health services director resume example with 11+ years of experience
JessicaClaire
, , 100 Montgomery St. 10th Floor(555) 432-1000, resumesample@example.com
Professional Summary
Highly dynamic, successful healthcare professional with hands-on health services experience. Skilled in forecasting activities of the business unit focused on setting and achieving short and long-term strategic goals. Adept in reporting progress status to senior management. Ensures accuracy and timeliness of output and deliverables for assigned functional areas. Implements and ensures compliance with corporate management policies, practices, and procedures. Establishes relationships with business users. Collaborates with senior management to establish strategic plans and objectives. Delivers analyses and project updates to all areas requiring information for management reporting, analysis and executive decision making. Serves as the liaison between operations and training. Participates in program design and ongoing maintenance.
Skills
Service Utilization Improvements
Health Services Coordination
Regulatory and Statutory Compliance
Employee Recruitment and Hiring
Operating Plans Development
Information Systems Development
Team Meeting Management
Professional Experience
09/2016 to CurrentHealth Services DirectorOakmont Management Group | Fullerton, CA,
Led the collaboration, development, and maintenance of standardized procedure guides for global programs. Developed processes for the enterprise to develop procedure guides and workflow testing guidelines in preparation for HIP migration. 25 global procedure guides completed
Produced 150+ assessment templates for HIP configuration. Led testing efforts pre/post- production. Partnered to submit all assessments to CMAP for Elevance Health and State approval. Created training for others to conduct these activities in the future
Constructed 119 care plan guidelines, 185 goals, 764 interventions, and 376 outcomes using strength-based language in addition to drafting the requirements for care plans in HIP. Developed care plan automation for assessments. Created training for others to conduct these activities in the future
Participated in the development of content configuration guidelines for enterprise use. Led efforts to complete configuration details for 25 global programs. Creating training for future use
Known for being a nexus of system development, operations, readiness, reporting, training, procedure development. Developed procedures/processes for end-to-end testing, assessment building, content configuration construction, requirements building while conducting these activities for global and non-global programs
Directed a team to implement a Motivational Interviewing training curriculum comprised of 37 Continuing Education Credits. Created video/audio training companions, reference guides, manager training guides, a resource site, and call monitoring/evaluation tools for managers and quality evaluators. The CEU credits created saved Elevance approximately $400,000
Orchestrated the collaboration of more than 350 key stakeholders across all lines of business, 12 specialty groups, 3 regions, 5 funding sources, 17 programs, 7 delivery models, and operational areas (quality, legal, accreditation, privacy, medical directors, compliance, clinical associates, enrollment specialists, health professionals, medical directors, operations delivery directors, clinical product owners, provider collaboration liaisons, information technology and system design teams, as well as learning and development) in efforts to enhance, revise, create, consolidate, and strategically position content (automation/artificial intelligence preparedness) in the new documentation platform
Led the creation and implementation of an in-house End Stage Renal Disease program replacing an external vendor in only 8 weeks
Served as liaison to several health plans ensuring compliance with NCQA requirements. Collaborated with business partners to spearhead new procedures and system enhancements related to social determinants of health
Presented Elevance’ s Evidence Based Best Practices for Post Discharge Management/Care Transitions Interventions Program at the annual CMSA conference in Las Vegas and received 4.57/5 stars from over 500 participants
Partnered with key stakeholders to enhance the Provider Collaboration program. Created and implemented new provider specific goals, drafted the bidirectional communication capability requirements for the Healthy Returns System. Efforts led to increased reporting capacity, and improved provider referral usage
Led efforts to improve non-member permission process in the HRS documentation system. Complex system requirements enabled to receive and update permissions in compliance with federal, state, legal and accreditation guidelines. Successful integration into HRS
Maintained the approved website database for all associates and created a SharePoint site resource for associates. The website collection of over 2,000 resources provided associates with enhanced educational resources
Program owner. ComplexCare, COBC, Case Management, & ESRD. Successfully maintains all aspects of each program and partners with stakeholders to update marketing materials, assessments, letters, goals, system enhancements, NCQA/State compliance, and other requirements on an ongoing basis
12/2013 to 09/2016Operations ManagerNational Express Corporation | Bakersfield, CA,
Coordinated a multidisciplinary healthcare team of licensed utilization management, case management, social work, and disease/ complex care associates
Accountable for performance including, productivity, utilization, reporting, hiring, interviewing, evaluations, improving quality outcomes, on-boarding/orientation, project management, retention, satisfaction, engagement, workforce management, teambuilding, complaint management, tactical staffing review and planning, VA local business continuity planning/emergency response duties, reporting, and mock/live incident command duties, education/growth and development
Performance Guarantees: Minimized financial exposure and associated risk related to performance guarantees for the VA local team
Consumer Centricity: Piloted a Successful Post Discharge Stabilization planning and implementation program
Provider Collaboration: EPHC referral automation; VA Local commercial pilot planning and implementation
Inventory Management: Successful planning and implementation of “Blitz” Day events reducing overdue worklist inventory and aged cases
Associate engagement: Among the best ratings achieved on the associate engagement survey 2014–2015. Voluntary turnover rate: 0%
Change management: successful team maintenance post de-centralization/multiple team and organizational changes
Project Management: Active participant in troubleshooting, preparing, and/or implementing several key initiatives related to Anthem Healthy Actions, VA EPHC pilot, VA CM Redesign pilot, creation/enhancement of orientation materials, Healthy Mind and Body daily Va local team activities, consistent biweekly team coaching meetings, weekly 1:1 associate feedback sessions
Successful integration and management of CM/DM programs, dialer demonstrations, and distribution of DM team/resources to newly assigned regions
Commended for creation of motivational interviewing curriculum materials, and post integration new hire training revision work and videos used across the enterprise
01/2011 to 12/2013Telephonic Nurse Triage ManagerWellPoint, Inc. | City, STATE,
Provided clinical program and project support in the Medical Management department outside of normal business hours.
Acted as a project manager for medical management initiatives, such as the development of policies and procedures, development and implementation of training procedures and manuals, and the development and implementation of metrics and other reporting capabilities.
Represented the department on enterprise-wide and regional committees and program initiatives.
Served as a member of the Process Improvement Committee, Led the Associate Activity Committee, and participated in the Hiring Committee
Exceeded all team/department wide business records for two consecutive years
Recognized for having the highest associate engagement scores for the department
Assisted with health exchange operational readiness planning
Participated in process improvement projects to enhance and showcase NurseLine value.
Education
Expected in 06/2024 to to Master of Science | Family Nurse PractionerUnited States University, San Diego, California, GPA:
Expected in 05/2016 to to MBA | Healthcare ManagementColumbia Southern University, Orange Beach, Alabama, GPA:
Expected in 06/2004 to to Bachelor of Science | NursingVirginia Commonwealth University, Richmond, Virginia, GPA:
Achievements
21 Impact Awards/Peer Recognition, Anthem, Inc. 2021-2022
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