OBJECTIVE:

To grow professionally and be able to manage and lead in improving healthcare globally.

PROFESSIONAL SUMMARY:

• Highly experienced and motivated to enhance, improve and build Care Coordination initiatives by organizing, leading and initiating changes within and outside of the organization.
• Extremely knowledgeable about developing and training on workflows for new and existing projects.
• Improved the healthcare cost savings of the current company from 2.4% to 10 % in one year.
• Very knowledgeable of quality improvement techniques like PDCA and SIX SIGMA.
• Developed and implemented patient satisfaction surveys followed by analysis of the results and development of quality improvement projects and training on the gaps in care identified. In depth understanding of NCQA Confidential, ACO and other shared savings initiatives.
• Medical records release, Prior Authorization, Referral Coordination, Hospital discharge follow up and Training and proficiency testing.
• Extremely proficient with interviewing, hiring, training, managing and mentoring the employees.
• Highly skilled in intensive assessment and care planning while maintaining the confidentiality and building a trusting relationship with clients or patients.
• Extremely knowledgeable on community resources, Medicare - Medicaid, home care etc.
• Diversely experience as RN in OR, ICU, Telemetry, med surg, Telephonic Disease Management and Case Management.
• Extremely experienced in developing Standardized Proficiency Assessment document for the company’s Clinical Staff. Well versed with developing power point presentations and training the staff on HEDIS measures, Workflows, Care Coordination other company initiatives.
• Highly skilled with computer applications, documentation, maintaining records and CLINICAL CUSTOMIZATION of Electronic Medical Record applications.
• Well versed with outlook, MS word, power point and MS Excel applications.
• Comfortable with navigation of, Allscripts, CRISP query portal and notifications, Cognos, IDEA, Med measures, Epic, Meditech and Popworks programs.
• Diversely experience in different Healthcare settings like Hospital, Ambulatory Care, Insurance companies, Managed Care and large physician practice.

EXPERIENCE:

Senior Program Manager

Confidential, Washington, DC

Responsibilities:

• Lead monthly meetings for all the blues plans on healthcare quality improvement projects.
• Provide monthly training to the plan employees on the IDEA- software and its applications..
• Experienced in building consensus among team members and other key stakeholders.
• Experience working with teams to implement new or revised processes and procedures.
• Experience with conducting management briefings that include the presentation of recommendations to changes in business processes, goals, and/or strategies
• Experienced in introducing and implementing new processes and methodologies to a diverse stakeholder group
• Setting strategic vision for a team, office, or organization
• Experienced with preparing written reports for technical and non-technical personnel?
• Experienced with compiling, organizing, analyzing, and presenting data to management regarding services rendered and costs estimates
• Lead and participate in the company meetings and provide expert recommendations on the various projects.
• Rate and analyze the vendors required for various projects and participate in the procurement process.
• Lead the development and maintenance of various HEDIS related projects and programs.
• Lead the testing of various software and ensure the defects are fixed before moving to production as Business Owner.
• Ensure the workflow is being followed and various entities involved are aware and moving forward with their responsibilities.
• Provide requirements for software development and provide interpretation of HEDIS technical specification for IT.
• Develop and enforce programs to improve the quality scores for the various health plans managing Federal Employee Plan for BCBSA.
• Act as a Liaison between the OPM (Office of personnel management) and the various health plans.
• Use the IBM’s reporting software Cognos to create reports and come with ideas to improve the scores for various measures..
• Act as a subject matter expert for the various health plans and for IT in interpreting the requirements for HEDIS as per the requirement for OPM’s Federal employee plan insurance.
• Represent the company at various conferences and seminars.

Consultant Business Analyst

Confidential, Windsor Mill, Maryland

Responsibilities:

• Leads the team as the scrum master to support the CMS Comprehensive Primary Care Project and other projects as assigned.
• Responsible for working with development and steady state test teams to correctly apply requirements and design document.
• Excellent writing skills, ability to assemble detailed design documents, interact with various team leads, developers, etc. for the purpose of validating design.
• Actively participates in the planning and technical consultation sessions and lessons learned, document decisions, action items, and processes, facilitate continually improving and growing a library of documentation and processes,
• Perform Business and System Analysts functions: creation and delivery of XLC artifacts and other contract deliverables, participate in specifications manual reviews and analysis, participate in peer reviews, support Enterprise Architecture Integration, and contribute to implementation documents, user guides and training.
• Track requests for assistance and resolution.
• Demonstrate knowledge of the business processes in the area of responsibility and can work with the External ADO to define requirements that will drive efficiencies in the business.
• Knowledge of various business process and system modeling tools including: Data Flow Diagrams, Process Models.
• Working knowledge of the system development life cycle and can train others on SDLC concepts.
• Demonstrate thorough working knowledge to effectively manage time, prioritize work, multi-task across many assignments, create deliverables and delegate to others as well as monitor their work for completion.
• Track and triage problems found in Operations and Maintenance Phase for delivered releases

