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Network Power<100 people
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IT
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C-level Executive
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SoCal OC PM Consultants LLCOwner
Feb. 2024Remote
JETT Business TechnologySr. IT Project Manager
Feb. 2024Remote
Apex SystemsSenior IT Project Manager
Jul. 2022 - Feb. 2024El Segundo, California, United States · RemoteAssigned to client Optum, serve as project lead in implementation, maintenance, and continual enhancement of two platforms—Market Consolidated Contracting and Market Consolidated Credentialing—across PacWest region sites. Manage comprehensive project roadmaps and plans. Schedule and lead project meetings; present weekly status reports and presentations; and carefully document project notes in MS Teams for stakeholder review. **Central contact in meeting with cross-functional teams across California, Oregon, and Washington to gather, analyze, and manage requirements. Developed future-state designs and solutions for two agile projects supporting Capitation Revenue and CIRC. **Hand-picked to oversee enhancements to Apollo contracting and credentialing system while also managing introduction of new platforms. **Skillfully negotiated with business teams and IT developers to set realistic projects timelines. Aligned all stakeholders around shared end goals. Presented project charter and secured buy-in from senior management.
ConduentProject Management Consultant
Feb. 2020 - Jun. 2022Albuquerque, New Mexico, United States (Remote) · RemoteLead high-visibility, reengineering projects from inception through launch, addressing barriers, issues, and roadblocks encountered throughout project lifecycles. Identify critical project priorities and milestones; and allocating cross-functional resources appropriately to maximize results. Set, monitor, and report on project metrics. Fulfill multiple roles as needed, including business analyst and data analyst, to advance project goals.
** Re-baselined project schedule that aligned five different schedules into one master schedule. Aligned internal and sub-contractor teams around each project’s scope, goals, roadmaps, and timelines; defining the critical path; developing and managing detailed project schedules; and delivering weekly status updates to the client. ** Demonstrated critical thinking and keen problem solving in managing competing project schedules, including: Implementation of Call Center migration from Conduent to Accenture (2020); key contributor on EVV Phase 2 FFS 835/837 development (go live 4/21/22); and Palco Implementation (scheduled for a 5/21 go live).
Sysazzle, Inc.Senior Project Manager
Oct. 2018 - Feb. 2020Remote · RemoteAs a Sysazzle employee assigned to client Conduent, managed or assisted with key system implementations. Served as first contact point for new project initiatives for the state of New Mexico, with responsibility for engaging with and presenting to clients, gathering requirements, mapping project timelines, and maintaining project documentation. ** Managed final phase of Western Sky system implementation (2019); initial release of Centennial Care 2.0 (2019) as addition of Service Category Limit function; and implementation of the NADAC Pharmacy project (2019). ** Created and documented company’s first official client onboarding process.
** Participated in deal reviews for Electronic Visit Verification and Service Category Limit functionalities.
Molina HealthcareSenior Program Manager
Nov. 2017 - Oct. 2018Long Beach, California · On-siteProgressed through a series of leadership roles overseeing key technology implementations. Managed Claims & Benefit configuration of business-critical Mississippi Implementation. Led Development Team in requirements analysis, project mapping, resourcing, development, testing, implementation, and ongoing support. Served as escalation point in removing barriers to progress.
**As Scrum Master, delivered the following functionalities to enable seamless system enhancement and implementation: Inbound Claims Validation, Inbound Claims EDI, Inbound Claims Paper to Electronic, Claims Editor - Provider/ Member Match, WebStrat, Claims Adjustment/ Recoveries, Claims Workflow, Provider Payment, Claims Auditing, Inbound Encounters, Outbound Encounters, Encounter Applications, Claims Viewer, 835 Outbound File, State Contractual Reports, Operational Data Store, Enterprise Reporting Repository, Data Mart, Interest Utility, Third Party Liability, Cotiviti, Explanation of Payment/ Remittance Advice Extracts, Claims Utility Reports, Outbound Encounters Management Systems, and Explanation of Benefits.
