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Click here or scroll down to respond to this candidate4014 Fairfield Gardens Ct.Louisville, KY Street Address
PHONE NUMBER AVAILABLEEmail EMAIL AVAILABLEPROFILEDedicated Leader with over 25 years of experience in the healthcare and Insurance industries. Outstanding leadership with excellent soft skills, negotiations, organizational and project management skills. Exceptional record of relationship building with cross functional teams, achieving bottom lines results and strategic planning. Significant experience as Super User for all technology to support large Contact Centers.AREAS OF STRENGTHEPICProject ManagementManaging Human CapitalStrategic PlanningRecovery of Healthcare dollarsForecastingPBMCertified Root Cause AnalysisRX Claim/NavigatorSuper User for all TechnologyAdvocacyLife and Health LicenseClinical oversiteClient ManagementBPOWF PlanningPBM/PHDClinical managementSix Sigma Green Belt trainedOutbound Dialer (Genesys)Medicare/MedicaidEDUCATIONUniversity of Louisville Louisville, KYBachelors degree (B.S.) Workforce Leadership 2010McKendree University Louisville, KYCertificate in Call Center Leadership 2006Continuing Education Courses and Seminars in ManagementProject Management certificateCertified in Root Cause AnalysisPROFESSIONAL EXPERIENCEPharmaCordSr Program Manager Jeffersonville, IN January 2024-August 2024Monitors and provides weekly updates on items impacting program financial forecastPrepares activity summary for the development and review of client monthly invoicesPrepares, reviews, analyzes client specific operational resultsPrimary responsibility for the preparation of client business review meetings with operational metrics and data insightsPoint of contact for program/operational queries and issue resolutionAssures client reporting of Adverse Events/Product Complaint received are reported in accordance with client work instructionsOptumSr Manager Nurse Triage Optum Care Remote February 2022-August 2023Collaboration with operations, reporting, analytics, finance and UHC to support the execution of the programWork with reporting to monitor Optum performance at the client level with presentation of results at monthly business reviews with internal/ external leaders and stakeholdersManage 50+ Nurses in 24/7 Triage programResponsible for License compliance for nursesOptumAssociate Director Medical Clinical OPS Atlanta, GA March 2020-September 2021Collaboration with operations, reporting, analytics, finance and UHC to support the execution of the programWork with reporting to monitor Optum performance at the client level with presentation of results at monthly business reviews with internal/ external leaders and stakeholders.Accountability for partnering on all custom / non - standard requests made by the client and they will need to represent Optum Advocacy during client auditsIdentifying and driving continuous process improvement opportunities with the support and direction of the client and UHC partnersOptumSr. Operations Manager Government Programs Atlanta, GA April 2017-March 2020Offline or Back office data entry responsibility for State of Massachusetts HIX programProvides leadership and guidance to assigned Supervisors to ensure the Optum team develops and executes tactical business plans.Is responsible for daily analysis of business and client results to ensure Optum and their clients business objectives are met.Is responsible for the smooth implementation of all change control in the Operations department.Provides daily analysis of results for all assigned Optum and client processes and is responsible for making recommendations on program enhancements to appropriate Account Management and Operations leadership.OptumOperations Manager (Optum Rx) Louisville, KY July 2013-April 2017Ensures attainment of internal and external key performance indictors on a daily, weekly and monthly basis.Provides leadership and guidance to assigned Supervisors to ensure the Optum team develops and executes tactical business plans.Is responsible for daily analysis of business and client results to ensure Optum and their clients business objectives are met.Is responsible for the smooth implementation of all change control in the Operations department.Provides daily analysis of results for all assigned Optum and client processes and is responsible for making recommendations on program enhancements to appropriate Account Management and Operations leadership.Educates, motivates, leads, guides and directs all assigned Supervisors and representatives.Monitors calls and provides feedback to Supervisors and Representatives based on observations. Monitors and tracks employees for progress against internal and external objectives.Has P&L responsibility for assigned clients ensuring attainment of revenue and cost budgets.RxCrossroadsProgram Manager Louisville, KY 2012-2013Develop and operationally manage Product Support Hotlines to conform to client contract and policies and procedures. This includes Problem identification and Resolution of any identified issues.PBM ManagementCreate and Maintain relationships with cross functional departments for proactive problem resolutionsMeasure, monitor and report on KPIs with client as well as internal standardsManage program to ensure profitability.Develop and adhere to budgetary guidelines.Develop and implement customized Standard Operating Procedures to accommodate the specific needs of specialty drugs.Serves as a liaison among patients, physician offices, payers and pharmaceutical company representatives for specific drug programs.Manage, recruit, train and develop program team members.HCA- National Patient Account ServicesCall Center Manager Louisville, KY 2001-2012Manager of 50+ exempt and hourly staffManaged projects ranging from low profile to high profile including the Business Continuity Plan recovering 100% of the collections business should a disaster occurSuper User for Technology including automated dialer, CRM system and SharePointManaging and developing staff to call center metrics including production, employee satisfaction and account receivable goalsProvided leadership to the supervisory staffProcess Management of current workflows to check for efficienciesLiaison for Operational and IT departmentsCreated and Managed Workflows for Call Center technologyTroubleshooter for all Technology used in Large Contact CenterReengineered processes to delete any deficiencies including both Operations and ITRoot cause analysis of any technology related issuesCertified DDI instructor for the Management teamManagement Liaison for employee satisfaction. The center achieved the highest score in the HCA family based on this workAssisted IT department with decisions for future technology needs (Cloud or Hosting Environment)Humana IncProject Manager Louisville, KY 1996-2001Humana Inc is an insurance company based in Louisville, KY. Humana provides health insurance to both large and small groups, as well as Medicare and Medicaid recipients.Led Commercial and Medicare projects for the call centeroMedicare project resulted in calls being answered within the call center metrics even when call volume increased by 35%Successful project completion of the Medicare Supplement business being sold to another insurance company, specific role as operations project lead.Super User for Contact Center TechnologyLiaison for Operations and IT for problem resolutionRoot cause analysis, reengineering and process management of call center processes looking for deficiencies.Managing human capital with a staff of 35-40 non exempt employeesAchieved predefined metrics and goals each yearStrategic planning each year to measure and make decisions regarding new goalsPresented Medicare plans to entire call center staff of 200+Prepared Medicare budget for call centerPrevious Experience includes Supervisory and Customer Service, Humana Inc. Louisville, KY for five years. |
