MARY J FERNANDEZ
Operational Manager
DUMONT,NJ
Summary
Business leader with more than 12 years' experience in management and customer service excellence. Recent accomplishments include NCQA accreditations and regulatory audits. Establish best practices across programmatic operations and identify areas of improvement. Collaborate to develop, monitor, and adjust operational procedures that maximize output for the direct end-to-end program operations of the Bronx Accountable Healthcare Network (BAHN), Montefiore’s Health Home, a Medicaid State Plan Service for care management comprised of 17 subcontracted Bronx-based Care Management Agencies (CMAs) with 350+ Care Managers who manage 8000+ Medicaid beneficiaries.
Overview
13
13
years of professional experience
Work History
Operational Manager
Montefiore Medical Center-CMO-BAHN Health Home
Yonkers, NY
09.2020 - Current
- Manage monitoring activities related to delegated functions of Utilization Management and Case Management, including internal/external audits
- Streamlined and managed external audits required by regulatory bodies including NYSDOH, CMS, OIG, OMIG, and DFS, ensuring compliance with regulatory standards and reducing audit findings by 40%
- Overhaul programmatic compliance with NCQA standards and assisting UM and CM leaders to become accreditation ready
- Co-led NCQA Renewal Accreditation Survey first time, resulting in three years of accreditation for Credentialing, Utilization Management, and Case Management, all achieving score of 90%, 95% and 97%
- Collaborate with UM process owners to refine procedures, devise best practices, identify root causes, and correct quality audit findings to ensure CMO meets obligations to all Health Plan clients
- Lead team of three Project Associates, providing consistent coaching and mentoring to improve job performance and maintain client service agreements
- Spearhead referral management process and overall administrative operations of centralized services of Health Home Program which achieved revenue growth in 10.5% over FY2021-2022.
Assistant Manager
Montefiore Medical Center, BAHN Health Home
Yonkers, NY
01.2017 - 08.2020
- Incorporated referral management infrastructure and overhauled process by developing comprehensive referral form and collaborating with IT and marketing stakeholders to create web-based referral system increasing to 22% in referrals
- Improved cross-departmental cooperation through presentations to staff members and administration about Health Home referral process
- Directed two project associates that provide exceptional customer service and technical support to Network Care Management agencies
- Collaborated with Health Plans to receive and analyze hospitalization and supplemental data reports, coordinating with Financial and MIS/IT team to understand and use data to support program
- Ensured coverage and program compliance by managing schedules and delegating assignments to teams
- Streamlined operational processes and procedures, resulting in 40% reduction in team inefficiencies and errors
Assistant Manager
Montefiore Medical Center, CMO Care Management
Yonkers, NY
01.2013 - 12.2016
Administrative Supervisor
Montefiore Medical Center, CMO Care Management
Yonkers, NY
06.2010 - 12.2012
Education
MBA -
Montclair State University
Montclair, NJ05.2024
Bachelor of Science - Marketing
Universidad Tecnologica De Santiago
Dominican Republic04.2008
Skills
- Adaptable and Flexible
- Business Administration
- Customer Experience Control
- MS Office Applications
- National Quality Assurance Standards (NCQA)
- Operational Efficiency
- Payroll administration
- Project Oversight
- Policy and Procedure Improvement
- Project Management
- Regulatory and Statutory Compliance
- SAP/ HCM HR Systems
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Operational Manager
Montefiore Medical Center-CMO-BAHN Health Home
09.2020 - Current
Assistant Manager
Montefiore Medical Center, BAHN Health Home
01.2017 - 08.2020
Assistant Manager
Montefiore Medical Center, CMO Care Management
01.2013 - 12.2016
Administrative Supervisor
Montefiore Medical Center, CMO Care Management
06.2010 - 12.2012
MBA -
Montclair State University
Bachelor of Science - Marketing
Universidad Tecnologica De Santiago
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