Experienced remote full-time quality assurance management professional and registered nurse with a background as a quality assurance coordinator. Specializes in ensuring electronic medical records compliance with regulatory standards. Advocates for patients/clients and supports team members by leveraging education, clinical experience, and personal values. Provides encouragement, relieves suffering, improves health, and enhances quality of life for all individuals encountered.
Hi, I’m
Bethanie Sweet
Rural Retreat
Summary
Overview
32
years of professional experience
1
Certification
Work History
Sentara Enterprises (Sentara Home Care)
Quality Assurance Coordinator
04.2023 - Current
Job overview
- My job duties and responsibilities as a quality assurance coordinator for Sentara Home Care include taking driveway calls from clinicians (registered nurses, physical therapists, occupational therapists, & speech therapists) after they have completed a start of care, resumption of care, or recertification OASIS assessment. I enter in code status and face to face encounters into the electronic medical record and develop individualized care plans that are based upon the clinical needs identified during assessments. I assist in coordination of care by communicating identified patient care needs with other members of the care team. I perform quality assurance audits of the OASIS assessments and Plans of Treatment completed by clinicians to ensure compliance with regulatory governing bodies. I support field staff in following Sentara policies and procedures.
Sentara Health Plans - Government Programs
Utilization Review Nurse
06.2023 - 12.2024
Job overview
- My job duties and responsibilities as a utilization review nurse included reviewing outpatient preauthorization requests for Virginia Cardinal Care Medicaid members managed by Sentara Health Plans. I utilized the DMAS Manual, Cardinal Care Contract, Cardinal Care Member Handbook, Sentara medical policies and MCG guidelines to determine benefits and medical necessity for durable medical equipment (DME), outpatient therapy, home health, and outpatient office services. I communicated with providers to obtain additional medical records to support requests and communicated with the Medical Directors when a request did not meet criteria for medical necessity or the requested amount was over the DMAS limits per Appendix B. I followed DMAS and NCQA regulatory guidelines to ensure that the needs of our members, including EPSDT members, were met at the appropriate time, at the appropriate level of care, with the appropriate treatment, by the appropriate providers.
Sentara Health Plans - Commercial
Integrated Care Manager
02.2022 - 06.2023
Job overview
- I coordinated health care for health plan members of the commercial lines of business by completing health risk screenings and comprehensive assessments to identify gaps in care and provide in-network provider options along with disease management and education to improve the health and quality of life of the members I served. I also served as the utilization review nurse for all commercial transplant members by reviewing transplant requests for medical necessity. Communicating with the medical directors regarding transplant preauthorization requests was also an important role I served in on the commercial team.
Virginia Department of Health Professions/Board of Nursing (VBON)
Education Program Inspector/Quality Assurance Auditor
02.2018 - 02.2022
Job overview
- My job duties and responsibilities as an inspector for the Virginia Board of Nursing include verifying that nurse aide education programs in the state of Virginia follow the laws and regulations set forth by the Virginia Board of Nursing.
Credentia | Bala Cynwyd, PA
Nurse Aide Evaluator & State Quality Assurance Auditor
12.2013 - 02.2022
Job overview
- My job duties and responsibilities as a nurse aide evaluator for Credentia include proctoring the NNAAP Examination to eligible nurse aide candidates. Upon passing this examination, nurse aide candidates receive their certification. As a state QA auditor, my duties & responsibilities include auditing nurse aide evaluators & testing sites to ensure compliance with policies and accurate scoring through objectivity. I also participate in orientations & reorientations of nurse aide evaluators.
Washington County Career and Technical Education (CTE) Center | Abingdon, VA
Nursing Instructor
08.2012 - 02.2022
Job overview
- As the Program Director & Primary Instructor for the Nurse Aide program, my job duties and responsibilities include educating and preparing high school students with the knowledge and skills required to pass the National Nurse Aide Assessment Program examination and receive certification. The nurse aide curriculum focuses on safety, infection prevention, residents’ rights, and promoting dignity & independence while assisting residents in long-term care with their activities of daily living (ADLs). I supervised the students and clinical instructors in the classroom, skills lab, and clinical sites. I also teach Introduction to Health & Medical Sciences and Medical Terminology.
