Quality Assurance | Program Manager
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Highly experienced in quality process excellence for health care utilization management and clinical review.
A Registered Nurse who is well verse in utilizing Lean Six Sigma Methodology.
Can deliver reports with high quality and creativity.
Very passionate in data analytics and capturing areas for improvement for the business.
Quality Program Manager - | Shearwater Health Advisors Inc. (BCBS, CIGNA, Molina, Scan Health, Humana Health, eviCore, Highmark Health Inc. and Clover Health Inc.) - 11/01/2022- 02/06/2023
Quality Assurance Supervisor - | Shearwater Health Advisors Inc. (Highmark Health Inc. and Clover Health Inc.) - 10/01/2021- 10/31/2022
Quality Assurance Specialist - | Shearwater Health Advisors Inc. (Highmark Inc.) - 4/16/2020- 09/30/2021
USRN Utilization Management - EviCore | Shearwater Health Advisors Inc. 06/24/2019 – 4/15/2020
USRN Utilization Management – NaviHealth | Shearwater Health Advisors Inc. 06/05/2019 – 06/23/2019
Research and Development Nurse Coder | EXL Service Philippine Inc (HUMANA INSURANCE INC)
07/01/2017 – 05/20/2019
Senior Executive Nurse Coder | EXL Service Philippine Inc (HUMANA Special Investigation Unit / Provider Payment Integrity)
03/01/2017 – 06/30/2017
Senior Executive – Quality Compliance Auditor | EXL Service Philippine Inc (HUMANA Clinical Claims Review)
08/20/2016 – 02/28/2017
Senior Executive Nurse Associate – Clinical Claim Specialist | EXL Service Philippine Inc (HUMANA Clinical Claims Review)
03/03/2014 – 08/19/2016
Booking Consultant – Team Leader| FASTRACT Agency Services Ltd (United Kingdom) 04/09/2009 – 04/02/2014
Private Duty Nurse (Part-Time)| Tacloban City Philippines 09/01/2013 – 11/13/2013
Medical Surgical Ward Nurse| Divine Word Hospital – Tacloban City 11/05/2010 – 11/13/2013
Nurse Rotator - Trainee| Divine Word Hospital – Tacloban City 05/01/2010 – 11/04/2010
Remedios Trinidad Romualdez Medical Foundation –Tacloban City Philippines
April 2009 - Bachelor of Science in Nursing
Manlabang National High School – Caibiran, Biliran, Philippines
March 2005 - Second Highest - Salutatorian Achiever
