Jim Rogalsky Email & Phone Number

Lithia, Fl, Us

United States

Jacksonville, Florida, United States

Merriam, Kansas

Tampa, Fl

• Directed the operations of the Call Center, overseeing the Sales, Customer Service, Nursing, Network Services, and Billing departments, while coordinating services for injured workers on behalf of their employer or insurance carrier.• Met the needs of a client base comprised of 15 carriers, 55 third party administrators, 110 self-insured employers, 3 government agencies, and 90 managed care organizations, as well as certified that the company was in compliance with applicable laws and regulations.• Shaped and defined how specialty managed care and network providers evolved, rising to meet marketplace needs while providing unrivaled expertise, commitment, and compassion.• Tailored solutions to match unique needs in order to ensure injured workers received the highest level of care, quality outcomes, and optimal return-to-work results, ensuring commitment to the physical health of workers and the financial health of their companies.• Understood injury trends and how the budget was developed by reviewing analytics on the previous three years' spend on the predetermined ancillary lines, as well as factored in anticipated employment changes and other outliers that impacted budget.• Used this analysis to determine areas of savings based on the provider network, recommending a new reduced budget which resulted in reducing spend by at least 10%, as well as beginning the 12 month program during any financial cycle.• Utilized Medical Outcome Indicators to develop the most efficient continuum of care, streamlining the rehab process, while leveraging physician-developed protocols and evidence-based medicine guidelines in order to ensure injured workers receive quality outcomes from receiving the best possible care.• Ensured the timely processing of workers' compensation claims, evaluating accident reports to determine accuracy and completeness, as well as to ensure adequate investigation.

Duluth, Ga

• Provided clinical and technology-based pharmacy benefit management, specialty health care services, PPO networks, medical bill review, and case management services.• Clients included workers' comp and auto insurance carriers, government agencies, third-party administrators, managed care organizations, and self-insured employers.• Proposed, developed, then executed a strategic plan for the department and units, supervising all functions or projects, while ensuring all work product was of the highest quality and completed in a timely manner.• Monitored and oversaw all activities of the department and management team, as well as oversaw the Quality• Assurance team's activities, providing leadership and direction on related projects.• Assisted in the monitoring of all unit progress and the achievement of established goals, focusing on strategic planning and goal-setting, while directing the operations in support of company goals.• Continually investigated and introduced process improvement measures, presenting suggestions to the Department President for consideration.• Managed, supervised, and led activities for superior responses to regulators, insurance carriers, employers, agents, brokers, or other employers' representatives, providing customer satisfaction and improved call efficiency.• Monitored operation systems, ensuring that they were continuously evaluated for proper operation, relevance, and utilization, while also designing enhancements, changes, or system improvements, providing support regarding work orders and proposals.• Proactively recruited talent, establishing a strategic staffing strategy to address needs, as well as providing effective orientation, onboarding, training, performance feedback, and performance development. • Conducted retention and succession planning, proactively managing and responding to turnover, while utilizing a reward systems.

Tampa, Fl

Berkeley Heights, Nj