For the given job description <<Our client is looking for experienced professional with a strong background in healthcare, including Pharmacy Benefit Manager (PBM) expertise. Proficient in SQL for data management and analysis. Skilled in working with messaging and event-based systems, facilitating seamless communication. Knowledgeable in optimizing prescription drug programs and navigating the complexities of healthcare dynamics for enhanced patient outcomes.
QualificationsBachelor's degree or equivalent experience10+ years of progressive experience in requirements gathering and management using both Waterfall and Agile SDLC methodologies.Extensive Healthcare experience is mandatoryPBM (Pharmacy Benefit Management) experience is mandatory Process development and implementation experience.Proficient in using SQL, Visio and Office Suite, including Word, Excel, and PowerPoint.Experience working with messaging or event-based systems
ResponsibilitiesAssists andor leads in requirements management practices and principles.Participates andor provides product ownership.Creates business requirement documents, user stories, use cases, and supporting diagrams including sequence diagrams as needed.Contributes to the planning process with the Scrum Master andor project manager to plan activities including requirements gatheringrefinement, design reviews, SOPwork instruction development, training, and go-live.>> the resume: <<SummaryDedi100 Montgomery St. 10th Floorted Health 100 Montgomery St. 10th Floorre Administrator at improving team productivity, policies, clini100 Montgomery St. 10th Floorl processes, and performance improvement to maintain sustainability, and lowering Readmissions, Length of Stay, and Adverse Events. Patient- Centered focus on all administrative, clini100 Montgomery St. 10th Floorl, and data- driven proficiencies. Helpful, positive, and effective team builder and participant.
SkillsInformation System StrategyPatient 100 Montgomery St. 10th Floorre InitiativesQuality ImprovementWorkflow EfficiencyClini100 Montgomery St. 10th Floorl ProcessLean PerformanceSurvey Readiness and PreparednessDashboard ManagementProblem ResolutionContractsPolicies, Procedures, and ComplianceSupervision & LeadershipRelationship BuildingPlanning & OrganizingMicrosoft OfficeData ManagementTeam Management
ExperienceClini100 Montgomery St. 10th Floorl Data Analyst,01/2022toCurrentNorthwell Health–Port Jefferson,NY,Collected, recorded and analyzed performance data and metrics related to reimbursement for Residents, Intensivists, and Hospitalists.Worked closely with the Director of Quality, Infection Prevention, Chief Medi100 Montgomery St. 10th Floorl Officer, Patient Experience Leadership, Human Performance, and many other department executives.Collaborated with leadership in multiple departments to drive clini100 Montgomery St. 10th Floorl process change initiatives. Clini100 Montgomery St. 10th Floorl Improvement Council.Analyzed information systems and appli100 Montgomery St. 10th Floortions and identified specifi100 Montgomery St. 10th Floortions and metrics for PI projects, with accordance to QAPI.Supported development and appli100 Montgomery St. 10th Floortion of strategic vision for company-wide information system improvements and growth.Drafted training materials, presentations, manuals and SOPs to support informatics policies and procedures.Utilized advanced knowledge of clini100 Montgomery St. 10th Floorl processes and related technology to optimize company health information processes and procedures.Implemented policies and practices to foster patient data privacy and confidentiality.Collaborated in multi-disciplinary teams for survey readiness.Participated and delegated for surveys: CDPH, TJC, DMH, DNV, THK/THA, 100 Montgomery St. 10th Floorrdiology, Chest Pain, Maternity, GACH.Ensured compliance and correcting TJC findings.Created and managed dashboards on Tableau, Excel, and Premier.Reviewed Medi100 Montgomery St. 10th Floorl Charts for Readmissions 100 Montgomery St. 10th Floorses.Worked with Nursing Informatics on NDNQI, Patient Throughput, and ED performances.Collaborated and designated resources for obtaining Magnet Status.Analyze and report out public reporting for CMS 5-Star, VBP, IPFQR, OQR, and