Dawn Schubert
Ruskin,FL
Summary
Results-driven quality and compliance leader with expertise in utilization review, regulatory compliance, and quality improvement. Proven success in leading accreditation processes, managing cross-functional teams, and driving performance improvements through data analysis and process enhancements. Skilled in navigating complex regulatory environments and ensuring compliance with TJC, CMS, and other standards. Strong analytical abilities to identify gaps, implement corrective actions, and foster collaboration to optimize patient safety and service delivery.
Overview
16
16
years of professional experience
Work History
Manager, Compliance & Audit | Trainer & Quality Specialist | Utilization Review
Cohere Health
01.2021 - 04.2024
- Managed utilization review compliance project that led to the expansion of scope from 12 states to 50 states
- Boosted external audit scores from 23% to over 95% within the first six months
- Managed all internal and external quality and compliance audits and developed and implemented corrective action plans to ensure compliance and continuous improvement
- Collected and analyzed data, compiled reports, and presented findings to leadership, driving informed decision-making and strategic initiatives
- Served as the subject matter expert for prior authorization decisions and denial letters; trained MDs and nurses on appropriate decision-making, documentation, and compliance with regulatory standards
Registered Nurse Global Nurse Advice Line
Optum
07.2020 - 01.2021
- Successfully provided 30 or more compassionate telephonic, video, and chat triage communications with military personnel and their families worldwide every shift
- Delivered exceptional service under a Department of Defense contract, consistently exceeding performance expectations - awarded the Diamond Quality Award for outstanding service and commitment to excellence
- Held active National Security Clearance, adhering to stringent confidentiality and security protocols
Quality Analyst & Trainer, Utilization Review | Service Delivery Manager, Pharmacovigilance
Cognizant Technology Solutions
06.2018 - 08.2020
- Managed the quality and training for a startup project with a new vendor, consisting of Medicare appeals and post-acute pre-authorizations, ensuring compliance and operational excellence
- Led quality and process improvements for utilization review, driving performance enhancement through auditing, coaching, and training of nurses, consistently meeting client quality SLA with scores of 95% or greater
- Expanded pharmacovigilance operations from one department to five, growing the team from 20 to 50+ employees and opening a new office in Manila
- Successfully managed global operations across two contact centers, overseeing daily functions, personnel, and resource allocation to ensure optimal service delivery, consistently meeting or exceeding all SLAs
- Analyzed and presented data to stakeholders, driving informed decision-making and risk mitigation; developed and managed CAPs, business continuity plans, and policies and procedures to ensure operational efficiency and compliance
Performance Improvement Accreditation Specialist
The Christ Hospital Health Network
05.2017 - 06.2018
- Led 4 successful Joint Commission certification and accreditation surveys, including the accreditation of a newly established hospital
- Led 1 successful Ohio Department of Health (ODH) state licensing survey for a newly established hospital
- Led 3 successful CMS complaint surveys
- Investigated non-compliance issues, collaborated with cross-functional teams to address gaps, implemented corrective action plans, and standardized processes to ensure consistent compliance
- Presented accreditation findings to senior leadership, driving informed decisions and continuous improvement
Program Manager, Compliance & Accreditation | Regulatory Lead & Quality Improvement Specialist
Cincinnati Children’s Hospital Medical Center
07.2008 - 05.2017
- Led 2 Joint Commission (TJC) and 4 CMS surveys, achieving successful accreditations
- Managed accreditation processes and action plans, addressing gaps identified in surveys by TJC, CMS, and ODH, ensuring ongoing compliance
- Led the hospital's largest project on continuous survey readiness and adherence to CMS Conditions of Participation, collaborating with C-suite executives (CEO, CNO, Patient Safety Officer) and frontline staff across the enterprise to ensure compliance and maintain high standards of care
- Managed and conducted hospital and physician office tracers, collaborating with Infection Control, Patient Safety, Emergency Management, and Clinical Engineering to ensure compliance with safety standards and regulatory requirements
Education
Master of Science - Nursing, Administration
University of Cincinnati
Cincinnati, OH05.2016
Skills
- Compliance certified (CHC)
- Quality certified (CPHQ)
- Registered Nurse
- Patient safety
- Internal and external audits
- Risk management
- Project management
- Utilization review
- Communication and presentation
- Critical thinking
- Coaching and consulting
- Collaboration with leadership
- Action plans
- Policy and procedure development
- Team building
- Microsoft Office and Google
Timeline
Manager, Compliance & Audit | Trainer & Quality Specialist | Utilization Review
Cohere Health
01.2021 - 04.2024
Registered Nurse Global Nurse Advice Line
Optum
07.2020 - 01.2021
Quality Analyst & Trainer, Utilization Review | Service Delivery Manager, Pharmacovigilance
Cognizant Technology Solutions
06.2018 - 08.2020
Performance Improvement Accreditation Specialist
The Christ Hospital Health Network
05.2017 - 06.2018
Program Manager, Compliance & Accreditation | Regulatory Lead & Quality Improvement Specialist
Cincinnati Children’s Hospital Medical Center
07.2008 - 05.2017
Master of Science - Nursing, Administration
University of Cincinnati
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