Iris W. Email & Phone Number

• Streamline business operations by implementing efficient process improvements and organizational strategies.• Optimize workflow efficiency by analyzing current processes and identifying areas for improvement.• Project support with cross-functional teams to develop turnaround times for accountability and streamline processes for utilization management. Manage project plans and complete tasks by the timelines.• Develop FedEx change management by using effective communication strategies that ensured accurate instructions for all Care Advocates involved in the process.• Mentoring and Subject Matter Expert for artifacts such as Project Charter, Business Use Case, and Cost Benefit Analysis.• Knowledge Now Authoring FedEx Content updates. Project Lead for nurse advice line.

• Streamline business operations by implementing efficient process improvements and organizational strategies.• Optimize workflow efficiency by analyzing current processes and identifying areas for improvement.• Project support with cross-functional teams to develop turnaround times for accountability and streamline processes for utilization management. Manage project plans and complete tasks by the timelines.• Develop FedEx change management by using effective communication strategies that ensured accurate instructions for all Care Advocates involved in the process.• Mentoring and Subject Matter Expert for artifacts such as Project Charter, Business Use Case, and Cost Benefit Analysis.

• Serve as the Behavioral Health (BH) Liaison for NC, MA, PA, MD, FL, and RI. • Assist in Quality reporting, analysis, and audits, and for developing plans and programs to support continuous quality improvement using applicable tools. Ensure behavioral health remains foundational in all engagements.• Monitor Behavioral Health Calls serviced by the UHC call teams to ensure quality standards are being met. •Resolve escalated issues or complaints for provider searches, claims inquiry and denials, prior authorizations, and behavioral health holds.• Create/Update all job aids and workflow processes for OHCA Employer groups such as FedEx and Health Care Advocates/Advisors, Advanced Nurse Advocates, and the BH team. • Partner with the Product Manager to provide support for stakeholders to identify priority requirements or issues. • Provide regular updates to leaders spanning multiple products and functional areas. • Mentoring and Artifact Subject Matter Expert.

United States

• Support the Inpatient Care Management team by obtaining member / patient status, disposition, and discharge dates. • Assist Case Manager Nurses in viewing clinical information to confirm member status, obtain medical record numbers for facilities, and assign special cases to nurses for members in long term care. • Use time management skills to enter work with the time limits of an omega tracking system when working in a spreadsheet to enter data for members who are in various facilities.

United States

• Responsible for initial review and triage of Care Team tasks. Identifies principal reason for admission, facility, and member product to correctly apply intervention assessment tools. • Monitored non-targeted cases for entry of appropriate discharge date and disposition. Identifies and refers outlier cases (e.g., Length of Stay) to clinical staff.• Supports the administration of the hospital care, case management and quality management processes in compliance with various laws and regulations, URAQ and/or NCQA standards, Case Management Society of America (CMSA) standards where applicable, while adhering to company policy and procedures.

United States

• Reviewed, researched, and audited provider demographic data in NDB, COSMOS, PVO, PDA systems and faxes for vision, dental and medical physician’s records.• Audited provider advocate calls ensuring they updated all the providers information and created documents to support defect findings while ensuring defects are corrected after acceptance.• Managed an Audit the Auditor (ATA) project on team members to ensure defects are correctly assessed and managed a project in excel for received and unwilling, unable to contact records for accuracy.• Identify gaps in resolution process and trained new hires on all auditing procedures. Analyze and updated procedures to improve efficiency.• Act as Subject Matter Expert by answering complex questions to help team members make fact-based decisions on escalated audits. Assign audits and conducted team huddles.

• Support the clinical team and nurses with administrative and telephonic duties for the heart failure disease management program. Performed detailed checks of member biometric health charts to ensure member’s health is stable.• Assisted members with trouble shooting and replacement of medical devices as well as handling all member issues while providing excellent customer service to customers.• Implemented and provided training on new processes for clinical teammates.• Assisted leadership with obtaining employee coverage, approving timesheets, and conducting meetings with staff.

• Assisted with complex customer service calls with benefits and eligibility information, billing, and payment issues for all plan types in a timely manner. • Handled customer material requests, physician, and facility searches. Explained members explanation of benefits for medical and prescriptions. • Assisted on MySme Quality project to better help team members navigate the application with finding accurate information needed on every call to assist all members.• Contributed to the Compliance team by checking appeals and grievances to eliminate errors for team members.​• Served as Team Lead assisting with printing and sending out Adherence reports. Coaching CCP on all metrics. Handled escalated supervisor calls.