Sandra Sealey
North Wilkesboro,NC
Summary
Quality Management Analyst with advanced knowledge of financial, business development and operational areas. Steps into new areas with adaptable approach. Quality manager and problem-solve 8 years of experience in insurance.
Overview
22
22
years of professional experience
1
1
Certification
Work History
Quality Management Analyst
Blue Cross NC
08.2018 - Current
- Establish and maintain a collaborative working relationship with assigned providers in order to streamline processes, maximize outcomes of NCQA and CMS quality measurement and improvement satisfaction.
- Educating assigned providers on NCQA and CMS quality metrics along with trending their successes of closing medical care gaps. My providers include one of the largest ACO's in NC along with other providers in 7 other counties in NC.
- Serve as a close liaison with Blue Cross of NC Network Management and Provider Engagement team to support communication with individual and large provider groups to support quality initiatives to improve outcomes for our members.
- I am involved with Blue Cross of NC/ NCQA accreditation through supporting our HEDIS data collection record review and documentation annually.
Case Manager
Wake Forest Baptist Health
06.2002 - 08.2018
- Achieved positive client outcomes by developing and implementing comprehensive case management plans.
- Enhanced communication between clients and providers through consistent follow-ups and progress updates.
- Coordinated essential services for clients, resulting in improved overall well-being and selfsufficiency.
- Collaborated with multidisciplinary teams to address client needs and formulate tailored support strategies.
- Conducted thorough assessments of clients'' situations, identifying issues, goals, and necessary interventions.
- Maintained accurate documentation on all cases, ensuring compliance with regulations and confidentiality requirements.
- Facilitated successful transitions between levels of care by developing detailed discharge plans and coordinating resources.
Education
Master of Science - Nursing Administration
University of Phoenix
Tempe, AZ2015
Bachelor of Science - Nursing
Winston Salem State University
Winston-Salem, NC2005
Associate of Science - Nursing
Surry Community College
Dobson, NC2000
LPN -
Surry Community College
Dobson, NC1997
Skills
- Management Consulting
- Business Analysis
- Quality Management
- Nursing
- Quality Improvement
- Process Improvement
- Healthcare
Certification
- CCM Certification
- ACM Certification
Timeline
Quality Management Analyst
Blue Cross NC
08.2018 - Current
Case Manager
Wake Forest Baptist Health
06.2002 - 08.2018
Master of Science - Nursing Administration
University of Phoenix
Bachelor of Science - Nursing
Winston Salem State University
Associate of Science - Nursing
Surry Community College
LPN -
Surry Community College
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