Experience

Health Partners Plans

• United States
• Hospitals and Health Care
• 300 - 400 Employee

• Network Account Manager

  • Jul 2007 - Present

  • Act as a liaison between Health Partners and our external customers • Responsible for education, training and oversight of the contracted network. • Conduct orientation sessions, makes educational visits, functions as a pro-active representative and coordinates resolution to provider issues. • Actively participates in weekly, bi-weekly and quarterly meetings with subcontractors and all providers to discuss operational issues, member issues, reports, etc. Prepare meeting agendas in advance of the meetings and maintain meeting minutes • Conduct user training and system demonstration in the use of HP tools. • Analyze data for cost reduction initiatives, guaranteeing profitable and efficient business relationships. • Excellent at organizing and managing multiple priorities and/or projects by using appropriate methodologies and tools. • Identify gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. • Collaborate with the Complaints and Grievances Department to ensure timely resolution of all member complaints.



AmeriChoice of New Jersey

• Newark, New Jersey

• Manager, Sales and Marketing

  • 2001 - 2007

  • Executed marketing strategy for consumers and Plan • Served a primary resource or knowledge expert for key products/activities within Plan • Assisted in the hiring and termination of staff • Managed the Member Advocate Team to ensure timely resolution of All Complaints and Grievances. Served as the conduit for all State and Regulatory inquires relating to member complaints and grievances and the reporting thereof. • Maintained up-to-date tracking system to ensure all complaint and grievances received were researched and resolved with-in the guidelines set forth be the State Regulators. • Developed Policies and Procedures specific to Complaints and Grievances and communicated them to members and Plan employees to support the Plan’s mission and values.



Health Risk Management

• 9th & Market Street

• Team Lead, Customer Service

  • 1997 - 2001

  • Lead 35 Customer Services Representatives at the operational level for claims, member and pharmacy services. Effectively trained, coached and motivated team in order to accomplish company goal and met Regulatory Standards as it related to call activity. • Developed and packaged new employee orientations and assisted in the scheduling of the training program • Managed Quality Assurance Program to ensure evaluations were completed timely and staff members were addressed for quality of concern issues and noted trends. • Used Call Management System to track all calls received.