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Yyyyyy x. yyyyyy   0000 xxxxxx xxxx , xxxx , xxxxx 00000

xxx-xxx-xxxx                                                                                               abc@xyz.com

 

Career Objective                                                                                            

Results-focused Health Administrator eager to contribute expertise in administrative operations, quality assurance, regulatory compliance, process improvements, and risk management toward supporting a solid organization in optimizing performance

 

Profile                                                                                                              

Ø  Offer over 20 years progressive experience in the health care industry, with comprehensive management background.

Ø  Extensive experience in nursing, health program coordination and case management in the not-for profit, managed care, public and private health sectors.

Ø  Effectively define, develop and implement targeted action plans to maximize operational productivity, efficiency and profitability.

Ø  Proactive leader who successfully trains/develops, mentors and leads top-performing teams committed to providing superior service.

Ø  Dynamic communication, presentation, relationship building and problem-solving abilities.

Ø  Excel at interacting with broad populations including senior management, medical professionals and staff as well as clients and external contractors.

Ø  Exceptional expertise in conducting quality initiatives, auditing and monitoring and evaluating quality of care and service issues.

 

Key Achievements                                                                                            

Ø  Collaborated with numerous high profile clients including: Med Assurant / Medical Site Reviewers, Inc., Aetna Health, Inc., UNIVAL, Iowa Foundation for Medical Care, Blue Cross/Blue Shield of IL, Maxi Care of IL, Advocate Health and the Ounce of Prevention Fund Head Start Programs.

Ø  Effectively developed and submitted technical reports and standard protocol manual revisions/updates, with strong focus on optimizing productivity and efficiency.

Ø  Literary Mention in the American Journal of Epidemiology, April 1, 1999, National Disease Study.

Ø  Conducted concurrent utilization and case management review to ensure appropriate service provision and cost effective utilization of inpatient/ambulatory services and procedures. 

Ø  Developed standards of operation and procedure manuals for special health programs, e.g., Young Parents, TOT Line and WIC (Women, Infant & Children) programs. 

 

Professional Experience                                                                               

Health Management Consortium - Homewood, IL                                                            1998-Present
Health Consultant

  Contribute solid industry expertise and dynamic communication skills in conducting regular field visits to evaluate and analyze clinical documentation and facility operations while monitoring regulatory compliance.

  Conduct comprehensive site review and abstraction to validate quality indicators, determine disease-specific core measures and relevant clinical documentation.

  Proficiently handle QM & UR reviews to assess medical necessity and quality initiatives, e.g. HEDIS and Capitation Risk Adjustment, demonstrating exceptional multitasking and organizational talents in achieving operational goals and timelines.

  Steer health and nutrition program monitoring and provide consultation and technical support to various health programs.

 

Humana, Inc. - Chicago, IL                                                                                             1996-1998

Appeal/Denial Specialist

  Applied industry experience and strong interpersonal relation skills toward acting as first point of contact in responding to enrollee grievances, appeals and complaints related to denied claims.

  Thoroughly reviewed clinical documentation to determine claim disposition and medical necessity. 

  Proactively built and established key relationships and liaised with medical advisors and non-clinical staff.

 

 

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Cheryl W. Russell                                                                                                                   page 2 of 2

 

 

US Dept. of Labor-Office of Job Corps - Chicago, IL                                                      1993-1996
Regional Health Consultant C Region V

  Actively contributed to maximizing cost controls and bottom-line profitability by conducting through evaluations of procurement proposals as well as medical, dental and mental health service provider subcontracts.

  Closely monitored all aspects of regional health program operations and evaluated performance, exhibiting detail-oriented talents.

 

Prior Experience

 

Advocate Trinity Hospital - Chicago, IL                                                                           1991-1993

Case Management Specialist

Michael Reese HMO - Chicago, IL                                                                                  1989-1991
Clinical Nurse Supervisor- Women Heath [OB/GYN]

Additional employment history and information available upon request.

 

Education                                                                                                         

Master of Science, Health Administration - Central Michigan University (Mt. Pleasant, MI)

Bachelor of Science, Nursing - DePaul University (Chicago, IL)    

 

Licensure & Professional Training                                                             

Active RN License:  IL, GA, NC & TX

Candidate - Healthcare Quality Professional Certification, 2008
Peer Reviewer - US Dept of Education, Office of Safe and Drug Free Schools, 2007

Early Intervention Head Start Consultant - National Consultant Directory Listing

Credentialing Review Training [Provider, Medical Records & Facility Performance Review]
HIPAA Compliance Training
HEDIS Reviewer Training
DHHS/Head Start Program Performance Standards Review Training
Zero Tolerance for Alcohol and Other Addictive Substances C USDOL

Maternal Drug Abuse Workshop
National Frontline Forum on HIV/AIDS

 

 

 

 

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