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• Coordinate care plans with community care coordinators for the member• Educate transitioning member about services, requirements, limitations and/or exclusions of services as a result of the transition

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 assessment plan for each open position.• 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