Healthcare Payer Project Manager, PMP

Industry: Health Care, Healthcare/Managed Care, IT, IT - Software | Type: Contract | Location: Remote

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Summary:

With over twenty years of experience in leading complex IT projects and programs in the healthcare industry, I am a Sr Project Manager/Director at Elevance health who also leads a team of Project Managers. My team and I are responsible for delivering high-quality solutions for claims, encounters, eligibility, accumulators, and provider data, following Agile and Waterfall methodologies, and ensuring effective communication with internal and external stakeholders.

I have a proven track record of bringing order and structure to business initiatives, leveraging analytical, data-driven thinking, and collaborating with cross-functional teams in a matrixed environment. I have a PMP certification and expertise in SDLC, Agile, and Waterfall methodologies, as well as various tools such as MS Office, MS Teams, MS Project, Jira, and Service NOW. I am passionate about solving today's healthcare needs and delivering value to customers.

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Certifications:

• Project Management Institute
  • Project Management Professional (PMP)
• Company Operational Leadership Academy
  • Leadership Development
  • Successful Negotiating Techniques
  • Agile Project Management Methodology
  • Six Sigma Training Cert 2

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Technical Skills:

• Influencing 
• Change Management 
• MS Office Skills 
• SDLC
  • Waterfall
  • Agile
  •  o Hybrid
• Negotiating 
• Project Execution 
• MS Teams 
• Analytical thinking 
• Team Leadership 
• MS Project 
• Managed Care 
• SLA Management 
• Service Now 
• Medicaid/Medicare 
• Risks Management 
• ITSM/ITIL 
• Infrastructure
• Healthplan Operations 
  • Claims/Encounters
  • Membership
  • Clinical/Provider
  • Benefits  
• Issue Management 
• Six Sigma Training 
• Business Process
• Resource Management
• IT Security
• Communication Skills
• Diplomacy/Discretion 
• Jira
• KPI Management
• HEDIS 
• M&A Due Diligence
• Vendor Procurement
• Vendor Management
• EDW

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Experience:

2022 Present  Health Payer
Sr Project Manager / Program Manager

Sr Project Manager (PMO)

• Transferred into Elevances Carelon PMO following the acquisition of Beacon Health Options (BHO) with the mandate of integrating a large portfolio of concurrent active projects into the Carelon PMO standards
• Managed multiple integrated cross-functional workstreams.Managed these projects from ideation, through requirements gathering, design, build/test, into production, and through the warranty period.
  • Produced project initiation documentation (estimates, SOWs, Project Charters, etc)
  • Projects followed Agile, Waterfall and Hybrid methodologies
• Strong communicator with client leadership, business leadership, program stakeholders and project team members
  • Maintained transparent communication channels
  • Fostered a collaborative and supportive work environment by building positive relationships
• Collaborated with client and business stakeholders defining functionality and specifying requirements for new IT initiatives
• Managed stakeholder relationships to assure successful delivery of solutions, and to assure effective solution adoption
• Managed project risks, actions, issues, decisions and changes throughout the life of the projects
  • Escalated risks and issues appropriately to client and business leadership
• Manage scope, budget, and timelines across multiple projects
• Performed financial reviews for capital projects ensuring ongoing budget tracking
• Integrated legacy BHO portfolio into the Service Now platform
• Resource Manager of Project Management team including guiding, mentoring, and evaluating team performance
• Assured efficient allocation of resources and project staffing

Sr Program Manager (IT Service Delivery)

• Hired with a mandate to increase transparency of IT Service Delivery to the BHO business constituents
• Managed the Project Intake and Prioritization process taking work from initial demand, ideation, prioritization, grooming, and scheduling.
• Served as a Sr Project Manager, who also led a team of Project Managers, supporting a portfolio of multiple, concurrent cross-functional projects
  • Projects followed Agile, Waterfall and hybrid methodologies
  • Acted as a Scrum Master during the pilot of Agile methodology
• Facilitated many requirements gathering sessions
• Oversaw the Release Management function
• Developed and maintained relationships with both internal and external constituents to assure that all priority projects were advanced to successful operational state
• Developed an IT Intake and Prioritization process
• Conducted business process improvement sessions for establishing standard SDLC processes and artifacts
• Defined project management practices to be followed by all projects within my control
  • Collaborated with stakeholders at all levels to ensure alignment with program objectives and strategies by creating a forum for two-way communication between business owners and IT leadership. This forum provided a means for communicating business priorities and resolving roadblocks
• Established a team to drive effective IT Intake, to oversee IT Project delivery, to manage IT Releases and to coordinate IT warranties. Among other functions, this team acted as the PMO for Elevances Behavioral Health SBU
• Led systems development projects, spanning from ideation, through the build/test phases, testing, implementation and warranty period support
• Resource Manager of IT Delivery team including guiding, mentoring, and evaluating team performance
• Assured efficient allocation of resources and project staffing

May 2015 Mar 2019  Healthcare Payer
Manager of Strategic Relations, Senior Capability Manager, and Senior Project Manager

