Jay Carter

• Oversaw daily operations, ensuring smooth functioning of all departments and timely issue resolution.
• Facilitated communication between various departments, encouraging collaboration for optimal results.
• Implemented data-driven decision-making strategies, optimizing resource allocation and performance tracking.
• Collaborated with executive leadership to devise strategic goals, aligning business operations accordingly.
• Managed cross-functional teams for improved project delivery and deadline adherence.
• Spearheaded process improvement projects aimed at increasing efficiency within specific departments or functional areas.
• Facilitated smooth onboarding processes for new vendors, providing clear guidelines on expectations and procedures for seamless integration into the supply chain network.
• Strengthened vendor relationships and enhanced revenue streams by applying business development opportunities.
• Recruited, hired, mentored and trained [Number] staff on business procedures, policies, duties and customer care methods.
• Assisted in organizing and overseeing assignments to drive operational excellence.
• Enhanced operational efficiency by streamlining processes and implementing cost-saving measures.
• Analyzed market trends and competitor activities to identify opportunities for growth or improvement within the organization.

• Successful onboarding of client needs via the Clinical Product Application - focusing on quality and timely delivery
• Conduct client data validation - branding configuration and fulfillment oversight
• Product Fulfillment - Document clear business requirements; translate to delivery partners; create and test user acceptance stories; validate/approve in test prior to implementation; conduct post implementation checkout
• Create standard operating procedures
• Cross-train team members on fulfillment updates
• Develop and present executive status updates
• Identify product gaps, opportunities and solutions to improve delivery
• Respond to fulfillment requests, offering excellent support and tailored recommendations to address needs
• Facilitate inter-departmental communications to improve team engagement/partnership

As a Project Consultant, dedicated to a high profile National client, I've successfully delivered several multi-million-dollar projects, in support of the client's overall medical management vision. Specific projects include:

• Custom Behavioral Health Solution: Spearheaded the implementation of a new Behavioral Health medical management program, resulting in contract renewal with client.
• Accountable Care Organization (ACO) Alerts - Implemented a systematic solution along with operational processes that alerted Nurses when a member was attributed designated to an ACO. This enabled early risk identification and collaborative management of the member's health.
• Care Path Portal Vendor Integration: Successfully integrated with a medical management communication vendor that translates medical terminology into a member friendly plan of care.

Other duties include:

• Managed the entire lifecycle of each assigned Health Care Management project, from initiation to closure.
• Coordinated project design meetings and decisions across internal departments and teams.
• Assessed vendor integration products while maintain a positive vendor relationship.
• Developed and presented project evaluation and process improvement strategies to key stakeholder's
• Collaborated with external vendors to implement medical management user interface tools that streamlined management of the member's wellness.

As the Call Center Manager, I was responsible for the day to day operations and management of the Health Care Coordinators. I developed and monitored performance goals to deliver world class customer service, closing gaps in member's care and wellness.

• Managed a team of 20 Health Coordinators and workforce managers.
• Facilitated inter-departmental communication to effectively provide customer support.
• Assumed ownership over team productivity and managed work flow to exceed quality service goals.
• Developed highly empathetic client relationships and earned a reputation for exceeding service standard goals.
• Followed-through on all critical inter-departmental escalations to increase customer retention rates.
• Met all customer call guidelines including service levels, handle time and productivity.
• Provided executive readouts on team performance.

• Identified and corrected performance issues.
• Referred major hardware and software problems and defective products to vendors or technicians for service.
• Trained users in the proper use of hardware or software.
• Followed internal procedures for change management, incident management and escalation.
• Managed call flow and responded to technical support needs of customers.
• Evaluated and responded to incoming sales leads and requests for technical support assistance.
• Provided base level IT support to non-technical personnel within the business.
• Defined and documented technical best practices.
• Installed software, modified and repaired hardware and resolved technical issues.
• Communicated with vendors to resolve network outages and periods of reduced performance.
• Installed software, modified and repaired hardware and resolved technical issues.

• Created databases and spreadsheets for various departments within the Health Care Management department.
• Provided security access for employees with workgroup admissions.
• Designed and maintained Modules (Visual Basic) and Macros using Microsoft Access Facilitated departmental staff meeting/ developed strategies and goals for the workforce.
• Constructed graphs, templates, and PDF files for the Policy and Procedure database.
• Documented and update Exception Payment Reports in Microsoft Access and Excel.

• Prepared pre-admission reports and/or assist in the preparation of statistical information.
• Designed and maintained reports for customer service database using Microsoft Access and Excel
• Precisely completed appropriate claims paperwork, documentation and system entry.
• Assisted in the maintenance of medical charts and/or electronic medical record (filing, Op Reports, test results, home care forms).
• Performed qualitative analysis of records to ensure accuracy, internal consistency and correlation of recorded data.
• Updated the monthly database for the HMO Individual Benefit Management.
• Reviewed, analyzed and managed coding of diagnostic and treatment procedures contained in outpatient medical records.
• Obtained scanned records and uploaded them into the database.