Project Management Customer Service
Resume:
Louisville, KY *****
Email **********@*********.***
PROFILE
Dedicated Leader with over 25 years of experience in the healthcare and Insurance industries. Outstanding leadership with excellent soft skills, negotiations, organizational and project management skills. Exceptional record of relationship building with cross functional teams, achieving bottom lines results and strategic planning. Significant experience as Super User for all technology to support large Contact Centers.
AREAS OF STRENGTH
EPIC
Project Management
Managing Human Capital
Strategic Planning
Recovery of Healthcare dollars
Forecasting
PBM
Certified Root Cause Analysis
RX Claim/Navigator
Super User for all Technology
Advocacy
Life and Health License
Clinical oversite
Client Management
BPO
WF Planning
PBM/PHD
Clinical management
Six Sigma Green Belt trained
Outbound Dialer (Genesys)
Medicare/Medicaid
EDUCATION
University of Louisville Louisville, KY
Bachelor’s degree (B.S.) Workforce Leadership 2010
McKendree University Louisville, KY
Certificate in Call Center Leadership 2006
Continuing Education Courses and Seminars in Management
Project Management certificate
Certified in Root Cause Analysis
PROFESSIONAL EXPERIENCE
PharmaCord
Sr Program Manager Jeffersonville, IN January 2024-August 2024
Monitors and provides weekly updates on items impacting program financial forecast
Prepares activity summary for the development and review of client monthly invoices
Prepares, reviews, analyzes client specific operational results
Primary responsibility for the preparation of client business review meetings with operational metrics and data insights
Point of contact for program/operational queries and issue resolution
Assures client reporting of Adverse Events/Product Complaint received are reported in accordance with client work instructions
Optum
Sr Manager Nurse Triage Optum Care Remote February 2022-August 2023
Collaboration with operations, reporting, analytics, finance and UHC to support the execution of the program
Work with reporting to monitor Optum performance at the client level with presentation of results at monthly business reviews with internal/ external leaders and stakeholders
Manage 50+ Nurses in 24/7 Triage program
Responsible for License compliance for nurses
Optum
Director Medical Clinical OPS Atlanta, GA March 2020-September 2021
Collaboration with operations, reporting, analytics, finance and UHC to support the execution of the program
Work with reporting to monitor Optum performance at the client level with presentation of results at monthly business reviews with internal/ external leaders and stakeholders.
Accountability for partnering on all custom / non - standard requests made by the client and they will need to represent Optum Advocacy during client audits
Identifying and driving continuous process improvement opportunities with the support and direction of the client and UHC partners
Optum
Sr. Operations Manager Government Programs Atlanta, GA April 2017-March 2020
Offline or Back office data entry responsibility for State of Massachusetts HIX program
Provides leadership and guidance to assigned Supervisors to ensure the Optum team develops and executes tactical business plans.
Is responsible for daily analysis of business and client results to ensure Optum and their clients’ business objectives are met.
Is responsible for the smooth implementation of all change control in the Operations department.
Provides daily analysis of results for all assigned Optum and client processes and is responsible for making recommendations on program enhancements to appropriate Account Management and Operations leadership.
Optum
Operations Manager (Optum Rx) Louisville, KY July 2013-April 2017
Ensures attainment of internal and external key performance indictors on a daily, weekly and monthly basis.
Provides leadership and guidance to assigned Supervisors to ensure the Optum team develops and executes tactical business plans.
Is responsible for daily analysis of business and client results to ensure Optum and their clients’ business objectives are met.
Is responsible for the smooth implementation of all change control in the Operations department.
Provides daily analysis of results for all assigned Optum and client processes and is responsible for making recommendations on program enhancements to appropriate Account Management and Operations leadership.
Educates, motivates, leads, guides and directs all assigned Supervisors and representatives.
Monitors calls and provides feedback to Supervisors and Representatives based on observations. Monitors and tracks employees for progress against internal and external objectives.
Has P&L responsibility for assigned clients ensuring attainment of revenue and cost budgets.
RxCrossroads
Program Manager Louisville, KY 2012-2013
Develop and operationally manage Product Support Hotlines to conform to client contract and policies and procedures. This includes Problem identification and Resolution of any identified issues.
PBM Management
Create and Maintain relationships with cross functional departments for proactive problem resolutions
Measure, monitor and report on KPIs with client as well as internal standards
Manage program to ensure profitability.
Develop and adhere to budgetary guidelines.
Develop and implement customized Standard Operating Procedures to accommodate the specific needs of specialty drugs.
Serves as a liaison among patients, physician offices, payers and pharmaceutical company representatives for specific drug programs.
Manage, recruit, train and develop program team members.
HCA- National Patient Account Services
Call Center Manager Louisville, KY 2001-2012
Manager of 50+ exempt and hourly staff
Managed projects ranging from low profile to high profile including the Business Continuity Plan recovering 100% of the collections business should a disaster occur
Super User for Technology including automated dialer, CRM system and SharePoint
Managing and developing staff to call center metrics including production, employee satisfaction and account receivable goals
Provided leadership to the supervisory staff
Process Management of current workflows to check for efficiencies
Liaison for Operational and IT departments
Created and Managed Workflows for Call Center technology
Troubleshooter for all Technology used in Large Contact Center
Reengineered processes to delete any deficiencies including both Operations and IT
Root cause analysis of any technology related issues
Certified DDI instructor for the Management team
Management Liaison for employee satisfaction. The center achieved the highest score in the HCA family based on this work
Assisted IT department with decisions for future technology needs (Cloud or Hosting Environment)
Humana Inc
Project Manager Louisville, KY 1996-2001
Humana Inc is an insurance company based in Louisville, KY. Humana provides health insurance to both large and small groups, as well as Medicare and Medicaid recipients.
Led Commercial and Medicare projects for the call center
oMedicare project resulted in calls being answered within the call center metrics even when call volume increased by 35%
Successful project completion of the Medicare Supplement business being sold to another insurance company, specific role as operations project lead.
Super User for Contact Center Technology
Liaison for Operations and IT for problem resolution
Root cause analysis, reengineering and process management of call center processes looking for deficiencies.
Managing human capital with a staff of 35-40 non exempt employees
Achieved predefined metrics and goals each year
Strategic planning each year to measure and make decisions regarding new goals
Presented Medicare plans to entire call center staff of 200+
Prepared Medicare budget for call center
Previous Experience includes Supervisory and Customer Service, Humana Inc. Louisville, KY for five years.
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