Nicole Cusick
Bennington,NE
Summary
A bilingual professional with over 15 years in the insurance industry focused primarily on Medicaid managed care healthcare programs. Highly skilled in both English and Spanish communication, supporting operations, community event planning, speaking engagements, and staff management. Built a strong professional network created through partnerships with several local organizations, government officials, and physicians to educate and deploy innovative outreach strategies. Enthusiastic about empowering the underserved through building long-lasting relationships to promote education, subscribership, and overall health. Completion and certification of Department of Health and Human Services (DHHS) Community Health Worker Training.
Overview
10
10
years of professional experience
Work History
Interim Regional Operations Manager/Manager of Provider Service Advocacy/Compliance Officer
Managed Care of North America (MCNA) Dental DBA United Healthcare Services, Inc.
Des Moines
07.2023 - Current
- Achieve improved operational efficiency through effective leadership support for provider relations department and internal operations teams. Drive initiatives that maximized growth and operational effectiveness. Deliver impactful guidance to enhance team performance and collaboration.
- Provide strategic guidance on Medicaid policy and program design to ensure compliance with managed care regulations and waiver requirements.
- Monitor state regulations and cultivated relationships to enhance operational efficiency.
- Direct coordination of delegated functions and duties to guarantee compliance with contracts and enhance overall quality.
- Coordinate efforts among departments to effectively tackle business problems affecting diverse operational areas.
- Ensure accuracy and timeliness of state monthly, quarterly, and annual reporting processes.
- Assess operational requirements and established comprehensive plans, policies, and procedures to ensure organizational efficiency.
- Establish comprehensive education and training manuals to support staffing needs and improve provider relations.
- Lead initiatives to organize and schedule MCNA's Iowa Dental Advisory Committee and Quality Improvement Committee, supporting clinical review staff to enhance service quality.
- Analyze organizational goals to develop effective strategies and policies that drive success.
- Implement mentoring programs and provide resources to ensure staff achievement and contribute to organizational goals.
- Facilitate professional development for regional teams through impactful site visits. Strengthen provider recruitment and education initiatives, enhancing service delivery. Cultivate relationships with Iowa Medicaid stakeholders through collaboration with state agencies. Coordinate successful provider education and events, improving engagement. Proactively addressed additional needs to ensure seamless operations.
External Provider Relations Representative
Managed Care of North America (MCNA) Dental DBA United Healthcare Services, Inc.
Lincoln
01.2019 - 07.2023
- Implementation Manager: Assisted in the implementation of the Provider Relations Department processes, provider education programs regarding dental codes, dental billing, fraud, waste & abuse, and overall network functions. Measured and optimized results via DentalTrac, PowerBI and the Practice Site Performance Summary (PSPS).
- Project Manager: Managed projects day zero to implementation using standard, agile approach & methodologies.
- Worked with the management team to develop and revise the Provider Manual, assisted in ensuring that the manual met operational, regulatory, and accreditation requirements while ensuring compliance program policies were followed.
- Managed and conducted the site audits and site review process (for credentialing and re-credentialing), provider manual documentation for education and training, referral, and authorization procedures, as well as department activities.
- Served as a mode of communication to provider offices.
- Assisted in meeting organizational goals and objectives.
- Functioned as the liaison between over 250 provider/stakeholder groups and the plan.
- Conducted methods of communication to the providers for changes, revisions, issue resolution, and general notices/updates from the plan.
- Attended Provider Relations meetings to determine network access & availability and meet the requirements for ongoing membership needs.
- Assisted with network publication, reports, updates, revision, analysis, and reporting to appropriate internal staff and the Dental Management Committee.
- Planned, coordinated & facilitated provider training and education within the guidelines of state and federal regulations.
- Researched and resolved disputes, billing discrepancies, and claims efficiently to maintain customer satisfaction, boosting satisfaction ratings 13.88 % year over year.
Bilingual Community Relations Specialist
WellCare of Nebraska
Omaha
01.2016 - 01.2019
- Focused exclusively on providing government-sponsored managed care services to families, children, seniors, and individuals with complex medical needs.
- Outreach owner for twenty-three assigned communities throughout Nebraska.
- Responsible for the education, retention, and subscribership of members in need of key services.
- Organized, planned, and executed community events to educate new and existing members on services.
- Member attendance increased ~300% month over month.
- Developed new outreach strategies and training to differentiate WellCare from other competitors.
- Established two unique partnerships a month with community-based organizations to promote local involvement and drive participation percentages up.
- Reduced operating costs by implementing scheduling strategies focused on travel and expenses.
- Cultivated relationships with key external stakeholders, such as community organizations, provider offices, and members, to ensure program customer satisfaction.
- Created & led quarterly, state-mandated, committee meetings involving external stakeholders to obtain crucial feedback on company performance.
Education
BACHELOR OF SCIENCE - International Business, Spanish
UNIVERSITY OF NEBRASKA - LINCOLN
Lincolne NESkills
- Operational efficiency
- Excellent interpersonal skills
- Staffing oversight
- Key performance indicators
- Compliance management
- Standard operating procedures
- Staff supervision
- Sales support
- Budgets
- Supervisory role background
- Customer and vendor relations
- Process improvements
Leadership Roles
- Governor Appointed Member, Women's Health Initiative Advisory Council
- DHHS Director Appointed Member, Minority Health Council
Languages
Spanish
Native or Bilingual
English
Native or Bilingual
Timeline
Interim Regional Operations Manager/Manager of Provider Service Advocacy/Compliance Officer
Managed Care of North America (MCNA) Dental DBA United Healthcare Services, Inc.
07.2023 - Current
External Provider Relations Representative
Managed Care of North America (MCNA) Dental DBA United Healthcare Services, Inc.
01.2019 - 07.2023
Bilingual Community Relations Specialist
WellCare of Nebraska
01.2016 - 01.2019
BACHELOR OF SCIENCE - International Business, Spanish
UNIVERSITY OF NEBRASKA - LINCOLN