Responsible for managing the portfolio and overseeing 250 accounts. Primary role as a liaison between clients and internal teams. Ensuring customer satisfaction for clients and members by providing support during new business sales and renewing accounts, includes underwriting negotiation and renewal analysis preparation. Responsible for new business sales, releasing pricing, and conducting client presentations for health insurance. Focused on identifying and developing new strategic… Show more Responsible for managing the portfolio and overseeing 250 accounts. Primary role as a liaison between clients and internal teams. Ensuring customer satisfaction for clients and members by providing support during new business sales and renewing accounts, includes underwriting negotiation and renewal analysis preparation. Responsible for new business sales, releasing pricing, and conducting client presentations for health insurance. Focused on identifying and developing new strategic processes to sell and retain clients.• Took on an account management role and provided direction. Trained and coached team members to improve results.• Retained clients by rebuilding trust with agencies and improving customer satisfaction for 9 out of 11 accounts.• Influenced 65% of renewal accounts to switch to a more focused network, resulting in significant cost savings for the organization and clients.• Responsible for monitoring sales metrics and trends and presenting key performance indicators (KPIs) to the executive leadership team. Increase the renewal rate to 90%, resulting in a significant boost to the company's revenue.• Developed new business opportunities, supported sales leadership, and provided direct assistance to clients. • Developed and executed go-to-market strategies, including client roadmaps identifying their journey and pain points, and redesigned retention strategy.• Collaborated with sales, marketing, and services teams to ensure the smooth client renewal of services and products. Show less

Selected by executive leadership team into a top talent leadership development program designed to grow emerging leaders through enterprise projects in order to grow key behaviors - cross functional awareness, inclusive leadership, and team engagement. Gained knowledge in value-based care, insurance sales, cross-functional collaboration, physician engagement, and effective high-level communications.• Identified and analyzed strategic methodologies and trends that can be utilized to enhance… Show more Selected by executive leadership team into a top talent leadership development program designed to grow emerging leaders through enterprise projects in order to grow key behaviors - cross functional awareness, inclusive leadership, and team engagement. Gained knowledge in value-based care, insurance sales, cross-functional collaboration, physician engagement, and effective high-level communications.• Identified and analyzed strategic methodologies and trends that can be utilized to enhance and improve sales performance.• Established a standard of work and implemented change management strategies to increase sales of Medicare Advantage plans.• Spearheaded and led a team to raise $10,000 for cancer research through fundraising activities and employee engagement events.• Led strategic workgroups and presented recommendations to executive leadership to leverage operations and reorganize departments/processes. • Developed presentations and materials for senior leadership. • Engaged and provided senior leadership with recommendations for post-acute strategy. Show less

Led an array of projects alongside managers, directors, & executives to contribute to corporate strategic planning for Health Plan Accreditation. Developed, coordinated, implemented, & evaluated the continuous quality improvement/community health activities for assigned populations. • Lead Project Manager for Health Plan Accreditation for Commercial line of businesso Subject matter expert on NCQA (National Committee Quality Assurance) Standards & HEDIS Measureso Oversaw quality… Show more Led an array of projects alongside managers, directors, & executives to contribute to corporate strategic planning for Health Plan Accreditation. Developed, coordinated, implemented, & evaluated the continuous quality improvement/community health activities for assigned populations. • Lead Project Manager for Health Plan Accreditation for Commercial line of businesso Subject matter expert on NCQA (National Committee Quality Assurance) Standards & HEDIS Measureso Oversaw quality strategies & activities; implemented Quality Workplan & annual Quality Improvement Evaluation• Restructured & led the Quality Improvement Committeeo Directed the implementation of quality dashboards to track key performance metrics & align with regulatory standards o Formalized committee procedures & processes• Directed quality work groups to enhance performance improvement processes in collaboration with project team leader(s)o Implemented diabetes & breast cancer work groups, resulting in increase in HEDIS ratingso Developed & expanded behavioral health, community, & social determinants resources for memberso Aligned diverse internal & external departments to processes with regulatory standards & improve efficiency• Oversaw HEDIS quality strategies that assisted the Health Plan to increase their Star Rating by 1.5 Stars• Trained leaders, clinicians, & physicians in performance improvement methodologies, data analysis, data processing Show less

