Manager of Clinical Operations Resume Example
"Possesses a combined total of over 20 years experience providing quality services in the healthcare sector-Strong understanding of communications between physicians and other health care professionals-Strong pharmacist support skills, quality assurance/control and project support experience within a fast-paced atmosphere-Proven ability to align organization's mission and values with business objectives-Adept at coordinating patient/physician/pharmacist relations and clinical quality-Special strengths include making significant contributions in the areas of management and team-building-Utilization of Microsoft Office: (Outlook, Word, Excel, Access, PowerPoint)-Web-based pharmacy processing systems: Argus, Express Scripts, Caremark, Walgreens, Benecard PBF-Excellent leadership, time management, customer service and interpersonal skills-Well organized and detail-oriented, great work ethic"
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Successfully decreased clinical staff turnover by 80%.
Developed departmental handbooks that presented criteria on how to navigate the clinical system.
Created training processes for both Customer Service and Clinical Service departments.
Leadership
- Served as key contributing member to Leadership team.
Recognition award for the masterminding and creation of the Denial Log Database 2005
Outstanding Annual Achievement Award-Presented 2/2009
Outstanding Achievement Award-Presented 11/2009
Outstanding Annual Achievement Award-Presented 3/2010
Outstanding Achievement Award-Presented 2/2012
Jacksonville , FL
- Coordinated with Supervisor of Clinical Operations on the day-to-day functions of the Clinical department Interviewed and recommended potential employees Supervised and assigned general tasks and responsibilities to 25 clinical associates, located between 3 states Coordinated attendance and time-off requests for employees Structured and implemented programs and policies for company training Monitored/Reviewed all Prior Authorization requests for Commercial and Medicare Part D members Knowledge of current clinical trends and prescription insurance plans Extensive involvement with the drug utilization management and formulary programs Proficient in resolving all types of third party issues with multiple Prescription Benefit Managers on a daily basis Monitored patient profiles for drug interactions and duplicate therapies Wrote monthly newsletter articles for RxTrainer and assisted on other patient-targeted clinical programs and projects Ensured HIPAA and ERISA compliance as federal guidelines describe Responsible for providing monthly Productivity Report Assisted in-house pharmacists with approval and denial of drug coverage and claims Knowledge of Medicare Part D Prescription Drug Coverage Medicare Part D Experience (CMS and Part D regulations) Knowledge and experience with using drug compendia and literature including AHFS, Thomsom Micromedex DrugDex, Clinical Pharmacology and NCCN Drugs and Biologics Compendium Experience in management of Medicare Part D coverage determination and Complaints, Grievance & Appeals Provided coaching to members, handle patient grievances, escalated calls and general inquiries Served as liaison /advocate between the insurance provider, pharmacies, physicians and patients Responded to member concerns via phone and written correspondence related to Prior Authorizations and requests for prescription drug coverage Facilitated training classes for new and current employees on systems and new procedures Provided semi-annual employee performance review to Prior Authorization clerks Provided initiatives to help boost employee morale.
- On a regular basis, provide coaching and feedback to employees Mentoring/coaching of new and current employees Created monthly authorization reports for billing Designed policies and procedures for the Clinical Department which are effective and compliant with legal regulations Managed relations between the clinical, client relations and call center staff to improve the workflow.
Cuba City , WI
- Coordinated with Vice President of Clinical Services on the day-to-day functions of the Clinical department Interviewed and recommended potential employees Supervised and assigned general tasks and responsibilities to 8 clinical associates, located between 3 states Coordinated attendance and time-off requests for employees Monitored/Reviewed all Prior Authorization requests Structured and implemented programs and policies for company training Knowledge of current clinical trends and prescription insurance plans Extensive involvement with the drug utilization management and formulary programs Proficient in resolving all types of third party issues with multiple Prescription Benefit Managers on a daily basis Monitored patient profiles for drug interactions and duplicate therapies Wrote monthly newsletter articles for RxTrainer and assisted on other patient-targeted clinical programs and projects Ensured HIPAA and ERISA compliance as federal guidelines describe Responsible for providing monthly Productivity Report Assisted in-house pharmacists with approval and denial of drug coverage and claims Knowledge of Medicare Part D Prescription Drug Coverage Medicare Part D Experience (CMS and Part D regulations) Knowledge and experience with using drug compendia and literature including AHFS, Thomsom Micromedex DrugDex, Clinical Pharmacology and NCCN Drugs and Biologics Compendium Experience in management of Medicare Part D coverage determination and Complaints, Grievance & Appeals Provided coaching to members, handle patient grievances, escalated calls and general inquiries Serve as liaison /advocate between the insurance provider, pharmacies, physicians and patients Responded to member concerns via phone and written correspondence related to Prior Authorizations and requests for prescription drug coverage Facilitated training classes for new and current employees on systems and new procedures Provided semi-annual employee performance review to Prior Authorization clerks Provided initiatives to help boost employee morale.
- On a regular basis, provide coaching and feedback to employees Mentoring of new and current employees Created monthly authorization reports for billing Designed policies and procedures for the Clinical Department which are effective and compliant with legal regulations Assisted with employee-performance issues.
- Wrote disciplinary reports and developed a strategy for resolution.
- Managed relations between the clinical, client relations and call center staff to improve the workflow.
Fort Scott , KS
- Assigned general tasks and responsibilities to the Customer Services Representatives.
- Processed manual reimbursements, collaborated with CS Manager with administrative tasks.
- Resolved drug coverage issues with physicians, patients and pharmacies.
- Coordinated attendance and time-off requests for employees.
City , STATE
- Processed enrollments, eligibility changes and proofing of patient records Answered calls regarding drug coverage and resolved pharmacy issues Maintained database used to tracked COBRA members billed to 3rd Party Administrators Appointed dedicated representative to 19 clients groups.
- Processed manual reimbursements, ordered quarterly COBRA ID cards, maintained Coordination of Benefits data and enrollments Served as back-up personnel for the submission of FTP (electronic files) Performed day-to-day functions on a need basis for Customer Service Dept.
- Manager.
City , STATE
- Assigned daily eligibility tasks to Customer Service Reps.
- Processed enrollment forms.
- Provided monthly status reports on member enrollments and terminations.
City , STATE
- Assisted brain-injured patients in the activities of daily living.
- Followed correct policies and procedures to provide best care.
Specializing in Executive Coaching
Psychology Cum Laude
Administrative, Benefits, billing, call center, CMS, coaching, client relations, Customer Services, database, forms, FTP, insurance, legal, Mentoring, newsletters, personnel, policies, proofing, strategy, Structured, Supervisor, Technician, phone, work-flow process, Staff training and development
Microsoft Office Suite expert, HR policies and procedures expertise, Maintains confidentiality
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Resume Overview
School Attended
- University of the Rockies
- Ashford University
Job Titles Held:
- Manager of Clinical Operations
- Prior Authorizations Supervisor
- Supervisor-Customer Service
- Large Client Coordinator
- Supervisor- Eligibility
- Client Care Worker
Degrees
- Master of Arts : Psychology
Bachelor of Arts : Psychology
Certified Pharmacy Technician (CPhT) Pharmacy Technician Certification Board, Inc
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