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Project Manager Process Improvement

Location:
Myrtle Beach, SC
Salary:
135000
Posted:
February 07, 2024

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Resume:

SUMMARY

A Program / Project Manager who brings a driving passion and velocity to improve the communications between Business and IT by transforming the culture, processes, technology, and management with more than 15 years of experience turning visions, strategies, and challenges into pragmatic solutions with high-performing teams using best practices and technology to ensure optimize systems, operations and quality deliverable services.

Excellent ability to understand the “big picture”, synthesize complex information simply, and extract key insights to convey complex ideas in easily understood manner through excellent verbal and written communications with Technical and Non-Technical audiences.

Strong bias towards action – efficient at driving projects to conclusion through proactive planning, extremely high attention to detail, and holding stakeholders accountable to achieve performance and yield meaningful ROI.

Product disposition – with strong intellectual curiosity to understand products, how they work, and how they solve business/client problems.

Solid business and technical expertise with a background from Product development/marketing, Data management/integration/analytics, COT Implementations, Data Warehouse updates and Implementations.

Champion high level of service excellence through proactive hands-on management of engagement at all levels of an organization to inspire and drive diverse teams to deliver client value, on-time and within budget.

TECHNICAL SKILLS:

Skill Highlights

Agile Methodologies - IT Project Management - Software and Application Development - Six-Sigma - Process

Improvement - Change Management - C-Suite Stakeholder Engagement & Relations - Enterprise IT Strategy - IT

Roadmaps - Strategic & Scenario Planning - Outsourcing & Vendor Management - Policy Governance & IT Risk Mitigation

- Business Continuity and Risk Planning - Enterprise Data Analytics - Organizational Change Management - Portfolio

Management - Mobile & Web Design - Enterprise IT Systems - Network-Communications – Digital Transformation –

Technology Proficiencies

Microsoft Office: Microsoft 2010 Suite, Microsoft Project 2010

Databases: SQL, Oracle, Sybase, AMDOCS, SSO, Teradata, DB2 OS/390 v6/5/4, Microsoft Access 97/2000,2003,2007,2010, MDMS, Informatica, Data stage, TIBCO, ODS, Data Lake, Graph QL Database

Test Tools: Load Runner; Win Runner, QTP, Mercury Quality Center Suite, ADO PMO

Software/Methods: Innotas, Clarity, Microsoft Project Server, Waterfall, Agile, Scrum, RUP, Sprint, Service Now, Smartsheet Salesforce Summer 15 / Winter 20 / Health Edge Rules 2.2 / Service Now/ Paycor/ Paycom/Workday

PeopleSoft 8 -- Maintenance Upgrades, Project Implementations, and Structure Content Changes

ICD-10 Software: LEAP 10

Health Care Claims/Provider Systems: NASCO, Facets (v4.6,4.7,5.0), ITS, BlueCard, MHS, Medco, McKesson, Blue Exchange, PEGA, NETWORKX, AE2, CDWF, Contract Gen, CDW, XML, Aerial, Allscripts, MACESS, Epic, HL7, HIPAA 5010, Medicaid Management Information System (MMIS), JIRA, ZeOmega(JIVA)

Infrastructure /Languages: LDAP, NOVELL, Active Directory, Microsoft .Net Framework 2.0, SailPoint IAM tool C#, .NET, SQL, COBOL, Aha, Alphabet, Mainframe, or z/Os Environment.

PROFESSIONAL EXPERIENCE:

Arizona Blue Cross, Pheonix AZ (Remote) 06/2023 – 09/2023

Program Delivery Lead

Responsible for the successful delivery of all EDI and Trading Partner HIPAA 5010 files for all AZ Blue Lines of business

Managing over 20 different vendors

Directly responsible for 12 developers, technical analyst, testers

Coordination between several vendors regarding resource allocation

Created a Program delivery status report template.

Created a Deployment roadmap and timeline.

Elevance Health, Indianapolis IN (remote) 11/2022 – 07/2023

Global Program Manager, Clinical Operations

Global Program Manager for Clinical Operations for Elevance Health Care managed 10MM to 20MM portfolio.

Installed health assessments for all Commercial, State of DC, and all Medicaid LOB in Central, South, East and North Coastlines of business 4.2 MM initiative.

