Regional Manager, Client Relations for East Valley Resume Example

 Maintain client satisfaction and demonstrate retention efforts for the Medicare, (PBM) Pharmacy Benefit Management program, SilverScript.

• Manage a book of business of 4 large-scale clients, with a membership of 30,000 plus lives.        
• Assist with the renewal and implementation of new and existing clients.        
• Set up new plans and make plan changes in CVS's designated program's AS400 adjudication system.        
• Analyze complex problems and identifying root causes for resolution
• Research and resolution of member issues that arise internally and by client in a timely manner.        
• Lead scheduled client calls to educate on plan enhancements, program updates, reports and any other identified program deliverables.        
• Identify and implement best practices to ensure client satisfaction.
• Foster teamwork and support departmental culture with emphasis on ensuring exceptional client service Coordinate implementations and assisting with driving practical and creative solutions.
• Coordinate implementations and assisting with driving practical and creative solutions.

Owned execution of fitness programs in the local market and act as liaison to the internal business unit, health plan partners and the fitness center provider network.  All to promote fitness solutions, create strategies for the SilverSneakers Fitness Program and other fitness products.  As well, maintained local client service level objectives, community outreach and awareness, day-to-day program operations with providers and managed program quality assurance.

• Launched SilverSneakers Fitness Program, in Houston market with HealthSpring/Cigna Health Plan in November of 2004 and supported network development by showing program's value proposition.  
• Had constant growth and retained assigned market share of 300K members by promoting current, developing and new program offerings.
• Developed and Implemented successful, strategic account plans,  managed daily operations, monitored program quality and promotions
• Was successful in building positive relationships with each 5 health plan clients to coordinate activities with internal stakeholders to drive utilization, improve member engagement to ensure that client goals are exceeded.
• Successfully managed 36 fitness locations accounts (including 33 YMCA's)
• Key liaison for Houston YMCA Association partner (3rd largest in nation), to aid in relationship building and meeting key financial, participation and retention goals, valued at close to 1 million in revenue.
• Incorporated strategies for community outreach, health plan programs, grass roots activities, medical community involvement and media opportunities, to promote program.
• Guided integration activities within the health plan as a Lead Account Manager, throughout that year and exceeded program goal average of 50% retention & participation and 100% renewal of assigned health plans.
• Reported outcomes data on programs to demonstrate success and determine opportunities for growth and engagement

Represent medical lab services, through sales and management of existing clients, with Physician Offices, Dialysis Centers, Clinics and other medical establishments.

• Increase market share by obtaining new sales within my assigned territory
• Present standard lab contracts and/or tailor pricing to meet specific needs to acquire new business
• Determine and set prices on various lab test utilized by existing lab clients
• Provide orientation on process and procedure for new clients and new staff of existing clients
• Foster positive relationships and act as key contact for continued business
• Review invoices and coordinate collection of payment for balances
• Attend to any service issues in regard to company equipment utilized by client office
• Prepare and submit weekly reports on top 20 management accounts and new account status in "pipeline"
• Communicate with all departments within lab that impact client.

Served to contract with physicians, maintain and enhance network, while mentoring and creating positive relationships with medical entities, community and department team.

• Contracting of Physicians and Ancillary providers for Medicaid network
• Create, coordinate and present at training meetings with Physician Groups and Long Term Care Providers
• Inter-Departmental communication for support in retaining and promoting positive provider relationships
• Work proactive to identify program issues in order to resolve potential problems
• Work with teams for claims resolution of hospitals, physicians and ancillary providers
• Identify and resolve systematic and operational issues affecting department and provider network
• Complete special projects related to using creative ways to illicit provider feedback & retention
• Report territory analysis on monthly and quarterly basis Train new department representatives and work as a team to meet required goals.

Maintained network providers by serving as liaison between UTMB and providers such as Physicians, Home Health Agencies, Nursing Homes and Ancillary entities.

• Contracted, educated and assisted in successful retention, process and procedures for all provider types.
• Research, resolve and respond to provider inquiries.
• Creation of provider network monthly and quarterly correspondences and inter-departmental communication to utilize best tools to support provider needs.

Key liaison for the hospital district's, managed care program, by creating and maintaining positive relationships, communicating and promoting advanced directives with a variety of entities (including physicians, community outlets and inter-departmental partners).

• Worked to build network of physicians and ancillary providers, by assisting in negotiations to contract with large group practices and hospitals.
• Created materials and promoted the counties commercial and Medicaid pilot program to hospital staff, physicians and ancillary providers on benefits, process and procedures.
• Coordinated credentialing activities, maintenance of database and conducted physician office and ancillary facility site reviews.