Manager Management
Resume:
Cynthia A. Moore
Fontana, CA *2336
*******@***.***
Career Summary: Health Care has been my expertise for many years. Have performed direct patient care, an effective manager for a health insurance company, and case management for another Senior HMO plan. Still as passionate about providing excellent patient care in any arena as I was when I first started this career.
PROFESSIONAL HISTORY:
Clinical Care Manager, Inter Valley Health Plan, Pomona, CA, (June 07-August 2015) Worked within the Medical Services department as Care Manager providing complex case management for approximately 3,000 members. Responsible for management of all IPA’s inpatient and skilled nursing admissions including assistance with discharge planning. Responsible for UM, QM issues for IPA’s assigned. Paid all claims associated with members assigned and advised Medical Director if down coding was required. Saved the company hundreds of thousands of dollar by extensive claims review. Reviewed all denials of members assigned. Gave seminars on Medicare 101 for seniors turning 65 years of age. Provided educational information for both DM and CHF as well as telephonic case management for SNP members. Attended all JOM’s and reported on HEDIS/CCIP/QIP and joint members cases. Beta tester and advisor for McKesson’s new product VITAL. Volunteered for Helping Hands week serving Senior’s in the Inland Empire. Worked on call for the last 3 years of employment.
Business Development Rep, VITAS Hospice, San Bernardino, CA (June 06-June- 2007) Generated referrals for hospice intake, developed business relationship with doctors, hospitals and families.
Business Development Representative, Visiting Nurses Association and Hospice of Southern California, Claremont, CA (May 05 – June, 06) Worked in the Business Development department with responsibilities that include marketing, supplier partnerships, educational in-services, and brand identity. Our agency provides nursing services throughout the Inland Empire. Continuous market segmentation is utilized including geographic, demographic, and competitor research.
Personal Care Planner™, SCAN (Senior Care Action Network) Health Plan, Riverside, CA (Dec. 2002 – May, 05) Worked within the Independent Living Power™ Department; collaborate with other SCAN staff and physicians as well as discharge planners, utilization management, home health agencies, community agencies and other professionals involved in the care of the SCAN member, and most importantly the family; assure provision of high quality cost effective services; perform initial assessments of SCAN members and determine eligibility for the Independent Living Power™ benefit and unmet needs; conduct reassessments every 90 days to each member within a caseload of approximately 130 cases; develop and implement care plans; monitor quality and quantity of service provisions for members while continuously monitoring qualification status by contacting members and their formal or informal support systems via phone, home visits and/or correspondence; complete necessary documentation on a timely basis per departmental guidelines. .Regional Manager, SCAN (Senior Care Action Network) Health Plan, Riverside, CA (April 1998 to Dec. 2002) Responsible for all daily operations and project development for a department of social workers and nurses (staff of 47). Utilized extensive knowledge in health care services, contract negotiation, conflict resolution, OSHA regulations, labor laws, and Medicare and Medicaid guidelines. Developed policies and procedures for all aspects of
daily operations for an HMO. Prepared both monthly and annual regional reports that focused on productivity and cost effectiveness. Maintained an annual budget in excess of 2 million dollars. Implemented time studies, researched new software systems, and a yearly departmental strategic plan. Utilized outstanding marketing and business development created and maintained a large network of vendors, health care professionals, and government agencies.
Program Director, Social Vocational Services, Inc., San Bernardino, CA (Feb. 1997- April 1998)
Managed all daily operations for a staff of 100+. Found job placements in the Inland Empire for clients with physical and mental challenges. Held training sessions and in-services for potential employers in conjunction with the Department of Rehabilitation.
Case Manager, Inland Regional Center, San Bernardino, CA (Sept. 1994- Feb. 1997)
Care management for challenged individuals as well as supervision for nurses in their rotation through social services component from Loma Linda University Medical Center.
Parkview Hospital, Emergency Staff, Riverside, CA (Mar. 1989-Feb.1994)
Provided direct patient care for emergency patients.
Scripps Hospital, Emergency Staff, Carlsbad, CA (new grad 1982-Feb)
Started in Medical/Surgical department and advanced to ER.
COMPUTER SKILLS:
Excel
Microsoft XP
Outlook
Power Point
Access
FACETS
CCMS/Case Management tool
VITAL/McKesson’s (new product)
Encoder
NPS Pharmacy
EDUCATION: Cynthia A. Moore
University of Phoenix, CA; M.A. in Organizational Management, Nov. 2003 – (3.83 GPA)
University of Redlands, Redlands, CA; B.A. in Communicative Disorders, History, Jan. 1991 (3.2 GPA)
Palo Vista College of Nursing, Vista, CA; Licensed Vocational Nurse, June, 1982
ORGANIZATIONS:
National Association of Social Workers, Sept. 1996-2000
Alumni Network, University of Phoenix, Dec. 2003-present
REFERENCES: Available upon request.
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