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The sample below is for a Health Care Management Executive Resume. This resume was written by a ResumeMyCareer professional resume writer, and demonstrates how a resume for a Health Care Management Executive Candidate should be properly created. Our Certified Professional Resume Writers can assist you in creating a professional document for the job or industry of your choice.

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HEALTH CARE MANAGEMENT EXECUTIVE

A proven Healthcare Manager with 20 years experience in managed Health Care Management development and training for Commercial, Medicare and Medicaid products. Seek to utilize extensive medical knowledge, staff leadership and development experiences, and exceptional provider relations acumen and national network development in a Healthcare Management role. Experienced URAC Utilization Management team member and provider of new business development with strict adherence to all regulatory compliance.
• Passionate Managed Health Care leader, skilled in providing organizational oversight, staff training and development, with strong business acumen offering customer-centric service and support.

Core Competencies
Team Leadership • Communications • Staff Development/Mentoring • Process Streamlining • Customer Relations
Operations Improvement • URAC Utilization Management • URAC Accreditation for Claims Processing

PROFESSIONAL EXPERIENCE
IntegraPartners IPA, Brooklyn • NY 2011 – Present
Vice President
Direct all operations and oversee provider relations and network development strategies on a regional and national level. Aggressively pursue and manage recruitment project and strategize and roll out new business development initiatives. Develop and implement innovative and compelling marketing materials and presentations. Provide oversight for RFP’s and RFI’s and directed 3 acquisitions and integrations of IPA’s and MCO’s. Utilize Website and social media content to market develop and maintain market share and oversee all Website maintenance and updates. Serve as direct liaison to clients, health plans and providers during daily operations.

Care to Care, New York • NY 2007 – 2011
Title
Developed and implemented national network of freestanding facilities and hospitals, and contracted with providers and clients regarding health plans and employers. Focused on new business development and implemented direct marketing campaigns, attended conferences and presentations to increase market share. Assisted in obtaining company certifications including URAC Utilization Management Accreditation, New York State Utilization Review Agent Certification and DS Certification. Directed daily operations that included quality assurance and improvement, regulatory compliance and vendor oversight.

Access Managed Health Care (Dr. John Rupolo) Floral Park • NY 2001 – 2007
Chief Operating Officer
Providing complete operational oversight for high volume managed health care company with more than 30 staff personnel. Provided quality improvement standards, reviewed employee production and quality assurance and reported findings to Board of Directors. Full oversight, preparation and organization of site visits, audits and peer review for more than 12 health plans, and ensured regulatory compliance with DOH, DOI, AG, URAC, NCQA, HCFA and HEDIS requirements. Managed all Automatic Call Distribution (ACD) activity, and monitored and maintained system in compliance with performance guarantees. Implemented call log system for all call center activity for inbound, outbound, inquiry, complaint, grievance, appeal that provided quick and effective conflict resolution initiatives. Negotiated terms and financial arrangements, audit organizations, development and implementation of transition process that maintained organization during mergers and acquisition initiatives. Oversight of information technology including member eligibility, encounter data, utilization reports, cost savings and developed proprietary information system and multiple Website development and maintenance. Developed proposals, projections, and budgets, analyses of costs, and reviewed utilization statistics and trends while focused on new business development. Development and implementation of business plans and Private Placement Memorandums (in conjunction with counsel), and reviewed/revised legal contracts, confidentiality agreements and fee schedules, collaborating with counsel
Key Highlights:
• Developed and implemented a comprehensive in-house call center servicing more than 1.3 million lives nationwide.

ADDITIONAL EXPERIENCE
(Details available upon request)

Assistant to Director of Operations – Access Managed Health Care (Dr. John Rupolo) Floral Park, NY
Chiropractic / Administrative Assistant – Dr. Walter V. Saviuk New Hyde Park, NY

EDUCATION AND CREDENTIALS

Chiropractic Assistant Certification – 1995
Parker College of Chiropractic, Dallas • TX

Licensed NY Insurance Agent (Accident and Health), License Number LA-989332 – 2003

Board Member .Fundraising Committee Member – Suffolk County Prenatal Coalition
Chief Advisor, Long Island Jazz Festivals Corp. New York Association for Ambulatory Care
North American Federation of Chiropractic Networks National Managed Health Care Congress
America’s Health Insurance Plans (AHIP)

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