Jamie Abbondanza
Monroe,NC
Summary
In-depth Quality Assurance, Registered Nurse that possesses a unique and invaluable skill set of clinical expertise in acute, critical care nursing and a Juris Doctorate from an ABA accredited law school. Committed to paying impeccable attention to reviews and auditing procedures. Applies creativity in improving clinical and operational processes to achieve higher productivity and quality of finished product. Experience in reviewing and interpreting regulatory and clinical guidance, implementation of corporate compliance, risk management and corrective action programs. Quality control professional experienced in developing organization's quality strategy, procedures and processes. Monitor quality performance life cycle including, identification, development, implementation, evaluation and maintenance. Manage quality audit program to identify and resolve non-conformities and embed culture of continuous improvement. Experienced with in-depth medical record review, adverse event investigations and chronologies in both legal and healthcare settings. Proactive change agent who encourages learning and promotes increased productivity that results in value-based customer service. Proven ability to communicate efficiently advocating for patient safety and outcomes as well as promoting employee health and safety. Able to effectively and accurately work in a high stress environment while maintaining attention to detail. Successfully led multidisciplinary teams to achieve cross-functional goals in various clinical and leadership settings.
Overview
24
24
years of professional experience
1
1
Certification
Work History
Quality Assurance Supervisor
CorVel Corporation
Irvine, CA
10.2021 - Current
- Purpose of Quality Assurance Supervisor is to ensure Case Managers are delivering remarkable patient experience to patients as well as high level of quality customer service to clients
- Continually perform audit activities on injured workers claims ensuring case manager’s performance aligns with pre-determined expectations that meet or exceed service delivery goals, quality performance metrics and patient feedback
- Responsible for leading designated group of case managers in day to day activities of quality assurance and documentation
- Serve as internal resource for staff in all departments, and act as extended liaison for other system entities and resource for clinical practice
- Educated employees on specific QA standards and confirmed maintenance of standards.
- Fixed identified issues to increase productivity and boost workflows.
- Promoted adherence to quality standards by educating personnel on quality control.
- Prepared and interpreted productivity reports, complete with comprehensive analysis of results, for leadership team.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Implemented process improvements to increase productivity in quality assurance operations.
Quality Assurance Nurse
CorVel Corporation
Irvine, CA
06.2021 - 10.2021
- Conducts quality chart audits for locations covered based on regulatory requirements, accrediting body requirements, as well as CorVel’s internal policies, procedures and quality expectations
- Perform daily, weekly, monthly reviews of Case Management files to ensure company policies and procedures are being followed
- Investigated and resolved issues affecting business operations and Injured Worker plans of care.
- Data collection, lead and facilitate continuous training and performance improvement projects
- Identify opportunities for improvements to process standards to achieve high quality customer services and relationships
Utilization Review Registered Nurse
Insight Service Group, ISG
Danvers, MA
01.2021 - 06.2021
- Job change due to ISG acquiring AIS First-Party Clinical Review services.)
- Utilization Nurse Review position provides support to carrier's personnel regarding medical care, medical necessity, relatedness and causality
- Review bills including HFCA's and UB92's on injured parties, involved in Automobile Accidents and General Liability Cases
- Perform utilization review in accordance with company policies and procedures
- Review of certain coding rules.
- Performed prior authorization review of services requiring notification.
Registered Nurse Reviewer
Auto Injury Solutions
Iselin, NJ
07.2019 - 12.2020
- Utilization Review - National, National Nurse Review position provides support to carrier's personnel regarding medical care, medical necessity, relatedness and causality
- Review bills including HFCA's and UB92's on injured parties, involved in Automobile Accidents and General Liability Cases
- Perform utilization review in accordance with Auto Injury Solutions (AIS) structure
- Review of certain coding rules.
Registered Nurse, Medical Legal Review
Advance Talent
Mayfield Heights, OH
12.2018 - 06.2020
- Work from home reviewing medical records, extracting data, preparing summaries and otherwise supporting legal professionals with claims or cases involving medical documents and/or patient data
- Review and analyze litigation, medical and scientific information
- Using sensitive and confidential material, work to compile and summarize pertinent medical and scientific issues into litigation relevant chronologies.
- Followed all personal and health data procedures to effectively comply with HIPAA laws and prevent information breaches.
- Summarized depositions, legal documents and other material to provide attorney with relevant material for cases.
- Completed detailed client intakes and entered information into company database.
