AMY RAAD
Summary
Results-driven management professional with proven ability to lead teams to success. Strong focus on team collaboration, operational efficiency, and achieving measurable outcomes. Adept at strategic planning, process improvement, and fostering a culture of accountability and excellence. Known for adaptability and consistently meeting changing organizational needs.
Overview
15
15
years of professional experience
1
1
Certification
Work History
Manager, Clinical Health Services
Aetna/CVS
2021.10 - Current
- Direct day-to-day utilization management operations, ensuring timely, clinically appropriate, and compliant medical necessity determinations across multiple lines of business.
- Partner with clinical leadership, quality, compliance and provider network teams to ensure alignment with accreditation, contractual, and regulatory requirements.
- Foster a culture a continuous improvement through staff engagement, performance management, training and cross-functional collaboration.
Clinical Care Manager
Aetna/CVS
2020.03 - 2021.10
- Assessed Medicare and Commercial policy members to identify social and behavioral health needs and referred to necessary services.
- Coordinated with members and providers to advocate for necessary services.
- Ensured documentation compliance with state, federal, contractual, and accreditation requirements while maintaining ongoing audit readiness.
Senior Manager Clinical Operations
Blue Cross Blue Shield of IL
2018.02 - 2019.10
- Managed operations of 4 teams with 60+ cross-disciplinary members serving approximately 4500 Medicaid members
- Developed and implemented programs, policies, and procedures that enhanced operational efficiency and improved member retention
- Established and monitored productivity measures for team and vendors to ensure effective service delivery and contract compliance
Unit Manager
Blue Cross Blue Shield of IL
2015.03 - 2018.02
- Led remote team of 20+ cross-disciplinary members to coordinate services for 2000 Medicaid members
- Represented the program in various provider forums and member advisory meetings
- Conducted team audits and established improvement plans
Care Coordinator
Blue Cross Blue Shield of IL
2014.02 - 2015.03
- Conducted assessments to identify care gaps and educated Medicaid members on available services to meet health needs
Care Advocate
OptumHealth
2011.04 - 2014.02
- Managed case reviews and utilization assessments for behavioral health and substance abuse services to ensure quality care
- Ensured compliance with regulatory and benefit plan guidelines for optimal utilization of client benefits
Education
Masters - Social Work
University of Illinois at Chicago
2003-01
Bachelors - Social Work
University of Illinois at Chicago
1997-01
Skills
- Utilization Management Operations
- Clinical Operations Leadership
- Regulatory Compliance
- Medicaid/Medicare
- Quality Improvement
- Risk Management
- Process Improvement and Workflow Optimization
- Team Leadership and Staff Development
- Stakeholder Engagement
- Audit Readiness and Remediation
Accomplishments
- Achieved [Result] through effectively helping with [Task].
- Collaborated with team of [Number] in the development of [Project name].
Certification
- LCSW, Illinois
Timeline
Manager, Clinical Health Services
Aetna/CVS
2021.10 - Current
Clinical Care Manager
Aetna/CVS
2020.03 - 2021.10
Senior Manager Clinical Operations
Blue Cross Blue Shield of IL
2018.02 - 2019.10
Unit Manager
Blue Cross Blue Shield of IL
2015.03 - 2018.02
Care Coordinator
Blue Cross Blue Shield of IL
2014.02 - 2015.03
Care Advocate
OptumHealth
2011.04 - 2014.02
Bachelors - Social Work
University of Illinois at Chicago
Masters - Social Work
University of Illinois at Chicago