Utilization Management Operations Manager (Interim Director)
Resume:
BRANDON M. URSO
Huron, OH 44839
Phone: 419-***-****
E-mail: *******.****@*****.***
Human Resources and Recruitment:
I am submitting my resume for consideration in response to the current job posting for the Regional Director of Operations.
I am interested in exploring the opportunity, as I believe I am able to offer the precise type of leadership and oversight required to perform and exceed the expected job requirements.
I have been described as a supportive and servant leader, and continually strive for excellence. During my employment at Paramount Health Care, as the Operations Manager (Interim Director) for the Utilization Management Department, I perform multiple job functions which require interdepartmental collaborative efforts. I’ve created, updated, and implemented various changes to assist in process improvement throughout the organization. Examples include but are not limited to the Transition of Care model, the Honoring Our Veterans program, Provider Appeals policy and procedure updates, Pended Claims through Prompt Pay improvement efforts, regulatory compliance audits, and additional Special Initiatives oriented towards expense reduction. As Operations Manager, I also assist with contract negotiations and the procurement of network provider partnerships through the recruitment and onboarding procedures. In addition, I attend and represent as Senior Leadership during Joint Operating Committee meetings with our provider partners. I also was heavily involved in the Ohio Department of Medicaid (ODM) Request for Application (RFA) to renew Paramount’s contract procurement.
As a result of my leadership over the Utilization Management Department, Paramount has been able to reduce medical expense reduction by 12% over the last year. A few examples of cost savings include savings on Skilled Nursing facility admissions, inpatient readmissions, and savings for proper DRG billing practices for Sepsis admissions. In addition, the Transition of Care model I have created was valued at $23 per member per year (PMPY) or $6.9M annually in cost savings. Over the last year, Paramount has made over $110M in profit with $35M in medical expense reduction.
I have been selected as one of the CEO’s Emerging Leaders, identified as being amongst the top 20 influential leaders within my organization, and have been selected as the spokesperson for ProMedica’s Organizational Excellence program.
I would like to request a formal meeting to discuss the possibility of being considered for the Regional Director of Opeations position available. Thank you for your time and consideration!
Very Respectfully,
Brandon Urso, MHA
UM/Operations Manager, Care Management (Interim Director)
Paramount Health Care
BRANDON M. URSO
516 Snowy Egret Drive
Huron, OH 44839
Phone: 419-***-****
E-mail: *******.****@*****.***
SUMMARY A highly motivated and driven professional capable of managing a large scale organization through the supervision of staff, elicitation of teamwork, and prioritization of projects. An experienced leader with the ability to perform in any type of assignment or setting.
EDUCATION Master’s in Health Care Administration
Ashford University
EMPLOYMENT
Paramount Healthcare APR 2018 – PRESENT
1901 Indian Wood Circle
Maumee, OH 43537
Utilization Management Operations Manager, Care Management (Interim Director)
Responsible for the supervision and management over the Utilization Management Department consisting of over 70 personnel, including both administrative and clinical staff.
Provides oversight and direction on regulatory compliance standards in order to meet and adhere to governing audit requirements by CMS, ODM, and NCQA standards.
Provides operational oversight for the implementation of updated policies and procedures, departmental restructure and redesign, and the application of new organizational programs.
Attends and provides administrative supervision during monthly Joint Operating Committee meetings with provider partners to respond to any and all inquiries in efforts to build and maintain strong working relationships.
Involved in multi-departmental process improvement through workflow and data analysis to increase organizational productivity and efficiency.
Created and implemented a successful Transition of Care model to ensure patients receive appropriate care management through all echelons of care which has been valued at roughly $23 PMPY (per member per year) annual medical expense reduction cost savings.
Created and implemented Paramount’s “Honoring Our Veterans Program” oriented towards assisting veteran patients apply and receive benefits through the Department of Veterans Affairs to assist with health care expenditures.
Created Paramount’s new Provider Appeals Department to effectively and efficiently process provider clinical appeals of denied administrative claims.
Participated as a key leader in the Ohio Department of Medicaid (ODM) Request for Application (RFA) in Paramount’s contract procurement
Assist with contract negotiations and the procurement of network provider partnerships through the recruitment and onboarding procedures.
Reduced annual medical expense by over $35M for the calendar year 2020
Department of Veterans Affairs JUL 2014 – APR 2018
Toledo Community Outpatient Center
1200 S Detroit Ave
Toledo, OH 43614
Administrative Officer (Director) of Mental Health
Responsible for the primary administrative supervision and management of over 30 personnel including Psychiatrists, Psychologists, Social Workers, nurses, and administrative staff for Mental Health, PTSD, Substance Abuse, Primary Care – Mental Health Integration, and Tele-Mental Health clinics.
Risk Management by supervising operations, resolving conflict within the organization, responding to all reports of inappropriate conduct and corrective action to protect patients, staff, the Department of Veterans Affairs, and other organizations.
Safety Management through the implementation updates of policies and procedures, quarterly health and safety site inspections, assistance with worker’s compensation documentation and incident reports, and the security management of practice sensitive items.
Human Resource Management through staff recruitment, development, performance evaluations, time keeping, and records management.
Patient Advocate over Mental Health through assisting over 5,000 patients to ensure prompt and adequate care is consistently being provided.
Systems Management through collaboration with the Clinic Profile Team in the appropriate creation of clinic maps utilizing the proper STOP codes, CPT codes, and ICD-10 codes to ensure appropriate billing.
Firelands Physician Group DEC 2012 – MAY 2014
1031 Pierce Street
Sandusky, OH 44870
Practice Operations Manager
Responsible for the primary supervision and management of over 25 Multi-Specialty Physician Practices consisting of over 46 providers and 106 staff members
Human Resource Management through staff recruitment, development, and performance evaluation of assigned practice staff.
Addressed employee problems and concerns by maintaining proactive and responsive employee relations in order to achieve a high rate of employee satisfaction and performance.
Risk Management by supervising operations, resolving conflict within the organization, responding to all reports of inappropriate conduct and corrective action to protect patients, staff, the Firelands organization, and others.
Direct supervision of office management, collaborates with clinical and business staff in development and implementation of policies, and assists in the development in facility planning in order to meet operational needs.
U.S. ARMY MAR 2007 – MAR 2013
Staff Sergeant/E-6: Medical Platoon Sergeant, NATO Medical NCOIC, Combat Life Saver NCOIC
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