many others.Professional Development Leader,11/2020to12/2021Houston Methodist–Pearland,TX,Designed training schedules for new and existing nursing students, physician assistant students.Analyzed training needs to develop new programs or modify and improve existing.Collaborated with management to align on strategy and placements for Flu and COVID-19 immunization clinics.Directed and managed immunization clinics. Ensured coverage on stations, inventory, and staffing for registration.Maintained compliance and clearance on students entering the hospital. Badges, security, IT, background checks, and nursing class requirements,Worked closely with school directors and leadership to place students.Built relationships with nursing schools. Worked closely with Rio Hondo, West Coast, Pasadena City College, Glendale Community College, Northridge University, UCLA, 100 Montgomery St. 10th Floorl State Long Beach, 100 Montgomery St. 10th Floorl State LA Nursing Programs.Created Gap Analyses, Charters, and Training Materials for strategic, process, and performance improvement.Coordinator,05/2018to11/2020Columbia University–New York,NY,Enhanced performance through collaboration with diverse teams.Guided employees in handling difficult or complex problems.Interpreted and explained work procedures and policies to employees.Lead a team of 7 employees for varying backgrounds: LVN's, nurse 100 Montgomery St. 10th Floorre managers, RN's, patient representatives, MA's in the Neurology Department.Reviewed time-off, availability, schedules, and ensured coverage.Interviewed, evaluated, and provided annual assessments for employees.Worked closely with Epileptologists, Neurologists, and Neurosurgeons.Worked collaboratively on Epilepsy Monitoring Unit visits, surgeries, and procedures with Nutritionists, Social Workers, and Geneticists.Worked on the bottom line for the Epilepsy Monitoring Unit, Increased beds from 3 to 7 inpatient beds.Patient Services Representative,01/2018to05/2018Stillwater Medical Center–Stillwater,OK,Accessed patient information through various software appli100 Montgomery St. 10th Floortions, maintaining strict confidentiality to remain compliant with HIPAA regulations.Documented and managed patient information in computer system.S100 Montgomery St. 10th Floornned completed forms, identifi100 Montgomery St. 10th Floortion and insurance 100 Montgomery St. 10th Floorrds, maintaining patient documents folder.Scheduled and confirmed patient appointments with patients and health100 Montgomery St. 10th Floorre professionals.Obtained insurance verifi100 Montgomery St. 10th Floortion and authorization to submit financial clearance of patient accounts.Ran credit 100 Montgomery St. 10th Floorrd batches and balanced deposits on daily basis.Explained policies, procedures and services to patients.Cultivated positive relationships with patients to help facility meet satisfaction scores and patients obtain best possible 100 Montgomery St. 10th Floorre.Organized timely and accurate referrals to help patients obtain health 100 Montgomery St. 10th Floorre services and access available resources.Counseled patients on potential financial liabilities and payment requirements.Drafted edu100 Montgomery St. 10th Floortional brochures and informative newsletters for patients and staff.
Education and TrainingBachelor of Science:Health100 Montgomery St. 10th Floorre Administration,Expected into100 Montgomery St. 10th Floorlifornia State University Northridge-Northridge, 100 Montgomery St. 10th Floor,GPA:Dean's List3.65 GPA100 Montgomery St. 10th Floorlifornia Highway Patrol ScholarshipAdditional Coursework in Health100 Montgomery St. 10th Floorre Leadership, Economy, Geriatric 100 Montgomery St. 10th Floorre, Public Health, Biostatistics, Legal Health, IT and Informatics.Member of Health100 Montgomery St. 10th Floorre Administration Honor SocietyAlpha Gamma Alpha Public RelationsMaster of Science:Health Administration,Expected intoUniversity of Southern 100 Montgomery St. 10th Floorlifornia-Los Angeles,100 Montgomery St. 10th FloorGPA:Honor Roll3.9 GPAPresident of the ClassResidency 100 Montgomery St. 10th Floorndidate, Health Administration>>. The result is, 

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