Manager of Strategic Relations

• Transferred into wholecare health with a mandate to liaison between Companys Product Health Plan and their strategic partners.
• Product Health Plan was a 51% provider-owned MCO in Arkansas following a Value Based Care model
• Participated in the gathering of Social Determinates of Health
• Product Health Plan Membership consisted of Dual Eligible Special Needs (D-SNP) members who have both Medicaid and Medicare eligibility
• Conducted data analysis to quantify member impact for continuously improvements
• Managed the Readiness Reviews with both CMS and Arkansas DHS agencies
• Acted as a liaison between Arkansas DHS, CMS, Company and Product Health Plan
• Assured that regulatory/compliance needs were addressed by conducting a gap analysis of existing Standard Operating Procedure (SOP) documents, and creating/altering SOP documents that were missing or deficient
• Provided strategic program leadership for executing a comprehensive, complex roadmap required for driving innovation and transformative change
• Managed the Administrative Services Agreement (ASA) between Company and Product Health Plan assuring that all core system functions and back-office operations activities needed by Product Health Plan were being addressed. This included management of HEDIS measures.
• Primary liaison between Product Health Plan and Company Medicaid implementation team
• Conducted business process improvement exercises for customizing operational business unit processes
• Business owner of many core system capabilities
• Performed ad hoc population health and value-based care analysis
• Assured that compliance needs were addressed by conducting a gap analysis of existing Standard Operating Procedure (SOP) documents, and creating/altering SOP documents that were missing or deficient
• Managed the interface with the MITA Framework Health Information Exchange (HIE) so that better informed patient care decisions could be made by the ForeveCare Care Coordinators

Senior Project Manager

• Transferred into Companys IT PMO with a mandate to be the liaison between Company Health Services and Company EDW to assure that all EDW Medicaid capabilities identified for expanding Medicaid footprint of Company were seamlessly integrated into their existing EDW platform
• Led the migration efforts for HMHS clients from their legacy platforms to the Inovalon HEDIS platform
• Performed Sr Project Manager functions for multiple, concurrent cross-functional projects following Agile methodology
• Acted as a backup Scrum Master for several teams
• Once in production, oversaw the first production of HEDIS measures for Clients
• Facilitated many requirements gathering sessions
• Developed project vision statements
• Built timelines and developed detailed project plans (WBS), prepare meeting minutes/agendas, tracked all project activity to completion, and regularly report status of project to varying levels of stakeholders

Senior Project Manager

• Hired into Companys Business PMO to lead the efforts of over 100 Business and Technical resources in the build of the annual ACA Product for the Individual and Small Group markets for both the Federal Market Place and Off- Exchange population
• • Managed the offering of these products through the MITA Framework Health Insurance Exchange (HIX)
• • This program-level effort involved overseeing several projects in both the IT and Business arenas
• • Worked closely with the IS Finance and the Program Management teams on monthly finance reporting

September 2011 April 2015  Healthcare IT
Healthcare IT Consultant

• Contracted with a mandate to lead Business and IT leadership in establishing a Data Release Management platform so that controls around releases of PHI data can be centralized, standardized and consistently managed
• Conducted a PHI Data Breach Assessment of all recent PHI Releases
• Established PHI Data Release Roles & Responsibilities
• Developed and conducted a training program that socialized PHI data release sensitivity across the enterprise
• Conducted business process improvement sessions for documenting current and revised PHI Data Release business processes
• Facilitated many requirements gathering sessions
• Developed & Implementation a PHI Data Release Certification program
• Created a standardized "Chain of Custody" procedure
• Contracted with a mandate to work with Business and IT leadership in defining Data Integration team consolidation strategy
• Led the tactical efforts in building and implementing the consolidated Data Integration team
• Consulted on Data Integration Team insourcing strategy
• Consulted in the design of Roles and Responsibilities for all Data Integration team members
• Selected and presented appropriate team members for client approval

October 2007 August 2011  Healthcare Payer
Practice Manager

• Implemented a Professional Services approach for delivery of Architecture services
• Led the Operations Group Consolidation Program
• Conducted Process Improvement efforts to consolidate various independent IT Operations groups into one integrated group
• Integrated Business Intelligence support into the Analytics groups service offerings supporting Business Objects, Cognos and MicroStrategy
• Led the HP Superdome retirement program
• Participated in the design of the Data Release Governance (DRG) program which dictated the security parameters and associated required documentation for all releases of protected data
• Led the implementation of the Cyber Security & Control program which enforced the DRG requirements
• Was a part of the team that established a PMO for the Data Security & Governance team

September 2001 October 2007 Healthcare
Director, BI/DW Consulting

• Involved in every major Facets implementation supporting the DW/BI, Reporting, Analytics, and extracts needs of those clients, assuring that those solutions were delivered was of high quality, on time and on budget
• Led the development of a Facets centric Data Warehousing accelerator which was a star schema following Ralph Kimballs methodology
• Led multiple consulting teams through numerous client engagements related to:
• Establishing the Healthcare Analytics platform and architecture
• Facilitating requirements gathering
• Managed Care Reporting
• HEDIS
• Packaged Data Warehouse Implementations
• Data Mart Design and deployment
• Accelerator toolkit development to jumpstart implementations
• Responsible for the profitability of all BI/DW Professional Services contracts

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Education:

Point Park University, Pittsburgh PA, Bachelor of Science, Computer Science - Graduated Cum Laude

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