Marcia J. Allen
Round Rock,TX
Summary
Healthcare professional with more than 20 years of nursing and supervisory/management experience. Solid knowledge of comprehensive nursing care procedures and excellent direct patient care skills. Reputation as a self-directed professional with superior problem solving, communication, and management skills. Successful in managing time, prioritizing tasks, and organizing projects to improve the quality of patient care.
Overview
2025
2025
years of professional experience
Work History
QA & Compliance Manager
Ethos Risk Services
01.2024 - 11.2024
- Managed compliance with the UR program.
- Trained clinical peer reviewers and nursing staff on URAC certification standards and state compliance requirements.
- Monitored jurisdictional legislative changes and audited compliance.
- Chaired Quality Management Committee meetings.
- Ensured adherence to information security, confidentiality, and HIPAA regulations.
- Conducted QA audits and developed quality improvement plans with UR management team.
- Ensured adherence to policy and procedures.
- Maintained URAC accreditation
- Submitted mandatory state audits and required documentation.
- Managed compliance for state UR licensing and certification.
- Actively functioned as a resource for provider, client, and vendor for UR.
Sr. Regulatory Compliance Analyst
Conduent Care Solutions
05.2021 - 01.2024
- Managed compliance for state UR and Managed Care licensure.
- Chaired Quality Management Committee meetings.
- Handled audit preparation and response activities.
- Maintained URAC accreditation
- Completed and submitted state-mandated reports.
- Ensured thorough understanding of rule changes through detailed staff training programs.
- Ensured accuracy of nursing credentials.
Quality Assurance/ Quality Review Nurse
York Risk Services (now Sedgwick)
01.2011 - 01.2016
- Contributed to achieving URAC accreditation success.
- Conducted quality assurance checks for nurse compliance.
- Ensured adherence to regulatory guidelines through document assessment.
Utilization Review Nurse
Forte Managed Care
Education
Licensed Vocational Nursing -
Schriener College
Kerrville, TX01.1983
Skills
- State filings
- State audits
- Research and documentation of state regulations and laws
- Staying abreast of state legislative and regulatory changes
- Documenting policy and process changes
- Workflow changes implementation
- Maintaining URAC accreditation
- Quality assurance in UR process
- Worker’s Compensation
- Managed Care Worker’s Compensation
- Medicaid managed Care UR team leadership
- In-house training manual design
- Compliance with federal and state government requirements
- Developing nursing protocols
- Creating flow sheets
- Assessment tools development
- Improving productivity
- Expediting state regulated turn times
Credentials
01/83, Texas, 01/83
Timeline
QA & Compliance Manager
Ethos Risk Services
01.2024 - 11.2024
Sr. Regulatory Compliance Analyst
Conduent Care Solutions
05.2021 - 01.2024
Quality Assurance/ Quality Review Nurse
York Risk Services (now Sedgwick)
01.2011 - 01.2016
Utilization Review Nurse
Forte Managed Care
Licensed Vocational Nursing -
Schriener College
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