Project Manager Senior
Resume:
Nadine Costanza, Senior Project Manager
Albuquerque, 87120, USA, 505-***-****, ******.********@*****.*** SUMMARY Dynamic Senior Project Manager with over 3 years of specialized experience in managing compliance and regulatory projects. Proven expertise in project scope definition, risk identification, and effective communication with management for timely project completion. Successfully led initiatives at UHG, driving collaboration and alignment with strategic objectives. Equipped with a BA in Psychology and Management, ready to leverage unique skills to enhance operational efficiency and drive success in challenging environments. WORK EXPERIENCE
01/2024 – Present Senior Project Manager I, Optum Behavioral Health Solutions
Albuquerque, USA
Orchestrate and finalize Compliance and Regulatory projects across diverse functional areas.
Provide subject matter expertise in defining project scope, identifying risks, and implementing project methodologies.
Deliver comprehensive presentations to management regarding project updates, ensuring timely completion and adherence to established scopes. 08/2022 – 01/2024 M&R Risk & Delegation Implementation, Capability Manager, UHG
New Mexico, USA
Spearhead activities for assigned Delegation or Capitation initiatives. Ensure alignment of program/project scope with organizational strategic objectives.
Facilitate and govern mid to large-sized workgroups to achieve collaboration and task accomplishment.
12/2020 – 01/2022 Provider Data Consultant, UHG New Mexico, USA Engineered provider contract templates within the Contract Lifecycle Management tool.
Diagnosed and solved moderately complex problems while providing explanations to colleagues.
08/2016 – 12/2020 Contract Management Expert (CME), UHG New Mexico, USA Conduct critical reviews for demographic accuracy, credentialing, and contract compliance.
Manage and submit Rate Escalator and Charge Master updates to CCI. 03/2015 – 07/2016 Provider Install Administrator, UHG New Mexico, USA Audit the installation and administration of contracts, including structure and billing setup.
Prepare plan materials such as administrative documents. 04/2012 – 02/2015 Senior Pricing Analyst Skilled Nursing Facilities-Medicaid, Evercare
New Mexico, USA
Manage SNF contracts, validating demographics and credentialing. Coordinate with the quality audit team to ensure contract loading accuracy. 01/2011 – 03/2012 Senior Medical Cost Analyst, Optum Insight New Mexico, USA Develop solutions for medical cost leakage for Community and State clients.
Analyze medical utilization of providers across various service lines. 12/2009 – 01/2011 Medicaid Reimbursement Specialist (MRS), United Healthcare
New Mexico, USA
Research and develop programs and strategies for Medicaid rates and reimbursement policies.
Analyze claims pre-and post-payment to ensure pricing accuracy. 03/2009 – 12/2009 Fraud & Abuse Specialist, Optum Health New Mexico New Mexico, USA Identify, investigate, and prevent inappropriately paid behavioral health benefit payments.
Communicate investigation results to management and collaborative agencies.
EDUCATION
2020 – 2022 University of New Mexico
BA, Psychology and Management
New Mexico, USA
09/1992 – 05/1993 Pima Medical Institute
Certificate, Medical Assistant Program
New Mexico, USA
SKILLS Project management Compliance and Regulatory projects Contract management Provider data management
Data analysis Claims systems expertise
Collaboration Problem-solving
Communication Leadership
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