Senior Project Manager Resume

SUMMARY:

Hands - on public and private sector healthcare consultant and Subject Matter Expert (SME) specializing in assisting healthcare organizations implement legislative and regulatory requirements into everyday business processes, workflows and clinical operations. Ability to integrate clinical, public health, information technology and healthcare business management into successfully completed project work.

MEDICAID EXPERIENCE:

Senior Project Manager

Confidential

Responsibilities:

Senior Business Project Manager tasked to integrate the 400,000-member Promise Confidential ’s product lifecycle into the Confidential Product Development organization. Resulted in standardized and optimized processes, reduced product defects and increased regulatory compliance. Concurrently created the needed infrastructure for strategic Confidential growth and expansion within California.
Delivered cross-functional current state assessment and future state design for benefit configuration, build and testing, implemented processes for Confidential managed care bulletins, legislative mandates, regulatory filings with Confidential and Confidential and the creation and distribution of Evidence of Coverage, erratum, Member Handbook and associated downstream member documents.
Created, documented and implemented a scalable business and operating model, improved and streamlined operational performance with touchpoints to 75 stakeholders/internal processes and 25 internal IT applications/systems.
Documented processes and upgraded policies, procedures and training.

Medicaid Subject Matter Expert

Confidential

Responsibilities:

As Medicaid SME planned and implemented the cross-functional business process re-engineering needed to ensure that the Nebraska Medicaid eligibility and enrollment business processes and systems were compliant with the provisions the Affordable Care Act (ACA).
Coordinate planning and implementation work with the System Integrator and IV&V in the replacement of a legacy system with a state-of-the-art COTS, ACA and MITA compliant eligibility and enrollment system.
Primary liaison to Confidential for ACA certification gate review and operational readiness reviews. Creation of advanced planning documents, mitigation plan, presentations and operational and performance indicator reporting.
Core member of the State's Confidential modular MMIS and E&E enterprise certification team. Lead on Provider Screening and Enrollment, Medicaid and CHIP Eligibility and Enrollment, multi-divisional Integrated Eligibility Project and Long-Term Care Case Management systems.
Project lead on MMIS Provider Management modular implementation and certification project. System certified by Confidential .
Contract management responsibilities for Independent Verification and Validation (IV&V) contractor working on multiple projects.
Project lead on Provider Rates and Reimbursement Project including cost containment and avoidance business process documentation and redesign.

Healthcare Subject Matter Expert & Liaison

Confidential

Responsibilities:

Integrated business, clinical and operational expertise to help expand the data sources, clinical analytics and information sharing capabilities of the statewide Confidential Data Warehouse and Decision Support System with the goal of providing better care for individuals, better health for populations while reducing costs.
As healthcare SME performed advanced business and clinical analytics related to the integration and implementation of the Confidential 1115 Waivers and Medicaid-related provisions of the Affordable Care Act (ACA), American Recovery and Reinvestment Act (ARRA), HITECH & HIPAA.
Implemented and trained state case management teams on clinical software and analytic tools used for population identification, creation of disease registries, risk stratification and evidence-based medicine used for community based coordinated care programs to reduce hospital readmissions under a Confidential grant.

Subject Matter Expert & Project Manager

Confidential

Responsibilities:

Drafted and submitted application to the Centers for Medicare & Medicaid Services ( Confidential ) seeking regulatory approval to offer these new Medicare Advantage Plans.
Approved by Confidential on initial submission.

Subject Matter Expert & Project Manager

Confidential

Responsibilities:

Successful elicited business requirements needed for the electronic transmission of Coordination of Benefits records between Confidential and the Centers for Medicare & Medicaid Services ( Confidential ).

Subject Matter Expert & Project Manager

Confidential

Responsibilities:

Primary liaison to the Centers for Medicare & Medicaid Services ( Confidential ) in developing the business and functional requirements needed to create, implement and administer Medicare Part D benefits for one of Confidential 's largest national clients.

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