Elite Learning/Southwest Virginia Education and Training Network (SVETN)
Medical Terminology Instructor
07.2017 - 05.2019
Job overview
- My job duties and responsibilities as a medical terminology instructor for Elite Learning include teaching high school students in southwest Virginia via an asynchronous, online format competencies established by the Virginia Department of Education. Included in those competencies are prefixes, suffixes, root words, combining vowels, medical abbreviations, and medical acronyms. Anatomy and physiology of the body systems, including their corresponding disease processes and treatments, is also covered.
Grace Healthcare & Rehabilitation Center | Abingdon, VA
Registered Nurse (RN) Supervisor
04.2013 - 10.2013
Job overview
- My job duties and responsibilities as a registered nurse for Grace Health Care include medication administration, venipuncture, initiation and maintenance of intravenous therapy, Foley catheter insertions, admission assessments, fall precautions and interventions, supervision of the nursing staff, documentation, and to coordinate responses to emergency medical situations.
Washington-Lee Elementary School | Bristol, VA
Registered Nurse (RN)
02.2011 - 08.2012
Job overview
- My job duties and responsibilities as a Registered Nurse at Washington-Lee Elementary include medication administration, first aid, and assessment for communicable illnesses and diseases.
Marion Youth Center | Marion, VA
Behavioral Health Registered Nurse (RN)
07.2009 - 10.2010
Job overview
- My job duties and responsibilities as a behavioral health Registered Nurse at Marion Youth Center included assisting adolescent boys with behavioral management, anger management, conflict resolution skills, & coping mechanisms. My role also included completing admission assessments, administering medications, venipuncture for lab work ordered by the physicians, verbal de-escalation, and initiating & supervising handle-with-care procedures when safety issues arose.
Johnston Memorial Hospital | Abingdon, VA
Registered Nurse (RN)
05.1996 - 11.2009
Job overview
- During the 13 years in which I was employed by JMH as a Registered Nurse, I worked on multiple units including Orthopedics, Oncology, Labor & Delivery, Joint Trails, Critical Care Unit, Emergency Room, Geriatrics, Med-Surg, and Home Health. I was hired as a charge nurse which included taking on the responsibility of being the charge nurse on almost every unit I worked. My responsibilities included ensuring compliance with OSHA and Joint Commission standards, staffing, delegating responsibilities to staff members, reporting to the oncoming charge nurse, documentation on patient charts, admission assessments, patient & family teaching, being a patient advocate, initiating & maintaining intravenous access, administering medications, maintaining epidurals, initiating & maintaining PCA pumps, inserting & maintaining foley catheters and nasogastric tubes, initiating & maintaining tube feedings, administering chemotherapy, wound assessments & dressing changes, monitoring for post-operative complications, maintaining wound drainage systems, initiating & maintaining wound vac therapy, sterile vaginal exams, applying fetal scalp electrodes, non-stress tests, induction of labor, assisting in C-Sections, postpartum care, triage (Labor & Delivery and ER), and venipuncture for labwork. I served as the admission nurse when working in home health.
Highlands Retirement Village | Abingdon, VA
Nursing Assistant (NA)
09.1993 - 05.1996
Job overview
- While I was in the nursing program at Virginia Highlands Community College, I worked as a nurse aide at Highlands Retirement Village. I was responsible for assisting residents in performing ADL's including bathing, grooming, dressing, incontinent care, mouth care, and feeding them meals. I also assisted in the administration of PRN medications and performed CPR as needed.
Education
Liberty UniversityLynchburg, VA
Master of Arts Degree from Human Services- Marriage and Family Cognate
05.2013
University Overview
Old Dominion UniversityAbingdon, VA
Bachelor of Science Degree from Registered Nursing
12.2003
University Overview
During my studies in nursing at ODU, I also completed several classes in Management.
