Javi Ramirez Email & Phone Number

Austin, Texas, United States

• Developing and implementing appropriate policies and procedures
• Creating effective organizational structure, roles and jobs
• Supervising staff to facilitate member and provider needs through entire case management cycle
• Communicating with internal staff on key initiatives and outreach for members as needed
• Coordinate and communicate on access issues, assessments, internal Managed Care Organization (MCO) protocols
• Compile and review multiple reports on work function and for process improvement to identify trends, make recommendations to management

5900 E. Ben White Blvd

• Manage the transition of care for members enrolling or exiting the health plan
• Identify new member requiring transition of care services
• Complete assessment of the new member’s health care needs
• Determine the presence of active care needs or possible outstanding service authorizations
• Ensure existing authorizations with previous health plan or in fee-for-service are honored during the transition, for a minimum of 90 calendar days from the date of enrollment in the health plan
• Assist the members with continuing authorization of medically necessary services, transitions into Integrated Care Program, transitions between MCOs, and transitions to private insurance or no coverage

Austin, TX

• Develop and Execute Recruiting Plans: Collaborate with Hiring Managers, assist in creating job descriptions, work with Compensation on position evaluation, and lead the creation of a recruiting, interviewing and.
• Assist with candidate Backgrounds for Talent Acquisition Specialists
• Organize and source candidate groups for mass interviews for various Texas cities
• Examine resumes and identify potential candidates based on requirements
• Source candidates using social media: LinkedIn, Career Builder, Indeed, etc
• Knowledgeable on various Applicant Tracking Systems and HRIS applications

Austin, TX

• Maintained the denial and/or appeals logs and assessments in accordance with associated guidelines
• Responsible for the Medical Management denial process including letter printing, tracking and disposition of letters within contractual guidelines to ensure compliance
• Served as the department liaison for all denial and/or appeals issues

Austin, Texas Area

• Assisted Superior Health Plan with scheduling the entire State of Texas
• Coordinated interviews with multiple Managers, Directors, and Vice Presidents to schedule effectively on their calendars
• Ensured to keep track of candidates that were being scheduled for their interviews
• Answering telephone calls/emails and handling with inquiries

Austin, TX

• Assisted with heavy formatting documents in Word and Excel
• Document control, tracking changes to documents, very detailed
• Inventory Control involved opening packages, and checking items

Austin, Texas Area

• Developed close and personal relationships with clients to ensure customer loyalty and retention
• Exceeded unit sales quota for spa memberships
• Maintained customer database information pricing

Austin, Texas Area

• Performed general administrative support, answered phones, scheduled appointments, and maintained reservation database
• Maintained up-to-date Texas Child Care Reimbursement information databases; process memos, letters, faxes, agreements, and contracts
• Tracked and planned meals on a daily basis for children via the Childcare Systems website in accordance with Child and Adult Care Food Program nutritional guidelines (CACFP)

Austin, TX

• Desktop configuration, drive mapping, email configuration & Technical Support
• Detect, diagnose, and resolve desktop and laptop software/hardware failures
• Repaired, serviced, and replaced parts, boards, and equipment for PC/MAC computers
• Troubleshoot workstation, application, as well as Local Area Network (LAN) connectivity issues

Master Of Science - Ms, Organizational Leadership

Bachelor’S Degree, Psychology

Minor in Business Administration