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urac consultant provider network quality management director senior director resume example with 20+ years of experience

Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA 94105
:
Executive Profile
Successful Senior Executive experienced in human resources, quality management, staff development, recruitment, benefits administration, onboarding, and employee relations. Skilled in talent recruiting, outstanding presentation and communication skills, problem resolution and a demonstrated ability to deliver mission critical results. Skill Highlights Leadership Team Player Effective Communication with Executive and Public Speaking/Presenter Board level personnel Mergers/Consolidations Employee Relations Policy/Procedure Writing Staff Development/Management Training Strategic Planning and Implementation Change Implementation Matrix Management Core Accomplishments Vice President Senior Director Wellness Program Implementation Quality Management Plan Development Leadership/Management Training Achieved National Accreditation Staffed/Trained for managed care organization. Developed Customer Service protocols and training. Implemented corporate customer service program. Implemented a reorganization of the Cosmetics Department for a major retailer. Received Best Practices Commendations for Human Resource Record Management, Training Program Implementation by Joint Commission (JCAHO) Successfully facilitated all Human Resource aspects of two separate mergers doubling the number of FTEs Customized and Delivered four part series of Matrix Management Training Created and implemented a case management/outreach team. Routinely set up new facilities, operations or teams to carry out programs beneficial to the organization. Implementation of HRIS System with Payroll Interface.
Skill Highlights
  • Guest services
  • Inventory control procedures
  • Merchandising expertise
  • Loss prevention
  • Cash register operations
  • Product promotions
Education
Nova University , Expected in Master of Science : Counseling Psychology - GPA : Counseling Psychology
, Expected in Professional Human Resources (PHR) Senior Professional Human Resources (SPHR), Lifetime Certification : - GPA :
Core Accomplishments
Professional Experience
Arthur J Gallagher & Co. - URAC Consultant, Provider Network Quality Management Director, Senior Director
Mission, TX, 08/2008 - Current
  • Recruited to lead first ever national accreditation for the organization.
  • Organized the preparation required of Senior Management and led successful desk review and on-site survey.
  • Established contracting guidelines and established a standard format.
  • Increased staff participation in cross functional activities.
  • 3M provider network development through a Request for Proposal process for a three county area.
  • Worked collaboratively to respond to both Provider Network and Quality Management sections of the 1915 b/c waiver Request for Application to the state of North Carolina.
  • Revised and expanded Onboarding processes for executive and line hires.
  • Effectively recruited 200+ staff to meet the needs of the transition from a $27M to $340M organization.
  • Led the HR aspects of the absorption of an organization with 186 employees in four months.
  • Transitioned from self-insured to fully insured welfare benefit plans saving $250,000.
Choiceone Financial Services, Inc. - Vice President
Lapeer, MI, 01/1991 - 01/2005
  • Reorganized and redefined Human Resource functions in policy and procedure related to recruitment, hiring.
  • Benefits administration (including a 403B Retirement Plan) and employee relations.
  • Developed and implemented new Salary Administration program.
  • Reduced advertising budget through assessment of applicant response.
  • Initiated benefit changes to include the addition of a group Short Term Disability plan.
  • Reorganized staffing patterns to address inpatient State requirements and saved $100,000 in staffing costs.
  • Reduced labor attorney legal fees by 60% through effective employee relations.
  • Developed and Implemented Performance Evaluation system.
  • Successfully led HR through three Accreditation Surveys by JCAHO and CARF Successfully led three departmental restructuring projects.
  • Merged two additional companies into Renaissance Behavioral Health Systems, one a large comprehensive community health center.
  • Active participant in Quality Improvement Committee and quality improvement initiatives and projects.
  • Developed Quality Improvement Extravaganza to highlight quality improvement initiatives and projects corporately.
LORD & TAYLOR - Human Resources Administrator
City, STATE, 01/1989 - 01/1991
  • Rapidly promoted from entry level position to senior level executive at third largest volume store.
  • Responsible for recruitment, training, EEO/AA guidelines, wage administration, pension/profit sharing (401K), payroll, benefits administration, workers compensation, unemployment and disciplinary action.
  • Supervise 250 employees in selling and non-selling capacity.
  • Developed seasonal hiring plan to hire and train 270 additional selling associates.
  • Successfully met staffing quota for first time in recent company history.
  • Increased store-wide efficiency without increasing budget.
  • Implemented new wage administration program.
  • Trained senior level executives in program.
  • Initiated and trained staff in customer service programs to improve overall outcomes.
HORIZON HOUSE REHABILITATIVE SERVICES - Consultant/Director
City, STATE, 01/1988 - 07/1988
  • Retained to establish case management/outreach team specializing in homeless dually diagnosed.
  • Established policy and outreach protocol for initial program implementation.
  • Successfully established program and trained new management team.
Affiliations
Human Resource Professional of the Year - 1994. President, Society for Human Resource Management Jacksonville - 1995-1996. Member, Society for Human Resource Management - 1991 - Current
Skills
advertising, attorney, Benefits administration, budget, c, interpersonal skills, customer service, detail oriented, employee relations, Senior Management, fast, functional, hiring, Human Resource, Human Resources, HR, legal, Microsoft office products, Network, organizational skills, payroll, problem solver, processes, profit, Proposal, Quality Improvement, Quality Management, recruitment, selling, staffing, Visio

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Resume Overview

School Attended

  • Nova University

Job Titles Held:

  • URAC Consultant, Provider Network Quality Management Director, Senior Director
  • Vice President
  • Human Resources Administrator
  • Consultant/Director

Degrees

  • Master of Science
  • Professional Human Resources (PHR) Senior Professional Human Resources (SPHR), Lifetime Certification

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