Project Management Program Manager

Over ** years of management experience in large, HealthCare IT environments (focused largely on Medicare and Medicaid, but commercial as well) managing process design/redesign and development of technology solutions to align with organization vision and strategy. Led the development and deployment of numerous programs, projects and products in both Managed Care and Fee-For-Service environments. Developed and led systems request prioritization mechanisms, process design, change management, architecture definition, and system implementations with robust quality and delivered within time and budget constraints.

Area of Excellence

Managed Care

HealthCare Insurance

Program/Project Management

CMMI/ISO 9000

Matrixed Resource Management

Financial Accounting; Knowledge and Management

Web Application Development

Waterfall/Agile

EHR Implementations

21 Years IT Program Management

SDLC Process Improvements

PMO Process Improvements

Technical Skills

Languages: COBOL, RPG, Easytrieve, Ads/O, XML, SQL, .net, JAVA

Databases: Oracle, MS SQL Server, DB2, IDMS/R, MS Access

Application Servers: WebSphere, Oracle Application server

Operating Systems: Windows 2000, UNIX (Solaris, AIX), Z06, Linux

Methodologies: CMMI, Waterfall, ISO, Crosby, Agile,PMI

Other Software: Microsoft Office (Excel (s30/25olid expertise Pivot Tables, VLokup/advanced functions), Word, Access, Outlook, Visio, PowerPoint, Project), SharePoint, Smartsheet, Clarity 2/21/25, JIRA

Methodologies: Portfolio Management (extensive past 8 years); SDLC, Waterfall, Agile, Risk Analysis

P R O F E S S I O N A L E X P E R I E N C E

Mindlance (Contract Position) Program Manager 9/30/24 – 2/21/25 (client: CIGNA)

Managed successful transition of departmental project reporting processes to streamlined structure

Managed specialized redesigned budgeting process for clinical projects running across multiple years

Managed multiple phases of large clinical software release project for MHK Software

Program/Project Management Specialist NTT Data 10/22 – 4/2024

Managed successful implementation of first phase of 1 million-dollar claims-related project; projected three million dollars per year savings; currently on schedule and within budget.

Managed implementation of Provider phase (Behavior Health) of 3 million-dollar migration project; ongoing phase on schedule and within budget.

Project/Program Manager Avista

Tech Contractor (Client Caresource) 06/25/22 – 8/8/22

Managing 5000 hour Teladoc Vendor Stand-up project with team of two project managers: On schedule and under budget at this time.

IT Senior Project Manager CGS Administrators 12/13/2021 – 06/24/22

Managing first project implementation of major upgrade for a Content Management System (OnBase); 40% complete all milestones met and under budget.

Position Responsibilities:

o25% Develops and monitors project plans, risk management plans, and project documentation from scope to post implementation. Ensures project documentation and deliverables are complete, on budget, within scope, and in accordance with standards.

o20% Identifies items that impact the scope, budget, risk, and resources of the work effort. Monitors resource requirements based on project specifications. Ensures resources are assigned to meet project objectives while managing project hours budgeted.

o20% Responsible for the development, execution, and maintenance of project communications. Facilitates effective communications between all parties involved in the project and/or work efforts. This will include meetings, correspondence, status reports, and other documentation.

o20% Identifies the impact of issues arising from the work efforts and/or resource requirements. Manages the project issues throughout the project life cycle. Communicates the implications of changes to the project scope with senior management and other appropriate parties.

o15% Responsible for ensuring all work efforts have appropriate documentation for audit purposes utilizing project methodology standards in accordance with ISSM.

Project/Program Manager Blue Cross BlueShield of Tn 4/1/2016 – 11/05/21

Responsible for management of all programs related to Medicaid Business Line Shared Health (both AGILE and WATERFALL USED)

Successful implementation of 70K hour program (value 20 million dollars) to fully automate the Virginia Medicaid Plan processing for external customer (Magellan)

oFull implementation from Eligibility/Enrollment through claims processing/reporting, inclusive of PBM implementation and all financial reporting

oManagement of 20K hours per year change order program for this same vendor; implementations largely on schedule within budget; program value relative to change orders 3-5 million; totally operational program 10-30 million annually

oContact Center processes established and stood up for the Virgina Magellan account

Successful implementation of 72K hour program (value 10 million dollars annually) to totally automate State Medicaid Plan (Mississippi) processing operating as Managed Care Organization (MCO)

oTotal implementation from Sales/Membership/Enrollment through clams processing, PBM implementation and financial reporting

oContact Center processes established and stood up for Mississippi Medicaid business line

Established Internal Client/External customer Governance Processes; management of both $7.5million dollar budget and reporting

Successful implementation of strategic 10k Hour program to establish fully independent technical environment for Shared Health business line (applications & infrastructure)

Project/Program Manager (Global Systems (consultant; client Kaiser Permanente)) 11/2015 –3/2016)

Management of program to implement Medicare Advantage Product; 40K hour project (5 million budget) with 3 direct PM reports, matrixed 40+ staff for technical delivery

Program consisting of 13 workstreams (sub-projects) encompassing both regional and national components