Molina HealthcareProgram Director
Feb. 2017 - Oct. 2017Long Beach, California · On-siteDirecting organization’s transition from paper-based to electronic claim billing, set to go live on July. Produce and publish on SharePoint weekly status reports for all health plans. Direct master project plan to meet critical commit dates, and orchestrate individual provider updates in line with overall schedule. Key Achievements:
~ Developed protocol for rejecting paper-based claims as well as a process for redelivering misdirected claims via electronic fund transfer (EFT). Wrote business case and future state documents for latter initiative. ~ Produced a learning slide deck for providers, as well as an FAQ document and training materials. ~ Successfully led New Mexico Joint Application Development (JAD) session, pulling in all New Mexico corporate operations teams to strategize and develop a comprehensive work plan.
Molina HealthcareSenior Project Manager
Jul. 2016 - Jan. 2017Long Beach, California · On-siteLed Core Operations through all phases of successful Centers for Medicare and Medicaid Services (CMS) Audit, serving as chief liaison between Molina and CVS in organizing audit logistics. Managed audit preparation, implementation, action item identification and write-up, and follow up. Key Achievements:
~ Led teams in addressing key improvement areas identified including new process to manage IT tickets and the update and centralization of executive documents. ~ Planned and facilitated a 3-day audit summit during which was focused on developing team goals.
Alignment HealthcarePharmacy Project Manager/ Business Analyst
Oct. 2015 - Jul. 2016Orange County, California Area · On-siteDefine and document business requirements and direct full life cycle of complex projects, processes, and initiatives; collaborate with IT team and key stakeholders for efficient, on-time delivery. Track and report data and communicate needs to senior leadership; identify potential areas for improvement and recommend creative, targeted solutions. Analyze complex data sets; create charts, graphs, and spreadsheets to compose reports spanning trend analysis, project delivery, and outputs/solutions. Key Achievements:
~ Thrived in dual-focus role of Project Manager and Business Analyst, requiring flexibility, subject matter expertise, and proactive thinking.
~ Created Visio process flows to support interaction between Prime Therapeutics and Alignment Healthcare, which identified gaps in coverage and supported day-to-day operations through additional functionality.
~ Managed implementation of Clinical Support Services and Prime Therapeutics within first two months of hire, involving an enrollment file setup and a new automated claims history to process outbound files.
~ Enhanced organization's CMS STARS rating by facilitating and implementing a process designed to increase medication adherence.
Molina HealthcareProject Manager II
Feb. 2015 - Oct. 2015Long Beach, CA · On-sitePromoted to Senior Project Manager role with responsibility for managing large programs comprised of multiple, complex sub-projects. Plan, implement, and oversee execution of action items to meet project goals. Communicate with stakeholders in individual, group, and conference meetings; lead and manage meetings. Develop and implement Summary of Procedures (SOPs) and Policy and Procedures (P&Ps); create process flows with MS Visio and track, monitor, and report on project progress. Mentor and inspire teams to move projects to full completion; enact critical decisions and assume Subject Matter Expert (SME) role to identify, remedy, and resolve barriers with projects.
Key Achievements:
Creating process flows to support sub projects in Medicare-Medicaid Plan (MMP) program to include Enrollment, In Home Support and Services (IHSS), Long Term Care (LTC), Share Of Cost (SOC), Care Plan Options, Multipurpose Senior Service Program (MSSP), and Los Angeles (LA) County Data Exchange.
~ Managed several projects slated for completion including: * SPD Risk Stratification; Inbound Encounters; San Bernardino (SB) County Department of Mental Health (DMH) Data Exchange; and Coordination of Benefits Agreement (COBA).
