Managed Care, Health Care Marketing and Human Resources Professional
Resume:
John W. Dent
Montgomery, Alabama 36117
Phone 334-***-****
E-mail: **********@*****.***
QUALIFICATIONS
•Extensive experience marketing to physicians, various other clinicians, managed care representatives, worker’s compensation and other healthcare professionals and representatives of government and business and industry.
•Strong total quality service approach in all aspects of marketing and service/product delivery.
•Extensive experience and training with Microsoft Office and other software applications as well as strong Internet proficiency.
EMPLOYMENT HISTORY
2006-present Provider Network Consultant, Humana Medicare
•Provider Relations and “Network” Development activities throughout Alabama with all types of medical Providers, Physicians, Hospitals, Rehab, Home Health, Skilled Nursing Facilities, Diagnostic Centers, Surgery Centers, and others.
•Achieved Medicare Advantage plan acceptance rate of 96% for hospitals with goal of 85%, and 96% for Physicians with goal of 85%.
•In-services as well as informal presentations to Providers accepting and networked with Humana Medicare plans.
•Claims assistance, e commerce assistance, specialty hospital (CAH) and clinic (RHC, FQHC) consultations and other Provider issue facilitation and resolution aimed at Provider MA plan acceptance and maintenance.
2004-2006 Clinical Evaluator/Marketing Rep, The Mentor Network and Timber Ridge Group
•Evaluated head trauma patients, adults and pediatrics, for admission to post acute brain injury rehab services available via company network of facilities. Primary area of activities, AL, GA, NW FL, MS, and LA..
•Marketed services to hospitals, physicians, work comp and managed care companies, municipalities and government agencies.
•Provided in-services to referral sources and participated in various related conferences and educational activities.
•Coordinated large and small group presentations involving company Professional Staff, Physicians, Administrators, Therapists, Family Members and Consultants.
1998-2004 Senior Provider Education Relations Rep., Humana Military HealthCare
Services/TRICARE
•Managed Care contract negotiations with all types of medical professionals and services to increase and enhance network of over 600 providers.
•Marketed electronic claims system to facilitate provider claims resolution.
•Educational presentations, site visits, and office inspections for individual network and non-network providers.
•Investigated and prepare response to beneficiary provider grievances in coordination with Health Systems Manager and Quality Management.
•Designated Internet Specialist for marketing Provider Internet Referral, Authorizations, Claims and other Provider Internet Inquiry Services.
•Developed PowerPoint presentations for various seminars and briefings.
•PowerPoint presentations distributed by management as a regional template.
•Initiate and facilitate credentialing and follow up monitoring for reporting qualitative and quantitative characteristics of provider activities.
•Provider Education Relations training curriculum development
•Provided training for new Provider Education Relations Representatives
1995-1998 Public Information/Resource Development Specialist, Alabama Dept of Rehab Services
•Established and coordinated statewide task forces to identify issues impacting individuals with significant disabilities, their families, service providers and employers as stakeholders in supported employment in Alabama.
•Developed resources, public and private, for funding supported employment extended services and a related action plan and resource directory to educate providers, consumers, employers and other stakeholders.
•Secured and coordinated sponsoring exhibitors for annual conference with over 300 participants.
•Developed, updated and maintained an information center with topical supported employment information in various media formats.
1992-1995 Marketing Liaison, HealthSouth Rehabilitation Hospital
•Marketed hospital services and programs to physicians, managed care representatives and other healthcare professionals in central and south Alabama to develop, maintain, and enhance patient referral resources.
•Evaluated acute care patients to determine their eligibility for hospital admission.
•Coordinated and facilitated continuing education in-services.
1990-1992 Assistant Director of Human Resources, Baptist Medical Center
•Conducted internal and external recruiting activities for all professional and ancillary nursing positions in a 454 bed acute care hospital and multiple outreach healthcare services that combined for over 1500 employees.
•Coordinated Nursing Scholarship Loan program for 75 students.
•Administered medical and dependent care tax-exempt reimbursement program (125 Plan: “Bene-Flex”) for 135 participating employees.
•Conducted new employee orientation and other employee and supervisory training.
•Processed unemployment compensation claims and appeals.
•Provided guidance and interpretation to supervisory staff regarding conflict resolution, HR policies and employee benefits.
•Supervised HR staff during Director’s absence.
•Conducted wage and salary surveys as well as a nursing staff attitude survey.
•Developed recruiting advertisements for print media.
1986-1990 Executive Director, Alabama Governor’s Committee on Employment of People with Disabilities, Alabama Department of Rehabilitation Services
•Directed a statewide network of (8) localized committees comprised of business representatives, and community leaders, rehabilitation professionals, citizens with disabilities and others concerned with increasing employment opportunities for people with disabilities in Alabama.
•Served as liaison between statewide committees and the President’s Committee on Employment of People with Disabilities.
•Coordinated awards presentations, speakers bureau, and conducted numerous presentations to various groups, organizations, associations and businesses.
Rehabilitation Employment Specialist
•Recruited, screened, referred and placed qualified job applicants in businesses in an 11 county area of central Alabama.
•Marketed employer consultant services, i.e., Targeted Jobs Tax Credit, OJT Employer Reimbursement, ADA Consults, Employee Assistance Programs, etc., to business and industry to facilitate employment opportunities for people with disabilities.
•Maintained database of business and industrial accounts.
•Served as liaison between business/industry and rehabilitation professionals and individuals with disabilities seeking employment.
•Assisted rehabilitation professionals in job readiness activities for individuals served.
•Prepared quarterly reports tracking employment development activities with businesses, community groups, rehabilitation professionals and individuals with disabilities.
Vocational Rehabilitation Counselor
•Coordinated and provided individualized vocational rehabilitation services to high school students with disabilities in (10) schools in Coffee and Covington counties in south Alabama.
•Provided students with disabilities transitioning from school to work, vocational counseling, guidance, community based vocational rehabilitation programs, technical school or college/university training, medical services as needed and job development and placement assistance.
EDUCATION
1988-1990 MS, Personnel Management, Troy State University at Montgomery
1978-1982 BS, Industrial Psychology, Auburn University at Montgomery
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