Summary
Overview
Work History
Education
Skills
Accomplishments
Certification
Languages
Work Availability
Quote
Timeline
BusinessDevelopmentManager
Edgar Ramirez

Edgar Ramirez

Compliance Manager
New York City,New York

Summary

Innovative Quality & Compliance Manager offering eight years of expertise in quality improvement, risk management and strategic planning. Advanced knowledge of healthcare regulatory compliance with proven track record of partnering with executives and business leaders to develop solutions for clients. Collaborative and team-oriented with excellent communication and interpersonal skills to foster strategic partnerships.

Overview

8
8
years of professional experience
2
2

Certification

Work History

Quality and Compliance Manager

TeleMedik, URAC Accredited Organization
06.2017 - Current
  • Responsible for the day-to-day operation of the Continuous Quality Improvement Program and the Corporate Compliance Program.
  • Oversees all ongoing activities related to the implementation, maintenance, and adherence to the organization's policies and procedures covering privacy and patient health information in compliance with federal, local, and healthcare regulations.
  • Leads different organizational, strategic, and clinical implementation projects, accreditations, and initiatives while monitoring their progress and completion.
  • Orchestrated projects within strict timeframes and budget constraints by solving complex problems and working closely with senior leaders.
  • Identifies potential areas of compliance vulnerability and risk to develop and implement corrective action plans while playing an instrumental role in company-wide risk assessment efforts, supporting enhancements in business processes and controls.
  • Develops, implements, and manages robust internal controls that improve operational quality and efficiency.

Quality Supervisor

TeleMedik, URAC Accredited Organization
11.2016 - 06.2017
  • Led the Clinical Committee and was responsible for their achievements, in coordination with the executive director and management staff
  • Managed the URAC re-accreditation process
  • Directed independent reviews, audits and monitoring procedures across the organization to ensure that indicators are being appropriately evaluated and followed as required by regulatory agencies and customers
  • Reviewed the clinical and non-clinical customer satisfaction surveys and complaints reports in order to establish initiatives and activities to improve the patients experience
  • Modernized and improved operational procedures regarding complaints investigations, satisfaction surveys and key operational procedures documentation to increase efficiency and profitability while tightly controlling costs such as labor and preventing waste
  • Developed quality planning for new product launches by verifying customer requirements and implementing in design and production
  • Collaborated with developers and product owners to stay current on product features and intended functionality
  • Implemented Customer Experience training initiatives by incorporating industry trends and collaborating with senior leaders.

Quality Specialist

TeleMedik
02.2015 - 10.2016
  • Evaluated and monitored key performance indicators for quality purposes
  • Defined action plans to reduce quality and efficiency variations from goal standards
  • Developed and rolled out new policies and procedures
  • Trained, monitored, coached and mentored staff to ensure best quality of service and adherence to policies and procedures
  • Worked directly with other departments and clients to achieve monthly quality goals
  • Used measurements, analysis and process improvement tools to arrive at best practices
  • Represented the company at conferences calls and meetings with clients, and participated as a liaison for some external and internal audits.

Education

Bachelor of Science - Sociology, Criminology

University Of Puerto Rico
06.2012

Skills

Project Management

Critical Thinking

Problem-Solving

Time Management

Customer/Patient Oriented

Leadership

Communication

Decision Making

Accomplishments

  • Satisfaction Rate: Improved customer satisfaction ratings by 10%
  • Audit Rate: 9/10 clients or regulators audits with no findings or observations (major improvement)
  • Restructured the Quality & Compliance Department, reducing operating costs by 31% in 13 months
  • Completed the Puerto Rico Government Health Plan Transition Project on time, as Project Lead of TeleMedik for the implementation and transition of services delegated by various Managed Care Organizations (MCO)
  • Collaborated with a team of 10 in a strategic organizational project for the development of the telemedicine in Puerto Rico (Virtual Community Clinics and Virtual Patients Consultations)
  • Other projects: Implementation of Organizational Dashboards in Power BI, Implementation of an Omnichannel Cloud Contact Center, Revision of the Organizational Disaster Recovery and Business Continuity Plan, Development of a Population Health Management Service, Transition of a Clinical Software to a Web-based Application, among others.

Certification

Lean Six Sigma Yellow Belt

Certified KPI Professional and Practitioner (C-KPI)

Languages

English
Native or Bilingual
Spanish
Native or Bilingual

Work Availability

monday
tuesday
wednesday
thursday
friday
saturday
sunday
morning
afternoon
evening
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Quote

Quality is not an act, it is a habit."
- Aristotle

Timeline

Quality and Compliance Manager

TeleMedik, URAC Accredited Organization
06.2017 - Current

Quality Supervisor

TeleMedik, URAC Accredited Organization
11.2016 - 06.2017

Quality Specialist

TeleMedik
02.2015 - 10.2016

Bachelor of Science - Sociology, Criminology

University Of Puerto Rico

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Edgar RamirezCompliance Manager