Rachel Chambers
Project Management / Consultant
Hollywood,FL
Summary
Senior-level professional with over 20+ years of overall healthcare experience. 10+ years spent in Medicare/Medicaid and HIX space and 4+ years leading PBM transitions. Solid work as a project manager/ business analyst in Agile and Waterfall environments. Demonstrated success in managing complex processes and implementing data-driven solutions. Work with senior-level executives/stakeholders to ensure project scope alignment.
Collaborative leader with dedication to partnering with coworkers to promote engaged, empowering work culture. Documented strengths in building and maintaining relationships with diverse range of stakeholders in dynamic, fast-paced settings.
Overview
20
20
years of professional experience
2
2
Years of post-secondary education
Work History
Program Manager/Advisory
Performance Improvement Partners
Shelton, CT
10.2020 - Current
- Oversee the execution of IT integration projects, scope, and project plans
- Execute program governance, including status reporting, risk issue management, decision tracking, and Steering Committee reporting
- Manage workstream leads and facilitate communication across projects and cross-functional workstreams
- Drive execution of IT program/project delivery
- Monitor and communicate issues relative to workstreams to operate a transitional environment
- Prioritized tasks and managed teams throughout multiple projects.
- Managed external client and business partner relationships.
- Perform QA on Due Diligence reports for M&A practice
Advisor / Implementation Specialist/Project Manager
Pyramid Consulting Group Inc, PBM
Fort Lauderdale, FL
05.2020 - 02.2023
- Supported multiple healthcare clients on PBM transitions to ensure current state and future state needs are defined and documented
- Identified key program stakeholders through discovery phase to ensure all operational areas are properly represented
- Conducted requirements gathering sessions leveraging requirements gathering tool for traceability and signoff
- Provided feedback and clarified requirements as needed to support system build
- Advised on best practices defect resolution process with client and PBM vendors
- Provided insight on gaps in testing
- Ensured benefit designs adjudicating as expected during the testing phase
- Document and communicate lessons learned post-go-live
- Enhanced development and drove continuous improvement of project delivery process by providing strong program leadership.
Manager - Healthcare & Life Sciences
Deloitte Consulting
Miami, FL
07.2018 - 12.2019
- Manage teams of business analysts and senior consultants to provide guidance on client-specific deliverables
- Develop the detailed, quantitative analysis work associated with developing meaningful insights to address Health plan clients’ biggest challenges
- Lead in setting engagement objectives and scope
- Develop work plans for components of engagements, coordinate activities between workstreams, and identify changes in scope
- Design deliverable content to precisely reflect the engagement contracts and clients needs
- Strive to improve deliverable quality through verification and validation of results
- Cultivated professional client relationships by asking appropriate questions, identifying needs and providing insightful information regarding products.
Business Analyst/Consultant
Anthem/TekPartners (Contract)
Fort Lauderdale, FL
07.2016 - 06.2018
- Provide consultation for integration activities to ensure successful implementation (pricing engine)
- Ensure the quality, development, review, approval, hand-off, and traceability of business requirements
- Leverage JIRA and confluence to create user stories and EPICS for all requirements
- Work closely with scrum team to determine release schedules and align on user acceptance testing results
- Ensured the quality, development, review, approval, handoff, and traceability of business requirements
Manager - Senior Business Analyst
Complex Care Solutions
New York, NY
03.2015 - 06.2017
- Developed data-specific requirements for HEDIS measures, STARS, Annual Wellness Visits, and HIX (Health Information Exchange)/Medicaid
- Assessment designed to be robust in gathering extensive data to drive diagnosis and conditions
- Led transition from the legacy platform to Salesforce, creating a system interface that calls out to Medispan (drug database) when user is performing a medication reconciliation
- Drafted requirements to create systematic flags to call out any contraindication during clinical medication review
- Managed Medicare / Medicaid membership pool to determine how members are risk stratified
IT Business Analyst/Supervisor
MCNA Dental Insurance
Fort Lauderdale, FL
07.2013 - 05.2015
- Maintained and documented migration from the current system to the new system
- Facilitated meetings with operational business units to better understand the systems outliers by incorporating agile methodology
- Identified key performance indicators and incorporate into reporting tools
- Conducted UAT sessions with the business and development teams to ensure seamless deployments.
Business Analyst
gMed (Contract)
Weston, FL
2013 - 2013
- Developed requirements specifications and collaborated with developers and subject matter experts to establish the technical vision and analyze tradeoffs between usability and performance needs
- Prepared requirements and testing for Meaningful Use certification
- Critically evaluate information gathered from multiple sources, reconciled conflicts, and distinguished user requests from the underlying true need
Business Systems Analyst
Simply Healthcare Plans
Coral Gables, FL
07.2012 - 04.2013
- Lead analyst on PBM transition from Envision to Catamaran
- Responsible for leading requirements-gathering sessions and assisting in mapping data elements
- Liaison between the business units and the IT dept
- Responsible for creating workflows and speck out business requirements
- Continuously remain updated on CMS guidelines around reporting requirements for HEDIS/Stars measures
Business Operations Analyst
United Health Group
New York, Miami, NY, FL
10.2005 - 07.2012
- 7-year tenure at United Health Group, holding several operational leadership positions
- The full timeline can be disclosed during the interview process
Education
Masters - Health Informatics And Data Analytics
Florida International University
10.2017 - 12.2018
Bachelor of Science - Organizational Psychology
Capella University
Minneapolis, MNSkills
- Project Management Business Analysis
- Requirements Gathering
- User Acceptance Testing
- Medicare/Medicaid Expertise
- Strategy & Planning Healthcare Consultant
- Compliance/Regulatory
- PBM Implementation Quality Assurance
- HEDIS/STARS/HRA/AWV/EHR
- M&A Diligence
- Team Leadership
- JIRA/Confluence
- Microsoft Office Cross-Functional Collaboration
- Modern Requirements /Azure
- Nasco Claims Platform RxClaims/Optum (PBM)
- Salesforce (CRM - Healthcare Cloud)
Timeline
Program Manager/Advisory
Performance Improvement Partners
10.2020 - Current
Advisor / Implementation Specialist/Project Manager
Pyramid Consulting Group Inc, PBM
05.2020 - 02.2023
Manager - Healthcare & Life Sciences
Deloitte Consulting
07.2018 - 12.2019
Masters - Health Informatics And Data Analytics
Florida International University
10.2017 - 12.2018
Business Analyst/Consultant
Anthem/TekPartners (Contract)
07.2016 - 06.2018
Manager - Senior Business Analyst
Complex Care Solutions
03.2015 - 06.2017
IT Business Analyst/Supervisor
MCNA Dental Insurance
07.2013 - 05.2015
Business Analyst
gMed (Contract)
2013 - 2013
Business Systems Analyst
Simply Healthcare Plans
07.2012 - 04.2013
Business Operations Analyst
United Health Group
10.2005 - 07.2012
Bachelor of Science - Organizational Psychology
Capella University
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