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Title: |
nurse auditor-QA-concurrent review
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Location: |
US-Arizona
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Work History: |
2004-2006 Arizona Department of Health
Assisted Living Licensure Surveyor
Monitored Assisted Living Homes and Centers for compliance with
Arizona Laws and Departmental Policy on an annual basis and for
Complaint investigations
Inspected Assisted Living Homes and/or Centers applying for new
License and/or renewal of license
On a rotating basis served as “Surveyor of the Day” taking complaint
Calls, providing telephonic consultation/information for inquiry calls
Re: regulation interpretation, and general licensure information, providing information to the public regarding Assisted Living
Homes, Centers, and approved ADHS training programs/sites
Provided in-service education to various community agencies, hospice,
Churches, schools, etc regarding the licensure regulations and process
2002-2004 Villa Ocotillo Assisted Living Center-Scottsdale
Provided supervision for a 225 bed assisted living center-monitored
Day to day care for residents, supervised care staff,
Maintained staff development
Monitored for regulatory compliance daily, reconciled doctor’s orders
Communicated daily with family members, physicians, nurse
Parishioners, Insurance companies, medical transport, equipment and
Supply companies, on call on weekends for nursing services
2000-2002 Trinity Hospice of Arizona
Continuous Quality Improvement Nurse Manager
Supervised CQI department staff, monitored
Interdisciplinary team notes for every patient record daily, monitored
forregulatorympliance.ledaily, communicated with patients, families, prepared reports
1998-2000 La Villita Assisted Living Center
Resident Services Coordinator
Supervised the day to day care of 125 assisted living
Residents, maintained staff development, communicated with
Families, physicians, medical service providers, monitored for
Regulatory compliance
1995-2000 Action Health Care Management
Prior Authorization Supervisor
Reviewed medical records to provide prior authorization for
Surgical procedures, diagnostic testing, treatment
Regimes, and inpatient hospitalization utilizing Milliman and
Roberts, and Interqual guidelines, ICD-9 and CPT coding for
Outpatient and inpatient procedures
Telephonic review of inpatient stays for continued authorization,
Utilizing M & R, and Interqual guidelines
Review hospital bills for accuracy for inpatient hospitalizations,
Defense audits of hospital bills for self-funded hospital groups
Communicated with insurance company liaisons for
Negotiated payments of procedures and inpatient hospital
stays
1996-present Senior Pastor Casa de Cristo Church
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Skills: |
extensive management experience-computer base Word Excel-
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Education: |
San Jacinto Junior College North Campus Houston Texas
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