JUDI A. WILLIAMS
Bradenton,FL
Summary
Experienced professional in the workers' compensation industry with expertise in quality assurance, medical education, and leadership. Key role in creating innovative quality assurance program, improving review tools for better outcomes internally and with external vendors, including Independent Medical Examination vendors.
Overview
44
44
years of professional experience
Work History
Quality Assurance in Managed Care
Amtrust Financial Group
11.2020 - Current
- Contributed to development of a new quality assurance program in the Managed Care division.
- Conducts ongoing formal quality assurance evaluations of internal clinical products, such as Case Management, Utilization Review, Disability Management, and Pharmacy.
- Participating in creation of quality assurance parameters to evaluate the quality of the external vendors utilized including IME, Field Case Management, Physical Therapy, Diagnostics, Home Health, and Durable Medical Equipment.
- Performed in depth review on the utilization of IME vendors to evaluate the effectiveness and impact of the IMEs performed.
- Contributed to development of quality assurance parameters for internal clinical products.
- Coordinated quarterly calibrations of clinical products internally.
- Led monthly training sessions for new case managers on quality standards.
- Led development and quality evaluations of a new offshore vendor for case manager support.
- Facilitated Medical Roundtable discussions with internal physicians, adjusters, and case managers on a rotating basis.
- Analyzes data obtained from quality reviews to identify opportunities to improve quality of the service.
- Increased case management quality scores to 98% following quality assurance program launch.
Quality Assurance Specialist
Examworks Clinical Solutions
01.2016 - 04.2020
- Executed customer-specific quality assessments of case management reports and files to ensure quality documentation to maintain service excellence that met or exceeded customer standards and URAC requirements.
- Through review of reports, evaluated the provider’s treatment plan and identified more cost-effective options for the case manager to discuss with the account and provider.
- Assisted case managers in identifying when there was a need to contact the treating provider to discuss discrepancies in treatment recommended against the guidelines.
- Analyzed files to suggest steps for the case manager to take to enhance timely file advancement and RTW.
- Identified and communicated to the case manager activities needed to meet customer quality expectations.
- Provided education to case managers on optimizing medication regimes utilizing evidence-based guidelines.
Clinical Solutions Nurse
Examworks Clinical Solutions
01.2015 - 01.2016
- Held role in Prescription Analysis department.
- Completed detailed medication cost analysis.
- Compiled pharmacists’ prescription analysis into concise, customer-friendly reports.
- Reviewed pharmacist’s Outreach Summary and summarized into report format to provide to customer.
- Evaluated referral medical records in relation to pharmacy suggestions to determine clarification needs.
Case Management RN
Examworks Clinical Solutions
01.2014 - 01.2015
- Provided onsite medical case management for workers’ compensation cases utilizing the case management core principles of assessment, planning, implementation, coordination, reassessing, and evaluation.
- Met with physicians and claimants to discuss examination findings and treatment recommendations.
- Evaluated physician reports to ensure treatment recommendations were within evidence-based guidelines and that documentation supported information obtained in the in-person visits, contacting physician for any clarification needed.
- Collaborated with customer, employer, providers, and claimant to ensure timely progression of medical care and RTW.
Manager and Owner
Proactive Case Management
01.2001 - 01.2014
- Company Overview: Manager and Owner of Medical Case Management Company
- Oversaw case management operations to maintain proactive case handling and customer satisfaction.
- Delivered constructive feedback and continuous training to enhance case management service quality.
- Developed and performed all onboarding of new hires through in-person, phone, and WebEx.
- Provided quality review of all case manager reports and files to ensure quality documentation that met customer standards and Evidence Based Guidelines.
- Provided ongoing support and functioned as a resource for case management staff to ensure they were able to manage their files effectively and efficiently.
- Processed invoicing using QuickBooks Accounting Program. Maintained and reviewed the budget, adjusting as needed to address ongoing Profit and Loss.
- Provided marketing services for current customers as well as securing new business.
- Provided both telephonic and onsite medical case management services of my own caseload.
- Manager and Owner of Medical Case Management Company
Disability Management Specialist
Preferred Disability Management
01.1998 - 01.2001
- Managed cases using both telephonic and onsite approaches.
- Coordinated medical care and Return to Work of Disability and Workers’ Compensation claims.
- Recognized as preferred case manager by customers.
Assistant Administrator
Casha Homecare
01.1997 - 01.1998
- Reviewed state and federal forms to ensure compliance.
- Reviewed nursing notes and reports to ensure they met federal and state compliance requirements.
- Provided hospital and in-home initial nursing assessments to facilitate discharge to home.
Homecare Registered Nurse
Americare Home Health
01.1991 - 01.1997
- Hospital and nursing home visits to review hospital records and assist in transition to home.
- Provided in-home nursing assessment and treatments.
- Identified potential medical or psychosocial concerns, then coordinated with treating physician and community resources to allow patients to safely remain in their homes and avoid hospitalization.
- Supervised Home Health Aides.
Homecare Registered Nurse
Visiting Nurse Associates
01.1989 - 01.1991
- Provided in-home nursing assessments and treatments to ensure medical and psychosocial needs were met.
- Supervised Home Health Aides.
Staff Nurse
Johnson Memorial Hospital
01.1988 - 01.1989
- Staff nurse on Medical- Surgical Unit.
- Charge Nurse on 24- hour Observation Unit.
Staff Nurse
Ball Memorial Hospital
01.1981 - 01.1988
- Staff nurse on Orthopedic Unit.
- Charge nurse on Medical-Surgical and Chemical Dependency Units.
Education
Bachelor of Science - Nursing
Ball State University
Skills
- C2Perform
- C2View
- CMP
- Occupational Disability Guidelines
- Medical Disability Advisor
- Word
- Outlook
- EXCEL
- SharePoint
- One Note
- WebEx
- Microsoft Teams
Timeline
Quality Assurance in Managed Care
Amtrust Financial Group
11.2020 - Current
Quality Assurance Specialist
Examworks Clinical Solutions
01.2016 - 04.2020
Clinical Solutions Nurse
Examworks Clinical Solutions
01.2015 - 01.2016
Case Management RN
Examworks Clinical Solutions
01.2014 - 01.2015
Manager and Owner
Proactive Case Management
01.2001 - 01.2014
Disability Management Specialist
Preferred Disability Management
01.1998 - 01.2001
Assistant Administrator
Casha Homecare
01.1997 - 01.1998
Homecare Registered Nurse
Americare Home Health
01.1991 - 01.1997
Homecare Registered Nurse
Visiting Nurse Associates
01.1989 - 01.1991
Staff Nurse
Johnson Memorial Hospital
01.1988 - 01.1989
Staff Nurse
Ball Memorial Hospital
01.1981 - 01.1988
Bachelor of Science - Nursing
Ball State University
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