Kari Stevens
Peoria,Arizona
Summary
To utilize my skills and 15+ years of experience in interdisciplinary fields with record of providing high quality results. Organized and dependable candidate successful at managing multiple priorities with a positive attitude. Willingness to take on added responsibilities to meet team goals.
Overview
15
15
years of professional experience
3
3
Certification
Work History
Auditor, Compliance Process and Quality Improvement
Humana Healthy Horizons
08.2023 - Current
- Monitor quality investigations and compliance processes
- Manages quality management system, department SharePoint, and department reporting
- Auditing processes for compliance
- Complete and submit to CMS and state regulators.
- Manage multiple concurrent audit engagements, prioritizing tasks to meet deadlines without compromising quality.
- Increase internal control effectiveness through diligent evaluation of processes and providing recommendations for improvement.
LTC Case Manager
United Healthcare
05.2020 - 08.2023
- Developed and implemented person-centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medication management and member safety in alignment with evidence-based guidelines.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Educated clients on available programs, benefits, and services, empowering them to make informed decisions about their care needs.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
Quality Assurance
Raindrop Services LLC
10.2019 - 10.2021
- Conducted chart audits for direct support providers (habilitation, respite, and independent living skills) that assist people with disabilities.
- Designed trainings for staff development of identified needs
- Collaborated with owner to ensure consistent product quality meeting customer specifications.
Clinical Team Lead
Jewish Family & Children’s Services
05.2015 - 05.2020
- Supervised team of 12-15 Children’s Case Managers to include high needs and targeted case managers.
- Trained new case management staff and served as point person for procedural questions to ensure oversight of ethical and quality departmental process implementation.
- Facilitated effective collaboration among multidisciplinary teams, resulting in improved client outcomes.
Education
Master of Arts in Sociology -
Arizona State University
05.2018
Bachelor of Science in Human Services -
University of Bridgeport, CT
12.2006
Skills
- Microsoft Office Suite
- FS Pro
- Excel
- HEDIS
- CMS
- CAPHS
- NCQA
- Medicaid
- Medicare
- Electronic Medical Records
- NexGen Health Records
- CGX
- Motivational Interviewing
- Compliance standards
- Audit reporting
- Internal Auditing
- Audit Planning
- Root Cause Analysis
- Risk mitigation strategies
- Regulatory filings
- Report Writing
- Contract compliance
- Data Analytics
- Microsoft Office
- Attention to Detail
- Team Collaboration
- Decision-Making
- Critical Thinking and Analysis
- Clear Communication
- Relationship Building
Certification
- 2024: Project Management Certification (eCornell)
- 2018: Personal Success Institute graduate
- 2015 Behavioral Health Technician (BHT)
- 2024 In Progress: Lean Six Sigma Certification, < $25k company savings
- 2024 Pending enrollment: Certificate in Healthcare Compliance (CHC)
Volunteer Experience
- Cancer Survivors Support Groups
- Vistancia Local Community volunteer activities, Youth coach and leader
- UMOM shelter delivery
- Salvation Army Toy Drive
Timeline
Auditor, Compliance Process and Quality Improvement
Humana Healthy Horizons
08.2023 - Current
LTC Case Manager
United Healthcare
05.2020 - 08.2023
Quality Assurance
Raindrop Services LLC
10.2019 - 10.2021
Clinical Team Lead
Jewish Family & Children’s Services
05.2015 - 05.2020
Master of Arts in Sociology -
Arizona State University
Bachelor of Science in Human Services -
University of Bridgeport, CT
- 2024: Project Management Certification (eCornell)
- 2018: Personal Success Institute graduate
- 2015 Behavioral Health Technician (BHT)
- 2024 In Progress: Lean Six Sigma Certification, < $25k company savings
- 2024 Pending enrollment: Certificate in Healthcare Compliance (CHC)
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