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director performance optimization sales ops resume example with 13+ years of experience

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Jessica Claire
, , 100 Montgomery St. 10th Floor (555) 432-1000, resumesample@example.com
Executive Profile

Performance-driven Director with 20+ years of experience aligning systems with business requirements, policies and regulatory requirements. Passionate about applying excellent organization and communication skills to manage and lead teams. Results-oriented individual well-versed in interfacing and consulting on business processes to drive results based on sound overall business judgment. Dedicated and compassionate healthcare leader with a track record for aligning strategy to achieve business goals and building a culture of accountability with people who are results driven, innovative and committed to excellence

Skill Highlights
  • Leadership
  • Customer-oriented
  • Strategic planning
  • Operational management
  • Compliance/Risk management
  • Rules and Regulations
  • Critical Thinking
  • Process Optimization
  • Performance Monitoring and Evaluation
  • Results Orientation
  • Team Engagement
  • Quality Control Planning
  • Leadership and People Development
  • Portfolio Management
Core Accomplishments

Health Services and Quality:

  • Oversight and participation in Individual, Small Group and Medicare management, including staffing, quality scores, monthly financial management, customer, broker and provider engagement and retention programs.

Strategic Planning:

  • Adept at the development of organization's business plan, quarterly reviews and course corrections. Oversee focused budgeting and financials including operational and commissions. Strong strategic thinking with problem solving skills.

Human Resources:

  • Highest ranking department within Health Plan for associate satisfaction, willingness to refer new associates, and intent to stay with the company.

Operations Management:

  • Launched the New member welcome and retention programs for Medicare, Medicare Supplement with enterprise adoption driving Net Promoter Score and STARS performance.
  • Established operating processes for health care team, remedied service issues, implemented new programs and supported all areas of the Health Plan to accomplish established business goals.
  • Built broad based support among key decision-makers and influencers to promote activities to achieve favorable organizational impact.

Promote Mission and Culture:

  • Demonstrated success in building teams with a culture committed to execution, collaboration, communication, and a positive learning environment for associates and the members served.


Professional Experience
01/2021 to Current Director, Performance Optimization, Sales Ops Blue Shield Of California | City, STATE,

Development, implementation and oversight of integrated Senior Markets, Medicare, Medicare Supplement Performance Optimization and Sales Operations. Initiatives include the establishment of indicators for monitoring and evaluating quality care, appropriateness, continuous improvement, member satisfaction, utilization and case management services across the continuum of care to members.

  • Directs and provides leadership for designing, developing and implementing Health Plan integrated medical management program to meet the demographic and epidemiological needs of the population served.
  • Collaborates with key health care professionals towards identification of opportunities for improvement, trend analysis, education, and development of actions plans to meet organizational goals.
  • Establish and execute objectives and annual goals to meet Health Plan initiatives.
  • Foster teamwork and collaboration to ensure the sharing of information and best practices across the corporate structure.
  • Manage successfully in a matrix model business environment which includes collaboration with HR, IT, Finance, Underwriting, Legal, Compliance/Risk Management, and Shared Services such as the National Call Center.
  • Executed successfully NCQA Health Plan accreditation.


07/2018 to 01/2021 Senior Program Manager, Markets Operations Blue Shield Of California | City, STATE,

Expertly planned, coordinated, organized and directed all operations for care management services for the State of WA Medicaid and Labor and Industries Departments.

  • Fiscal responsibility for the department including contract deliverables to the State of WA (review timeliness, ROI, etc.).
  • Strategic planning/Contract negotiations with providers.
  • Ensured department fully met with all required legal, contractual, and accreditation standards.
  • Primary point person for collaboration and communication between providers, Qualis Health, and State of WA.
  • Ensured the integrity and high quality of care management delivery utilizing LEAN methodology. Case in Point Platinum Awards Finalist. According to Dorland Health, these awards aim to recognize the most successful and innovative UM programs working to improve healthcare across the care continuum.


11/2013 to 07/2018 Program Manager, Markets Operations Blue Shield Of California | City, STATE,

Created, directed, and managed an operational management program for Individual Family Plans, Medicare, Medicare supplement, vision, dental and life.

  • Created and organized departmental resources that supported the corporate strategic plan.
  • Assisted in corporate selective contracting for services provided outside of HMO.
  • Monitored contract administration of external services.
  • Responsible for the achievement of clinical, utilization, and quality outcomes with established performance measures.
  • Collaborated with HMO physicians, hospital leaders, and external providers to establish and implement clinical programs that supported the objectives and growth initiatives of the organization.
  • Assured effective and efficient utilization of facilities and services through ongoing monitoring and educational programs.


05/2010 to 11/2013 Business Analyst, Principal, Installation and Bill Blue Shield Of California | City, STATE,

Directed all clinical services for this facility within the framework of the established philosophy and objectives of the national corporation.

  • Negotiated contracts for funding sources from private insurers, Medicare, and Medicaid.
  • Responsible for the design, coordination, and implementation of rehabilitation programs.
  • Formal liaison with the corporate office, medical staff, funding sources and management staff for strategic planning.
  • Analyzed and evaluated services rendered to improve quality of care and utilization of staff and services.
  • Participated in community educational health programs for head-injured patients.


Education
Expected in 02/2013 to to Six Sigma Black Belt Certification | Process Improvement Expert Rating, Sacramento, CA, GPA:
Expected in 12/1994 to to Bachelor of Science | Business Administration California State University, Sacramento, Sacramento, CA, GPA:

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Resume Overview

School Attended

  • Expert Rating
  • California State University, Sacramento

Job Titles Held:

  • Director, Performance Optimization, Sales Ops
  • Senior Program Manager, Markets Operations
  • Program Manager, Markets Operations
  • Business Analyst, Principal, Installation and Bill

Degrees

  • Six Sigma Black Belt Certification
  • Bachelor of Science

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