Virginia Highlands Community CollegeAbingdon, VA
Associate of Science Degree from Registered Nursing
05.1996
University Overview
Skills
- Accurate clinical documentation
- Comprehensive patient management
- Interdisciplinary care coordination
- Patient-centered treatment design
- Comprehensive nursing evaluations
- Management of electronic health records
- Regulatory compliance management
Certification
- Registered Nurse
- Expires March 31, 2027
- Commonwealth of Virginia Department of Health Professions
- 0001149336-Multi-State Privilege
- Basic Life Support Certification
- Expires May 2027
- American Heart Association
- IMP258HYXHZ8
- Heartsaver First Aid Certification
- IMP25B725R41
Training
Training
- Care Guidelines Specialist (Inpatient & Surgical Care/General Recovery Care)
- April 2024
- MCG Part of the Hearst Health Network
- COVID-19: Epidemiology, Modes of Transmission and Protecting Yourself with PPE; Nursing Care; Basic Law & Ethics for Nurses During COVID-19; and Credible Information, Hoaxes, and the Medics online courses
- May 2020
- National Council State Boards of Nursing International Center for Regulatory Scholarship
- American Sign Language
- Fall 2019
- Virginia Highlands Community College
- Nurse Aide Curriculum Revision
- Participated in October 2019
- Virginia Department of Education
- Train-the-Trainer for Nurse Aide Trainers
- Completed in July 2019
- Tidewater Medical Training
- Gerontology Certification Course
- Complete in May 2019
- Virginia Western Community College
- Sexuality Issues & Answers for Long Term Care
- Completed in March 2018
- Virginia Adult Care Education
- Completed in September 2017
- Virginia HAMSEA Summer Conference
- July 2017
- Train-the-Trainer for Medication Aide Trainers
- Completed in February 2017
- Train-the-Trainer for Direct Care Staff/Personal Care Aide Trainers
- Train-the-Trainer for Nurse Aide Instructors
- Completed in July 2016
- July 2016
- Best Practices Update with Temika Younger
- Completed in April 2016
- Virginia Board of Nursing
- Virginia Health & Medical Sciences Educators Association
- Joined in July 2017
- Train-the-Trainer for Trainers of Nurse Aides
- Completed in November 2013
- Curriculum Instruction & Procedures in Career & Technical Education
- Completed in July 2013
- James Madison University
Timeline
Utilization Review Nurse
Sentara Health Plans - Government Programs
06.2023 - 12.2024
Quality Assurance Coordinator
Sentara Enterprises (Sentara Home Care)
04.2023 - Current
Integrated Care Manager
Sentara Health Plans - Commercial
02.2022 - 06.2023
Education Program Inspector/Quality Assurance Auditor
Virginia Department of Health Professions/Board of Nursing (VBON)
02.2018 - 02.2022
Medical Terminology Instructor
Elite Learning/Southwest Virginia Education and Training Network (SVETN)
07.2017 - 05.2019
Nurse Aide Evaluator & State Quality Assurance Auditor
Credentia | Bala Cynwyd, PA
12.2013 - 02.2022
Registered Nurse (RN) Supervisor
Grace Healthcare & Rehabilitation Center | Abingdon, VA
04.2013 - 10.2013
Nursing Instructor
Washington County Career and Technical Education (CTE) Center | Abingdon, VA
08.2012 - 02.2022
Registered Nurse (RN)
Washington-Lee Elementary School | Bristol, VA
02.2011 - 08.2012
Behavioral Health Registered Nurse (RN)
Marion Youth Center | Marion, VA
07.2009 - 10.2010
Registered Nurse (RN)
Johnston Memorial Hospital | Abingdon, VA
05.1996 - 11.2009
Nursing Assistant (NA)
Highlands Retirement Village | Abingdon, VA
09.1993 - 05.1996
Old Dominion University
Bachelor of Science Degree from Registered Nursing
Virginia Highlands Community College
Associate of Science Degree from Registered Nursing
Liberty University
Master of Arts Degree from Human Services- Marriage and Family Cognate
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