Management Account Executive

Sandra R. Macovei

**** ******* ***.

Cincinnati, Ohio 45227

513-***-**** (H)

513-***-**** (W)

********@*****.**.***

Performance-driven health care business professional with a proven track

record in managing processes to meet customer/cost/operational

requirements. Possesses 12+ years of experience in the managed care

industry developing, implementing, and managing health promotion/disease

management initiatives, as well as overseeing the Quality Management System

for clinical teams.

Competency Summary

Team lead for maintenance of Oversight of external vendor

Departmental Quality Management System, programs/relationships

including audit preparation and

conducting internal audits

Collaborate with external vendors to Design and implementation of internal

improve program referral, participation, chronic disease programs, i.e. CAD,

and enrollment yields CHF, and Diabetes

Consult with teams within Humana's Consult with Market Offices regarding

Clinical Guidance Organization relative Health Promotion and Disease Management

to disease management program program issues and opportunities

interventions/enhancements

Professional Experience

Project Analyst, Integrated Clinical Solutions Dept. - Humana, Inc.

2007 - Present

. Led department in ongoing build-out and maintenance of Quality

Management System, including oversight of program metrics, corrective

actions, document control, and service level agreements.

. Provided ongoing education to staff regarding the components of the

ISO 9001:2000 standard in preparation for external audits.

. Currently act as liaison between clinical programs and IT regarding

system enhancement requests, including consultation, intake, and

tracking of requests.

. Generate weekly project milestone reports and ad hoc reports as

needed.

. Create, implement, and report the results of customer feedback

surveys, as well as plan and conduct internal departmental audits.

Regional Process Manager, Disease Management/ISO Management Representative

- Humana, Inc.

2003 - 2007

. Program ownership and strategic planner for Humana's CAD, Heart

Failure and Diabetes Disease Management programs. Accountable for

target-setting around program participation and enrollment yield

rates.

. Provided guidance and leadership to disease management and wellness

vendors in the development of initiatives to improve program referral,

participation, and enrollment yield rates.

. Led the department in ongoing maintenance of Quality Management System

including oversight of program metrics, corrective actions, and

document control.

. Acted as the liaison between the Corporate Disease Management

Department, markets/regions, and Disease Management vendors.

. Participated on Clinical Condition Center teams and solicited their

input on opportunities for Disease Management program enhancements.

Disease Management Coordinator - Humana Health Plan of Ohio

2000 - 2003

. Researched and developed comprehensive diabetes management program,

staying within timeline and budget. Oversaw and implemented

enhancements to contracted disease management programs. Regularly

reported outcomes to both internal and external stakeholders.

. Served as primary interface between health plan and its Medical

Advisory and Quality Improvement Committees for 12 disease

management/health promotion programs and ongoing enhancements.

. Participated in quality activities related to NCQA (National Committee

for Quality Assurance), with particular focus on health

promotion/disease management standards.

Regional Wellness Manager - Mercy Health Partners, Cincinnati, Ohio

1998 - 2000

. Successfully led start-up of new delivery site for a broad spectrum of

wellness services. Hired and supervised staff, developed accurate

financial projections for budgets and projects, and participated in

development of business plan. Revenue and volumes steadily climbed

over two-year period, ahead of targeted projections.

Health Education Coordinator - ChoiceCare, Cincinnati, Ohio

1994 - 1998

. Promoted to Manager, Health Promotion/Disease Prevention, June 1997

. Led Health Services management team in the evaluation, assessment, and

analysis of disease management programs for 240,000 HMO members,

resulting in significant contribution to three year NCQA

accreditation.

Donor Recruiter - Hoxworth Blood Center, Cincinnati, Ohio

1993 - 1994

. Coordinated blood drives with area businesses and organizations

. Successfully met targets for number of blood drives/year.

Senior Account Executive - American Red Cross, Cincinnati, Ohio

1987 - 1992

. Account Executive 1987 - 1989. Led department in sales related to

worksite CPR/First Aid/Wellness programs to area employers which

resulted in promotion to Senior Account Executive

. In addition to Account Executive role, served as HIV/AIDS Education

Coordinator providing worksite training specific to HIV/AIDS, and

represented American Red Cross on Community Council related to this

effort.

Education

M.Ed. (Community Health Education), University of Cincinnati, Cincinnati,

Ohio, 1981.

B.S. (Health Services Administration), University of Cincinnati,

Cincinnati, Ohio, 1980.

Achieved Project Management Certification through Xavier Consulting Group,

Xavier University, June 2000.

Completed ISO 9001:2000 Lead Auditor Training, March 2005.

Completed Six Sigma Yellow Belt Training, July, 2007

REFERENCES AVAILABLE UPON REQUEST

Contact this candidate