As a dynamic and results-oriented professional with a proven track record in healthcare management, I am dedicated to optimizing the delivery of quality care through strategic leadership and effective managed care solutions. With expertise in the managed care field, I excel in driving operational efficiencies, maximizing revenue, and fostering collaborative relationships with key stakeholders.My career spans over 10 years, during which I have successfully led managed care initiatives and achieved significant cost savings while maintaining exceptional patient outcomes. I possess a deep understanding of healthcare regulations, reimbursement models, and contract negotiations, allowing me to navigate complex landscapes and drive sustainable growth.Key Skills and Attributes:Utilization Management: Experienced in conducting medical necessity reviews, analyzing utilization patterns, and developing utilization management programs to improve efficiency and compliance.Clinical Quality Improvement: Skilled in implementing initiatives to enhance clinical outcomes and patient satisfaction while reducing financial burden.Contract Compliance: Proficient in managing health plan delegation requirements and conducting contract compliance audits to ensure adherence to regulations.Team Leadership: Successful in growing and managing utilization management teams, fostering professional development, and optimizing team performance.Regulatory Compliance: Well-versed in healthcare regulations and policies, ensuring adherence to guidelines and maintaining compliance.Customer Service: Committed to providing excellent customer service, building positive relationships, and maintaining patient confidentiality.
Listed skills include Medical Terminology, Bls, Utilization Management, Leadership, and 46 others.
