New York-Presbyterian Community Health Plan
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New York-Presbyterian Community Health Plan Employees
Anthem, Inc. January 2014 - Present
Anthem 2010 - Present
New York Presbyterian Community Health Plan 2007 - 2009
Metropolitan Jewish Health Systems 2005 - 2007
Iona Realty, Inc 2003 - 2005
Skills
PeopleSoft, Benefits Administration, Recruiting, Human Resources, Outlook, Process Improvement, Data Entry, Microsoft Excel, Software Documentation, Employee Benefits, Management, Customer Service, PowerPoint, Coaching, Talent Acquisition, Administration, Deferred Compensation
Education
Long Island University 2009 — 2011
M.S Human Resource Management, Human Resource Management
Touro College 2005 — 2009
Bachelor's degree, Psychology
Touro College 2006 — 2008
AS, Human Services
n/a - between jobs - who wants me? March 1998 - Present
Visiting Nurse Service of New York July 2012 - September 2012
New York Presbyterian Community Health Plan July 2007 - July 2009
Community Premier Plus Health Plan July 2006 - July 2007
Mariano Nevarez-Tapia MD PC May 2001 - November 2004
Skills
Customer Service ..., Microsoft Office, Customer Service, Windows 7, Microsoft Excel, Outlook, Microsoft Word, PowerPoint, Teamwork, System Administration, Process Improvement, Windows Server, Team Leadership
Education
City University of New York-Herbert H. Lehman College 2009 — 2012
Bachelor's Degree, Health Services Administration, 3.25
Borough of Manhattan Community College New York 1998 — 2009
Associate's Degree, Business Administration and Management, General, 2.98
The Career Center 2005 — 2005
Certificate Program, Medical Billing and Coding, N/A
EmblemHealth October 2011 - Present
Touchstone Health December 2009 - September 2011
New York Presbyterian Community Health Plan October 2005 - July 2009
Continuum Health Partners 2001 - 2005
Skills
Medical Claims, Medicare, Medicaid, HMO, Provider Relations, Customer Service, Network Development, Healthcare Consulting, Claims Management, Managed Care, Data Entry, Insurance, Call Centers, Revenue Cycle, Healthcare Information..., Employee Benefits, Utilization Management, PPO, Access, Medical Billing
Education
City University of New York City College 1984 — 1989
Bachelor's Degree, Sociology
High School of Music and Arts 1980 — 1983
Diploma, Instrumental Music
U.S. Department of Health and Human Services March 2010 - Present
Touchstone Health 2009 - 2009
New York Presbyterian Community Health Plan 2005 - 2009
Northeastern Asset Recovery 2005 - 2005
Aetna 2003 - 2004
Aetna 2002 - 2003
Value Options 2001 - 2001
Waterbury Hospital 2001 - 2001
NexClaim Technologies 2000 - 2001
NexClaim Technologies 1999 - 2000
Skills
Insurance, Health Insurance, Analysis, Managed Care, Software Documentation, HIPAA, Access, Medicare, Training, Employee Benefits, Medicaid, Data Analysis, Human Resources, Healthcare, Management, Policy, Health Policy, Leadership, Strategy
Education
The University of Connecticut 1970 — 1975
BA, English
Southern Connecticut State University
MA, English
Wellcare March 2015 - Present
Corinthian Medical IPA August 2013 - Present
Fidelis Care November 2012 - December 2012
Amidacare October 2011 - August 2012
Office Team/Memorial Sloan Kettering Cancer Center July 2009 - March 2010
New York-Presbyterian Community Health Plan April 2008 - March 2009
Temporary Excellence November 2006 - March 2008
Skills
Healthcare, Microsoft Office, HIPAA, Customer Service, Data Entry, Administrative Office..., Medicaid, Bilingual-English/Spanis..., Office Organizing, HMO, Managed Care, Healthcare Management, Access, Medicare, Clerical Skills, Outlook, Employee Benefits
Education
Plaza College 2004 — 2006
Associate Degree, Information Science
Plaza College 2004 — 2006
ASSOCIATE DEGREE; High School, INFORMATION SCIENCE; 2004
Centene Corporation October 2012 - Present
Centene Corporation April 2010 - October 2012
New York Presbyterian Community Health Plan November 2000 - April 2009
Skills
Managed Care, Medicaid, Provider Relations, HEDIS, Medicare, EPSDT, Disease Management, Bilingual-English/Spanis..., Qualified Bilingual..., Process Improvement, Project Management, Affordable Care Act, Healthcare Consulting, Medicare Part D, Network Development, Credentialing, Health Policy, Medicaid Managed Care
Education
Kaplan University-Davenport Campus 2014 — 2016
Master's Degree, Health/Health Care Administration/Management
Mercy College 2007 — 2009
BS
Mercy College 2007 — 2009
Bachelor's degree, Organizational Leadership
New York-Presbyterian Hospital July 2015 - Present
New York Presbyterian Hospital May 2003 - Present
New York Presbyterian Community Health Plan 2007 - 2009
Skills