Managed the planning, design, & production on Medicare Advantage HEDIS Initiatives. Supported & collaborated with client & internal teams to ensure successful implementation of solutions. • Primary communicator with external stakeholders; built credibility & trust• Spearheaded & implemented quality community programs & strategies• Presented quality of care reports to physicians & clinicians • Analyzed data & metrics to evaluate projects success. Provided recommendations & new… Show more Managed the planning, design, & production on Medicare Advantage HEDIS Initiatives. Supported & collaborated with client & internal teams to ensure successful implementation of solutions. • Primary communicator with external stakeholders; built credibility & trust• Spearheaded & implemented quality community programs & strategies• Presented quality of care reports to physicians & clinicians • Analyzed data & metrics to evaluate projects success. Provided recommendations & new strategies when metrics were not met Show less

- Coordinates formulary change process with internal and external partners (guidebook updates, website updates, communications, PA forms, UM Platform changes, Operations training)- Partners with Client Operations Specialist to execute on decisions made by LOB (Line of Business) Program Manager and Client Manager specific to the market- Initiates Claim Reviews and identify coding issues for resolution- Coordinate both client and cross-functional (i.e., Evolent PBM Operations, Evolent… Show more - Coordinates formulary change process with internal and external partners (guidebook updates, website updates, communications, PA forms, UM Platform changes, Operations training)- Partners with Client Operations Specialist to execute on decisions made by LOB (Line of Business) Program Manager and Client Manager specific to the market- Initiates Claim Reviews and identify coding issues for resolution- Coordinate both client and cross-functional (i.e., Evolent PBM Operations, Evolent Health Plan Operations, Key Partner Stakeholder, key vendors) operational teams to support benefit setup and implementation- Analyzes LOB competitive landscape for our partner markets - Primary testing resource of LOB Benefits (Existing, New, and Changes)- Manages Source Documents and Creates Materials for Operational Staff- Assists with training of operational staff on new and changing benefits- Serves as a Subject Matter Expert on claim processing and rejections, secondary support personnel to the Pharmacy Resource desk- Ensure quality and service standards are met; including client contractual deliverables related to claims processing, conducts claims audits to identify issues- Identify process inefficiencies and provide innovative solutions to solve for gaps Show less

Patient Care Support and Coordination -Develop and staff a program/ progress for indigent care drug coverage and reimburesment -Coordinate and triage all pharmacy inquires -Serve as direct contact for pharmacy benefit information, clinical determinations and program information -Assist in develop provider education materials and physician benchmark reports Care Management Collaboration -Provide assistance to Care Management program including drug information… Show more Patient Care Support and Coordination -Develop and staff a program/ progress for indigent care drug coverage and reimburesment -Coordinate and triage all pharmacy inquires -Serve as direct contact for pharmacy benefit information, clinical determinations and program information -Assist in develop provider education materials and physician benchmark reports Care Management Collaboration -Provide assistance to Care Management program including drug information research and clinical guideline management -Assist in development and execution of pharmacy- specific Care Management strategic and tactical plans including HEDIS measure and CMS Star rating improvement -Support Medication Therapy Management and pharmacy monitoring programs Show less

-Applied excellent customer service skills in accommodating all patients in need of pharmacy benefit support -Promptly addressed all customer concerns and issues regardless of the area via phone or email. -Oversaw the implementation of a new pharmacy system during the transition to Evolent Health while also providing training to initial users

Provided friendly customer service to all patients and other healthcare providers. Accurately and efficiently prepared prescription orders for patients. Verified prescription information and dosage. Entered patient’s prescriptions and submitted insurance data. Assisted with managing inventory control.

Counseled to pregnant women, children, postpartum breastfeeding women, and families about their nutritional status, which, further developed my counseling and communicational skills. Provided nutritional information to low income families.Prepared proper documentation of patients, including intake and nutrition information.Tracked anthropometric measurements (heights and weights) of clients.

Reviewed residents’ medical records and completed nutrition assessments.Assisted at patient care meetings about nutrition issues and concerns of certain residents.Gained in-depth knowledge of nutrition and medication interactions.