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@elizabethvallejos
I am an experienced clinical auditor and compliance analyst focused on healthcare quality, auditing, and process improvement.
United StatesI am a clinical auditor and compliance analyst with a master's degree and over a decade working in healthcare operations, program evaluation, and managed care. I bring verified experience auditing clinical health plan data and documentation and a proven record in state-level program evaluation.
I develop and automate audit tools and summaries, produce tracking graphs for management, and deliver timely, actionable audit reporting. I am expert in Microsoft Excel (including VLOOKUP, data mining, and advanced formulas), audit methodology, HEDIS measurement alignment, and process-improvement techniques, and I have routinely worked remotely with full trust from supervisors.
After a planned medical hiatus, I am eager to return to full-time auditing and compliance work where my attention to detail, organizational rigor, and commitment to continuous improvement will immediately add value.
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Work history, roles, and key accomplishments
Presbyterian Healthcare
Oct 2020 - Jun 2023 (2 years 8 months)
Completed end-to-end clinical and operational audits (NCQA, NM-HSD, CMS) and developed automated audit tools and dashboards to streamline reporting and identify training gaps. Produced weekly/monthly progress reports to senior management and tracked corrective actions.
Michigan Department of Community Health
May 2008 - Dec 2009 (1 year 7 months)
Oversaw Tobacco Control and Building Healthy Communities contracts across regions, designed training webinars, and managed department web resources to support contractors. Implemented audit tools and monitoring to ensure contract compliance and program delivery.
Families Plus
May 2005 - Jun 2007 (2 years 1 month)
Delivered home-based care coordination and respite services to a caseload of 25 clients with disabilities, liaising with families and providers to implement individualized care plans. Created audit tools to capture service touchpoints and measure compliance.
New Mexico Department of Corrections
Mar 2003 - Jul 2004 (1 year 4 months)
Supervised inmate populations and community probationers, facilitated reentry planning, and improved database systems to capture required audit points and reporting metrics. Coordinated placements and community resources for parolees.
Socorro Mental Health Foundation
Dec 2001 - Dec 2003 (2 years)
Managed a $53,000 tobacco education grant and implemented community health initiatives across Socorro County and the Alamo Navajo Reservation, improving program reach and compliance. Developed and tracked program audit measures to ensure delivery.
James Healthcare
Jun 1995 - Dec 2001 (6 years 6 months)
Performed technical nursing procedures (blood draws, IVs, catheterization) and assisted with activities of daily living, supporting clinical teams and maintaining accurate patient records. Ensured adherence to clinical protocols and patient safety.
United States Air Force
Dec 1986 - Mar 1990 (3 years 3 months)
Managed maintenance, repair, and safety compliance for military aircraft and engines under Strategic Air Command standards, ensuring mission readiness and regulatory adherence. Supervised maintenance operations across multiple bases.
Presbyterian Healthcare
Oct 2013 - Present (12 years 1 month)
Managed clinical assessments and interdisciplinary care plans for high-need members, coordinating transitions from facilities to community services and ensuring service continuity. Developed audit tools to capture touchpoints and HEDIS measures to improve compliance.
Degrees, certifications, and relevant coursework
UMMaster of Science, Education
2000 - 2001
Grade: 3.9 GPA
Master of Science in Education with a concentration in human and environmental health education, completed 2000–2001 with a 3.9 GPA.
UMBachelor of Science in Nursing, Nursing
1992 - 1999
Grade: 3.6 GPA
Bachelor of Science in Nursing completed 1992–1999 with a 3.6 GPA.
Software and tools used professionally
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