Experience

HMSA

• United States
• Insurance
• 200 - 300 Employee

• Project Manager - Health Management Operations/Strategic Partnerships

  • Nov 2015 - Present

  Responsible for complex project management related to the development and implementation of Health Management-related programs focused on members of high medical risk, revenue management and expense reduction. Utilize project management models, skills and tools to incorporate concepts and processes into the normal business functions through Heath Management Operations. -Develop and manage projects involving research, analysis, planning, and development and implementation activities, monitor the progress and timeline, and communicate with the project stakeholders, management and other relevant parties. -Facilitate and participate in cross-functional workgroups, setting goals and objectives and providing work products. -Ensure alignment with other teams across the organization. - Identify project requirements, milestone criteria, task dependencies, and create schedules to effectively manage multiple, simultaneous projects. -Create and foster working relationships with internal and external parties that facilitate project success. -Applies project management principles to ensure the successful delivery of objectives: * Scope management for requirements baseline, changes and conflicts *Issues, risk, change management *Schedule including delivery and maintenance of project plans *Costs/budge management



Healthways

• United States
• Wellness and Fitness Services
• 700 & Above Employee

• Quest Program Manager

  • Nov 2014 - Oct 2015

  ◦Provide strategic leadership and direction to Healthways activities ensuring that all contractual, regulatory, governmental, and accreditation requirements and objectives of the Medicaid QUEST program for members are met, with direct responsibility to oversee: ◦Strategy, planning, design, development, integration, and management of programs and services offered to the Medicaid QUEST Integration services provided by Healthways. ◦Communication and coordination with Healthways departments, partners, and business associates to ensure compliance with Medicaid QUEST program requirements and performance standards are met. ◦Planning, goal setting, monitoring, and oversight activities related to the Medicaid QUEST Integration program requirements and objectives. ◦Projects related to enhancing existing capabilities and developing new capabilities. ◦Delivery of all required reports, and development of manual reporting processes in the cases where automated reports are not available. ◦Operational delivery by vendor partners. ◦Identifies and implements opportunities to improve services provided to the Medicaid QUEST Integration program and collaborates with Healthways partners and providers to ensure effective communication, operations, and customer experience. Responsible for maintaining awareness of industry developments, policy or regulatory changes, and other factors that affect Healthways and collaborating to develop effective long and short term strategies and tactics in response. ◦Serve as primary Healthways representative to our partners for all activities related to the Medicaid QUEST Integration contract to include financial, contractual, administrative, operational, and compliance. Responsible for monitoring, interpreting, and effectively communicating changes in Medicaid QUEST requirements within Healthways. ◦Coordinate all communication and marketing activities for the Medicaid QUEST Integration program in strict compliance with all regulatory requirements.



AlohaCare

• United States
• Insurance
• 1 - 100 Employee

• Clinical Operations Manager

  • Sep 2011 - Jun 2014

  I managed the AlohaCare’s Clinical Operations Department, which includes supervising non-clinical staff who perform utilization management activities including timely data entry and processing of medical prior authorization requests from members and providers, referrals to specialty care and service notifications. Other responsibilities include coordination and interfacing with other Managers and Directors from both Clinical and Plan Operations Divisions, Provider Network, IS as well as interaction with Med-Quest. Assist in ensuring the Plan’s accreditation, contractual and regulatory compliance in all areas related to utilization management.



MicroDyne

• Hawaiian Islands

• Sales and Implementation Specialist

  • Jul 2010 - May 2011

  My primary responsibilites: Prepared product analysis as a sales tool; Performed Return on Investment (ROI) for clients & potential customers; Performed Work flow analysis for clients or potential customers; Responsible for direct sales via print media, website or site visit; Prepared presentation & product demonstration for potential customer; · Developed marketing material & sales campaign; Coordinated software implementation and training My primary responsibilites: Prepared product analysis as a sales tool; Performed Return on Investment (ROI) for clients & potential customers; Performed Work flow analysis for clients or potential customers; Responsible for direct sales via print media, website or site visit; Prepared presentation & product demonstration for potential customer; · Developed marketing material & sales campaign; Coordinated software implementation and training



Pacific Island Medical

• Kailua, HI

• Manager

  • Dec 1997 - Jun 2010

  Designed and implemented cost saving programs; Designed and implemented programs to increase productivity and revenue; Spearheaded Internal Audits; Assisted with Government Audits and Company Accreditation Process; Accountable for Cost Analysis on Medical Equipment & Supplies; Accountable for Staff workflow; Oversaw Company's Customer Service and Billing Departments Designed and implemented cost saving programs; Designed and implemented programs to increase productivity and revenue; Spearheaded Internal Audits; Assisted with Government Audits and Company Accreditation Process; Accountable for Cost Analysis on Medical Equipment & Supplies; Accountable for Staff workflow; Oversaw Company's Customer Service and Billing Departments