Healthcare, Access, Excel, Word, Microsoft Office, Microsoft Word, Management, Marketing, Microsoft Excel, Human Resources, Leadership, Training, Outlook, Team Building, Employee Relations, Process Improvement, Employee Benefits, Healthcare Management, Managed Care, HIPAA, Medicare
Education
State University of New York Empire State College 2012 — 2014
Bachelor's Degree
New York Presbyterian July 2007 - March 2009
New York Presbyterian Community Health Plan November 2004 - July 2007
Community Premier Plus 2004 - 2007
Gertrude H January 1999 - November 2004
Harlem Hospital January 1998 - January 1999
Union Hospital January 1992 - January 1998
Dr. Francisco Lavandier Hospital. Pediatric Department January 1989 - January 1990
Skills
Microsoft Word, Healthcare, Managed Care, Hospitals, Clinical Research, Physicians, Home Care, ICD-9, Customer Service, Healthcare Management, Inpatient
Education
Universidad Autónoma del Estado de México 1986 — 1989
Postgraduate, Pediatrics
Universidad Autónoma de Santo Domingo 1974 — 1982
Doctor, Medicine
UnitedHealthcare February 2012 - Present
United Healthcare Community Plan February 2011 - March 2012
New York-Presbyterian Community Health Plan 2007 - April 2011
Community Premier Plus 2004 - 2007
Atlantis Health Plan 2004 - 2004
US Family Health Plan 2002 - 2003
CSC Healthcare Group 2000 - 2002
Blue Cross Blue Shield of AL 1996 - 2000
Skills
Leadership, Team Building, Management, Process Improvement, Healthcare, Networking, Change Management, Strategic Planning, Training, Insurance, Program Management, Customer Service, Project Management, Data Analysis, Access, Healthcare Management, Medicaid, Medicare
Education
Birmingham-Southern College 1999 — 2002
MPPM, Healthcare Management
Birmingham-Southern College 1990 — 1994
Muscle Shoals High School 1986 — 1990
FidelisCare 2011 - Present
New York Presbyterian Hospital 1979 - Present
New York Institute of Technology 2009 - Present
Vaughn College 2011 - Present
Geel Community Services 1993 - Present
The Epilepsy Foundation of Metropolitan New York September 2003 - 2012
New York Presbyterian Community Health Plan 2006 - 2009
1199 National Benefit Fund for Hospital and Health Care Employees 1992 - 2009
AHRC New York City 1996 - 2004
Arms Acres Outpatient Clinic for Substance Abuse (Manhattan) 1996 - 2000
Skills
Medical Education, Clinical, Public Health, Healthcare Information..., Healthcare, Clinical Research, Mental Health, Medicine, Treatment, Hospitals, Psychology, Psychotherapy, Psychiatry, Healthcare Management, Informatics, Wellness, Internal Medicine
Education
Joan & Sanford I. Weill Medical College of Cornell University
MD
Yale University
BA
CMO - The Care Management Company of Montefiore Medical Center March 2015 - Present
Columbia University Medical Center July 2013 - February 2015
Mount Sinai Medical Center June 2011 - July 2013
Care To Care LLC October 2009 - June 2011
CMO - The Care Management Company of Montefiore Medical Center November 2006 - October 2009
Affinity Health Plan August 2004 - November 2006
New York Presbyterian Community Health Plan October 2003 - July 2004
Red Sky Interactive 1998 - 2001
Skills
Healthcare, Managed Care, Healthcare Management, Medicaid, Credentialing, Hospitals, HIPAA, Healthcare Consulting, Medicare, Provider Relations, Microsoft Excel, Microsoft Word, Healthcare Information..., Healthcare Industry, Physician Relations, Physicians, Revenue Cycle, EMR
Education
City University of New York-Baruch College - Zicklin School of Business 2000 — 2006
BBA, Human Resource
CUNY New York City College of Technology 1994 — 1996
Associate of Arts and Sciences (AAS), Accounting
OptumHealth July 2009 - Present
New York-Presbyterian Community Health Plan October 1999 - July 2009
Education
Clemson University 1989 — 1993
BSN, Nursing
UnitedHealth Group June 2015 - Present
Park Slope Center for Mental Health December 2014 - March 2015
VNSNY July 2013 - November 2013
Amerigroup Corporation July 2009 - July 2013
New York-Presbyterian Community Health Plan November 2005 - July 2009
Skills
Quality Management, Medicaid, Medicare, Healthcare Management, Managed Care, HIPAA, Healthcare, Healthcare Information..., Healthcare Consulting, Healthcare Industry, Hospitals, EMR, Health Policy, Revenue Cycle, Health Insurance, Provider Relations, Utilization Management, Home Care, Physician Relations, Microsoft Office, Microsoft Excel, Disease Management, HMO, Informatics, Customer Service
Education
University of Nebraska-Lincoln 2015 — 2019
Master's degree, Social Work
University of Nebraska at Omaha
Master of Social Work (MSW), Social Work
Children's National Medical Center August 2004 - Present
New York Presbyterian Community Health Plan 1999 - 2002
Education
Central Michigan University 1996 — 1999
Master of Science (M.Sc.), Hospital and Health Care Facilities Administration/Management
Baruch College, City University of New York (CUNY) 1983 — 1990
BBA, Operations Management