Quality Assurance & Management Director Resume Example PRIDE IN NORTH CAROLINA, INC

QUALITY ASSURANCE & MANAGEMENT DIRECTOR

Executive Profile

Compassionate , empathetic and solutions- oriented professional dedicated to providing quality clinical care and implementing effective treatment plans for individuals. Excellent analytical skills with keen attention to detail, ability to analyze data, situations, and research information to develop sound and ethical clinical/business solutions with a focus on quality. Enthusiastic individual and an excellent communicator, recognized ability to establish and maintain effective working relationships across cross-functional teams. Effective communicator and advocate for individuals, couples and families from various populations and backgrounds. Strong clinical application and documentation skills to ensure compliance and treatment fidelity.

Core Accomplishments

Protect Risk Management plan for agency's annual revenue (approx.. $6-$ 8 Million a fiscal year) . Successfully completed multiple State and Federal Medicaid Audits with minimal recoupement/paybacks (less than 0.5% of annual revenue) for the agency.
Directly developed and implemented agency Evidenced Based Programs over the past 10 years.
Oversee the implementation of Evidenced Based treatment interventions within clinical services, TF-CBT, Brief-CBT, DBT, Illness Management and Recovery and Seven Challenges.
Coordinated, planned, and oversee process(es) for achieving and maintaining national CARF accreditation three cycles.

Protect Risk Management plan for agency's annual revenue (approx.. $6-$ 8 Million a fiscal year) . Successfully completed multiple State and Federal Medicaid Audits with minimal recoupement/paybacks (less than 0.5% of annual revenue) for the agency.
Directly developed and implemented agency Evidenced Based Programs over the past 10 years.
Oversee the implementation of Evidenced Based treatment interventions within clinical services, TF-CBT, Brief-CBT, DBT, Illness Management and Recovery and Seven Challenges.
Coordinated, planned, and oversee process(es) for achieving and maintaining national CARF accreditation three cycles.

Professional Experience

01/2005 to Current

Quality Assurance & Management DirectorPRIDE IN NORTH CAROLINA, INC

Promote and advocate quality achievement and performance improvement across the organization.
Conduct internal audit and quality reviews to ensure compliance with prescribed methodology in a risk focused manner monthly/quarterly.
Provide QA/QI monitoring to ensure that agency operates within applicable rules, regulations and standards set forth by governing and funding bodies.
Medicaid, Medicare, MCO, CARF, NC Division of MH/DD/SAS) Provide ongoing monitoring, assessment, and revision of clinical programs to ensure quality services are consistent with the mission of the agency.
Directly developed and implemented agency Evidenced Based Programs over the past 10 years.
Oversee the implementation of Evidenced Based treatment interventions within clinical services.
Develop and coordinate the ongoing implementation of the annual Quality Improvement/Quality Assurance plan to promote an agency culture of continuous improvement and quality care at all levels of the agency.
Coordinate and lead quality improvement activities including the development and data analytics of clinical consumer outcomes, review of adverse events, and overall agency performance/quality of care.
Chairs and maintains documentation of Human Rights Committee meetings and QA activities.
Distributes required documentation to local and state agencies.
Authors and compiles aggregate data, clinical consumer level outcomes and agency demographics into an annual report to internal and external Stakeholders.
Develops and implements a systematic process for conducting consumer and employee satisfaction surveys.
Compiles information from satisfaction surveys into usable format to institute change and process improvement.
Authors and completes annual satisfaction survey data for Stakeholders.
Coordinates, plans, and oversees process(es) for achieving and maintaining national accreditation.
CARF) Responsible for consistent auditing of agency E.H.R and other documentation to ensure integrity to agency Risk Management plan.
Coordinates MCO monitoring audits/reviews and acts as agency lead during Medicaid/MCO audits.
Provides clinical trainings for staff on agency utilized Evidenced Based Practices, Person Centered Thinking, and various other Medicaid/funding source requirements.
Develops and maintain training curriculum for agency Training site and compliance standards.
Participates in clinical supervision for staff at various levels.
Responsible for development of new programs and project management, including meeting licensure, endorsement, monitoring, and accreditation requirements, hiring and training staff, etc.
Serves as agency representative on State wide committees, agency collaborative and groups.
Provides outpatient therapy to adults, children and families as needed by the agency to help maintain licensure and meet clinical hours for full LMFT licensure.

01/2002 to 01/2005

Regional DirectorPRIDE IN NORTH CAROLINA, INC

Reviewed financial statements, sales and activity reports, and other performance data to measure productivity and goal achievement and to determine areas needing cost reduction and program improvement.
Determined staffing requirements, and interview, hire and train new employees, or oversee those personnel processes within Region.
Assisted with administering program policies and procedures and ensures all policy and procedure manuals are revised in a timely manner when revisions are distributed.
Ensured all expenses were monitored and reviewed so overspending and/or unauthorized spending does not occur.
Worked closely with accounts receivable and billing staff to address payment and authorization issues and denials.
Conducted internal audits of services provided to identify any problem areas and make needed corrections and changes in procedures.
Serves as liaison within the community and with other agencies serving PRIDE consumers, and accesses needed services.
Routinely sought input from stakeholders to ascertain effectiveness of services and overall satisfaction level.
Provided clinical and administrative supervision and guidance to all staff, therapeutic parents and facilities through frequent on-site visits and modeling appropriate therapeutic interventions and teaching techniques.

01/2001 to 01/2002

Outpatient TherapistONSLOW COUNTY BEHAVIORAL

Provided outpatient therapeutic intervention services to women and their children using individual, family, and group therapy treatment.
Primary focus on co-occurring diagnoses of Mental Health and Substance Abuse.
Provided DWI recovery group and Psychoeducation groups related to court ordered services in outpatient services.

Education

May, 2001

Master of Science: Marriage and Family TherapyEast Carolina University － Greenville, NCMarriage and Family Therapy

May, 1995

Bachelor of Science: PsychologyEast Carolina University － Greenville, NCPsychology Licensed Marriage and Family Therapist-Associate Status NC LMFTA 9021A

Skills

accounts receivable, administrative, agency, auditing, billing, continuous improvement, cost reduction, documentation, financial statements, focus, forth, hiring, meetings, Mental Health, modeling, personnel, policies, process improvement, processes, project management, quality, Quality Improvement, QA, Quality Assurance, Risk Management, sales, SAS, staffing, supervision, teaching

Resume Overview

Companies Worked For:

PRIDE IN NORTH CAROLINA, INC
ONSLOW COUNTY BEHAVIORAL

School Attended

East Carolina University

Job Titles Held:

Quality Assurance & Management Director
Regional Director
Outpatient Therapist

Degrees

Master of Science : Marriage and Family Therapy
Bachelor of Science : Psychology

Quality Assurance & Management Director Resume Example

Resume Score: 90%

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