PRODUCT DIRECTOR PRODUCT DIRECTOR MEDICARE RETIREMENTASSOCIATE DIRECTOR DIRECTOR OF OPERATIONS
Ambitious Operations Manager with more than [Number] years of management experience in the [Industry name] industry. Applies strong analytical and critical thinking skills to solve complex operational problems.
Word, Excel, Excel, Access, Outlook, Power Point, Microsoft Project, ABT Project workbench, Mini-Tab (statistical), VISIO, and BPI Accounting
Other Relevant Software Programs: Kronos (timekeeping), Taleo (Human Resource), Remedy (IT Case tracking), Replican (IT project time tracking) Milliman care guidelines (Medical Case Management), MSOW-Morrissey (Physician Credentialing), Client Relation Management Software-CRMS (Client issue/PR tracking)
Transaction Systems Utilized and Programming and computer language skills: Facetts, CAMS, ACS, RIMS (1.0,1.5 and 2.4), DISCorp, ILIAD, NICE, COSMOS, CSC, Lawson, Medical Manager, IDX
Certification: Passing score on the California Basic Educational Skills Test (CBEST); Certified Six Sigma Black Belt through the Juran Institute
Training: Executive Development Program (EDP) through Wharton Business School at University of PA; Performance Plus Customer Support Training through FHP University; Management Skills through the UC Berkeley Extension
UnitedHealth GroupMay 2008 to May 2016Product Director Product Director Medicare & Retirement Associate Director Director of Operations Minnetonka, Minnesota
My current role as Product Director Employer & Individual I am responsible for the implementation of a new benefit and claims transaction system.
Primarily focused as a Product Owner for system configuration.
As a Product Director Medicare & Retirement I was responsible for management, oversight and collaboration of multiple capital investment programs totaling $270 million dollars annually.
These investments advance the capabilities of the Medicare and Retirement strategy while improving the constituent experience through accurate claims and transaction processing.
SUTTER CONNECTOctober 2000 to May 2008Assistant Bay Regional Director
Director of Performance Improvement
Director of Transition Services Emeryville Sacramento, California
In my position as Assistant Bay Regional Director I was responsible for the operational activities in the Sutter Connect Bay Region satellite office as they relate to one of our largest IPA clients.
Responsible for six direct reports and twenty indirect reports.
Direct oversight of Facilities, Utilization Management, Medical Management, Quality Management, Client Services, Provider Relations.
As the Director of Performance Improvement I deployed and administered the "Six Sigma" process improvement program.
Which included mentoring, developing and leading five newly trained "Black Belt" consultants.
As the Director of Transition Services I was responsible the management of twenty-four, technical, business and training Analysts.
I was responsible for oversight of all phases of project management including, meeting planning, facilitation, budgeting, data gathering, analysis, detail design, testing, training, and implementation.
Previous roles within UnitedHealth Group highlight my skills in Operations including developing, implementing and maintaining a provider network for a new Special Needs Program (SNP) through the Evercare product line.
Ongoing management of the operational components within the Evercare product line.
Additionally, reviewing materials for the Centers of Medicare & Medicaid Services (CMS) filings and member provider related outreach materials and programs.
Support to the Marketing/Sales and Network teams ensure compliance with CMS and Department of Managed Health Care (DMHC) guidelines.
EAST BAY MEDICAL NETWORK EBMNMarch 1999 to October 2000Director of Operations Oakland Emeryville, California
Responsible for the management of thirty-five MSO employees.
EBMN managed 96,000 members for an Independent Physician Association (IPA).
I provided leadership for Claims Administration, Eligibility, Benefit Administration, Information Technology and Customer Service departments.
I was accountable to the CEO of East Bay Medical Network as well as the President of Alta Bates Medical Group.
Under my direction the staff maintained daily operations including the monitoring of production and turn-around time to assure compliance with all contractual obligations and governmental agencies.
PACIFICARE TakeCare/FHPJuly 1990 to July 1998Supervisor Training/Quality Assurance Manager Assistant Supervisor HMO Claims Trainer/Auditor
Senior Claims Examiner Membership/Accounting Specialist Concord Costa Mesa, California
During my seven years at Pacificare I served in many roles, all requiring excellent management, leadership and project management skills.
Education and Training
CHAPMAN UNIVERSITYBachelor of Arts degree: Organizational Leadership StatisticsOrange, CaliforniaOrganizational Leadership Statistics
ALS Association (ALSA): Raised over $150,000.00 in the last 18 months for the ALSA. Represented the ALSA in Washington DC by speaking to congress to get 4 bills passed on behalf of the ALS patients. Mt. Diablo Soccer League (MDSL): AYSO Certified Soccer Coach 2006 - 2008 - Assistant Coach for three years for Girls (U14 - U16) Project Sunshine: Organized volunteers to make over 200 art kids for children confined to the hospital or receiving chemotherapy and/or dialysis
Case Management, Medical Management, mentoring, Mini-Tab, process improvement, Sales, system configuration, transaction processing
VOLUNTEER AND COMMUNITY SERVICE ALS Association (ALSA): Raised over $150,000.00 in the last 18 months for the ALSA. Represented the ALSA in Washington DC by speaking to congress to get 4 bills passed on behalf of the ALS patients. Mt. Diablo Soccer League (MDSL): AYSO Certified Soccer Coach 2006 - 2008 - Assistant Coach for three years for Girls (U14 - U16) Project Sunshine: Organized volunteers to make over 200 art kids for children confined to the hospital or receiving chemotherapy and/or dialysis