Telephonic Case Manager Resume
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RN
SUMMARY
- Experience as an IT project manager, business analyst & mainframe programmer in teh, Aerospace, mechanical and production engineering, Bank Card, travel, health care fields.
- Covered all levels of waterfall and agile SDLC from customer liaison through system design, project control, programming, testing, documentation and implementation, while simultaneously being responsible for a 'hands on' approach to system support and query handling.
TECHNICAL SKILLS
- Microsoft: - Word, Excel, Visio, Powerpoint, Project,. HTML, n-tier architecture and associated security, RDMS: DB2, SQL, Informatica/Oracle 9.i ETL
- DbVisualizer, Progress, EDI X12, IBM, ISPF, JCL, FILE AID, IMS DB/DC, CICS, COBOL, Easytrieve Plus, TSO, Method/1 requirements documentation.
- Limited Microsoft Access. Six Sigma Green belt certified.
PROFESSIONAL EXPERIENCE
Confidential, RN
Telephonic Case Manager
Responsibilities:
- Converted to an employee as an RN insurance case/care Manager responsibilities included:
- Performing utilization management\review and concurrent review of inpatient cases using Milliman
- Participating in rounds with teh Medical Director and discussing cases as needed
- Determining need, if any, for intervention, and discussing with Case Managers and physicians
- Initiating a discharge planning and readmission prevention plan
- Reviewing bed days for inpatient cases using Milliman and standardized coverage positions.
- Initiating a discharge planning and readmission prevention plan
- Gathering clinical information to assess and expedite care needs
- Consulting with teh Medical Director as needed to troubleshoot difficult or complex cases
- Maintaining appropriate documentation utilizing CHC ICMS, providerlink (Covisint)
Project Manager
Confidential
Responsibilities:
- Network Voice Infrastructure PM consultant responsible for teh roll out of teh Pan European re-engineered call routing infrastructure moving from a Periphonics based application to an Avaya\Cisco Voice Response VoIP telecommunications solution utilizing teh UK based host vendor for Voice contact solutions while retaining teh back end host applications access, Peripheral Gateway servers and ACD inhouse. dis involved:
- Creating project plans for both teh internal infrastructure upgrades.
- Managing Risks and Issues identification and mitigation arising due to multiple vendor integrations and associated design linkages.
- Working with external vendors, internal stakeholders and architecture team to champion program/project(s) across teh entire organization while mitigating design solutions.
- Developing detailed work plans, schedules, estimates, resource plans, and status reports in order to facilitate budget and invoice management for all new hardware, software and services from internal groups and vendors.
- Coordinating firewall\security connectivity alignment by managing subnet integration to international routers.
- Leading weekly program status meetings for program\project tracking and analysis.
- Reporting to VP, sponsor and program level including 47 stakeholders.
- Ensuring adherences to quality standards and reviews program/project deliverables.
- Managing teh integration of vendor tasks, tracked and reviewed vendor deliverables.
- Providing technical and analytical guidance to project team.
MATRIX Consultants
Confidential
Responsibilities:
- Offshore consultant. After contract signature, managed teh off shoring of teh companies first subcontract of IT projects. dis role included:
- Creating project plans, overseeing invoices and budgets, facilitating project activities between onsite and offshore project development teams, providing project cost scope schedule, liaising with teh business over ticket priorities, status and metrics reporting to CIO and Marketing VP, passing requirements to offshore\onshore work assignments, defining project ‘sprints’, liaising with QA and end users for ‘sprint’ pre implementation acceptance and creating scope and vision documents for new projects.
- Renegotiating contracts and restructuring staffing levels per workload.
- Managing vendor, ensured adherences to quality standards and reviews program/project deliverables. Managing teh integration of vendor tasks and reviewed vendor deliverables against contract standards.
- Analyzing data issues utilizing SQL on DbVisualizer
- Working on teh replication DB solution definition, comparing multiple solutions to support a reporting replication DB, a hot Disaster Recovery site and a data warehouse utilizing ETL and ESB messaging.
Clear Choice health Plans
Confidential, OR
Responsibilities:
- Project Manager\Business Analyst for various projects including CMS Medicare service area expansion, EDI X12 Claims parsing and HEDIS reporting.
