Nissin Behar Email & Phone Number

Chicago, Il, Us

Healthcare Business Project Manager supporting Medicaid health plan senior leadership team. Coordinate implementation activities ensuring regulatory requirements are achieved. Managed more than 200 requests from the state healthcare authority, completing them within a stringent four-month timeline. Led cross-functional calls with various subject matter experts to ensure all production readiness deliverables were submitted by the state deadline. Supervise health plan Ombudsman and Vendor Manager and oversee performance to ensure they effectively address concerns and manage vendor relationships.

Healthcare Business Project Manager supporting Medicaid actuarial senior leadership team overseeing the expansion of various prospective risk adjustment and clinical programs. Key accomplishments include:Dedicated stewardship for Medicaid health plans Kentucky, Missouri, and North Carolina related to implementation of a vendor product focusing on member engagement to drive positive change in patient outcomes and improve business ROI. Aligned Community & State compliance and both member and provider communication deliverables with vendor’s implementation plan. Secured health plan subject matter experts for input and decision making. Conducted stakeholder assessment. Elicited and thoroughly documented business requirements. Created issue and risk tracking log and documented decisions. Established repeatable process for future vendor installs.Developed project charters for health plans Hawaii, Louisiana, North Carolina, and Texas Medicaid implementations of the Optum HouseCalls program. Program is an annual in-home clinical visit by Advance Practice Clinicians to help identified members follow their treatment plan and identify potential care opportunities. Managed project objectives. Coordinated end-result requirements and established project milestones with checkpoints.

Greater Chicago Area

Onboarded 10 clients to Optum Rx Pharmacy Benefit Manager for group purchasing organization HealthTrust for deployment within 90-day timeline. Conduct client benefit discussions with all parties and ensure approval of business and clinical requirements. Coordinate efforts with internal departments for the creation of formulary, specialty products and pharmacy networks. Work with Operations and Functional leaders to proactively identify implementation issues and drive resolution. Facilitate meetings at various levels of the organization, including management weekly reviews. Monitor, track, and report implementation status and performance both internally and to client.

Northbrook Il

Managed 2 pharmacy benefit implementations for insurance broker National Financial Partners for 1/1/2019 delivery within 60-day timeline. Planned and coordinated both client and cross-functional operational teams to support all aspects of setup and design. Project plan on-time closure rate was 97%. Mitigated client risks and internal risks through comprehensive understanding of all downstream impacts. Facilitated member data transition activities for 30 clients to obtain mail service open refills, historical claims, and prior authorizations from incumbent vendor.

Greater Chicago Area

Transformation Office liaise between United Kingdom, South Africa, and North America operations for 2018 delivery of Business Process Outsourcing of contact center services for motor vehicle and property insurance claims. Determined project goals and prepared project completion schedules. Identified and managed risk and issue resolution. Led weekly Senior Leadership teleconferences to manage expectations of global partners and ensure project objectives were met in accordance with requirements. 14 positions from U.S. to South Africa on-boarded and trained in 5 months.

Northbrook, Il

Managed 5 pharmacy benefit installations for Third Party Administrator RxBenefits for 1/1/2018 delivery within aggressive 30-day timeline. Managed project objectives on track, ensuring completion in a timely and cost-effective manner. Negotiated with internal and external groups to set priorities and obtain required resources to ensure successful project completion. Acted as direct liaison for escalations between RxBenefits and CVS Caremark stakeholders. Rated 4.6 out of 5 in 2018 Client implementation satisfaction survey.

Northfield Il

Achieved key domestic and international milestones for customer enrollment in laboratory proficiency testing, educational products/program and collection of member dues generating 70% of annual revenue for organization. 2016 revenue goals achieved resulting in $145M in sales and 5% increase over 2015.• Implemented program to ensure membership dues arrived on time with minimal follow-up needed. Engaged key stakeholders in process and managed to standard operating procedures resulting in greater efficiencies and reduced costs. • Facilitated Post-Implementation support planning and Initial Response Team meetings to mitigate risk for escalated issues after project implementation. Resulted in immediate corrective action. • Managed project financial tracking for 12 portfolio projects against assigned budgets. Resulted in project completion on time and on budget.

Developed complex project plans and timelines, managed cross-functional resources, served as primary point of contact for project stakeholders, managed status communications/updates, and proactively navigated roadblocks to meet established timelines for Business and IT initiatives. Notable projects include:* Regulatory – Average Wholesale Price (AWP) Source Change* Consumer Engagement – Prescription Savings Guide * Vaccination– Enterprise Flu Immunization Program*Sales and Differentiated Customer Service – myCustomer

*New System Development • Managed and successfully delivered 5 pre-launch upgrades. Project positioned for complete system launch which will increase usage by 30%.• Facilitated cross-functional collaborations to identify business and functional requirements, resulting in minimal revisions for release.• Influenced planning of department capital budgets.• Conducted extensive User Acceptance Testing.* Expand an Underutilized System • Established the expansion work plan integrating Clinical and IT view points and partnering with external vendors.• Launched 6 new drug classifications within 6 months.* Ongoing maintenance • Created SOPs, Process Flows, and User Acceptance Testing of 2 releases, exceeding project goals. • Configured 250 rules.* Request for Information Prior to Development• Conducted market research, constructed complex questionnaires, conducted telephone interviews, compiled and analyzed the data and dovetailed the results. • Wrote and presented PHR report to senior management including recommendations for future action.

Managed transition of retiree benefits from company plans to Caremark’s SilverScript Medicare Part D plan. Created project plans, client marketing strategy and communication plans, enrollment requirements, and reporting. Liaison between employer groups, SilverScript operations and service centers.

Led cross-functional teams to complete contract process by focusing on client business objectives: financial terms, service expectations, performance guarantees, special program offerings, and legal considerations. Analyzed Request For Proposal (RFP) documents and collaborated with business areas to research, formulate and document responses. Assessed performance requirements and recommended performance guarantee strategy and penalty amounts.

Collaborated with employer HR departments to develop benefit design, packaging, financial commitments, enrollment and timelines for new programs and addition of new employee groups as a result of mergers and acquisitions.

Managed and serviced $88 million book-of-business in 6 states. Conducted on-site client reviews to provide plan analysis and benefit design recommendations for non-national book-of-business accounts. Empowered to act on client’s behalf to implement changes and exceptions.Former Positions Include:Plan Enrollment Analyst (1997 – 1998)Team Leader (1994 – 1997)Claims Customer Service & Patient Service Rep (1993 – 1994)