Stacy Sims RN, MSN, CMCN
Summary
Highly motivated and results-oriented professional leveraging a strong foundation in analytical methodologies, quality assurance and auditing principles, and developing business acumen to excel in analyst, auditor, quality, or business change roles. Proven ability to serve as a Subject Matter Expert, evaluate processes, identify areas for improvement, and drive positive organizational results through data-driven insights and a commitment to excellence.
Overview
19
19
years of professional experience
1
1
Certification
Work History
Quality Assurance Evaluator
Elevance
01.2024 - Current
- Auditor for Medicare, Medicaid, and commercial insurance plans to ensure adherence to state regulations and company guidelines..
- Evaluated clinical and non-clinical interactions to ensure adherence to protocols, safety standards, and clinical effectiveness.
- Provided constructive written and verbal feedback to staff to drive performance improvement and professional growth.
- Analyzed trends in individual and team performance to identify opportunities for process enhancement and operational efficiency.
- Served as a subject matter expert on clinical and non-clinical policies, offering guidance on compliance with organizational and regulatory requirements.
- Conducted quality reviews and delivered training on evaluation processes to improve program effectiveness and team performance.
- Contributed to positive clinical outcomes by ensuring staff met performance criteria and effectively engaged participants in care plans.
- Developed reports on quality trends, collaborated with operations management, and recommended enhancements for participant engagement, retention, and health outcomes.
- Leveraged expertise in Medicaid, Medicare, and managed care policies to ensure compliance with quality standards and drive improvements in member care delivery.
- Contributed to cost-saving efforts by identifying areas for improvement in QA processes and recommending more efficient testing strategies.
Medical Content Reviewer (Contractor)
Medical Learning Institute
11.2019 - Current
- Conducted thorough nursing reviews of diverse healthcare educational materials (articles, transcripts, presentations, etc.) to ensure scientific rigor, accuracy, and freedom from commercial bias, directly impacting the quality of continuing education for healthcare providers.
- Critically analyzed medical content against Accreditation Council for Continuing Medical Education (ACCME) standards and provided detailed, actionable feedback and suggestions to presenters to enhance the educational value and compliance of their materials.
- Served as a subject matter expert in nursing, applying clinical knowledge to evaluate the appropriateness of educational content for the target healthcare audience.
- Collaborated with presenters to refine educational materials, contributing to the overall quality and effectiveness of continuing medical education programs.
Infusion Therapy Registered (Subcontractor)
RN Enterprises
05.2023 - Current
- Administered intravenous medications and fluids strictly according to physician orders and established protocols, ensuring patient safety and adherence to clinical guidelines.
- Conducted thorough patient assessments and continuously monitored vital signs and responses during and after infusion therapy, proactively identifying and addressing potential adverse reactions to maintain quality of care.
- Provided comprehensive education to patients and families on infusion therapy, medication administration, and self-care practices, promoting adherence to treatment plans and improving patient outcomes.
- Accurately and promptly documented patient assessments, treatments, and outcomes in electronic medical records, ensuring data integrity and compliance with regulatory requirements.
Nurse Demand Management SR
Elevance
04.2013 - 11.2024
- Conducted comprehensive patient assessments and analyzed healthcare needs to provide targeted wellness coaching, triage, and case management, optimizing resource utilization.
- Ensured adherence to state regulations and managed care quality standards through meticulous evaluation and implementation of best practices in telehealth service delivery.
- Identified gaps in patient care and proactively implemented solutions, contributing to improved continuity of care and more effective utilization of healthcare services.
- Served as a mentor and resource for new hires, providing guidance on quality standards and contributing to staff performance coaching and education within the virtual team.
- Evaluated patient outcomes and coordinated follow-up care, identifying trends and implementing strategies to enhance the quality and effectiveness of virtual care delivery.
Faculty /Staff Development Specialist
Galen College
02.2011 - 04.2014
- Developed curriculum content and course outlines for Foundations of Nursing and Medical Surgical Nursing Laboratory, aligning with learning objectives and in consultation with the College of Nursing.
- Led the staff development committee, ensuring quality standards met accreditation guidelines, continuing education was within compliance, and performance improvement plans supported staff professional growth.
- Conducted student evaluations (online and on-ground) and provided targeted remediation to improve student performance in classroom, laboratory, and clinical settings.
- Served as a clinical mentor to newly hired clinical faculty, contributing to their effective onboarding and professional development, ensuring consistent quality of instruction.
- Served on the Curriculum and Campus Program Evaluation Committee (CPEC), contributing to the analysis of program effectiveness and recommending improvements based on data and feedback.
Charge Nurse
Veterans Affairs Medical Center
05.2006 - 12.2011
- Monitored patients on telemetry, TBI, and medical-surgical units utilizing the IntelliVue monitoring system, requiring continuous analysis of patient data to identify and respond to changing conditions.
- Developed and implemented individualized nursing care plans based on patient needs and desired outcomes, meticulously documenting nursing interventions in CPRS and VISTA.
- Served on the Nursing Quality and Risk committees with a focus on patient safety, contributing to the evaluation of performance and outcome measurements to improve quality of care and reduce risk.
- Served as a preceptor to newly hired staff and nursing students, ensuring consistent application of quality standards and best practices in patient care.
- Evaluated performance and outcome measurements by reviewing patient outcomes based upon reason for admission, quality scores, quality of care outcomes, and treatment goals achieved upon discharge.
Education
Master of Business -
Western Governors University
Salt Lake City, UT07-2026
Master of Science - Nursing Education
University of South Florida
Tampa, FL08-2012
Bachelor of Science - Nursing
University of South Florida
Tampa, FL05-2010
Associate of Science - Nursing
St. Petersburg College
St. Petersburg06-2009
Skills
- Client relationship management
- Quality control frameworks
- Test strategy development
- Application performance evaluation
- Performance evaluation and enhancement
- Workforce optimization
- Diversified Clinical Background
- Research and teaching experience
- Registered nurse with multi-state licensure
- Quality assurance standards adherence
- Effective organization strategies
- Effective time organization
- Compliance audit reporting
- Detail-oriented analysis
Accomplishments
- Earned recurring Top Performer recognition, demonstrating sustained excellence and leadership among peers.
- Graduated cum laude with a Bachelor's degree, 2010.
- Graduated with a Master's degree, 2012.
- Anticipated Graduation with a Master of Business Administration, 2025
Certification
- Certified Managed Care Nurse (CMCN), American Association of Managed Care Nurses - 2019
Timeline
Quality Assurance Evaluator
Elevance
01.2024 - Current
Infusion Therapy Registered (Subcontractor)
RN Enterprises
05.2023 - Current
Medical Content Reviewer (Contractor)
Medical Learning Institute
11.2019 - Current
Nurse Demand Management SR
Elevance
04.2013 - 11.2024
Faculty /Staff Development Specialist
Galen College
02.2011 - 04.2014
Charge Nurse
Veterans Affairs Medical Center
05.2006 - 12.2011
Master of Business -
Western Governors University
Master of Science - Nursing Education
University of South Florida
Bachelor of Science - Nursing
University of South Florida
Associate of Science - Nursing
St. Petersburg College
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