Summary

Offering more than 15 years of progressive experience in the healthcare industry and 10 years utilizing proven project management tools to visualize opportunities and implement solutions. Thrive in a fast-paced, virtual environment teaming with diverse resources in various locations. Personal and professional fulfillment in making healthcare delivery process more efficient and beneficial to all.

Project Management: Trained in PMI standards but have applied other methodologies to build, guide, and motivate successful teams through positive, transparent collaboration. Solid in managing multiple complex project teams simultaneously. Projects include:

• Process Improvement: Strength in identifying, understanding, and helping improve business issues that stretch across entire organizations.
• Decreased contract implementation time 15 days by incorporating a Service Level Agreement to map data to EDW, standardize reporting, and establish ETL processes
• Data Management: Confident in working with health plan, PBM, CMS, and clearinghouse data files and in defining valid reporting metrics. Diverse analytic experience associated with care management programs, provider reimbursements and pricing arrangements, and financial contract reconciliations.
• Credited with advancing company from reliance on summary data to receiving detailed data feeds which allowed for more comprehensive reporting, creation of statistical process control, and other analytics showing the efficacy of using proprietary technology
• Refined data extraction methodology and detected fraudulent billing patterns exposing over 30M of erroneous billing practices

Professional Experience

Confidential

Project Manager, Change Management

• Led process improvement initiative supporting multi-million dollar mobile communications project for 2 urban hospitals and a medical school. Improved communication paths by meeting with staff, mapping out processes, and negotiating methods to decrease patient wait time and improve quality of care.
• Created mobile usage trend reports to assist in determining actual need of devices

Confidential

Project Consultant, Database Integration

• Managed the migration to a new platform stabilizing B2C experience. Documented editorial process requirements to warehouse survey data, cartographic and graphic objects, and customer details.
• Increased sales 60 and customer satisfaction to 98
• Decreased manual hours 75 and prevented possible data entry errors

Confidential

Senior Project Director, Health Intelligence

• Supervised team of analysts reporting operational and outcomes metrics for a Medicaid care management program. Liaison to Corporate leaders and State Missouri officials.
• Identified errors in admission logic and improved methodology to reduce billing inconsistencies and prevent potential HIPAA violations

Confidential

Project Management Consultant, Magellan Health Services

• Led multiple, concurrent projects bringing cross-functional teams together to define deliverables, identify and resolve issues, and maintain budget and milestones. Conducted virtual planning sessions, established project objectives and ensured the alignment of project goals.
• Developed PMO standards and online tools to manage mid-to-large scale projects. Utilized SharePoint to provide visibility to PMOs function, value, and progress
• Spearheaded process improvement initiative by documenting business flow through visual aids, leading brainstorming sessions, and reporting to Project Sponsors
• One of 5 leaders managing a 6-month Medicaid care program implementation in 27 clinics. Responsible for data ETL and warehousing efforts including contractual reporting. Facilitated virtual meetings with diverse teams to guarantee client expectations were documented, approved and realized.
• Dedicated 4 months in Maricopa County AZ with resource gathering information to ensure seamless transition after deployment - 1st business day after holiday weekend
• Recognized by State of AZ for under budget/on time implementation and acknowledged by Corporate Leadership as Project of the Year

Confidential

ForeSee Health Account Manager

• Recruited to join a new initiative targeting care to 250K Medicare and commercial lives as Primary Contact providing issue resolution, report analyses, and techniques to improve operational and outcomes reporting. Coordinated data acquisition, consulted on predictive modeling logic, and supplied identification and stratification methodologies based on available data sources.
• Generated business process diagrams illustrating standard operating procedures and program descriptions for submission to URAC - awarded 2 year accreditation
• Responsible for RFP management: developed an internal database standardizing responses which contributed to a new Medicaid contract providing care to 80K members

Confidential

• On-point for managing IT project requests from 12 strategic service units in 6 states. Monitored the execution of plans, deliverables, and tasks of various requests from physicians and administrators. Facilitated issue resolution and escalation to decision makers. Provided training for Project Server.
• Inventoried software used within system and developed project plan to eliminate unsupported software and to consolidate licenses establishing IT system control and cost savings

Confidential

Implementation

• Joined a start-up promoting customized Web-based solutions for provider/patient collaboration through EMR/EHR and data consolidation. Collaborated with external clients to design most efficient platforms.
• 100 successful implementations on time and within budget 25 accounts

Confidential

• Promoted to serve on Executive Committee and participated in sub-committees to improve business process, standardize reporting metrics, and ensure compliance with government regulations - URAC and NCQA.
• Supervised programmers and analysts maintaining the integrity of external client data feeds through automated ETL processes and quality assurance reporting
• Primary contact for 150 vendors providing business critical data and other supporting files
• Maintained an online tool to centralize and standardize more than 90 contracts. Through design meetings with cross-functional teams, established corporate contracting standards. Presented variance reports to help distinguish contract requirements from business as usual contracts.
• Assisted in more than 75 care management contract implementations
• Negotiated over 35 contracts, specifically for data requirements and reconciliation as well as supported up-selling ideas to existing contracts based on analysis of outcomes reporting
• Managed the development and deployment of EDW to house valid data, standardize methodologies and reporting parameters, and normalize business processes. Facilitator of multi-department project meetings, supplied tracking mechanism for issues resolution, and provided progress reports.
• On point for the collection and quality of data used in proprietary identification criteria, forecasting tools, product deliverables and initiatives, outcomes and consulting projects
• Integrated home-grown Impact Pro analytical application, an advanced predictive model used to identify high-risk members in need of care management into monthly process