Summary
Overview
Work History
Education
Skills
Languages
Accomplishments
Certification
References
Timeline
Generic

Tamika Andrews

Miami,FL

Summary

Seasoned Senior Medical Management Trainer with a solid background in healthcare training and development. Known for strategic skills in curriculum design, staff education and process improvement in medical management settings. Standout abilities include strong communication, leadership, and passion for enhancing medical knowledge. Previous roles demonstrate significant impact on improving operational efficiency through effective training programs. Results-driven Senior Medical Management Trainer recognized for high productivity and efficient task completion. Specialized skills include curriculum development, regulatory compliance training, and performance improvement strategies. Excel in communication, leadership, and problem-solving to enhance team capabilities and deliver impactful training programs. Energetic training and development professional versed in developing and implementing improved training programs to improve performance. Success driving participation by leveraging employee incentives, employing engaging training methods and implementing team-building activities to meet training needs. Bringing several years of industry expertise. Highly-motivated employee with desire to take on new challenges. Strong work ethic, adaptability, and exceptional interpersonal skills. Adept at working effectively unsupervised and quickly mastering new skills.

Overview

16
16
years of professional experience
1
1
Certification

Work History

Senior Medical Management Trainer

HealthSun Health Plans/Anthem
Miami, FL
07.2020 - 10.2023
  • Developed training materials for medical management staff across multiple departments.
  • Conducted workshops to enhance skills in patient care and compliance standards.
  • Collaborated with leadership to identify training needs and gaps in knowledge.
  • Evaluated training programs for effectiveness and alignment with organizational goals.
  • Mentored junior trainers, providing guidance on best practices and methodologies.
  • Facilitated onboarding sessions for new staff in medical management roles.
  • Implemented feedback mechanisms to continuously improve training content and delivery.
  • Coordinated cross-functional meetings to ensure alignment on training initiatives and resources.
  • Identified potential areas for improvement in existing training materials by analyzing feedback from previous sessions.
  • Created instructional materials such as handouts, presentations, and videos for use during trainings.
  • Adapted lessons plans according to the needs of different groups attending trainings.
  • Organized and conducted workshops to help new employees learn the fundamentals of medical management.
  • Advised senior managers on ways to improve their organization's approach towards medical management.
  • Maintained records of all trainings conducted, including attendance logs and assessment results.
  • Developed and delivered training programs for medical staff on topics such as patient care, clinical processes, and healthcare regulations.
  • Researched current trends in the field of medical management and incorporated them into training programs.
  • Assessed employee performance and provided feedback to improve skillsets related to medical management.
  • Analyzed existing training materials and identified areas that needed improvement or updating.
  • Collaborated with other trainers to develop comprehensive curricula for medical management courses.
  • Evaluated effectiveness of existing training programs by conducting surveys among participants after completion of each session.
  • Monitored progress of trainees throughout the course duration and evaluated their performance at the end of each session.
  • Provided individual coaching sessions to help employees understand difficult concepts related to medical management.
  • Developed strategies for providing effective feedback to participants regarding their performance during trainings.
  • Provided guidance on professional development opportunities available within the organization.
  • Contributed ideas for new methods of teaching complex topics related to medical management.
  • Explained goals and expectations required of trainees.
  • Monitored, evaluated and recorded training activities or program effectiveness.
  • Participated in and attended meetings or seminars to obtain information for use in training programs.
  • Created and offered additional materials to enhance training.
  • Used role-playing, lectures, and simulations to present information in variety of instructional techniques and formats.
  • Obtained and organized manuals, guides and visual materials for development and training purposes.
  • Suggested and offered specific training programs to help workers maintain or improve job skills.
  • Worked collaboratively across departments and with various stakeholders to deliver comprehensive, effective training sessions.
  • Evaluated training materials prepared by instructors and offered actionable suggestions for improvement.
  • Assessed training needs through surveys, interviews with employees or focus groups.
  • Selected and assigned instructors to conduct training.
  • Evaluated modes of training delivery to optimize training effectiveness, training costs or environmental impacts.
  • Supervised, evaluated or referred instructors to skill development classes.
  • Maintained strong knowledge by participating in workshops, conferences, and online education classes.
  • Remained up-to-date with developments in area of expertise by reading current journals, books or magazine articles.
  • Monitored training costs and prepared budget reports to justify expenditures.
  • Devised programs to develop executive potential among employees in lower-level positions.

