Director of Academic...Ardmore, Pennsylvania
Dedicated professional with background in social service, health care, and education fields. Experienced in management,
Excellent interpersonal and communication skills.
Managed team of 32 Dedicated Service Managers in place of Team Manager on extended leave of absence. Performed all job functions related to manager position, including communication and enforcement of corporate policies, handling of escalated customer issues, assistance to employees with daily job functions, and human resource issues.
Selected to serve in pilot program of 20-employee self-directed team granted full responsibility for resolving all issues related to needs of members and providers in Bergen County, NJ. Managed all relations with 3500 plan members and 21 private practice physicians. Researched and resolved issues involving complex medical claims. Investigated medical histories interacting with patients, providers, and medical facilities regarding billing and payment issues. Provided benefit and eligibility information. Coordinated medical care to provide optimal quality patient care in accordance with Oxford Health Plans' specific benefits, policies, and procedures within a cost-effective environment. Served as Mentor to 32 coworkers, providing ongoing training and assistance with complex issues. Represented department in company-wide marketing effort, conducting presentations to insurance brokers, corporate benefits administrators, and physicians. Served on corporate review board to develop medical terminology program used in corporate training program.
Provided service to members and health care providers related to utilization management programs through responding to telephone inquiries. Precertified elective and emergent inpatient admissions, emergency, and selected outpatient services according to policy and procedure. Acted as a resource to other departments on Medical Management policies. Assessed clinical information to identify and refer members to appropriate case management programs.
Coordinated and supervised homecare services provided to a caseload of approximately 100 patients. Scheduled and supervised a field staff of approximately 250 Certified Home Health Aides. Managed select caseload of services contracted by area Visiting Nurse Associations and managed care patients. Processed payroll and billing.
Coordinated all skilled and unskilled services provided to a diverse caseload of homecare patients. Scheduled and supervised a field staff of approximately 120 caregivers, including CHHAs, LPNs, RNs, and PTs. Acted as a liaison between patients and employees. Interviewed, hired, and oriented all field employees. Processed employee payroll and participated in billing process. Participated in sales and marketing by providing program education to potential clients and referral sources.
Coordinated and managed services provided to a caseload of homecare clients. Handled all incoming service inquiries regarding home care needs. Provided referrals to other community resources. Functioned as liaison between clients, families, and employees. Scheduled, supervised, and evaluated approximately 300 field employees providing care to clients, including RNs, LPNs, and Home Health Aides. Interviewed, hired, oriented, and initiated salary increments and terminations for field employees. Provided supervision to on-call supervisor. Processed employee payroll.
Performed comprehensive social service assessments, developed and monitored service plans, and arranged for services for homebound elderly through the Philadelphia Corporation for Aging. Facilitated the development of informal resources, provided counseling around adjustment issues associated with aging, and provided support to families. Maintained caseload of approximately 85 clients.
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Director of Academic...Ardmore, Pennsylvania
Companies Worked For:American Reading Company, Oxford Health Plans, Pat...
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