Experience

CMO - The Care Management Company of Montefiore Medical Center

• Hospitals and Health Care
• 1 - 100 Employee

• • Sep 2015 - Present

  Responsible for planning, directing and overseeing all CMO projects, initiatives and new business implementation for Data Analysis and Reporting. Works closely with client management and evaluates requests and proposals for reporting, new systems, enhancements and other business opportunities. Applies technical and business knowledge to provide departmental guidance and project management methodology in order to ensure the successful delivery of project based work.

• • Dec 2005 - Aug 2015

  Provide business, technical and analytical support to Medical Management, Behavioral Health, Operations and Contracting Departments.Responsible for Health Plan, HEDIS, DOH and NCQA Audits, inclusive of data requirements, data extract, review and submission.Provide technical support for the testing of new systems, interfaces, and system modifications.

• • Jan 2003 - Dec 2005

  Responsible for analyzing, reporting and developing recommendations on data related to multiple, varied business metrics. Work with clients on data specification requirements and data issues identified.Develop applications and provide automated reports using Microsoft ACCESS, Excel, Microsoft Reporting Services, Infomaker PC SAS and SQL

• • Nov 1999 - Mar 2003

  Provide production and ad-hoc reports to Medical Management and Operations using PC SAS and Sql.



Oxford Health Plans

• United States
• Insurance
• 1 - 100 Employee

• • Mar 1999 - Nov 1999

  Developed and implemented corporate Medical Management projects from concept to completion. Analyzed and evaluated service-level trends to improve business results, service capabilities and customer satisfaction. Supervised and led multiple teams of 18-20 coordinators in the pre-certification process.Responsible for interviewing, hiring and training employees as well as educating them on policies, performance feedback and salary review. Interfaced with senior management team regarding compliance to regulatory requirements. Show less

• • Feb 1997 - Mar 1999

  Provided ongoing training and re-education of Medical Management staff on an individual and/or group level. Formalized company and departmental workflow process design for: Pre-existing Conditions, Coordination of Benefits, Updating Authorization Logs, Direct Case Routing, Focused Utilization Review, Late and Non-Notification and Retrospective Review.

• • May 1996 - Feb 1997

  Worked directly with hospitals, Oxford Case Managers, and Medical Management Coordinators to provide member pre-certification. Provided ongoing support, research, and guidance for staff. Liaison with Medical Management personnel throughout the tri-state area. Resolved inquiries regarding Medical Management policies and procedures.Participated in the testing and implementation of the Pulse Production System, which is directly responsible for the maintenance of member records.

• • Nov 1995 - May 1996

  Responsible for pre-certification of elective and emergency patient admissions. Compiled clinical information regarding medical criteria to assess for coverage. Acted as a resource to other departments on Medical Management policies.