Experience

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  Gilmore General Contracting

  • Office Manager

    • May 2016 - Present

    Management of office and field site operations.

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  Molina Healthcare (Via contract with Accountemps A Robert Half Company)

  • Program Director

    • May 2015 - Apr 2016

    Simultaneously managed business implementation of 2 new Medicare product lines within the states of CA and WA.  Planned budget of 1M - finished projects below budget, while meeting all milestones.  Led Implementation Team of approx. 140 participants.  Responsible for creation and maintenance of all project artifacts and uploading on SharePoint sites. Provided weekly Status Reports to Corporate Stakeholders and Project Sponsors.

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  Brandt Construction

  • Project Manager

    • Sep 2013 - Apr 2015

    Manage office performing: Customer Service; Accounts Payable/Receivable; Sales/Lead Generation; documentation of Bids/Proposals; creation/maintenance of Project Plans to ensure materials/resources were allocated properly resulting in timely completion of work at job sites.

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  UnitedHealth Group

  • Market Manager

    • Jan 2010 - Jul 2013

    Market Manager - No. California & Hawaii.Represented West Region Medicare Solutions department.Responsible for creation/development of new Medicare Member Plan Benefits (annually)Presentation of new Plan Benefits to all internal depts.Analyze CMS 5 STAR data to determine areas for improvement, and communicate potential solutions to internal depts. and external provider groups.Market SME for Sales, Customer Service, Provider Services for education/problem resolution.Key accomplishment – introduced new benefit plan in No. Ca. that resulted in an increase of10,000+ new members.

  • Project Manager II / Network Program Consultant

    • Jan 2007 - Jan 2010

    Represented West Region Performance & Project Management department as Project Lead.Successfully managed various projects with budgets up to $1.4 million to develop and launch new annual Products, resulting in increased member enrollments. All projects required development of new business P&Ps and provider system enhancements. Managed cross–organizational teams on the critical tasks required to add/term providers via the PMG/IPA, Hospital and Ancillary Add/Termination Task Force. Required extensive knowledge of all business processes/impacts and legal and regulatory requirements.Provider Data SME for Network Management, Provider Services and Network Data Management

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  PacifiCare of California

  • Project Manager II

    • Jan 1998 - Nov 2003

    Represented department as the business and systems expert on multiple projects and task force committee’s at all corporate levels. Responsible for drafting annual requests for proposal (RFPs) and submitting to senior management. Through interviews with internal/external users, identified and documented business needs requirements for new development of, or enhancements to, provider database systems. Facilitated (or participated in) team meetings - including the documentation of meeting minutes, determination of action items and issues, and updates to project plan. In coordination with I.S. department, determined all system requirements - assisting with system format, screen design and layout, functionality and fluidity. Developed and documented test cases, performed system testing (UAT) and validated results. As a result of new systems/enhancements, responsible for drafting new, or updating existing, policies and procedures, as well as providing training to all affected users. Entrusted with the “Go/No Go” approval authority for all projects. Performed project closure activities to determine success rate and identify lessons learned. Developed outstanding reputation as the department Subject Matter Expert.As business liaison, established effective working relationship with I.S. department resulting insuccessful and timely systems implementation and solutions.Timely creation and implementation of new screens/fields to support new products (CorporateStrategic Initiatives). Developed/documented/implemented complete Business Continuity and Disaster Recovery plans for all functional areas within department.Successful releases of system enhancements and business policies, procedures, and processflows to support healthcare regulatory agency requirements (HIPAA, NCQA, HEDIS, etc.).Successful implementation of several emergency system fixes/upgrades.All projects successfully completed on or before deadlines.

  • Associate Trainer II

    • Jan 1997 - Jan 1998

    Successfully trained 30 new and existing staff in a 1 year period to properly load 15,000 new physicians due to a health plan acquisition. Developed and documented (first-ever) Policies and Procedures manual for all data entry and workflow processes. Instituted Train the Trainer programs for internal/external corporate departments. Promoted to Project Manager.

  • Quality Control Analyst / Provider Data Specialist

    • Aug 1996 - Jan 1997

    Developed auditing tool to measure data input accuracy. Performed manual data audits of provider database. Established measurements used by management to determine performance levels. QC functions resulted in faster claims payments, reduction in I.R.S. penalties, and increased data integrity of provider directories. Promoted to Associate Trainer II.

  • Supervisor - Provider Information Management

    • Jun 1993 - Aug 1996

    Responsible for hiring, development and training, and performance reviews of 8 full time employees. Developed professional working relationships, trust, and a positive working environment with all 8 staff members, resulting in zero staff turnover in 3 years. Key business liaison between department and internal/external clients. Developed management reports documenting production (data received/processed, turnaround times, etc.). Promoted to Quality Control Analyst/Data Specialist.

  • Provider Information Coordinator

    • Jan 1993 - Jun 1993

    Responsible for maintaining provider database integrity. Exercised accuracy and efficiency in data entry. Established effective working relationships with physicians and medical groups/IPAs.Promoted to Supervisor after 3 months of service.