~ Assumed leadership of Delegation Oversight Project; rewrote requirements and communicated with teams to enhance IT estimation. ~ Spearhead Claims Special Operations Clean Up and Health Essentials Implementation; held instrumental role in cleaning up backlog, establishing benchmarks, and overseeing project team. ~ Managed multiple previous projects to achieve on-time, on-budget, successful launches including: * Enrollment Set Up; IHSS Implementation; LTC Implementation; SOC IT Configuration; Outbound Encounters; and Care Plan Options Implementations. * MSSP Implementation; Claims History Data Sharing; LA County DMH Data Exchange; Riverside DMH Data Exchange; HealthNet Delegation Outbound; and Rate Code Configuration.
Molina HealthcareProject Manager I
Oct. 2013 - Jan. 2015Long Beach, CA · On-siteDirected and served as business analyst on assigned projects; assigned, supervised, and monitored up to 5 team members tasked with completing projects. Supported and empowered team members and ensured proper task execution; ensured productive interteam communication. Supported other projects as the business analyst, communicating with business teams within California health plan, corporate, and independent physician association (IPA). Monitored deliverables, ensuring compliance with timeline; organized and facilitated meetings. Designed and implemented efficient workflows. Key Achievements:
~ Successfully balanced dual role of project manager and business analyst, providing excellent contributions in both.
~ Created process flows for Medicaid Long-Term Services and Supports (LTSS) and the Contract Configuration Request (CCR) process. Developed smooth, efficient workflows contributing to project goals.
~ Managed California marketplace and deployed / managed California Appeals and Grievance database.
~ Recognized for adjusting well to multiple position demands, follow-through, and dedication.
Molina HealthcareBusiness Analyst II
Apr. 2013 - Oct. 2013Long Beach, CA · On-siteLiaised among all stakeholders, including IT, health plan, and business teams, to understand the organization's structure, policies and operation; evaluated and analyzed processes and recommended solutions to improve operations and support achievement of goals. Prepared requirements for business application and projects, including business requirement documents (BRD). Designed and developed business processes and documentation; created test scenarios and addressed defects as necessary. Key Achievements:
~ Selected to provide project management support as needed, overseeing sub-teams and/or project components and expanding scope of skills and knowledge.
~ Provided leadership and support in completing California Duals Readiness Review as well as documenting SB208 requirements.
~ Developed document outlining Continuity of Care workflow and crafted test matrix for 834 Enrollment File project.
OptumRxAssociate Project Manager
Jun. 2009 - Mar. 2013Irvine, CAAssigned to claims operations department, focusing on Fresh Start Migration project to migrate all UHC business from Medco to OptumRx. Drafted business decision documents, supervised subject-matter experts (SMEs), interfaced with IT, and led in development of processes and contingency plans. Coordinated client management requests, interacted with accounts to identify needs, clarified requirements, and communicated across departments and functions to meet client goals; resolved escalated issues. Oversaw Consumer Account Card and HRA projects. Key Achievements:
~ Partnered with business team to produce conceptual design to migrate into SalesForce software.
~ Coordinated implementations for several key clients as well as coordinating integration and testing with vendors and IT.
~ Defined communication process and drafted SOP to standardize approach for all new client requests.
~ Leveraged extensive customer service and client management expertise to augment project manager role and ensure seamless project flow.
~ Achieved 50% reduction in time required to plan, develop, implement, and deploy Part D plan for key client.
~ Led team that created process for client benefit testing team, including SharePoint set-up, project plan, process creation, and SOPs.
~ Authored step-by-step manual on implementing external Part D clients to ensure seamless, efficient process for future client implementations. ~ Leveraged account management expertise to effectively manage client relations along with project management requirements.
OptumRxSenior Client Relations Manager / Associate Account Manager
Jan. 2008 - Jun. 2009Irvine, CAInteracted frequently with key clients, conducting meetings and communicating individually to address issues ranging from eligibility, claims and billing to member issues; tracked issues. Planned and executed special projects. Partnered with clients to pinpoint improvement areas. Coordinated benefit fairs. Supported sales department via presentations; trained and coached new hires. Conducted detailed research and developed reports. Crafted member materials. ~ Rescued unhappy client and secured contract renewal through effective relationship management and problem solving.
