- Oversees Communication, coordinates and collaborates with The Florida Department of Health and Agency for Healthcare and Administration (AHCA)- Collaborates with market and shared service departments to optimize performance of product across programs, as well as financially and operationally.- Assesses operational performance and supports strategic planning activities to improve member and provider outcomes.- Develops cross-functional partnerships to effectively influence and drive operational enhancements.- Ensures compliance with contract provisions with various agencies and applicable State and Federal laws.- Identifies escalation trends and monitors the root cause of member/provider issues; works cross functionally with different departments to ensure enterprise-wide solutions.- Supports quality improvement initiatives through team participation, data collection, process change implementations and other activities.- Tracks Reviews and Monitors all Key Performance Indicators for CMS Health Plans.

- Appointed Account Manager for State Pharmaceutical Assistance Programs. (SPAP)Managed operations for WellCare’s Pharmacy Benefit Relations Department. - Assisted in all phases of PBM oversight, including project planning, implementation of new business regulations and monitoring results.- Provided strategic planning, direction, and leadership in managing state programs.- Maintained ongoing account relationships at multiple levels.- Collaborated with Customer Service, Clinical Management, Pharmacy Management, Provider Operations to ensure superior pharmacy operations service and member satisfaction were met.- Trained employees on procedures, new software, and created training documents for future new-hires.- Successfully helped eliminate barriers, and ensured consistency in performance and production.- Drove change and innovation through continually seeking and implementing innovative solutions; Partnered with PBM Analyst to design and drive new initiatives throughout the organisation. - Demonstrated skill in organising, leading, and inspiring individuals toward the pursuit of customer satisfaction.

- Managed operations for WellCare’s Pharmacy Benefit Relations Department. - Assisted in all phases of PBM oversight, including project planning, implementation of new business regulations and monitoring results. - Provided support and assistance to staff encouraging optimal performance while adhering to compliance standardized operating procedures and governmental regulations.- Spearheaded DMR processes and procedures (Reconciliation, Production, and Quality)- Maintained all supporting documentation to ensure compliance with government, managed care, and commercial regulations.- Determined appropriate and effective performance metrics and staff requirements for the department.- Oversaw all department audits; From preparation to execution. Participated in Corrective Plan Action (CAP) Monitoring leveraged Regulatory Affairs and Internal Auditing to achieve department compliance. - Conducted informative and educational meetings for the staff on coding, documentation, and reimbursement issues.

- Supervised and managed a staff of 25 service desk analysts.- Directed, planned, coordinated, and administered day-to-day operational activities of the Help Desk department and staff.- Monitored productivity and quality, maintained optimal staffing at all times, to ensure that service level agreements were met.- Corresponded with various departments including (Vendor Management, Grievance and CTM) requesting feedback and suggestions to identify and implement areas of improvement.- Created yearly and quarterly reviews to track and evaluate staff development. - Managed, analyzed and documented sensitive data via Cisco reporting.- Assembled SOP’s for the Help desk Department including complete root-cause analysis. Coordinated and ran meetings to determine root-cause of issues by analyzing incidents and trends.- Cultivated a strong and cohesive team that was customer-focused and possessed the technical competence to deliver services that meet or exceed needs of organization.