Cenquisha Alexander
Long Beach
Summary
Focused on exceptional patient-centered care while driving quality assurance and compliance initiatives. Proven ability to analyze medical claims and documentation to ensure adherence to regulatory standards, contributing to optimal patient outcomes. Collaborative team player committed to enhancing service delivery through effective training and strategic oversight.
Overview
6
6
years of professional experience
1
1
Certification
Work History
Utilization Review Nurse
United Health Group
El Segundo
02.2024 - 01.2026
- Performed retro reviews of medical claims and records and applied nationally recognized, evidence-based criteria and guidelines, including CMS to determine the appropriateness of performed services and procedures.
- Conducted secondary case reviews to assess criteria compliance.
- Collected clinical documentation to support Medical Director in making informed decisions during retrospective reviews.
- Ensured compliance with State and Federal contractual and regulatory requirements in utilization review processes.
- Ensured optimum outcomes and cost effectiveness for necessary inpatient and outpatient services according to DOFR and member eligibility.
- Collaborated with utilization management team to meet regulatory timeframes and enhance review efficiency.
- Achieved departmental goals and objectives by adhering to implemented processes, procedures, and standards.
Quality Assurance Nurse
Attain Home Health
Redondo Beach
09.2022 - 01.2024
- Reviewed and analyzed patient care documentation for compliance, ensuring adherence to quality standards.
- Performed regular audits of medical records to ensure accuracy and completeness of documentation.
- Coordinated training sessions for staff on quality improvement practices.
- Monitored and reported adverse events, contributing to enhanced service delivery and patient safety.
- Participated in interdisciplinary meetings focused on developing strategies for improving the delivery of safe, high-quality care.
- Developed and implemented best practices for providing quality care to patients in accordance with applicable regulations.
- Identified improvement areas to elevate overall patient satisfaction and care quality.
- Ensured that medical staff was adhering to established protocols and procedures related to patient safety and quality assurance.
- Completed intake of patients discharging from a hospital or doctor’s office.
- Responded to emergency situations with speed, expertise and level-headed approaches to provide optimal care and support.
LVN
First To Serve Ministries
Los Angeles
05.2020 - 04.2022
- Administered medications and treatments according to established protocols.
- Educated patients on health management and wellness strategies to enhance self-care and improve health outcomes.
- Collaborated with interdisciplinary teams to ensure comprehensive patient care.
- Coordinated multidisciplinary care among healthcare professionals to optimize patient care plans and outcomes.
- Maintained accurate patient records in electronic health systems, ensuring compliance with standards for documentation and continuity of care.
- Maintained accurate patient records documenting treatments, medications administered and other pertinent information.
- Observed changes in patient conditions and reported any unusual findings to supervisor.
- Ensured compliance with safety regulations and infection control practices.
- Implemented infection control measures per facility policy.
- Collected specimens for laboratory analysis, prepared specimens for transport to lab.
- Applied interventions to progress patients toward wellness and address maintenance of wellness.
LVN Team Lead
LA County Dept Of Public Health (Remote)
Los Angeles
10.2020 - 01.2022
- Managed staffing of RNs and LVNs for Vaccination Clinics, optimizing clinic operations.
- Coordinated Vaccination Clinics for employers, school districts, and skilled nursing facilities across LA County, enhancing community access to vaccines.
- Led team of Contact Tracers in case management, ensuring timely opening and closing of cases.
- Conducted interviews with patients who tested positive for Covid and provided access to resources available through the County.
- Participated in daily meetings with supervisory staff to discuss case management strategies.
Education
Diploma - Nursing
American Career College
Anaheim, CAAssociate of Arts - Social Sciences
El Camino College
Torrance, CASkills
- Utilization management
- Clinical oversight
- Care coordination
- Medication management
- Retrospective review
- Medical documentation review
- Milliman guidelines
- Healthcare quality management
- Quality assurance
- Case Management
- Attention to detail
- Time management
- Decision making
- Problem solving
- Effective communication
- Team collaboration
Certification
• IV Certification
• AHA Certification
• BLS Certification
• CPR Certification
• AHA Certification
• BLS Certification
• CPR Certification
Personal Information
Authorized To Work: US
Timeline
Utilization Review Nurse
United Health Group
02.2024 - 01.2026
Quality Assurance Nurse
Attain Home Health
09.2022 - 01.2024
LVN Team Lead
LA County Dept Of Public Health (Remote)
10.2020 - 01.2022
LVN
First To Serve Ministries
05.2020 - 04.2022
Diploma - Nursing
American Career College
Associate of Arts - Social Sciences
El Camino College