Initiated a Rebranding Program for Elevance Enterprises from various entities of Wellpoint, BCBSA to

Elevance holding. 5.8 MM initiative o Sydney Member Claims Project. Increase AI capability 1.8 MM initiative.

Implemented an audit of internal Sailpoint updates, including a completer overhaul of security updates and features, Developed auditable Program structure for multiple lines of business.

Initiated an Enterprise approach for dealing with projects which are in Red, Yellow

REDUCED TRAINING COST BY 100K, by making training materials available on TEAMS for all interested parties.

Streamlined Communications for both IT and Program related issues.

Designed, Developed Implemented various SNOW reports including Utilization, Capacity, Financial and resource planning.

Identified 143K dollars’ worth of inappropriate project billing. Remediated the charge backs to the project.

Integrated IT stakeholders, application development teams and project managers by implementing Project Management Lifecycle PMLC) and Systems Development Lifecycle (SDLC) best practices for processes, procedures and required documentation for ISO-Compliance and contractual services.

Initiated a “Buddy Program” for new consultants to initiate Elevance P&P, SNOW requirements and general project management processes.

Created an Escalation touch point for all projects in RED/YELLOW Status, initiated a path to green protocol with senior leadership and respective project/program managers.

CareSource, Dayton Ohio (remote) 04/2022 – 10/2022

IT Delivery Lead

Designed, Developed, Implemented an Enterprise-Wide JAD: (Joint Application Development session) for 2 programs, Marketplace, and Mycare Reporting Requirements. Key Result: Improve time and efficiencies on identifying those Business Requirements who specifically require reporting development needs and help expedite those requirements for IT design, development activities.

Implemented a Teams Channel for the above Reporting for 2 programs at Caresource: Key Result: Improve communication to reporting staff where communication did not exist prior to my arrival.

Designed, Developed, Implemented an Enterprise-Wide JAD(Joint Application Development for 2 programs, Marketplace, and My care: Key Result: Removing the need to have adhoc sessions for specific requirements identifying the need to have IT development, increase communication process, and increase time to design, development, improve communications through a single point of contact Teams Channel

Key Result: Being able to identify down environments will help with improving scheduling.

Have streamlined the transition from a departing FTE, so little to no loss in progress for 2 programs.

Blue Cross Blue Shield of Louisiana, Baton Rouge,Louisiana 03/2021 – 12/31/2021

Senior IT Project Manager

Responsible for assigned projects by BCBSLA leadership in the State and Federal marketplace.

Coordinated Projects in Episode Grouper, Consolidated Appropriations Act, RADV, Rational Medicine, Digital Signature Solution, Annual Product Enhancements. NET Projects SAVINGS 150K

Coordinated with BCBSA association on National Data Warehouse updates, coordinated with BCBSLA Project Sponsors on timeline and deliverables.

Responsible for ensuring 4 Annual Product Enhancements met DOI expectations and was satisfactory implemented in accordance with BCBSLA guidelines. Net Project Savings $ 250K

Responsible for Coordinating a Program with 10 separate workstreams for Product Implementation of HRA for Pilot Banking Customer, Implemented Member and Group SSO, Debit Cards, Enrollment and Eligibility, Medical, Prescription, Dental and Vision Claims. NET Program savings was $100K in overall 1MM budget.

Managed Business analysts collaborated with Solution Architects on path forward to implement HSA HRA FSA ASO product implementation with outside vendor.

Directly responsible for interacting with Senior Management and C-suite for Project Scope, Budget, and Timelines.

Adhered to BCBSLA standards on product implementation.

Managed multiple vendor engagements on designated projects, adhered to timelines, budgets, staff constraints throughout BCBSLA.

Improved Efficiencies with BCBSLA PMO offering suggestions on Best Practice PMO improvements, recognized for contributions by reducing meetings and estimates by combining efforts both Waterfall and Agile Methodology.

Florida Blue, Jacksonville FL 04/2020 – 03/2021

Senior Manager, Medicare Digital Experience (Contract) via Interactive Resources

Communications & Collaboration

Established partnerships with C-Suite Medicare stakeholders across the business and IT to create a cross functional process that enable a consistent and connected digital experience for Medicare members.

