Manager Customer Service
Resume:
Belinda Lavie, Lmsw
Smyrna, GA 30080
**************@*****.***
EDUCATION
****- ******* *.*.* Masters Business Administration
Kennesaw State University, Kennesaw, GA
1999-2001 M.S.W., Masters Degree Social Work
Stony Brook School of Social Welfare, Stony
Brook, NY
1994-1999 B.A., Criminal Justice
John Jay College of Criminal
Justice, New York, NY
EXPERIENCE
12/2010 -Present
WellPoint Inc. Blue Cross/ Blue Shield, Atlanta, GA
Manager II, Medicaid Outbound Call Center, (08/2012 - Present)
. Promoted to Manager II upon expansion of the program to include
additional staff and scope
. In this role, I manage 40+ associates (contractors & Perm associates)
including outbound call center agents, Health Professionals (Social
Workers) and Team Leads.
. Primary duties include, but are not limited to: Prepares and
communicates information to appropriate parties regarding health care
programs, procedures, changes and government mandated disclosures.
Recommends benefit plan changes to management. Supervises workflow and
performance of Health Services staff. Ensures compliance with
departmental policies and procedures. Provides quality control
services by monitoring work results of direct reports
. Performs audits to monitor efficiency and compliance with policies.
Develops and implements associate training. Plans and executes
financial objectives, and forecasts staffing needs. May be assigned to
special project work consistent with the role and dictated by the
needs of the business.
. Hires, trains, coaches, counsels, and evaluates performance of direct
reports.
Training/Quality Specialist Lead, Health Services Program (05/2012 -
08/2012)
. Responsible for providing oversight for the development and
maintenance of training programs within the department.
. Primary duties included, but are not limited to: Overseeing and
assisting the Quality/Training Specialists in their development of
training programs. Participating in the delivery of training programs.
. Performed quality control functions, including the timely and accurate
completion of required audits. Responded to inquiries and system
changes. Identified, investigated, and resolved audit processing
issues, and provided oversight and assistance with procedure
guidelines. Resolved Rebuttal Issues for the Quality Auditors.
. Developed and delivered training program for clerical staff. Provides
oversight of the training, coaching, and mentoring of the
Quality/Training department staff. Provided ongoing feedback to the
manager regarding the performance of the Quality/Training team.
Health Educator/Team Lead, Atlanta Health Educator Assessment Team (12/2010
- 05/2012)
. In this position, I led a team of 40+ Health Educators who primarily
enrolled and engage members into an appropriate Disease Management
program. I successfully leverage technology (Office Communicator,
SharePoint, and Email) to maintain communication with the virtual team
and program leadership
. This position required strong people skills sufficient to establish
positive and collaborative relationships with peers, direct reports,
and the executive management. I served as a knowledge and resource
expert for the team and as an expert on our proprietary system
technical matters.
12/2009- 12/2010
Ridgeview Institute, Smyrna, GA
Clinician, Access Center
Conducted clinical assessments to determine level of care for
individuals voluntarily seeking psychiatric and substance abuse
treatment. Conducted pre-certifications with managed care companies
for authorization of requested services.
Reviewed clinical information with psychiatrist for level of care
endorsement and documents discussion in hospital program.
9/06-09/2009
Diva Beauty Supply, LLC, Atlanta, GA
Owner
. Successfully launched a start-up company retailing medical hair
replacement systems for individuals with hair loss as a result of
Alopecia, Chemotherapy, or desire for cosmetic enhancement.
Successfully managed Operations, Customer Service, and Order
Fulfillment for store and e-commerce website. Managed finances,
inventory purchase, and payroll.
5/05- 8/06
AmeriChoice Inc., United Health Group, New York, NY 10004
Trainer, Health Services - New York / Rhode Island
. In this position, I reported to the VP of Health Services and
collaborated with management from various departments to ensure an
effective on-boarding of newly hired associates. In this role, I
provided training and orientation to newly hired employees on
organizational policy and procedures, case management clinical
software (CarePlanner,) and other duties
. Created and developed a four week training guideline which provided an
introduction to Medicaid/Medicare, our managed care products, and an
introduction to Case Management and Utilization Management
. Appointed Administrator for New York and Rhode Island for a national
project for programming data variables into a newly acquired version
of our case management database. Also, provided training support to
employees within the New York and Rhode Island sites.
5/2003-8/2006
Center for Urban Community Services (CUCS), New York, NY
Social Work Supervisor - Per Diem
. Responsibilities included carrying out program management activities,
providing task supervision to clinical staff, and clinical services to
individuals and groups. Other duties include dispensing prescribed
controlled substances (i.e. methadone, benzodiazepines) and providing
crisis intervention.
8/2003-8/2004
Managed Health Network (MHN), Health Net Inc., New York,
NY
Clinical Care Manager
. MHN is a national provider of managed behavioral health care and
Employee Assistance Programs (EAPs), providing employers and employees
with mental health support, chemical dependency treatment and
disability management.
. Duties included reviewing clinical information for medical necessity
and providing authorization for treatment.
. Documented all initial, concurrent and discharge reviews, including
but not limited to diagnosis, symptoms, interventions, goals and plans
for next review and/or after care. In addition, conducted
retrospective reviews of medical charts to assess eligibility for
reimbursement.
6/2001-6/2003
The Legal Aid Society, Mentally ill, Chemically Addicted Defendants
Project, New York, New York
Social Worker, MICA Specialist/Resource & Assessment Coordinator
. The MICA Coordinator position, a four-year, federally funded project,
was created to provide enhanced social work services to chemically
addicted, mentally ill clients.
. As a MICA Coordinator, responsible for developing assessment tools and
protocols, providing case management, court advocacy, conducting
informational and training seminars, establishing and participating in
collaborative alliances with various institutional, community and
governmental entities.
TRAINING Licensed Master Social Worker (LMSW) in Georgia
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