Patricia Louis
Port St Lucie,FL
Summary
High-energy Manager enthusiastic about empowering teams to help others. Brings demonstrated team and program leadership abilities honed in fast-paced environments. Responsible for strategic client account management, exceptional copay program management, in-depth program knowledge and operational excellence for their assigned pharmaceutical clients. As the primary point of contact between our valued customers. Serves a crucial role in driving internal project teams to deliver Clients full suite of products and services on schedule, on budget, and within scope.
Overview
7
7
years of professional experience
Work History
Clinical Hub Manager
Mercalis
09.2017 - Current
- Evaluated employee performance through close observation and performance rubrics.
- Educated service personnel on company policy and procedure.
- Manage client contracts/statements of work and execute accordingly.
- Interface with clients and maintain relationships on a day-to-day basis as the primary business relationship manager.
- Identified issues, analyzed information and provided solutions to problems.
- Developed and maintained courteous and effective working relationships.
- Resolved conflicts and negotiated mutually beneficial agreements between parties.
- Managed team of 15 employees, overseeing hiring, training, and professional growth of employees.
- Managed team of 15 employees, overseeing hiring, training, and professional growth of employees.
- Be well-versed on third party service vendor landscape and coordinate client vendor relationships (agencies, SPPs, HUBs, service providers, data/analytics teams)
- Conduct regular meetings (phone, Webex, onsite) to update the client on program performance, deliver presentations and provide consultative recommendations for program enhancements
- Used coordination and planning skills to achieve results according to schedule.
Program Supervisor
Mercalis
09.2017 - 11.2021
- Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence
- Liaison between Program Manager and Team
- Keeps the Program Manager abreast on all aspects concerning the Program
- Plans daily schedule, assigns tasks and ensures daily goals are met
- Submits daily and weekly reports to the Program Manager regarding productivity statistics at both the team and employee level
- Provides organization and direction for daily reimbursement support according to the scope of services provided in the statement of work
- Evaluate and monitor Program needs, identifies unmet needs and provides recommendations for internal process improvement and workflow efficiency
- Follows program guidelines and assists with the implementation of process improvements
- Serves as an advocate to patients and healthcare professionals regarding insurance coverage, medical billing, reimbursement process, and general access for complex pharmaceuticals
- Ability to perform thorough insurance benefit investigations, communicate insurance coverage to patients and providers, guide and follow up on prior authorizations, and assist with appeal processes
- Provides counsel and strategies on complex coverage and reimbursement issues to patients and healthcare providers, and works on patients’ behalf to identify and assess reimbursement coverage options
- Establishes relationships, develops trust, and maintains rapport with patients and healthcare providers; Acts as an assigned liaison to client contacts (e.g., regional contact for sales representatives)
- Preparation of and participation in client audits
- Communicates and coordinates with inter-departmental stakeholders to resolve program specific escalations, conflicts and/or questions
- Problem solves issues with autonomy and serves as first line of escalation for complex reimbursement issues
- Routinely conducts quality assurance activities through reviews, meetings, reports, observation of results, according to standard operating procedures, program specific procedures and regulatory compliance
- Participates in and conducts meetings, as necessary
- Responsible for performance management including but not limited to, coaching and mentoring subordinates, employee counseling, employee performance appraisals, conflict resolution and schedule adherence
Clinical Case Manager
WellCare
09.2016 - 09.2017
- Worked in matrix management environment with oversight of division level managers, operations, sales, finance, human resources, safety and compliance.
- Identified and resolved unauthorized, unsafe or ineffective practices.
- Conducted weekly staff meetings to motivate staff members, address concerns and questions, plan improvements, and evaluate progress toward goals.
- Reviewed shift reports to understand current numbers and trends.
- Facilitated customer satisfaction by executing personal communication and frequent follow-ups.
- Partnered with physicians, social workers, activity therapists, nutritionists, and case managers to develop and implement individualized care plans and documented patient interactions and interventions in electronic charting systems.
Education
Master of Science - Health Care Administration
SMHU
Phoenix, AZ12.2027
Bachelor of Science - Nursing
Palm Beach State College
Lake Worth, FL05.2017
Associate of Science - Nursing
Florida Career College - Miami
West Palm Beach, United States12.2015
High School Diploma -
Royal Palm Beach High School
Royal Palm Beach, FL05.2001
Skills
- Decision Making
- Planning and Coordination
- Teambuilding
- Active Listening
- Excellent Communication
- Clerical Support
- Organization and Time Management
- Good Telephone Etiquette
- MS Office
- Problem-Solving
- Critical Thinking
- Data Entry
- Multitasking Abilities
- Training and Development
- Flexible and Adaptable
- Dependable and Responsible
Timeline
Clinical Hub Manager
Mercalis
09.2017 - Current
Program Supervisor
Mercalis
09.2017 - 11.2021
Clinical Case Manager
WellCare
09.2016 - 09.2017
Master of Science - Health Care Administration
SMHU
Bachelor of Science - Nursing
Palm Beach State College
Associate of Science - Nursing
Florida Career College - Miami
High School Diploma -
Royal Palm Beach High School
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