Influenced C-Suite and Sr. Medical Directors to challenge conventional practices and instill customer insights into the decision-making processes.

Actively participated in customer journeys and played an integral role in supporting products and experiences.

Provided oversight, decision-making and prioritization for multiple complex business critical initiatives.

Integrated IT stakeholders, application development teams and project managers by implementing Project.

Management Lifecycle PMLC) and Systems Development Lifecycle (SDLC) best practices for processes, procedures and required documentation for ISO-Compliance and contractual services.

Digital Transformation

Coordinated digital transformation of the Medicare digital business case in partnerships with Florida Blue Medicare, digital leadership, and technology teams, complying with CMS requirements. NET RESULTS: Increased baseline adoption rate from 10% to 35% exceeding internal goals

Supported ad hoc project/initiative work as a floating team member.

Key Results: Increased Digital adoption by 20% with institution of metric-based process improvements resulting in reduction of defects and rework, increased productivity, and meeting or exceeding quality goals using project portfolio management (PPM): Created a single point contact for Medicare segment to define, articulate and determine best utilized experiences.

Optum, Minneapolis MN USA 02/2016 – 02/2020 Director Solutions Architecture/ Program and Product Integrations

Communications & Collaboration

Directly responsible for leading a team of individuals for selecting A Security System (Sailpoint) which was to be implemented. Program was 10MM program.

Collaborated with UHG/Optum Enterprise wide DevOps and Release Management for large scale transformation projects in Agile Transformation information .

IT Project Management

Developed Medicare specific products using Google and Microsoft productivity tool in current Salesforce release.

Cradle to grave implementation working with Marketing to design, develop and implement Caregiver Product, worked throughout product lifecycle including legal to implement for go live October 2019

Implemented Graph database and Aha technology to ensure environmental goals and compliance. Net savings of $6.5M.

Implemented Pega Implementation version 7.4 with Blue Cross Blue Shield Net Savings of $3.5M

Directly responsible for the oversight, hands on participation and delivery of large-scale projects/programs.

Designed, developed, analysis findings for over 35 system impacts throughout UHC and Optum

Decreased IT development costs by 55% through establishment of multiple offshore development partnerships, process improvements to reduce defects and rework, and increased productivity through improved resource management t and standardized-fixed resource price contracts. Net savings $3.5M.

Solution Architect

Solution Architect for Medicare STARS HEDIS Reports Team and Risk Based Entity Programs for CT, NV and Mountain West Region

Lead JAD sessions in Medicare / Medicaid Claims, Benefits, Authorizations, Provider, Portal, Data Lake, NVHI, EODs, HCE,

HEDIS

Partnered with Principle / Enterprise Architect and contributes from a domain perspective in the evaluation, selection and implementation of technology solutions including detailed analysis of pros and cons and build vs buy options in accordance with defined strategy.

Developed Salesforce CRM Product Development recommendations in accordance with specific business segment requirements.

Influenced and negotiated with senior leaders across functions and problem solves with vendors and multiple business area/entities regarding business and technology solutions required.

Mainframe or z/Os Environments

Blue Cross of Mass, Boston 10/2015 – 02/2016 Human Care Systems – Bio Pharma. Boston 4/2015-10/2015

CareFirst BCBSMD, Baltimore, MD 12/2013-7/2015

AmeriHealth Caritas 2011-2013

Sensus – Director, PMO 2010-2011

Comcast / Xfinity – Intranet Program Delivery Lead 2009 - 2010

Independence Blue Cross 2000 – 2009

Program Lead on M&A between Highmark Blue Shield and Independence Blue Cross on all Auditable transactions between both companies..

EDUCATION

Master of Science, Information Technology and Analytics, Rutgers University, 1997

TEMPLE UNIVERSITY

oBachelor of Science, 1988

oMaster of Science ®, 1988

CERTIFICATES

Physical Therapy License, 1988 –1998 (PA, NJ,FL)

PMP Program and Project Manager, 1998/2008/2019

Master’s Certificate, Project Management, 1998

Certified Six Sigma Green Belt, 2016

Certified Scrum Product Owner, 2019 .



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