Project Manager

Confidential, Columbia, Maryland

Responsibilities:

• Project Manager for various Quality Improvement and revenue enhancing projects like Patient Satisfaction survey, ER reduction project, in-house medication dispensing project, ACO Case management coordination, NCQA Confidential certification project, Transition Care management project.
• Educate and train the Providers and Medical assistants in Clinical quality improvement initiatives, HEDIS Measures, Motivational interviews, Care team Huddle, Risk stratification and Care Coordination. Develop power points and other educational material for the same.
• Evaluating the effectiveness of existing policies and write or review new policies.
• Perform clinical customization of the EHR application as required to smoother and faster workflow.
• Analyze data pertaining to ER visits, Readmissions and Satisfaction surveys and presenting it to the administration and providers in a way to effect positive changes in the practice.
• Collaborate with community resources to help patients with medical care as well as to meet their psychosocial needs.
• Supervise and coach employees involved in coordination of care by coordinating referrals to specialists, Prior authorizations, and hospital discharge follow ups with in 2 days of discharge.
• Assist with proficiency training and assessment of Medical Assistants.
• Report to the Director of Clinical Operations, Chief Financial officer and Chief Executive officer on Clinical Quality Measures and Q/A reports for the organization and steps to improve them.
• Prepare the agenda and lead the Clinical Care Committee to develop new policies and processes.
• Perform chart audits/prepare reports to monitor the results of implementation of quality initiatives.
• Develop professional relationships with HCGH Hospitalist Program, CMP preferred referral specialists and ancillary services network to facilitate patient access, and ease of communication in the coordination of care
• Assist the administration in the assessment of specialists with regards to responsiveness, access, ease of communication, documentation and follow-up.
• Served as a liaison for care coordinators from shared savings programs like CareFirst Confidential and JH ACO.
• Prepare and circulate reports on Confidential program to the shareholders and administration. Continuously monitor and improve the healthcare cost savings initiatives for the company.
• Selling and introducing the new Confidential program and training the Physicians and office staff on new software for CareFirst Patient Portal.
• Educate the patients on disease management and chronic conditions management.
• Assessment of information, from the medical history and physical, laboratory data, pharmacy information, and other diagnostic testing results, screens and assessments and develop an individualized, goal-oriented CARE PLAN in collaboration with the physicians.
• Discuss disease specific and preventative national care guidelines with physicians and ensure optimum and appropriate care for the patients.
• Collaborate with community resources to help patients with medical care as well as to meet their psychosocial needs.
• Take steps to prevent unnecessary hospitalizations and close gaps in care with Care coordination and education of the patients.
• Worked as Intensive Case Manager at the Call center taking care of patients with complex medical conditions that required various interventions to improve health and lower costs associated with health care.
• Educated Confidential patients on action plan to prevent readmissions and conducted telemonitoring of Vital and Weight.
• Mentored and trained new employees consistently.
• Initiated and led the colleague engagement Committee in collaboration with the administration to improve the morale of the employees.
• Provided direct patient care to hospitalized cardiac patients and med/surg patients.
• Oversaw and administered medications and interpreted physician treatment plan.
• Carefully monitored and promptly treated cardiac patient, Confidential patients, electrolyte imbalances and diabetes.
• Efficient in assessing telemetry and Confidential . changes.

Registered Nurse

Confidential

Responsibilities:

• Monitored patients on ventilators and cardiac monitors.
• Assisted the physician in making decision in patient care.
• Observed and reported patient status and treated the same.
• Administered cardiac drugs.

Registered Nurse

Confidential

Responsibilities:

• Assisting with eye surgeries and Ob -Gyn surgeries, wound dressing and immunization.
• Answered telephones and scheduled appointments for office visit and outpatient procedures.
• Managing the smooth functioning of the facility at all times, by replenishing supplies, coordinating care between different physicians.
• Maintaining records of patient’s visits and follow-up appointments.