Director, Clinical Compliance Program
Atrium Healthcare, Previously Carolinas Healthcare System
Charlotte , NC
11.2017 - 01.2019
- Oversaw clinical aspects of Corporate Compliance program including HelpLine investigations, Conflict of Interest reporting and risk mitigation, Compliance Workplan, Risk Assessment and Employee Departure Survey
- Managed compliance personnel work assignments, daily decision making and goal setting, and performance evaluations for direct reports
- Restructured and implemented companywide reporting system for HelpLine investigations and Conflict of Interest management and risk mitigation
- Led multidisciplinary team that restructured HelpLine reporting system which successfully streamlined all investigations and ensured appropriate investigation and closure of all reports
- Developed and implemented streamlined approach to potential Conflict of Interest reporting
- Process required system wide education and training as well as implementation of new process and forms to ensure all appropriate information was being obtained and reviewed to ensure mitigation of risk to teammate and organization
- Successfully organized and chaired monthly Conflict of Interest Oversight Steering Council
- Council consisted of several executive and physician leadership stakeholders as well as Chief Compliance Officer, Chief Privacy Officer, Office of General Counsel representatives and Senior Vice President of Risk Management.
- Consulted with clients on best practices and served as project manager for process improvements and regulatory initiatives.
- Delivered subject matter expertise for internal and external customers on compliance best practices and quality control.
- Managed compliance efforts, reporting and audits.
- Defined and developed policies and procedures for consumer reporting and privacy practices.
- Found appropriate stories and ideas for programming to engage target audiences and hook advertisers
Clinical Compliance and Quality Coordinator
Atrium Healthcare, Previously Carolinas Healthcare System
Charlotte, NC
05.2015 - 11.2017
- Designed and implemented quality improvement programs for Emergency Department and Kidney Dialysis Units
- These activities included design and implementation of "test and learn" pilots, evaluation and optimization of core model of care processes and workflow, as well as measurement and analysis of clinical program's outcomes
- Chaired Nursing Event Peer Review Council where adverse care events were referred by Risk Management for additional review to determine whether breakdown in systems or processes contributed to adverse patient outcome
- Based on professional standards and evidenced-based nursing practice, would review and recommend additional action steps that would proactively mitigate risks to patients and organization in the future
- Reviewed all Emergency Department related Adverse Care Events for Level 1 Trauma Center and determined need for further investigation or follow-up
- If additional review was needed, worked collaboratively with Risk Management and Patient Safety to investigate events through staff interviews and root cause analysis
- Worked as multi-disciplinary team to ensure appropriate follow-up actions were taken either through staff education, process change and/or policy change
- Responsible for decreasing waste, improving regulatory compliance with quality controls and assist in maintaining consistent culture of accountability
- Developed monthly, end-of-quarter and other statistical reports for leadership team and quality improvement programs.
- Collaborated with management to provide training on improved processes and assisted with creation and maintenance of quality training.
- Provided regular updates to team leadership on quality metrics by communicating consistency problems or production deficiencies.
- Scheduled and chaired quality review meetings to review effectiveness of performance mitigating risk, improving throughput and achieving customer satisfaction.
- Determined quality department standards, practices, and procedures.
- Analyzed quality and performance data to support operational decision-making.
- Established and tracked quality department goals and objectives.
Nursing Supervisor
Atrium Healthcare, Previously Carolinas Healthcare System
Charlotte, NC
11.2015 - 02.2017
- Supervised and coordinated hospital activities with emphasis upon communications, patient throughput, patient experience, rounding for quality, safety and operational efficiency, performance improvement activities, service recovery, and compliance with regulatory requirements interacting with nursing and hospital teammates in daily operations
- Guided staff in understanding and compliance with state and federal laws concerning healthcare services and practice, compliance with Nursing Practice Act, and company policies and procedures
- Supervised performance of nursing personnel, identifies problems, initiates corrective action, and communicates/provides documentation of actions/investigative findings to appropriate department manager, Nurse Leader and/or Administrator-On Call
- Supervised staff registered nurses, licensed practical nurses and certified nursing assistants in daily staffing assignments and hospital resource allocation.
- Confidently directed overall operation of nursing services and patient care.
- Organized department in accordance with administrative guidelines in order to provide specified nursing services to meet legal, organizational and medical staff guidelines.
Clinical Supervisor /Staff Nurse, Emergency Department
Atrium Healthcare, Previously Carolinas Healthcare System
Charlotte , NC
08.2001 - 05.2015
- Responded to patient emergencies to provide prompt and correct intervention .
