Career Goal: Secure a position within the HealthCare delivery system where my experiences and skills are aligned with strategic goals of the organization.
Summary Skills Profile
Established career in managed care industry.
Network Development for New Program/Initiatives and Lines of Business, most recently Managed Long Term Care in NYS.
Extensive Credentialing experience with all facets of programs for both Managed Care ( NCQA/URAC) and Medical Staff ( JC)
Experienced in staff management with successful coaching and mentoring results.
Comprehensive knowledge of regulatory standards and compliance requirements.
Confident self-starter with high work ethic and complete dedication toward achievement of goals and objectives.
Works well under pressure consistently meeting or exceeding goals
Professional History
HealthFirst
New York, NY
Assistant Director Ancillary Services April 2013 to present
Key Position Responsibilities:
Policy and Procedure Development for Managed Long Term Care Product
Network Development to meet regulatory standards for line of business
St. Luke’s Cornwall Hospital
Newburgh, NY
Physician Business Systems Manager Feb. 2012 to April 2013
Key Position Responsibilities:
Policy and Procedure Development for Multispecialty Physician Group
Practice Management oversight to include Revenue Cycle Management and Systems Development
Managed Care Activities: Quality Incentive Program design for group, Credentialing and Plan Enrollment Activities
Montefiore Medical Center/CMO, the Care Management Company, LLC
Bronx, New York
Director, Credentials Department October 2004 to September 2011
Key Position Responsibilities: Full management of Credentials program for managed care and medical staff for major medical center, over 4500 providers and vendors
Main Accomplishments:
Consistently maintained full Joint Commission and SNYDOH compliance
Restructured credentials program to correct compliance deficiencies. Process improvement and staff re-design resulted in full compliance to all regulatory bodies (The Joint Commission, NCQA, CMS, DOH and all delegated health plan contracts)
Implemented new credentials software system (Health line Systems Echo Web) based on electronic workflows allowing for increased efficiencies
Re-designed all forms, application materials in addition to developing Policy and Procedure Manuals and Joint Commission Periodic Performance Review (PPR)
Designed staff training and education program for managers, credentialing processing teams.
NYU Medical Center/ University Physicians Network (UPN)
New York, NY
Director, Credentialing, Database and Network Management 1998 to 2004
Key Position Responsibilities: Full management of IPA Provider Network Management and Credentialing Program
Main Accomplishments:
Developed and implemented credentials program for managed service organization and Physician IPA to meet contractual requirements for full risk and messenger model health plan contracts. . Process improvement and staff re-design resulted in full compliance to all regulatory bodies (NCQA, URAC, CMS, DOH and all delegated health plan contracts)
Developed and implemented electronic credentials software system (FileMaker Pro) to allow for increased efficienc...
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