Medical Manager

HealthSun Health Plans/Anthem
Miami, FL
12.2019 - 07.2020
  • Led cross-functional teams to implement new medical protocols and guidelines.
  • Developed training materials for staff on regulatory compliance and best practices.
  • Coordinated patient care strategies with healthcare providers to improve service delivery.
  • Managed inventory of medical supplies and equipment for operational efficiency.
  • Facilitated communication between departments to enhance collaborative efforts in patient care.
  • Oversaw the scheduling of clinical trials and research initiatives within the organization.
  • Analyzed data to identify trends and inform decision-making in medical management processes.
  • Ensured adherence to safety standards and regulations in all operational activities.
  • Provided training to new employees on company policies and procedures.
  • Reviewed patient information for accuracy prior to submission of claims.
  • Conducted regular meetings with staff members to discuss issues or concerns regarding patient care or safety protocols.
  • Resolved conflicts between staff members or between staff members and patients.
  • Monitored the performance of staff members and provided guidance as needed.
  • Prepared reports summarizing departmental activities for management review.
  • Developed and implemented strategies to improve patient care quality.
  • Reviewed daily operations logs from various departments and identified areas of improvement.
  • Coordinated with other health professionals to provide optimal healthcare services.
  • Analyzed data related to patient outcomes, satisfaction scores.
  • Assisted in recruiting, hiring, orienting, evaluating and disciplining staff members.
  • Maintained a safe working environment for all medical personnel by adhering to safety guidelines.
  • Collaborated with other departments in order to ensure efficient operations.
  • Established protocols for responding effectively during emergency situations.
  • Managed financial aspects of the department such as budgeting, billing, coding.
  • Responded promptly to inquiries from patients, family members or other physicians and clinicians.
  • Organized educational seminars for medical staff on topics related to current trends in healthcare.
  • Participated in community outreach programs aimed at promoting public awareness about healthcare services offered by the organization.
  • Communicated with patients with compassion while keeping medical information private.
  • Explained policies, procedures and services to patients.
  • Built work schedules and staff assignments, taking workload, space and equipment availability into consideration.
  • Maintained records management system to process personnel information and produce reports.
  • Directed, supervised and evaluated medical, clerical or maintenance personnel.
  • Maintained awareness of government regulations, health insurance changes and financing options.
  • Assessed need for additional staff, equipment and services based on historical data and seasonal trends.
  • Managed changes in integrated health care delivery systems and technological innovations while keeping focus on quality of care.

Department Lead

HealthSun Health Plans
Miami, FL
01.2017 - 12.2019
  • Led team in daily operational activities and ensured adherence to policies.
  • Coordinated communication between departments to enhance workflow efficiency.
  • Assisted in training new staff on processes and company protocols.
  • Implemented process improvements to streamline administrative tasks.
  • Managed scheduling and resource allocation for team projects.
  • Developed and maintained documentation for departmental procedures.
  • Facilitated team meetings to discuss goals and address challenges.
  • Monitored team performance and provided constructive feedback regularly.
  • Provided leadership, motivation, direction and support to team members in order to achieve individual success as well as team goals.
  • Coordinated with other departments to ensure efficient workflow across the organization.
  • Provided training and guidance to new employees on policies and procedures.
  • Managed effective stock rotation and inventory placement.
  • Monitored employee performance and provided feedback to ensure job expectations were met.
  • Put together special displays and coached employees on latest promotions.
  • Utilized pre-determined corporate plans to merchandise new products.
  • Collaborated with senior management on strategic initiatives that impacted the overall business objectives.
  • Resolved customer complaints in a timely manner by identifying root causes of issues.
  • Oversaw department schedule, projects and quality standards.
  • Managed inventory levels by placing orders when necessary and monitoring stock levels throughout the year.
  • Ensured compliance with all federal, state, local laws and regulations related to the department's operations.
  • Reviewed time sheets for accuracy prior to submitting them for payroll processing.
  • Developed and implemented departmental policies and procedures.
  • Implemented systems for measurement of key performance indicators to track progress against organizational objectives.
  • Managed daily operations within budget constraints while ensuring quality standards were met.
  • Supervised and delegated tasks to departmental personnel during manager's absence and busy periods.
  • Reviewed weekly reports from subordinate staff members outlining project status updates.
  • Trained and supported new teachers by providing information on successful strategies for classroom instruction and management, instructional techniques, and multimedia integration.
  • Conducted regular meetings with staff to review objectives, deadlines and progress towards goals.
  • Prepared monthly reports summarizing departmental accomplishments, challenges faced and upcoming projects.
  • Administered standardized tests and evaluated results to assess performance of students and teachers.
  • Performed recruitment activities such as interviewing candidates, creating job postings and conducting reference checks.
  • Recommended student class and program placement based on student abilities.
  • Analyzed operational trends to identify areas for improvement in efficiency or cost savings.
  • Performed administrative duties such as scheduling shifts, approving time off requests.

