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Experienced operations and managerial professional with several years of experience within high-stress environments with a strong background within the medical/health insurance industry. Experienced in managing complex programs, assisting patient with insurance inquiries, developing strategies, and supervising cross-functional teams. Equipped with a significant level of communication and interpersonal abilities in addition to a strong background in effectively fostering positive relationships with co-workers, vendors, patients, and members of management.

• Direct a variety of administrative and operational functions within a fast-paced environment with a focus on overseeing both utilization management and case management tasks
• Supervise a cross-functional team which provides support to over 282,000 Anthem Medicaid members/providers in addition to handling escalated customer service situations
• Maintain a keen knowledge of industry regulations/best practices, create comprehensive reports, and develop streamlined organizational processes
• Achievements Include:
• Oversaw the roll-out of a program which more successfully manages disabled, blind, and elderly members
• Analyzed and improved out-of-network processes which resulted in greater cost efficiency and shorter turn-around time for claim related issues
• Played a lead role in the expansion of membership into other state regions along with the Foster Care Children within the City of Richmond
• Rolled-out several programs such as Medicaid and Medicare Demonstration program and the Quality Evaluation program

• Supervised a team of Nurse Care Manager and Certified Case Managers which required providing individualized feedback/coaching in addition to managing human resources functions
• Oversaw daily operations in both a traditional office and remote setting which required significant interpersonal and communication skills
• Achievements Include:
• Successfully reduced voluntary turnover by 48% in 2010 in addition to achieving an associate engagement score of 81% and a Manager Effectiveness Score of 87% (2010)
• Selected by executive management in order to represent an internal program which required creating presentations and performing both site and field visits
• Oversaw the URAC desk review and re-accreditation for the Richmond, VA office, led a telephony role out, and managed a scorecard redesign initiative

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• Facilitated several daily operations within the organization with a concentration on coaching and developing staff members, creating schedules, and improving employee engagement levels
• Played a lead role in the role-out of several new products, acted as a leader within several internal committees, and created annual competency testing for employees

• Utilized superior medical and administrative acumen in order to perform clinical patient assessments over the phone in addition to coaching patients on disease management
• Fostered positive relationships with participants, Physicians, and health plan representatives in addition to encouraging positive client relationships
• Acted as the Team Lead for a Motivational Interviewing Initiative, implemented streamlined standard operating procedures, and performed several peer interviews

• Coordinated several administrative functions within a high-stress environment which included overseeing the logistics of multiple complex research studies
• Ensured all studies complied with internal best practices and federal regulations in addition to maintaining a keen knowledge of HIPAA regulations and ICH guidelines
• Successfully advocated on behalf of patients, documented research study outcomes, and assisted patients with inquiries in person or via telephone

Additional Professional Experience Includes:

• Clinical Coordinator/Nurse Manager, CJW Medical Center, 2001-2002
• Registered Nurse, Riverside Regional Medical Center, 1999-2001