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

Collaborator with a proven outstanding work ethic and practiced ability to adapt in any situation. A passionate teammate, leader by example, and difference-maker with dynamic interpersonal skills. 5 years of experience within the Managed Care space. Supporting geographic and product expansion, and partnering with healthcare providers to create easy to navigate processes ensuring an elevated customer and provider experience.

Skills
  • Value Based Partnerships
  • Medicare Expansion and Operations
  • Leadership
  • Collaborator
  • Problem Solving
  • Data Analysis
  • Adaptability
  • Creativity
  • Empathy
  • Work Ethic
  • Project Management
  • Initiative
  • Client relations
  • Strategic thinking
Education and Training
University Of Connecticut Storrs, CT, Expected in 12/2015 Bachelor of Science : Allied Health Science & Public Health - GPA :
Certifications
  • AAPC Certified Risk Adjustment Coder
Experience
Crown Castle Usa Inc - Network Expansion Advisor
Jacksonville, FL, 07/2019 - Current
  • Strategize and plan the launch of new Medicare Advantage networks within the Northeast.
  • Ensure team is meeting critical project milestones (internal and external regulatory).
  • Keep leadership informed on overall project health, escalate and inform on any barriers or risks to project success.
  • Maintain expansion one pagers and executive level dashboards to inform leadership on our progress towards building adequate, affordable, and marketable networks within project timelines.
  • Support contracting team in conversations with key providers to explain the Cigna Medicare Advantage product and benefits of partnering.
  • Partner with operational teams to ensure we are on track for AEP readiness – outline contracting submission processes for internal contractors and external vendor contractors.
  • Manage external vendor relationships related to Medicare Advantage expansion contracting for the Northeast and act as a liaison for local teams working on expansion builds.
  • Assisted with creation of prioritization decision framework to help provide data-driven decision making related to the Medicare Advantage geographic expansion. Evaluated key performance indicators of opportunities and overall impact to company goal of double customer growth and double revenue in the next 5 years in addition to other indicators of market success.
  • Monitor and assist teams with meeting CMS adequacy requirements for network. Provide data insights using Quest analytics.
  • Coordinate onboarding and smooth transition of network and relationships to the local FTE’s that will be responsible for day to day operations of new Medicare Advantage market.
Korn/Ferry International - Network Operations Specialist
Indianapolis, IN, 07/2018 - 07/2019
  • Served as administrator for Independent Physician Association (IPA) in Chicago, the Greater Chicago IPA.
  • Responsible for contract performance of group and assisted with management of professional medical cost risk.
  • Provided guidance to physicians on how to be successful in their value based contract with Cigna Medicare Advantage.
  • Developed and executed performance improvement plans for IPA related to quality (Medicare Stars measures) and cost initiatives.
  • At conclusion of year 1 (2018), IPA experienced a positive net income despite startup expenses and was able to distribute a surplus.
  • Worked closely with sales and marketing to coordinate AEP sales initiatives to drive membership growth.
  • Through active engagement with providers, sales, and marketing Greater Chicago IPA was the only Cigna Medicare provider group in Illinois to experience positive net growth in 2018.
  • Assisted Cigna Medicare Illinois and Kansas City markets with various initiatives such as 2020 bid design, provider specific plan development and revamped 2020 sales strategy.
  • Assisted with go live of Greater Chicago Physicians IPA. Raised $48,000 in participating physician start-up capital by explaining agreement and financial opportunity to physicians.
  • Served as primary contact and relationship owner for providers and health systems within the Illinois market. Assisted with any questions, or problems related to working with Cigna Medicare.
  • Implemented and tracked initiatives to improve patient health outcomes drive quality, and lower medical loss ratio.
  • Navigated a highly matrixed environment to provide quick resolutions to any issues or barriers providers were experiencing related to Cigna Medicare.
  • Organized regular meetings with provider groups, or managing provider entities to review financial performance of contract, quality, and to partner to improve outcomes.
CIGNA MEDICARE ADVANTAGE - Associate
City, STATE, 07/2016 - 06/2017
  • Selected to participate in the highly competitive, one-year Managed Care Rotational Program comprised of rotations through three business units within the organization.
  • Led key projects related to strategy, process evaluation, and cross-matrix communication in order to improve operations and deliver business results.
  • Presented findings, outcomes, and strategies to senior leadership with regular cadence.
  • Rotations completed included Medical Economics and Finance, Health Services, and Operating Effectiveness.

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Resume Overview

School Attended

  • University Of Connecticut

Job Titles Held:

  • Network Expansion Advisor
  • Network Operations Specialist
  • Associate

Degrees

  • Bachelor of Science

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