- Managed teh companies Medicare service area expansion. dis included performing JAD sessions with all internal departments to capture all teh transitional tasks and software functional and non functional business requirements to support all aspects of expansion into a different Medicare service area, including CMS compliance, Formulary, HR, G&A, Claims, Billing and Enrollment, marketing and Web Site considerations. Created and maintained teh project plan for all tasks. Created status reporting on cost, scope and schedule to all management.
- Worked with external vendors and internal stakeholders to champion program/project(s) across teh entire organization.
- Managed teh integration of vendor tasks. Reviewed vendor deliverables. Lead program meetings being responsible for program tracking and analysis.
- Performed teh gap analysis investigation and implementation of teh new claims X12 EDI (Electronic Data Interchange) project that parsed teh electronic 837, 834, 270, 276 and 278 files information.
Confidential, Phoenix, AZ
Customer and Product Support - Contract Manager
Responsibilities:
- Worked with teh Globalization team to look at low cost region opportunities, specifically for teh order management applications.
- Liaised with many internal departments to review work scope and compliant feasibility.
- Worked with IT to ensure that we could comply with ITAR/EAR for all applications.
- Reviewed OffShoring work for SOX compliance.
- Worked with teh Database administrators, mainframe access groups and web/midrange administrators to design user roles and RACF groups.
- Determined and introduced teh Oracle RLS functionality solution to teh DBA group for secure access.
- Created an Access DB for OffShore to track all access permissions.
- Worked with compliance (Export Control Officers) to create automated PDT27 workflows.
Confidential, Phoenix, AZ
IT Project manager / Business Analyst/ Mainframe programmer
Responsibilities:
- Visited all global company locations, (India, UK and USA), conducting requirements gathering and design review sessions with business partners and technology and subsequent documenting of project scope and requirements utilizing Method\1 documentation standards.
- Gathered all local market disbursing requirements based on individual market processes and legal/compliance requirements.
- Designed a single web enabled secure application, involving all internal security and standards groups.
- Obtained global alignment on scope and design.
- Created project plans, managed cost, scope, schedule, stakeholder status reporting and Issue/ Risk tracking and management.
- Participated in vendor selection.
- Created and reviewed vendor proposals (RFI/RFP) and staff ‘Statement of work’s’
- Acted as an intermediary between teh business community, teh internal technical community and teh vendor during requirements sessions.
- Worked with external vendors to ensure application custom code was modified to our requirements within cost scope and schedule of teh gap analysis.
- Acted as project manager, ensuring stakeholder status reporting, managing funding across global departments, managed cost, scope and schedule, created and managed Microsoft project plans and ‘offshore / onshore’ resources.
- Liaised with internal standards/security departments to review vendor n-Tier architecture with regarding security, bandwidth/response times, network setup and architecture compliance, for teh externally hosted application.
- Visited international markets (UK, Australia) to gather local and regulatory requirements
- Created analysis documents for design pre-requisites.
- Obtained stakeholder sign off of all documentation.
- Created Microsoft project plans, ran issues/action item meetings.
- Created system test plan and assisted in system test, while maintaining teh issues log and running daily system test progress meetings.
- Managed ‘offshore’ support groups, utilized under a 70/30 ratio, responsible for project deliverables.
- Worked with CGEY for an Oracle 9i system replacement utilizing Informatica ETL.
- Worked with business partners while application support relocated offshore.
- Reinstated teh domestic check application after application and hardware failure within two days, while in a remote location.
- Supported teh business partners in all their concerns and support issues.
Spherion/Interim Technology
Confidential, Phoenix, AZ
Responsibilities:
- IT Project Manager / Business Analyst for Cardinal health Systems - pharmaceutical warehouse and distribution Company. dis was an ‘on contract’ position to convert teh MIS systems from Mainframe to AS400. dis involved:
- Managing teh Mainframe to AS400 conversion effort.
- Investigating teh existing system in order to provide conversion solutions and help desk support.
- Creating system changes to reflect changing business needs, utilizing mainframe COBOL, DB2, TSO, Easytrieve