Utilization Management Representative

HealthSun Health Plans
Miami, FL
01.2013 - 01.2017
  • Reviewed patient care requests for medical necessity and compliance with guidelines.
  • Coordinated with healthcare providers to gather necessary medical documentation.
  • Evaluated treatment plans for appropriateness and adherence to policies.
  • Communicated decisions to stakeholders, ensuring clarity and understanding.
  • Assisted in training new team members on utilization management processes.
  • Monitored ongoing cases to ensure timely reviews and updates were conducted.
  • Documented all interactions and decisions in the electronic health record system.
  • Collaborated with interdisciplinary teams to address complex patient cases effectively.
  • Monitored cases referred for case management services including those involving complex conditions such as cancer treatment or organ transplantation.
  • Attended educational seminars and webinars related to current topics in healthcare delivery systems.
  • Conducted initial review of requests for medical necessity and appropriateness of services in accordance with benefit plan criteria.
  • Facilitated interdisciplinary team meetings with other healthcare professionals involved in the care planning process.
  • Identified potential areas for improvement within the organization's utilization management program based on quality indicators or feedback from internal or external sources.
  • Communicated clinical decisions verbally and and or in writing to physicians, other health care professionals and members as appropriate.
  • Reviewed and evaluated clinical documentation submitted by providers to ensure compliance with applicable laws and regulations.
  • Responded timely to inquiries regarding prior authorization status from external customers via telephone or email correspondence.
  • Participated in external audits conducted by state agencies or third-party payers regarding utilization management practices.
  • Evaluated the need for additional information from providers or members to support a request for service authorization.
  • Collaborated with internal departments such as Case Management, Quality Improvement, Pharmacy Services. to obtain necessary information for case reviews.
  • Assisted in developing new policies and procedures related to Utilization Management processes.
  • Provided guidance on appropriate utilization management techniques to other staff members as needed.
  • Contributed to appeals process by providing pertinent clinical information upon request from appeals department personnel.
  • Ensured that all authorizations are documented accurately in the patient's medical record.
  • Determined medical necessity and cost-effectiveness of services through utilization review processes.
  • Applied medical criteria and clinical judgement to researched cases to evaluate and establish determinations.
  • Collaborated with providers to obtain required clinical information, supporting prior authorization determinations and individual inquiries.
  • Remained up-to-date on various benefit plans, medical policies and state-specific clinical guidelines or criteria.
  • Referred cases to secondary review for failure to meet criteria.
  • Collaborated with staff members in group meetings to identify issues and find cost-effective solutions.
  • Documented all utilization review activities, findings, and decisions in patient records and databases.
  • Performed pre-certification, concurrent, and retrospective reviews of inpatient and outpatient services.

Enrollment Specialist

HealthSun Health Plans
Miami, FL
01.2009 - 01.2013
  • Managed member enrollment processes for HealthSun Health Plans effectively.
  • Coordinated communication between members and healthcare providers.
  • Reviewed applications to ensure compliance with health plan guidelines.
  • Assisted members in understanding benefits and coverage options clearly.
  • Collaborated with cross-functional teams to streamline enrollment procedures.

Compliance Coordinator

HealthSun Health Plans
Miami, FL
07.2007 - 01.2009
  • Assisted in developing training materials for compliance staff and stakeholders.
  • Monitored policy changes and communicated updates to relevant departments effectively.
  • Maintained accurate records of compliance activities for audits and assessments.
  • Collaborated with teams to identify potential compliance risks and propose solutions.
  • Prepared reports summarizing compliance findings for management review and action.
  • Drafted written reports summarizing audit findings and recommended corrective actions.
  • Devised and deployed strategies for promoting critical health and safety standards to employees.

Education

High School Diploma -

South Miami Senior High
Miami, FL
05-2001

Skills

  • Employee training
  • Performance evaluation
  • Data analysis
  • Project management
  • Communication skills
  • Decision-making
  • Process improvement
  • Team collaboration
  • Conflict resolution
  • Employee engagement strategies
  • Medical coding
  • Clinical documentation proficiency
  • Training needs assessment
  • Medical management expertise
  • Excellent communication
  • Medical management training
  • Team leadership

Languages

English
Professional
Spanish
Professional

Accomplishments

  • Achieved Recognition by previous employer HealthSun Health Plans/Anthem for Leadership skills.

Certification

  • Certification of Completion by previous employer Healthsun Health Plans/Anthem for various Compliance Trainings.

References

References available upon request.

Timeline

Senior Medical Management Trainer

HealthSun Health Plans/Anthem
07.2020 - 10.2023

Medical Manager

HealthSun Health Plans/Anthem
12.2019 - 07.2020

Department Lead

HealthSun Health Plans
01.2017 - 12.2019

Utilization Management Representative

HealthSun Health Plans
01.2013 - 01.2017

Enrollment Specialist

HealthSun Health Plans
01.2009 - 01.2013

Compliance Coordinator

HealthSun Health Plans
07.2007 - 01.2009

High School Diploma -

South Miami Senior High

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