Reviewed internal systems and organized training plans to address areas in need of improvement.
  • Supported clients with business analysis, documentation and data modeling.
  • Provided outstanding service to clients to maintain and extend relationship for future business opportunities.
Med3000 - Utilization Review Nurse
City, STATE, 08/2004 - 06/2007
  • Supervised and maintained all utilization review documentation.
  • Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
  • Obtained authorizations from multiple insurance carriers for various levels of care.
  • Performed prior authorization review of services requiring notification.
  • Submitted cases to Medical Director for criteria failures and helped facilitate resolutions and approvals.
  • Leveraged feedback and process improvement opportunities to create safer and healthier environment and increase patient satisfaction.
  • Educated patients and answered questions about health condition, prognosis and treatment.
  • Implemented care plans for patient treatment after assessing physician medical regimens.
  • Facilitated workgroup meetings with Vendors to find effective solutions to issues.
  • Performed admission reviews based for medical necessity based upon Insurance specification.
  • Submitted cases to Medical Director for criteria failures and helped facilitate resolutions and approvals.
  • Reported patients' status and delegated nurse assignments to achieve optimal outcomes.
  • Accurately documented all elements of nursing assessment, including treatment, medications and IVs administered, discharge instructions and follow-up care.
  • Educated patients, families and caregivers on diagnosis and prognosis, treatment options, disease process and management and lifestyle options.
  • Performed triage on all incoming patients and determined severity of injuries and illnesses.
  • Provided direct patient care, stabilized patients and determined next course of action.
  • Performed admission reviews based for medical necessity based upon Insurance specification.
  • Submitted cases to Medical Director for criteria failures and helped facilitate resolutions and approvals.

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Resume Overview

School Attended

  • Northwest Junior College

Job Titles Held:

  • Outsourcing & Quality Manager
  • Consultant
  • Utilization Review Nurse

Degrees

  • Associate of Science

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