Montgomery Street, San Francisco, CA94105609 Johnson Ave., 49204, Tulsa, OK
H: (555) 432-1000
C:
resumesample@example.com
Date of Birth:
India:
:
single:
Professional Summary
16 years managerial experience as MLTC Assistant Director, IDT Supervisor, Assistant Field Services
Manager and Intake and Patient Services Case Manager in managed community/home care
settings. Extensive experience recruiting, developing and managing clinical staff. Expert in planning
and organizing activities consistent with agency goals and mission.
Education and Training
Bachelor of Science: Nursing, Expected in - PACE University - , NY GPA: Nursing
Certified Cancer Registrar: , Expected in - Lehman College - Bronx, NY GPA:
Associate of Applied Science: Nursing, Expected in - Bronx Community College - Bronx, NY GPA: Nursing
Skill Highlights
Assistant Director for NYS Experience with government program Partial(Medicaid), Select(Medicaid MLTC) at Dual(Medicaid/Medicare), and Centerlight Healthcare. Direct the FIDA demonstration project responsibility for the day to day Fluent in spoken and written operation and delivery of quality Spanish services to approximately 7,000 Apply critical thinking and members. creative approaches leading to Direct supervision of Care successful customer satisfaction Management Teams composed Deliver increased efficiency, of 28 Registered Nurses, 34 increased productivity, and Licensed Clinical Social Workers, reduced cost 14 ancillary staff workers. Yearly performance review of Care Management Team Leaders Special projects development leader Able to manage complex health delivery systems issues
Experience
Accomplishments
Project Management: Initiated Medical Review Template which resulted in focused clinical presentation to the Medical Director for determination of appropriate Personal Care Worker hours based on medical necessity.
Lead person for the Medicaid recertification project which has increased advanced notification of members at risk for loss of Medicaid and reduced need for APS referrals.
Initiated workflow process to improve efficiency and expediency of the NOA(notice of action) turn around time for meeting member notification guidelines and improve Fair Hearings outcome Managed and drafted initial schedule pairing of sales/marketing personnel with care managers to identify potential members appropriate for transfer to a higher level of care health plan model(Medicaid to Medicaid/Medicare product) Staff Development: Launched well-received program of professional development courses for all staff.
Mentored and coached employees resulting in a 45% increase in productivity.
Career Chronology
, - – ,
Skills
agency, Cancer, Case Manager, Case Management, critical thinking, customer satisfaction, delivery, diagnosis, government, Team Leader, Director, meetings, PowerPoint presentations, patient care, performance reviews, presenting, Primary Care, problem-solving, processes, quality, receiving, Spanish, supervision, Surgery, therapeutic intervention, trend, wound care, wound care, written
Professional Experience
Assistant Director Select MLTC, 06/2016 - Current Berry Global Group Inc. – Princeton, IN,
Accountable for all daily operations in the delivery of services to our members including overall customer satisfaction.
Designed PowerPoint presentations for monthly meetings with upper-level management.
Devised short and long-range action plans to address a wide variety of member needs.
Demonstrated analytical and problem-solving ability by addressing barriers to receiving and validating accurate health care information.
Achieved departmental goals and objectives by instituting new processes and standards for member case management.
Ensured efficacy of treatments through monitoring of the wound care tracker and implementation of weekly Care Manager/Team Leader review of wound care status.
Conducted qualitative and quantitative monthly trend analysis of daily work performance operations using established systems metrics and other tools.
Team Leader, 02/2016 - 06/2016 Kaiser Permanente – Fort Collins, CO,
Select(Medicaid Product) Carefully selected, developed and retained qualified staff, as well as trained new staff annually.
Evaluated patient care procedural changes for effectiveness.
Administered, directed and coordinated the activities of the agency in order to deliver goods and services to the members.
Served as liaison between management, clinical staff and the member community.
RN Interdisciplinary Care Team Supervisor, 03/2013 - 01/2016 Emblem Healthcare – , STATE,
Managed day to day operations, performance reviews and outcomes of Primary Care Managers.
Continuously improved effectiveness and efficiency in delivering services.
Ongoing identification and management of high risk, high cost cases where intervention will provide quality of care and reduced cost.
Meeting established Metrics for delivery of care coordination by the assigned professional staff.
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