Front Line Leader Operational Support Senior Products Texas Region Resume Example Humana

FRONT LINE LEADER- OPERATIONAL SUPPORT - SENIOR PRODUCTS TEXAS REGION

Professional Background

Patient-focused, high-energy Front Line Leader successful in building and motivating dynamic teams. Cultivates a company culture in which staff members feel comfortable voicing questions and concerns, as well as contributing new ideas that drive company growth. Results-focused management professional offering 6 years of progressive leadership experience. Transforms high-potential staff into outstanding leaders who demonstrate the creativity and savvy that is critical to financial and operational success.

Skill Highlights

11 years working knowledge in the telephonic Healthcare arena
Front Line Leader with working UM/CM/DM/PODS experience
Front Line Leader to lead multiple Cross-Functional Teams

Health and wellness expertise
Procedure development
Working knowledge in several Humana systems
Staff development
Change management
23 years Registered Nurse experience

Professional Experience

HumanaAugust 2013 to CurrentFront Line Leader- Operational Support - Senior Products Texas Region
San Antonio, Texas

Provide guidance and leadership up to 8-15 direct reports.
Successfully manage and streamlined 7 different HSO teams at one time. The HSO Teams included: Analyst, SNF Team, Clinical Care Coordinators, Social Workers, Administrative Assistant, Auditor and ER Nurse.
Continue to collaborate and maintain proactive communication with several different areas within Humana to ensure efficient, accurate and timely responses to internal/external customer needs.
Identify departmental objectives and drive process methodology that will achieve all desired business outcomes.
Maintain organization, models agility, adaptability and openness to new ways of thinking and operating.
Meets established expectations and takes responsibility for acheiving results.
Have become the "Go To" Front Line Leader for various troubleshooting situations for staff and members

HumanaJanuary 2012 to August 2013PDCC RN/ Clinical Care Coordinator
San Antonio, TX

Conducted post discharge calls, screening and planning, recommended services for Humana Plan Members utilizing care alternatives available within the community.
Examine clinical programs information to identify members for specific Case Management and or Disease Management activites.
Collaborate with other Humana care partners to ensure our members and external partners needs are being met.
Collaborate with PODS team members to meet the "Triple Aim" goal: Cost Management, Documentation (Medical Risk Adjustment), and Quality (Stars)
Covered for Front Line Leader and was considered "Go To" Nurse for team.
Received STAR Award for volunteering to give class to MCCI staff to educate about Humana Programs.

HumanaJanuary 2011 to January 2012Telephonic Utilization Review Nurse
San Antonio, TX

Obtained and review necessary medical reports and subsequent treatment plan request to conduct review in accordance with all state managed regulations.
Assignment included: Acute Hospital, LTAC, Rehab and SNFs
Performed continuing review on medical records and identify need of on-going acute stay.
Ensured appropriate and cost effective healthcare services to patients.

Methodist Hospital Health for Life CenterJuly 2008 to December 2010Registered Nurse, Certified Bariatric Nurse
San Antonio, TX

consulting with patients entering the bariatric program, provided education for patients both before and after surgery and life long term follow up care with patients.
Dressing changes and administer IV fluids as needed.
Radiology Nurse certified to run c-arm for bariatric band adjustments.
Charge Nurse Experience.
Bariatric Nurse Certified.

Humana MilitaryApril 2007 to July 2008Patient Care Coordinator
San Antonio, TX

Monitored quality of care, identified and documents any potential quality issues regarding the patient\'s care.
Coordinate pt transfers and document appropriately is MSR and Liberty MSR programs.
Contact Morbid Obesity referrals to Bariatric Centers of Excellence.
Assist Health Care Finders with referral and medical questions.
Charge Nurse Experience

United Health Group Optum/AlereApril 2007 to July 2007Treatment Decision Support Nurse
San Antonio, TX

Inbound/Outbound calls to members to provide information and resources that hep members take a more active role in their healthcare decision making process.
Areas covered Breast/Prostrate Cancer, Lower back pain, back knee and hip surgery, fibroids, endometriosis, abnormal uterine bleeding, BPH, C-section/induction per maternal request.

CareMark/Care PatternsNovember 2005 to April 2007RN - Patient Educator
San Antonio, TX

Made outbound/inbound calls to member who belonged in DM programs
assess, educate and follow up on members who had DM, CHF, CAD, COPD, Pedi-Asthma.
Implemented and assisted the set up for the CHF Home Monitoring Program, Depression Program, Pain Program and recent hospitalization Program.

United Health Group Optum/AlereDecember 2004 to November 2005Cardiac Telehealth Nurse
San Antonio, TX

Provide telephonic clinical assessment, health education and utilization management services of CHF patients. Responsible for inbound/outbound day to day monitoring.

Kaiser PermanenteJuly 2003 to December 2004RN-Telemedicine Specialist
San Diego, CA

Provide a telephonic nursing service through assessing a set of symptoms and then determine the appropriate level of care needed (911, ED, UC, Home Care, PCP visit)

El Centro Medical Center, Scripps Mercy Hospital, Sharp Chula Vista Medical Center, San Diego CountyMarch 1994 to June 2003RN Experience in Various Settings
San Diego, CA

Operating Room Trauma Center- able to scrub and circulate in general surgery, open and laparoscopic gastric bypass surgery, GYN, Ortho, Eye, Vascular and Heart Cases.
Labor and Delivery
Telemetry Step Down Unit-Covered for Charge Nurse
Med/Surg- Night Shift Charge Nurse
Correctional Nurse for San Diego County-Night Shift Charge Nurse

Education and Training

Southwestern CollegeJune 1993Associate of Science: NursingOtay Lakes Chula, CA, San Diego

Montgomery High School Palm AveJune 1987High School DiplomaSan Diego, CA, San Diego

Certifications

MCG Utilization Management Specialist Expiration 07/01/17
Diabetic Teaching Certified on 1/26/14

Affiliations

HELLO- Humana Leadership Forum
Unidos-Humana's Hispanic Network Resource Group
Women's Network Resource Group
HAPI-Humana's Asian/Pacific Islander Network Resource Group

Current Registered Nursing License

California-Registered Nurse License #497180 Expiration 01/31/18
Texas- Registered Nurse License #710942 Expiration 12/31/16

Resume Overview

Companies Worked For:

Humana
Methodist Hospital Health for Life Center
Humana Military
United Health Group Optum/Alere
CareMark/Care Patterns
Kaiser Permanente
El Centro Medical Center, Scripps Mercy Hospital, Sharp Chula Vista Medical Center, San Diego County

School Attended

Southwestern College
Montgomery High School Palm Ave

Job Titles Held:

Front Line Leader- Operational Support - Senior Products Texas Region
PDCC RN/ Clinical Care Coordinator
Telephonic Utilization Review Nurse
Registered Nurse, Certified Bariatric Nurse
Patient Care Coordinator
Treatment Decision Support Nurse
RN - Patient Educator
Cardiac Telehealth Nurse
RN-Telemedicine Specialist
RN Experience in Various Settings

Degrees

Associate of Science : Nursing
High School Diploma

Front Line Leader- Operational Support - Senior Products Texas Region Resume Example

Resume Score: 90%

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