SHEENA CRUZ
Plantation,FL
Summary
Patient Care Coordinator with over ten years of hands-on clinical experience in the ever-evolving healthcare industry Holds extensive experience in leading and motivating high-performance teams of patient navigators. Work closely with physicians, patients, and families to ensure the highest and most thorough patient care quality. Highly effective and detail-oriented healthcare professional with excellent communication and analytical skills. Offers a strong clinical and case management background and an in-depth knowledge of medical treatment protocols. Experienced working in a diverse variety of high-volume and fast-paced facilities.
Overview
14
14
years of professional experience
1
1
Language
Work History
Account Manager
Nuvem
07.2022 - Current
- Operate as the lead point of contact for Clients and associated vendors
- Coordinate the involvement of company personnel, including support, service, and management resources, to meet or exceed Client Operations performance objectives and customers’ expectations
- Working with Sales teams to manage project implementations ensuring that the documents and resources are in place to begin projects on-time
- Adequately track and report on implementation and existing account status
- Lead client progress meetings as well as kick-off and annual wrap-up meetings in coordination with the Sales team
- Ensures client communications and updates are accurate, professional, and timely. This also includes client documentation being shared on a standardized schedule and format; that meeting notes and commitments are recorded for both parties’ review and acceptance
- Work on reports and contracts as necessitated by project
- Resolve escalated Customer Services issues or complaints, provide corrective action plans and immediate resolutions; assist with high severity requests or issue escalations as needed
- Participate in development and presentation of programs to decrease inventory and receivables losses
- Clearly communicate the progress of monthly/quarterly initiatives to internal and external stakeholders
- Perform key analyses of potential profit centers for recommendation to Clients; identify and grow opportunities within territory and collaborate with sales teams to ensure growth attainment; assist in researching sales opportunities
- Proactively leads the strategic Client Operations planning process that develops mutual performance objectives, financial targets, and critical milestones. Completes strategic customer Client Operations plans that are aligned with company objectives; assist company in achieving key metrics and quarterly/annual revenue targets
- Collect, analyze, and summarize Client data and trends. Forecast and track key account metrics
- Assesses, clarifies, and validates customer needs on an ongoing basis and partners with clients to ensure retention while seeking opportunities to promote expansion of services
- Ensure that client surveys are distributed, working towards “excellent” and “exceeds expectations” scores
- Contribute to a positive working environment and perform all duties as assigned to enhance the overall efforts of the organization
- Assist in training new employees
Pharmacy Coordinator III
Evolent Health
Arlington, VA
03.2021 - 07.2022
- Role is divided responsibilities to Clinical Pharmacy Services Team for Pharmacy Call Center
- Clinical Outreach support and Utilization Management support
- Responsibilities are varying on business needs
- Serve as direct member, pharmacy, and or provider contact for pharmacy benefit information, clinical determinations program information
- Function as liaison and subject matter expert related to client PBM systems and processes, specifically related to drug utilization management
- Support Medication Therapy Management and pharmacy outreach programs, refill reminders, and Adherence calls
- Aid clinical pharmacy programs including collection of medication history data and pharmacy care plan initiation under the guidance and direction of Clinical Pharmacists
- Managed over 40 customer calls and prior authorizations per day
Pharmacy Network Coordinator
340B, Pharmaceutical Strategies Group
Dallas, TX
09.2018 - 08.2020
- Worked closely with 340B Account Managers to provide service to new and existing clients
- Role functions were key resource for multiple 340B Account Managers on all new and existing client management
- Collaborate with Account Managers to maintain and implement client needs
- Evaluates current and future contract pharmacy opportunities, contract language, fee structure, data setup, and internal and independent external auditing
- Verifies HRSA eligibility for all new client relationships, including child sites or contract pharmacies, and advises clients as to compliance with their registration status
- Performed Account management of clients and prescribers via Salesforce
- Attended 340B conferences to learn new practices and improvements to enhance 340B program.
Patient Navigator- Team LeadP
Premier, Inc
Charlotte, NC
09.2010 - 08.2018
- Led Patient Navigator Team, overseeing day-to-day and providing mentoring and training
- Obtained patient information to process prescriptions, and approval information to activate copay cards based on eligibility and prescriptions
- Managed financial assistance process for patents
- Facilitated appeals between patients, physicians, and insurance companies
- Coordinated prescription transfers between patients and pharmacies
- Completed over 65 prior authorizations daily
- Met revenue and customer satisfaction goals by educating patients on Medicare Part D coverage and options for Patient Assistance Programs and nonprofit programs for copay relief.
- Trained new employees on effective patient navigation techniques, ensuring continuity of care across the organization.
- Streamlined communication between patients and healthcare providers for enhanced care coordination and timely treatment.
- Served as an advocate for vulnerable populations within the healthcare system, addressing disparities in access to care and treatment outcomes.
- Engaged with patients to provide critical information.
Education
New York City Board of Education
New York, NY06.2002
Skills
- Microsoft Office (Word, Excel, PowerPoint, Outlook
- Account management
- Critical Thinking
- Problem Solving
- Remote
- Quality review processes
- Drug utilization review
- Teamwork and collaboration
- Project management
- Client relationship management
- CRM systems
- Upselling
- Revenue generation
- Issue resolution
Timeline
Account Manager
Nuvem
07.2022 - Current
Pharmacy Coordinator III
Evolent Health
03.2021 - 07.2022
Pharmacy Network Coordinator
340B, Pharmaceutical Strategies Group
09.2018 - 08.2020
Patient Navigator- Team LeadP
Premier, Inc
09.2010 - 08.2018
New York City Board of Education
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