Deborah Wertheimer, Pmi-Acp, Pmp, Itilv4, Smc, Dol Email & Phone Number

Professional consultant on a volunteer basis to assist small businesses in many aspects including, but not limited to: Starting a business; Closing a business; Operations; Reporting; Business Social Media; Business Website; Business Plan; Financials; Inventory; and more. This includes brick and mortar, e-commerce, local and non-local business.

Provide consulting services related to both Technology and Business in areas including, but not limited to: IT Product Development; Implementation of Agile / Waterfall Project Management Methodologies; Business Process Improvement; Operations; Business Social Media; Personnel Development, Training, Onboarding, and Evaluations; Relationship Building, and more

A United Healthcare Company

• Recruited by previous leader to build implementation team and processes from ground up in order to create a sustainable product to service members of Medicare and/or Medicaid products that required non-emergency.
• Developed standardized processes, documentation, and 12 various tools that successfully streamlined implementations/project management and resulted in a sustainable and scalable product.
• Successfully implemented, either directly or through oversight, 10+ projects utilizing SaaS applications, and both waterfall and agile methodologies.
• Received recognition from successfully built working relationships with 10 internal/external clients across nine different states and government levels to implement Medicare, Medicaid, and Dual Special Needs Plan.
• Identified and resolved pre/post implementation process issues to encourage smoother procedures, more efficient workflow, and promote business growth.
• Actively participated in the development and oversight of personnel to ensure their personal growth and advancement, which led to an employee’s successful first-time implementation.

• Core member of Strategic Initiatives team with direct reports, responsible for development and implementation of medical expense initiatives to increase quality of care and reduce costs involving both IT, and.
• Successfully implemented a vendor program, with integrated project plans, to assist members with their surgery including alternatives, pre-op, post-op and readmit avoidance across 12 states; return on investment (ROI).
• Successfully outsourced three utilization management programs, with integrated project plans, to third party vendor across 11 states in order to save the company over $7M in medical expenses; achieved 4:1 ROI.
• Recognized by Chief Medical Officer (CMO) for creating best practices for vendor management after providing ongoing direction and leadership for program operations including: risk identification and mitigation.
• Established and cultivated relationships with internal/external clients, including executive level, using active engagement, positive communication, reporting, and presentations.
• Monitored vendor performance through quarterly performance scorecards and joint operating committee conferences.

St. Petersburg, FL

• Hand-picked by COO to lead Operational Improvement Team and Resolution Team to reduce company costs, regulatory complaints, and improve organization-wide processes. Successes include:
• Recognized for client/customer satisfaction based on member/provider surveys for reducing team involvement in regulatory complaints from 20% to 2% by spearheading company knowledge and understanding of “resolution”.
• Reduced duration to review foreign claims from 120 business days to 60 calendar days by procuring third party vendor to translate claims; built review of claim by Medical Director for official determination into.
• Identified process improvements enterprise wide through root cause analysis, audits, and review of operational processes. Recommended changes while remaining compliant with Center for Medicare and Medicaid Services.
• Provided projections/forecasts, reporting on SOW deliverables, dashboards and presentations regularly to executive level on projects.