- Collaborated with multidisciplinary team to evaluate patient data and determine patient care plans.
- Participated in quality improvement initiatives to improve patient care outcomes.
- Evaluated, prioritized, diagnosed and stabilized patients at busy Emergency Department seeing over 100 individuals per day.
- Operated diagnostic testing equipment such as EKGs, scans, ultrasounds and other devices.
- Maintained accurate and comprehensive patient records in line with regulatory standards.
- Evaluated preliminary results and administered initial treatment such as stitching lacerations, splinting, casting broken bones or installing tubes and devices.
- Analyzed complex trauma conditions and quickly determined treatments for various illnesses and injuries.
- Handled patient transfers, following safety protocols to prevent injuries.
- Stayed current with health system initiatives and incorporated evidence-based practice and research into care routine.
- Utilized evidence-based practice to assess and provide care for patients.
- Monitored patients, evaluated results, and recommended further courses of treatment to quickly improve patient outcomes.
- Coordinated departmental operations according to administrative, legal and medical guidelines.
- Supervised professional and paraprofessional nursing staff and delegated tasks to maintain continuum of care.
- Interacted effectively with department managers to promptly correct problems and improve services.
- Evaluated nursing staff's performance and developed education programs and professional development opportunities to improve individual and team competencies, clinical knowledge and delivery of care.
- Followed all hospital policies and procedures and complied with local, state, and federal agency and accrediting body guidelines.
- Monitored, analyzed, and corrected staff performance and worked with nurse manager to raise standards of practice.
- Participated in nursing research and evidence-based clinical audits and leveraged data to improve research-based methodologies within clinical areas.
- Facilitate hiring of qualified Emergency Department personnel by interview applicants and making recommendations for employment.
Legal Externship
Legal Services Of Southern Piedmont, Inc
Charlotte, NC
01.2015 - 04.2015
- Legal Services of Southern Piedmont (LSSP) is a non-profit agency that provides legal assistance in civil matters to low income persons in Charlotte and mid-western North Carolina
- LSSP provides learning opportunities for interns/externs in legal process, substantive law and ways in which low-income people are affected by law
- Assisted attorney adviser with interviewing clients and witnesses; collecting, evaluating and preparing evidence for presentation, performing legal research; drafting pleadings, briefs and other legal documents
- Represented clients during Medicaid Disability appeal hearings to advocate for their right to receive benefits based on North Carolina's Social Security guidelines for adult disabled
- Wrote and submitted an appeal to North Carolina Department of Health and Human Services Office of Administrative Hearings requesting a second review of client's Adult Medicaid claim.
Education
J.D - undefined
2015
Certificate of Completion - Healthcare Law
07.2014
Bachelor of Science - Nursing
01.2009
Associate of Science - Nursing
05.1999
Skills
- Process Improvement
- Quality Assurance
- Change Management
- Operational Standards
- Clinical Quality Program Standards
- Clinical Quality Improvement
- Nursing Operations Management
- Compliance Advisory
- Project Implementation
Certification
Certified in Health Care Quality and Management (CHCQM) October 2020 to October 2024
Timeline
Quality Assurance Supervisor - CorVel Corporation
10.2021 - Current
Quality Assurance Nurse - CorVel Corporation
06.2021 - 10.2021
Utilization Review Registered Nurse - Insight Service Group, ISG
01.2021 - 06.2021
Registered Nurse Reviewer - Auto Injury Solutions
07.2019 - 12.2020
Registered Nurse, Medical Legal Review - Advance Talent
12.2018 - 06.2020
Director, Clinical Compliance Program - Atrium Healthcare, Previously Carolinas Healthcare System
11.2017 - 01.2019
Nursing Supervisor - Atrium Healthcare, Previously Carolinas Healthcare System
11.2015 - 02.2017
Clinical Compliance and Quality Coordinator - Atrium Healthcare, Previously Carolinas Healthcare System
05.2015 - 11.2017
Legal Externship - Legal Services Of Southern Piedmont, Inc
01.2015 - 04.2015
Clinical Supervisor /Staff Nurse, Emergency Department - Atrium Healthcare, Previously Carolinas Healthcare System
08.2001 - 05.2015
Charlotte School of Law - J.D,
American University, Washington College of Law - Certificate of Completion, Healthcare Law
University of North Carolina At Charlotte - Bachelor of Science, Nursing
Bluefield State College - Associate of Science, Nursing