· Responsible for quality activities & interventions that supported data collection, reporting, communication, analysis of data & results, & development, implementation & evaluation of clinical & service quality improvement projects.· Implemented quality improvement initiatives to directly impact HEDIS & CAHPS scores; developed activities that supported specific quality projects & activities, health & process improvement strategies; collaborated with associates throughout the organization & with individual Providers, Provider Groups, & other healthcare entities to achieve desired outcomes.· Committee coordinator for Arizona Quality Improvement Committee. Developed regular agendas, sent materials to both internal & external participants & ensured all presentations were done timely to meet NCQA requirements. · Developed, implemented & maintained Quality Program annual core documentation, including work plans, status reports, policies, procedures, committee presentations & all documentation required to meet regulatory & accrediting requirements.· Collaborated with Medical Directors & other functional areas to assure clinical appropriateness of quality improvement projects & facilitated alignment between the Company & contracted providers regarding evidence-based care protocols impacting quality & safety, to ensure optimal performance & regulatory compliance.· Facilitated multidisciplinary involvement in process improvement, project development, implementation & evaluation through leadership of cross-functional work groups to increase accessibility, efficiency, effectiveness, & stakeholder satisfaction with services delivered.

Key Accomplishments – Senior Project Manager, Enterprise Solutions OfficeActed in the role of program manager with successfully directing three high visibility project teams of 27 individuals simultaneously, working in a virtual, matrixed environment, while fostering an atmosphere of initiative, collaboration, & trust. Managed & coordinated their business activities ensure compliance of sensitive regulatory requirements throughout the Health Net Enterprise.Key participant in the design & implementation of the regional Project Management Office. Established processes around role definition, responsibilities, & deliverables resulting in operational clarity, improved results of program & project teams, & projects completed on time & within budget.Instrumental in developing a quality assurance/peer review effort. .Led regional Wellness Program. Developed overarching wellness strategy. Designed employer group wellness program, which led to the launch of Health Net’s own associate wellness initiative. Directed efforts to identify product opportunities within the Individual & Family Plan (IFP) Market Segment. Executed multiple process improvement initiatives including collaboration with the Chief Medical Officer to revise several underwriting guidelines, advised during the development of new policies & procedures, & redesigned the enrollment application to facilitate external ease of completion & improving its functionality & effectiveness for internal processing. Developed long term tactical plans, to meet the market goals & objectives of the strategic plan.Performed competitive analysis to determine most preferable market position for the IFP products for the next annual renewal.Successfully developed a new product concept, strategy & approach, while managing expectations of multiple stakeholders with different business needs & requirements with regards to scope & direction. Successfully introduced the new product in the Arizona market.

Developed & managed innovative strategies to ensure product performance. Improved product performance was demonstrated by increased enrollment, market share growth, & greater profitability.Directed all phases of strategic development from research & product assessment, through strategy execution, ongoing monitoring & oversight of tactical implementation & results measurement.Led cross-functional teams through all phases of product lifecycle. Achieved new product functionality including development, marketing a full product launch, quality assurance, production & operations. Accomplished successful retirement of products at the end of their lifecycle.Created annual marketing plans that resulted in surpassing corporate enrollment goals by 67%.Restructured & implemented new central focus for marketing & selling. Introduced lead-tracking concept. Established the use of customer database, which led to increased efficiency & productivity while maximizing the allocated advertising budget.Developed & managed several successful vendor relationships. Facilitated corporate strategic planning sessions to drive company vision & mission.Key Accomplishments – Medicare Compliance Administrator, Senior Business UnitDeveloped & managed all aspects of compliance for a highly regulated managed care Medicare product.Acted as single point of contact with Federal Government agency holding contract.Analyzed & determined product compliance with legislative & regulatory rules.Created product revenue/expenditure forecasts by selected regional markets.Ensured the development, documentation & implementation of complete policies & procedures. Ensured adequate audit trails & continuous quality checks.Successfully passed intense Government audit with no corrective action citations.Promoted to manager within six months of employment.

Created marketing & advertising plans, developed sales strategies & full sales collateral for high-potential new product.Developed all aspects of in-house call center; job functions, recruiting & hiring, formulating an incentive based compensation plan, creating workflows, training, monitoring & establishing a resource center.Conducted focus groups & in-depth interviews to analyze specialized customer buying behavior.Launched new Medicare product, which enrolled over 8,000 net members in the first 12 months.Key Accomplishments – Senior Product Analyst, Individual Programs, Product Development & Management Championed & co-managed consumer health insurance products for Washington & Alaska. Led matrix product team in the development of positioning, strategic & market planning for products, resulting in an increase in annual revenues from $52 million to $103 million in five years.Implemented successful marketing & advertising programs for three distinct distribution channels, which achieved enrollment growth of 146%.Coordinated the redesign of corporate marketing materials to improve ease of comprehension by consumers while realizing a 50% savings in production costs.Developed & launched new products in both Washington & Alaska. Solicited insurance commissioner approval to create pilot product to provide coverage for alternative services (acupuncture, naturopathic, etc.).Key Accomplishments – Billing & Membership Specialist, Customer Accounts Maintained large group accounts, reconciled group payments in excess of $2 million each month, problem solving & customer contact with groups & brokers.Acted as division representative on several corporate level projects ranging from new product implementation to vendor selection for new membership system.Selected to develop, document, & implement policies, processes, & procedures for COBRA introduction.