Program on schedule and under budget through project close-out process

Senior Project/Program Manager (Electronic Transaction Consultants 5/2014 – 5/2015)

Responsible for management of all software development for company's largest account (NTTA)

Management PMO team (3 PMs, 2 technical managers, 50 matrixed development staff) for $18 million account; role included both managing projects and having responsibility for additional projects being run by direct report project managers (within PMO structure)

Multiple successful implementations of several software projects with hours exceeding 20,000

and cost savings exceeding $300K; implementations included development of new/modified policies and procedures; projects expanded interoperability with other Toll companies generating additional revenue of $200K per year

Projects/Product deliverables focused on financial services in the areas of large-scaled accounts receivables (large, substantial customer base) totaling over $100 million yearly

Responsibility for accounts receivable collection for ETC’s largest customer (NTTA); redesigned process and reduced cycle time by 30%, leading to 20% gain in cash flow

Implementation of various quality improvements to process, leading to 75% reduction in defects in release implementation

Project/Program Manager (National Government Services/Wellpoint Health Enterprises 5/2013 – 5/2014)

Acting in Business Development role on large Hosting/Infrastructural contract opportunities

Management and Technical solution contributions to recent NGS Federal Government agency (CMS) contract win; contract value $200 million plus; project management role in driving solution development to tight target dates

Contract award involved the implementation of a hardware/software monitoring tool across multiple implementations within coastal US, as well as the management of a infrastructure tool suite, requiring extensive deployment strategy planning in which I was heavily involved

Successful project management for process involving large Data Center footprint reduction; this involved the movement of significant data center resources to an outsourced vendor, projected savings $5 million

Director, Applications/Client Services (Companion Data Services) 10/2006 – 12/2012

Acting in Roles as Program Manager/Project Manager/Account Executive

•Managed Client Services Systems (all development and support for four national accounts), consisting of 2 managers, 4 Project managers, 14 Systems/ Programmer Analysts with development/maintenance duties on 150+ systems (EDI interfacing, claims processing, claims payments, financial reporting, multiple customer portals) and several platforms (Multiple SQL Servers, Web-based architecture, IBM Z06 mainframe) ; all programs run using standard SDLC processes and developed to internally based standards, with associated project and software deployment planning, featuring measurements, risk management and SLAs; adhering to high compliance standards (HIPPA) auditable by Federal government contractors

Key role in acquiring and managing $60 million dollar Infrastructure Design/Implementation/Software Development Process Account (CMS Medicare Advantage/ National Encounter Program); highly collaborative environment consisting of vendors, clients, IT applications professionals, and matrix managed infrastructure team in the CDS national datacenter; my responsibilities included successful management of Infrastructure stand-up, Business Analysis and Requirements Definition, Testing/Quality Assurance, policy and procedure development; program key milestones and SLA measurements met and within budget

Responsible for managing customer-facing websites for TrailBlazer Enterprises that were focused on key customer service attributes around presentation of products and customer enrollment

Responsible for contract initiation and ongoing account management associated with the implementation of CMS Section 1011 UARS Claims Processing system for Novitas Medicare Services; key role in developing the contract and leading the implementation; value $6 million dollars; support recognized each year by client as outstanding

Tenure as Account Executive/Program Manager for TrailBlazer Health Enterprises(CMS Medicare Contractor) has included implementation of numerous process improvement projects for TrailBlazer Part A, and Part B Non-Base systems, resulting in tightly controlled, high accuracy processing environment; ISO Quality Standards met consistently with high accuracy and major improvements to support capabilities implemented

Successful implementation of TrailBlazer MAC Jurisdiction 4 for Part A and Part B claims processing/payment and reporting processes; included extensive interface development, both data cleansing and conversion; all projects within this program delivered both on schedule and within budget; CMS recognized as one of the best MAC Program implementations in the nation

Successful management of CMS CWF Eligibility contract management servicing six Hosts for three years; SLA measurements met and 40% reduction in labor budget achieved

Systems Application Manager (Blue Cross Blue Shield TN) 9/1993 – 10/2006

Managed Government Systems (CMS Medicare and State Medicaid), consisting of 5 Project managers, 22 Systems/ Programmer Analysts with development/support duties on 100+ systems, several platforms (Multiple SQL Servers, UNIX/HP, IBM ES9000 mainframe)

Managed large, successful HIPAA Programs for both Medicare and Medicaid (all on time and within budget)

Total responsibility for corporate budgeting for all Medicare Information Systems (26 cost centers inclusive of applications and infrastructure); process improvements for cost accounting resulting in 2-5 million dollars in savings for the Medicare Program

Successful conversion of Medicare New Jersey Part A workload from Horizon to Riverbend both on time and under budget

Large-scaled conversion from HP 3000 to server-based COTS ORACLE AMISYS claims processing system

Education

University of Tennessee - Master of Business Administration

(General Business)

Georgia Southern University - Bachelor of Business Administration

(General Business)

Cleveland State College - Associate of Science with Data Processing major

Certifications and Professional Development

Six Sigma Black Belt (In Process)

PMP (applied and approved to take exam)

HIAA Managed Care Part A, Part B

Keane Project Management

Effective Leadership

Agile & SAFE Training

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