Ayanna Ellis
Albuquerque
Summary
Detail-oriented healthcare professional with over ten years of experience in regulated medical environments, including utilization management, compliance review, and interdisciplinary collaboration. Experienced in reviewing services against clinical guidelines, investigating discrepancies, and ensuring accurate, compliant outcomes. Known for professionalism, strong communication skills, and the ability to manage complex information with precision. Brings a patient-centered mindset, strong organizational skills, and a proven ability to contribute meaningfully to quality, compliance, and operational efficiency.
Overview
9
9
years of professional experience
1
1
Certification
Work History
Contract Reviewer
Blue Cross Blue Shield
Albuquerque
04.2022 - Current
- Conduct detailed reviews of medical service requests against state and organizational clinical guidelines
- Apply clinical judgment to support high-quality, cost-effective outcomes for members
- Identify discrepancies, documentation gaps, and compliance issues and ensure appropriate resolution
- Screen enrollees for eligibility in support programs aimed at improving quality of life and care outcomes
- Maintain accurate documentation within electronic systems while adhering to strict confidentiality and compliance standards
- Collaborate with internal teams to support consistent, timely review processes
- Utilization Management
Contractor
Raymond G. Murphy Department of Veterans Affairs Medical Center
Albuquerque
10.2021 - 04.2022
- Supported workplace health initiatives by assessing employee health status and identifying risks
- Implemented and reinforced infection control protocols in accordance with federal guidelines
- Educated staff on compliance-related health and safety procedures
- Streamlined outbreak tracking and coordinated testing schedules to support efficient pandemic response
- Maintained accurate records and reports in compliance with privacy and regulatory standards
- Employee Health Division
Assistant Director of Nursing/Wound Care Coordinator
Bear Canyon Genesis Skilled Nursing Facility
Albuquerque
02.2017 - 10.2021
- Oversaw care coordination and documentation for up to 36 patients with varying acuity levels
- Collaborated with interdisciplinary teams including therapy services, social services, and physicians to support positive outcomes
- Supervised, delegated, and evaluated nursing activities to ensure quality, compliance, and consistency
- Developed and implemented nursing programs to enhance service quality and regulatory adherence
- Identified departmental issues, conducted investigations, and prepared reports recommending corrective actions
- Provided education to staff, patients, and families regarding care plans, prevention strategies, and ongoing management
- Maintained up-to-date knowledge of disease processes, treatment protocols, and documentation requirements
Education
Compact State Licensed Practical Nurse -
LPN22629, Expires 09/2027
Skills
- Utilization Review & Compliance
- Documentation Accuracy & Quality Assurance
- HIPAA & Confidentiality Compliance
- Investigative Review & Issue Resolution
- Interdisciplinary Collaboration
- Client & Stakeholder Communication
- Time Management & Prioritization
- Electronic Medical & Administrative Systems
Certification
Career Enrichment Center
May 2014
May 2014
Timeline
Contract Reviewer
Blue Cross Blue Shield
04.2022 - Current
Contractor
Raymond G. Murphy Department of Veterans Affairs Medical Center
10.2021 - 04.2022
Assistant Director of Nursing/Wound Care Coordinator
Bear Canyon Genesis Skilled Nursing Facility
02.2017 - 10.2021
Compact State Licensed Practical Nurse -
LPN22629, Expires 09/2027