Jennifer A. Garvas, RN,MBA
Willoughby,OH
Summary
Accomplished Operations Manager driving organizational improvements through leveraging expertise in claims and medical policy operations. Well-versed in collaborating with employees and leaders to resolve control and procedural problems negatively affecting business operations. Dedicated to cost, process and resource optimization.
Overview
11
11
years of professional experience
Work History
Clinical Program Consultant/Project Manager
UnitedHealth Group
05.2023 - Current
- Manage a variety of projects within the Medical Policy Operations space, including experience working with Benefit Interpretation Guidelines and a variety of medical policies
- Collaborate across department lines to ensure success of implementations and large scale projects
- Leads both small and large scale projects while continuing to support peers with day to day objectives and deadlines
- Develop projects leveraging AI integration and machine learning capabilities
- Enhance the quality of care through comprehensive program evaluation and modifications based on data analysis.
Manager of Operations, Medical Claims Review
UnitedHealth Group
02.2021 - 05.2023
- Responsible for key operational processes of business line with direct exposure to quality, change management and facilitating execution plans
- Develops and initiates projects, manages costs, and monitors performance
- Established working relationships with key stakeholders
- Assesses, plans and implements new end-to-end processes
- Manages high performing, versatile team of over 20+ direct reports
- Active problem solver through root cause analysis and solutioning
- Drives efficiencies through value creation and organizational partnerships
- Mitigates business risks by working closely with staff members and assessing performance
- Assists in recruiting, hiring and training of team members
- Reduces operational risks while organizing data to forecast performance trends
- Decreased department inventory turnaround time by 10 day average
- Direct oversight of UM process in the managed care setting
Supervisor, Medical Claims Review
UnitedHealth Group
09.2018 - 02.2021
- Managed team of 18 staff to ensure timely and accurate processing of work items
- Responsible for process improvement, quality assurance, regulatory adherence and inventory management
- Hired, trained and coached 20+ direct reports
- Handled customer concerns and escalations in timely manner
- Interpreted reporting data to balance claims review and potential financial impacts
- Resolved issues through active listening and open-ended questioning, escalating major problems to manager
- Introduced new methods, practices, and systems to reduce turnaround time
- Implemented project management techniques to overcome obstacles and increase team productivity
Clinical Claims Review Nurse
UnitedHealth Group
05.2016 - 09.2018
- Performed clinical review of medical claims to determine coverage eligibility
- Worked closely in team environment with physicians to perform accurate clinical review of medical claims
- Provided members quality and efficient service with timely and accurate review of claims
- Worked to ensure quality of claim review to reflect member plan and eligibility
Case Manager
UnitedHealth Group
11.2014 - 05.2016
- Performed health plan assessments with over 50 community members
- Reviewed HEDIS Measures for accuracy and implementation
- Created and reviewed care plans
- Ensured adequate health care service delivery to members and prevented hospitalizations to over 50 member caseload
- Developed and implemented comprehensive case management plans to address client needs and goals
- Collaborated with an interdisciplinary team to determine timely delivery of services
Registered Nurse
Heartland Home Care
03.2014 - 05.2016
- Provided hands on nursing care to patients in the community
- Case managed patient care including supervision of LPNs and Home Health Aides
- Participated effectively in team Case Conferences
- Taught patients, family members and other members of the Interdisciplinary Team on disease processes
Clinical Supervisor
WillCare
03.2013 - 03.2014
- Lead and directed team of 315+ clinical personnel and support staff
- Reviewed clinical documentation and implemented Performance Improvement plans
- Provided continuing education and in depth training to all field staff
- Worked closely in team environment to achieve desired outcomes
- Provided outstanding Customer Service to all clientele
- Utilized critical thinking skills to create/implement appropriate plan of treatment for home care clients
- Established and maintained effective communication with staff, physicians and community organizations to promote high quality patient care
- Recruited, hired and trained all staff, providing direct supervision, ongoing staff development and continuing education to employees
Education
Bachelor of Business Administration - Finance, Accounting
The University of Toledo
Toledo, OHMaster of Business Administration - Finance, International Business
The University of Toledo
Toledo, OHAssociate Degree of Nursing -
The University of Toledo
Toledo, OHCertified Lactation Counselor
The Health Children's Project
11.2020
Skills
- Quality Standards
- Operational Efficiency
- Finance and Accounting Oversight
- Insurance Practices
- Project Workflow Management
- Policy Development and Enforcement
- Cost Control
- Operations Oversight
- Hiring and Onboarding
- Process Development and Streamlining
- Reporting Tools
Timeline
Clinical Program Consultant/Project Manager
UnitedHealth Group
05.2023 - Current
Manager of Operations, Medical Claims Review
UnitedHealth Group
02.2021 - 05.2023
Supervisor, Medical Claims Review
UnitedHealth Group
09.2018 - 02.2021
Clinical Claims Review Nurse
UnitedHealth Group
05.2016 - 09.2018
Case Manager
UnitedHealth Group
11.2014 - 05.2016
Registered Nurse
Heartland Home Care
03.2014 - 05.2016
Clinical Supervisor
WillCare
03.2013 - 03.2014
Bachelor of Business Administration - Finance, Accounting
The University of Toledo
Master of Business Administration - Finance, International Business
The University of Toledo
Associate Degree of Nursing -
The University of Toledo
Certified Lactation Counselor
The Health Children's Project