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QA Manager Resume Example

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QA MANAGER
Professional Summary
Registered Nurse with 14+ year experience in community health providing nursing care to diverse populations. Responsible job title with excellent communication skills demonstrated by number years of experience I health care. Nurse Case Manager with a valid State RN license. Solid clinical, utilization review and case management experience within a managed care environment.
Licenses
RN 079404 State of Georgia
Skills
Determining a level of care, AIMS, Schedule appointments, Agency, Auditing, caregiver, Case Manager, CCSP, conferences, clients/clients, DAS, diabetes, direction, disease management, documentation, financial, forms, Home Care, Home Health, ICD-9, notes, Director, Medical Assistance, medication management, Meetings, Network, nursing, Patient evaluation, training patient, personnel, personnel training, Policies, protocols, Quality Assurance, supervisory, teaching, triage.
Professional Experience
QA Manager
August 2015 to CurrentCompany Name - City, State
  • Monitor Community Care Services Program (CCSP) activities according to Home Community Based Waiver and all applicable DAS Policies and Procedures: Auditing includes Completed Level of Care (LOC) and LOC Crosswalk Comprehensive Care Plan, especially triggers, client assessment protocols, interventions, and triage level Minimum Data Set Home Care (MDS-HC) documentation which supports LOC eligibility and scoring between the LOC and the nursing assessment Case notes and follow-up activities include use of the Referral and Support screens in AIMS Completed Comprehensive Care Plans.
Chronic Disease Self Management Coordinator
September 2014 to December 2014Company Name - City, State

  • Led participants (12-16 participants) experiencing chronic health conditions such as hypertension, arthritis, heart disease, stroke, lung disease, pain and diabetes in a 6 week self- management plan.
  • The lessons included improving healthy behaviors (exercise, cognitive symptom management, coping, and communication with physicians), improve their health status (self reported health, fatigue, disability, social/role activities and health distress), and decreasing their days in the hospital.
Chronic Disease Self Management Coordinator
April 2014 to June 2014Company Name - City, State
Assisted the Wellness Coordinator in scheduling and organizing a 6 weeks training, which helped individuals deal with their chronic diseases, which included Diabetes, Hypertension, Pain, Dealing with emotions, etc. to learn effective coping, and to decide  to beban active manager in the care of the disease.
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RN Program Manager
July 2007 to June 2012Company Name - City, State
  • Supervise personnel and/or acted as the liasion between care coordination and the.
  • Executive Director of subcontract agency or lead agency.
  • Interprets Policies and Procedures.
  • Provides or arranges in service training for care coordination personnel.
  • Represents care coordination at quarterly Network Meetings as directed by the Executive Director.
  • Serves as the contact person for lead agency staff, providers, care coordination and Division of Aging.
  • Assures that case files and care coordinator's performances are reviewed as needed or at a minimum, that monthly supervisory staff conferences are held.
  • Assigned to monitor performance and prepare written performance of care coordination staff at the direction of the Executive Director.
  • Arranges and participates in case conferences.
  • Maintains current and appropriate personnel training records.
RN Care Coordinator/ Team Leader
June 1999 to June 2007Company Name - City, State
  • Perform work of considerable difficulty in the professional assessment and determination of a level of care and appropriateness for community base services for Medicaid recipients or potentially Medical Assistance Only clients.
  • Schedule appointments for face to face interview with prospective client at client's residence, hospital, long term care facility, or other appropriate site as indicated.
  • Reviews initial financial, medical, and social information of potential client as presented by referral source.
  • Verifies DFACS (Department of Family and Children Services) Medicaid eligibility and/or screens for MAO/PMAO eligibility by using a standardized guideline.
  • Develops with SW care coordinator an initial care plan.
  • Coordinates disease management education and referral to physician and other health care providers to manage chronic disease.
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Case Manager
October 1990 to April 1999Company Name - City, StatePer MD ordersx admit to Home Health for skilled observation and assessment, medication management, and skilled procedures such as IV administration, foley catheter changes, wound care, and teaching and monitoring significant others.
Education and Training
Bachelor of Science : Nursing, 1985Albany State CollegeNursing
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Resume Overview

School Attended

  • Albany State College

Job Titles Held:

  • QA Manager
  • Chronic Disease Self Management Coordinator
  • RN Program Manager
  • RN Care Coordinator/ Team Leader
  • Case Manager

Degrees

  • Bachelor of Science : Nursing , 1985

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