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Blue Cross Blue Shield Of Illinois - Senior Director Resume Example

Ctary Cwmaok
XXXX XX XXXXXXX XXXXX, Plainfield, IL 60586 XXXX XX XXXXXXX XXXXX, 60586, Plainfield IL | XXXXXXXXXXXXX | XXXXXXXXXXXXXXXXXXXX
Summary

Accomplished and energetic registered nurse with a solid history of achievement in clinical operations leadership including state and federal programs. Motivated leader with strong organizational and prioritization abilities. Areas of expertise include Dual Medicare-Medicaid Alignment, Integrated Care Programs and Family Health Plans.

Skills
  • Administration and Management
  • Critical Thinking
  • Active Listening
  • Speaking
  • Judgment and Decision Making
  • Complex Problem Solving
  • Social Perceptiveness
  • Management of Financial Resources
Experience
Senior Director 08/2011 to Current
Blue Cross Blue Shield of Illinois Chicago, IL
  • Responsible for directing, planning, and organizing the Clinical Operations programs.
  • Providing leadership in the management of the clinical areas; representing the department to internal personnel and external key stakeholders such as ACOs, Medical Homes, providers, regulatory bodies, members and customers.
  • Accountable for budgetary goals being met.
  • Responsible for custom group implementation and partnered with Vice President of Clinical Operations, external consultants, and internal stakeholders to oversee strategic planning.
  • Analyze and report statistical data for HEDIS/STARS.
  • Champion program success to meet and exceed standards awarded full accreditation for NCQA and URAC year over year.

Senior Manager- Clinical Operations

  • Responsible for providing direction and oversight to management teams when administering components of Medicare Medicaid Alignment Initiative and Integrated Care Programs(MMAI/ICP).
  • Analyze and report statistical data from care management programs in LTSS and Non-Waiver products.
  • Assess and make recommendations for program changes and enhancements to special, high risk groups to improve specific utilization issues and optimal application of the available healthcare dollars.
  • Represent BCBS with Community Based Partner for specific state Waiver and Non-Waiver members, which may require out of area travel. 
  • Developed training manual for community based partners to deliver MMAI/ICP CareCoordination.
Adjunct Clinical Instructor 01/2009 to 11/2012
Resurrection University Chicago, IL
  • Develop and led the nursing curriculum for the undergraduate Obstetrics and Gynecology clinical rotation and role transition class.
Senior Manager 01/2008 to 08/2011
United Health Insurance Lisle, IL
  • Clinical Operational lead with winning RFP for Oxford Health, State of New York Medicaid Maternity Program over 2 million lives.
  • Led a team of 183 maternity and infertility nurses and non-clinical team.
  • Identify potential for loss and develop strategies to eliminate it.
  • Develop and revised policies and procedures.
Clinical Nurse Team Leader 10/1999 to 01/2008
RUSH University Medical Center Chicago, IL
  • Led clinical operations team.
  • Served on the Magnet Task Force resulting in Magnet re-designation in 2006.
  • Served as a member of the Shared Governance Committee.
  • Developed and revised policies and procedures.
Affiliations

American Nursing Association (ANA),  2000- Present

  • Fostering high standards of nursing practice by lobbying the Congress and regulatory agencies on health care issues affecting nurses and the public.

Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN), 2005-Present

  • Improve and promote the health of women and newborns through advocacy, research, and education
Education
Masters of Science- Nursing Administration May 2009 West Suburban College-Nursing - Oak Park , IL
Bachelors of Science in Nursing Dec 2000 Lewis University - Romeoville , IL
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Resume Details

This is a real resume for a Senior Director in Plainfield, Illinois with experience working for such companies as Blue Cross Blue Shield Of Illinois, Resurrection University, United Health Insurance. This is one of the hundreds of Senior Director resumes available on our site for free. Use these resumes as templates to get help creating the best Senior Director resume.

Previous Companies:

  • Blue Cross Blue Shield of Illinois
  • Resurrection University
  • United Health Insurance

Previous Job Positions:

  • Senior Director
  • Adjunct Clinical Instructor
  • Senior Manager

Schools:

  • West Suburban College-Nursing
  • Lewis University

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