value base care manager resume example with 10+ years of experience
Jessica
Claire
resumesample@example.com
(555) 432-1000,
Montgomery Street, San Francisco, CA94105
:
Professional Summary
Experienced Provider Relations with a demonstrated history of working in the health care industry for over ten years. Skilled at time management, problem-solving, improving processes, maximizing team productivity and reducing costs to achieve team goals.
Skills
Microsoft Office Suite, Salesforce, Google, SharePoint, Tableau
Excellent presentation, written and verbal communication skills
Process and Performance Improvement Experienced
Relationship building and retention
Workflow Analysis
6+ years of provider relations and/or provider network experience
10+ years of health care/managed care experience
Strong organizational skills with ability to meet multiple deadlines
10+ years of experience with Medicare and Medicaid regulations
Intermediate level of knowledge of claims / systems processes, provider contracting
Education
Rasmussen UniversityTampa, FLExpected in 12/2022 ā āBachelor of Science:Healthcare Management - GPA:
Decatur County Memorial Hospital - Value Base Care Manager Greensburg, IN, 06/2021 - 01/2022
Successfully able to facilitate Provider Web Portal and virtual training for existing and new provider contracted with Aetna Health Plan using Evoke 360
Communicate with provider groups on benefits of Value Base Care and how to increase their Quality and Risk scores
Increased user engagement across all provider groups and improved clinical and financial outcomes
Led Value Based Care strategies to increase quality metrics for Medicaid or Medicare line of business
Educate providers on products enhancements and new releases
Participated in continuous improvement by generating suggestions, engaging in problem-solving activities to support teamwork
Conducted research, gathered information from multiple sources and presented results
Led projects and analyzed data to identify opportunities for improvement
Participated in team-building activities to enhance working relationships
Quickly learned new skills and applied them to daily tasks, improving efficiency and productivity
Created spreadsheets using Microsoft Excel for daily, weekly, and monthly reporting
OPTUM PART OF UNITED HEALTH GROUP/WELLMED MEDICAL - Sr. Physician Business Manager City, STATE, 12/2015 - 06/2021
Collaborate with healthcare providers to help them achieve high performance with their contracts
Confidently manage overall operation of patient care, or conditions, that might hinder patient's well-being including financial management, quality assurance, patient care, safety risk management, team satisfaction, quality scores, high utilization, and facility maintenance
Maintain communication between department heads, and medical staff by attending bi-weekly and quarterly financial meetings
Work with marketing, network, member retention, operations, and related operational areas to identify improvement opportunities focused on improving financial outcomes and member and provider engagement and satisfaction
Assist in credential audits and on-site provider assessments for Well Med Management
Identify and remediate claims to ensure early resolution of claim problems
Provider education of incentive programs and facilitation of member Healthcare records
Created spreadsheets to track monthly statistics of workshops and provider feedback for reporting purposes
Expanded cross-functional organizational capacity by collaborating across departments on priorities, functions, and common goals
Answered provider inquiries via email, telephone, and written correspondence
Chaired weekly meetings with executive leadership to identify opportunities for improvement, establish milestones and tailor to individual markets
Onboarded and trained new staff to keep team efficient and prepare team members to effectively handle demands of simultaneous and large-scale contracts
Decreased utilization cost by 20% by implementing cost-saving initiatives that addressed long-standing problems
IGNACIO SALZMAN - Practice Manager City, STATE, 02/2011 - 12/2015
Managed staff of 5 personnel by implementing company policies, protocols, work rules and disciplinary action
Executed planning, implementation, and direction day-to-day operations for clinical, clerical, and billing staff
Acted as liaison between physician and staff to ensure achievement of mutual goals
Maintain and oversee employee continuing education program
Evaluate employee performance quarterly and recommended merit increases
Responsible for hiring, training, coaching, and counseling
Established staff schedules and assignments based on office needs
Achieved high staff morale and retention through effective communication, prompt problem resolution, efficient supervisory practices and facilitating proactive work environment.
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