NICOLE VILLANUEVA
Tampa,FL
Summary
Highly committed employee with superior communication and organizational skills and a talent for networking. Seeking a position that reflects personal attributes, including dedication, meeting goals, creativity, and the ability to complete tasks independently. Encouraging manager and analytical problem-solver with talents for team building, leading and motivating, as well as excellent customer relations aptitude and relationship-building skills. Proficient in using independent decision-making skills and sound judgment to positively impact company success. Dedicated to applying training, monitoring and morale-building abilities to enhance employee engagement and boost performance.
Overview
17
17
years of professional experience
Work History
AREA DIRECTOR
CSI CAREGIVER SERVICES- NURSE REGISTRY
05.2022 - Current
- Perform Administrative duties as outlined by AHCA
- Manage daily operations for both Clearwater and Tampa offices
- Oversee all client and caregiver files
- Participate in audits
- Assist with business development and relationship building to strengthen daily revenue and referrals
- Maintain current knowledge of the policies and laws which apply to Nurse Registry programs and compliance regulations
- Involved in planning annual operating budget report to meet corporate goals and objectives
- Recruit qualified team members as well as assists with recruitment of caregivers to maintain appropriate staffing levels
- Attend in person conventions and expos as a representative of CSI
- Analyzed financial performance of area by monitoring budgets and expenses, reviewing financial statements and recommending appropriate actions.
- Increased revenue growth with the implementation of innovative marketing strategies and sales techniques.
- Performed audits to reduce and control loss and meet internal audit and compliance objectives.
- Created a culture of accountability among staff members by setting clear expectations regarding job responsibilities and performance goals consistent with company values.
- Improved customer satisfaction ratings by reinforcing a customer-centric approach within the area teams.
- Enhanced communication between departments, fostering collaboration and cross-functional teamwork to achieve company objectives.
SENIOR PROVIDER RELATIONS ADVOCATE
UNITED HEALTH GROUP-COMMUNITY & STATE
01.2016 - 05.2022
- Establish and maintain relationships with internal departments and external providers
- Seek new providers for network needs
- Negotiate and write provider contracts for Adult Day Care Centers, Assisted Living Facilities, Home Health Agencies, Nurse Registries, and Therapists.
- Conduct virtual and live visits monthly
- Host and attend live conferences representing the network team
- Assist case managers with staffing
- Comply with terms and conditions with state policies
- Identify solutions to providers requests and concerns
- Acted as a liaison between the company and providers, maintaining open channels of communication to ensure smooth collaboration.
- Streamlined provider relations by developing effective communication strategies and addressing concerns promptly.
- Supported company growth by identifying potential providers, conducting due diligence, and facilitating partnerships.
- Maintained accurate provider directories through regular audits, updates, and staff training sessions.
- Enhanced network performance by evaluating provider contracts and negotiating favorable terms.
- Developed targeted education initiatives for providers to improve understanding of processes, guidelines, and best practices.
- Facilitated timely resolution of escalated issues through effective collaboration with internal departments and external partners.
- Answered provider inquiries via email, telephone and written correspondence.
PROVIDER RELATIONS ADVOCATE
UNITED HEALTH GROUP-OPTUM
11.2011 - 12.2015
- Perform monthly Skilled Nursing Facility visits for Medicare providers and annual visits for Medicaid providers
- Use data and facts to identify and solve problems
- Analyze and investigate provider claim issues
- Assist with special internal projects
- Conduct webinar trainings
- Document provider details in Care Link and Sales Force
- Research and resolve AHCA complaints
- Oversaw the successful transition of new or acquired provider groups into our network systems and processes.
- Achieved high levels of member satisfaction due to prompt resolutions of escalated grievances involving out-of-network services or billing disputes.
- Strengthened provider relations by organizing and conducting regular meetings to address concerns and discuss improvements.
- Conducted comprehensive on-site reviews to evaluate service quality, adhering to regulatory requirements and company standards.
- Generated reports detailing findings and recommendations.
CREDENTIALING AND CONTRACT ANALYST
UNITED HEALTH GROUP-EVERCARE
04.2007 - 11.2011
- Research provider information and create Skilled Nursing Facility and Primary Care Physician contracts
- Meet with Primary Care Physicians to negotiate contracts
- Submit credentialing applications and tracked until completed
- Review and distributed monthly member rosters
- Established performance metrics to monitor contract progress, enabling timely intervention when needed.
- Coordinated and attended meetings as company's main contact to review contractual obligations.
Education
PARALEGAL CERTIFICATE -
FAIRLEIGH DICKINSON UNIVERSITY
MADISON, NJ12.2006
ASSOCIATE DEGREE - LEGAL STUDIES
Gibbs COLLEGE
LIVINGSTON, NJ05.2005
Skills
- Proficient in Microsoft Word, Excel, and Power Point
- Exceptional presentation, written, and verbal communications
- Staff Training and Development
- Team Management
- Operations Management
- Program Leadership
- Teamwork and Collaboration
- Problem-Solving
- Customer Relations
- Scheduling
- Influencer Marketing
- Effective Communication
Groups
- Rotary Club Member-Westchase, FL
- Volunteer for Rescue America, Westchase, FL
Timeline
AREA DIRECTOR
CSI CAREGIVER SERVICES- NURSE REGISTRY
05.2022 - Current
SENIOR PROVIDER RELATIONS ADVOCATE
UNITED HEALTH GROUP-COMMUNITY & STATE
01.2016 - 05.2022
PROVIDER RELATIONS ADVOCATE
UNITED HEALTH GROUP-OPTUM
11.2011 - 12.2015
CREDENTIALING AND CONTRACT ANALYST
UNITED HEALTH GROUP-EVERCARE
04.2007 - 11.2011
PARALEGAL CERTIFICATE -
FAIRLEIGH DICKINSON UNIVERSITY
ASSOCIATE DEGREE - LEGAL STUDIES
Gibbs COLLEGE
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