~ Developed initial job descriptions for three levels of client relationship managers.
~ Created for all drugs a log that allows clinical pharmacists to easily and accurately review plan-specific drugs and associated edits.
OptumRxClient Relations Manager I/II
Dec. 2005 - Dec. 2007Irvine, CAServed as client liaison, addressing and resolving all questions, problems, and issues. Coordinated and interacted across internal teams to resolve client issues and ensure smooth results. Tracked, monitored, and reported on project status, claims research, and specific client questions. Delivered client presentations and supported client retention efforts.
Key Achievements:
~ Oversaw development and implementation of new plans from concept through deployment.
~ Provided detailed hands-on support for high-risk client, cementing and growing relationship.
OptumRxAssociate Customer Service Pharmacy II
Sep. 2004 - Dec. 2005Costa Mesa, CACommunicated daily with customers to process new information, provide responses to inquiries, initiate prescription refills, provide quotes, and deliver customer support. Researched questions and collaborated with pharmacists to address problems.
PanasonicLogistics Clerk
Mar. 2001 - Nov. 2002Cypress, CA · On-siteOversee customer billing and preparation of loans for the Sales Department. Address and resolve customer service issues, answer questions and track product shipments. Process return authorization for damaged products and make associated inventory adjustments in Delta system. Schedule incoming shipments of international/domestic containers, relay orders to warehouse supervisor and manage distribution of product from warehouse facility. Monitor and replenish office supply inventory and ensure office is well maintained and functional to achieve daily business objectives.
Ocean Technology SystemsWarehouse Worker
Dec. 2000 - Feb. 2001Orange County, California Area · On-siteMaintain efficiency and orderliness of warehouse operations; enter new shipments of parts/products onto computer system and place into appropriate bins. Fulfill requests for parts and replace unused items back into stock. Monitor bin levels by performing frequent physical stock counts and create lists of obsolete parts using Excel. Complete various other duties as needed such as light assembly and freight packaging.
BoeingCrater, Packer, and Preserver
Jun. 1997 - Jan. 2000Huntington Beach, CA · On-siteDesigned and constructed special storage/shipping containers for parts, assemblies, and materials being shipped to military and commercial sectors. Obtained exact dimensions of items to be shipped from blueprints and measurements, calculated length/width and cutting angles of crating materials, then determined method and sequence of operations to build and assemble shipment containers/fixtures. Reviewed paperwork to verified accuracy of part numbers and item counts prior to crating/packing. Loaded and secured shipments on trucks/rail cars, ensured proper reinforcement and packing procedures to prevent damage. Prepared individual parts/assemblies for shipment by applying protective coatings and special wrapping materials to protect items from corrosion, moisture, and friction damage. Reconciled order documents to shipment items and notified inspector of any clerical discrepancies found. Enclosed packing lists/invoices, then sealed and labeled packages with special handling instructions and shipping information.
Roadway Packaging Systems (RPS)Package Handler
Nov. 1996 - May. 1997Orange County, California Area · On-siteSorted packages by street address and loaded them onto trucks/vans for local delivery. Assisted drivers with package counts and delivery documentation. ~ Received Employee of the Month Award
UPSLoader
Jul. 1995 - Jun. 1997Anaheim, CA · On-siteExpedited delivery of priority shipments to their correct destinations by rapidly sorting packages from conveyor belt according to state/zip code information. Verified and corrected any address inaccuracies. Strategically and securely loaded packages onto 25-45 foot trailers in order to maximize space and prevent damage during transit. Regulated and performed special handling of packages containing hazardous materials, inspected for leaks/damage, and notified hazardous crew when necessary. Monitored compliance with all safety regulations, assisted department manager with time cards, employee supervision and training.
~ Earned Employee of the Quarter two times for safety and dedication.
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