Melodie Shepherd
Waxahachie,TX
Summary
Quality Assurance Nurse with a proven track record at , excelling in clinical expertise and quality improvement. Adept at conducting thorough audits and ensuring compliance, while demonstrating strong clinical judgment and compassionate care. Committed to enhancing service appropriateness and driving continuous improvement in healthcare management.
Overview
20
20
years of professional experience
Work History
Quality Assurance Nurse
Nexus
10.2022 - 09.2025
- Performed disability and workers compensation peer reviews
- Performed quality assurance reviews on disability and workers compensation peer reviews to ensure, accuracy and consistency to provide professional reviews.
- Conducted audits on peer reviewers to ensure compliance, provide feedback and focus on continued improvement.
LVN Utilization Review Supervisor
Health Direct
05.2006 - 10.2022
- Supervised all LVN's and administrative staff in all day to day activities
- Monitored timesheets, attendance monitors, and call center activity.
- Working knowledge of Excel and Microsoft Outlook.
- Handled/Resolved customer complaints.
- Evaluated employee performance and initiated improvement plans.
- Evaluated medical guidelines including ODG, ACOEM, and NYMTG to determine appropriateness of service.
- Submitted cases to physician review for criteria failures and helped facilitate resolutions.
- Performed audits of all nurses in accordance with URAC.
- Performed utilization peer reviews.
Utilization Review Nurse
Intracorp
06.2005 - 05.2006
- Conducted comprehensive medical reviews of clinical documentation to ensure compliance with medical necessity and appropriateness of service.
- Evaluated medical guidelines and benefit coverage to determine appropriateness of services.
- Ensured compliance with regulations and accreditation standards by maintaining accurate documentation of all utilization review activities.
- Submitted cases for criteria failures and helped facilitate resolutions and approvals.
Education
LVN - Nursing
Hill College
Cleburne Texas08-1994
Skills
- Clinical expertise
- Audit preparation
- Clinical best practice
- Quality improvement reports
- Attention to detail
- Compassionate and caring
- Reliability
- Strong clinical judgment
- Healthcare management
- Quality improvement
Timeline
Quality Assurance Nurse
Nexus
10.2022 - 09.2025
LVN Utilization Review Supervisor
Health Direct
05.2006 - 10.2022
Utilization Review Nurse
Intracorp
06.2005 - 05.2006
LVN - Nursing
Hill College