Quality Improvement Specialist, Healthcare, Operations

JOHVENSKY

PLAISIME **********@*****.*** 609-***-****

Brooklyn, NY 11206

PROFESSIONAL SUMMARY

Lean Six Sigma-certified Quality Improvement Professional with 5+ years of experience across pharmaceuticals, healthcare, and nonprofit organizations. Expertise in data analysis, process mapping, and workflow optimization, with a proven track record of driving data-driven quality initiatives, improving compliance, and translating healthcare data into actionable operational improvements.

SKILLS

• Data Analysis • SQL

• Microsoft Office • Workflow Optimization

• Lean Six Sigma • Project Management

• Tableau • Regulatory Compliance (CMS, Medicaid/Medicare) WORK HISTORY

Quality Improvement Engineer Public Partnerships LLC - New York, NY 04/2025 - 09/2026 Drove 15% operational efficiency gains across a high-volume, multi-million dollar Medicaid self-directed care program by executing Lean Six Sigma-driven process mapping and root-cause analysis on complex audit data.

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Managed a 10-person cross-functional team tracking weekly operational compliance, performance metrics, and service delivery against rigorous state contractual benchmarks and stakeholder SLAs.

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Built and deployed scalable quality management systems from scratch to bridge the gap between technical execution teams and healthcare stakeholders in a heavily regulated environment.

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Delivered data-driven strategic roadmaps to executive leadership, translating complex operational findings into actionable business growth strategies.

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Risk Adjustment Specialist Healthcare Partners - Garden City, NY 09/2022 - 04/2025 Safeguarded annual risk adjustment revenue and ensured 100% CMS regulatory compliance across 70+ healthcare providers by navigating regulatory hurdles to accelerate program execution.

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Bridged the gap between technical coding teams and healthcare stakeholders by negotiating workflow alignment and building functional, scalable systems for risk documentation.

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Executed data-driven risk adjustment strategies across Medicare/Medicaid plans, leveraging SQL analytical models to identify systemic process gaps and optimize population risk scoring.

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Designed and launched a provider training program, converting complex CMS coding standards into streamlined, day-to-day operational workflows.

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Project Analyst Flywheel Partners - New York, NY 08/2021 - 09/2022 Ensured go-to-market execution for an FDA-approved liquid biopsy test by leading cross-functional requirements gathering, mapping user stories, and driving SDLC-based workstreams.

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Streamlined pharmaceutical vendor and cross-functional workstreams to synchronize product promotion with GTM timelines, applying SDLC principles to ensure rapid product delivery.

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Built the end-to-end operational framework for a STEM internship program from scratch, collaborating directly with senior leadership to scale outreach, project delivery, and candidate acquisition.

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06/2019 - 08/2019

Social Determinants of Health Research Intern Horizon Blue Cross Blue Shield of NJ - Newark, NJ Partnered with cross-functional teams to convert data collection insights into targeted operational interventions addressing community health initiatives.

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Synthesized research findings and produced core project deliverables to align organizational operations with key external stakeholder goals.

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EDUCATION

Rutgers, The State University of New Jersey - New Brunswick, NJ 12/2021 Master of Healthcare Administration: Healthcare Administration GPA: 3.75/4.0

Rutgers, The State University of New Jersey - New Brunswick, NJ 05/2020 Bachelor of Arts: Public Health

GPA: 3.41/4.0

CERTIFICATIONS

• BrainStation Data Analytics Certification (Excel, SQL, Tableau) - 2024

• Lean Six Sigma (Green Belt) Certification - 2021

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