Precious

PRECIOUS LYNNE P. PIEGA, USRN 📫 Bataan Rd. San Julian East Agoo, La Union  preciouslynne.piega24@gmailcom Phone no- OBJECTIVES: To devote and develop my knowledge and abilities to building a secure and fruitful career in an An environment that motivates individual growth and advancement. WORK EXPERIENCE Athena Operations Manager April 2022 – present Work Description: The Operations Manager enables our EAs to consistently provide excellent quality services to our clients by addressing needs, skill gaps, and feedback with effective and personalized coaching, and performing multiple EA-support functions include real-time support and monitoring. High-level Responsibilities ● Support: Provide the resources, empowerment, training, and support necessary for EAs to deliver consistent high performance. ● Guide: Direct our EAs to work on areas for improvement, and reinforce strengths to sustain the EA's progress. Be available to help EAs with the problems that they’re facing daily by providing real-time support and having a deep understanding of the tasks that your EAs are responsible for. ● Track: Monitor client-EA partnership health, EA attendance, EA issues, escalations, and owning the resolution of performance and quality issues Specific Responsibilities Team Management and Leadership Basic Client Interface EA Onboarding Own EA and client escalations from start to finish Attend, participate and contribute during meetings Complete all administrative tasks Alphanumeric Regional Senior Team Lead May 2021 – August 1, 2022 Work Description: This role provides team management for a COVID 19 Vaccine contact center. One of the most important responsibilities of this role is to ensure that the regional operations team meets the set KPI by the client. This team provides contact service support to consumers and health care professionals for both phones and email on their inquiries about the COVID 19 Vaccine the team is supporting. Primary Duties Manages a team of registered pharmacists and nurses. Reports directly to Operations Managers. Provides weekly performance team report of the team handled focusing on the agreed KPI. Conducts weekly huddles with her team and ensures that the new processes are cascaded and well understood by her team. Also ensures that the whole regional team I informed of the process updates through a cascade mechanism set in place. Works closely with the Quality and Training team so the three pillars of operations are aligned with the processes. Conducts bi-monthly coaching / OTO meetings with my team focusing both on performance and behavior. Creates action plan to ensure that each team member reaches Works on escalations and other inquiries that require client review. Coordinates with our clients with the inquiries and cascades correct approach with the inquired escalations and cases. Work closely with the regional leads to ensure that the teams are aligned with the process and the team’s monthly QA Performance is above the target QA score. Works closely with the clients for any process updates, case requests, and process-related enhancements. Maintains the Process Updates Tracker to ensure this is cascaded to the Regional Team. Attends weekly client calls to represent the operations team and provide Work closely with other Regional Leads, Operations Managers, and Quality Compliance managers to ensure Conformance cases will be identified. This includes consistent monitoring of cases and calls and acting on any identified deviation of the process. Monitors coaching compliance with all identified Non-Conformance and confirms completion of each action item in place. Creates SME / Super User Development plan and Development activities to ensure professional growth and process enhancement. The Super Users are guided accordingly and developed to be future leads. Develops processes such as Notification Process, Non-Compliance Process, and Coaching process which helps in more systemize operations. EMAPTA Offshore Staffing Solution Clinical Governance Manager January 2018- July 2020 Work Description This role provides clinical support for Tierra Health Services and Nursing Homes in Australia. The role manages the operations of the Philippine-based clinical team. Ensures the team meets the goals set by the client. The team provides clinical and risk review, Facility Quality Status Analysis, and Trends Review for the clients. Collaborates with the Care Manager and Facility Managers of the nursing home clients in implementing the improvement plans. PRIMARY DUTIES: Planned the activities, timetable, deliverables, and resources for the launching of the account and led the team to complete the assigned tasks within the projected schedule and budget. Reviewed business requirements and functional specifications and other project documents and ensured that all are within agreed scope and methodology standards. Served as liaison and coordinator amongst the team, IT, and client business unit affiliates and ensured that teams collaboratively worked together to achieve the desired outcomes within the projected timeframe. Participated in and supervise each phase of the project and ensure that risks are identified and roadblocks are addressed immediately. Supervised project completion and ensured that the project stayed within the scheduled and adhered to the deadlines. Managed the team, set performance objectives, and ensure proper coaching and training is in place to monitor and evaluate performance. Tracked project milestones, deliverables, and change requests. Coordinate with clients, stakeholders, and various teams to drive the targeted goals and tasks. Created Scope of Work description and Qualifications for the employees the company needs to hire. Created Key Performance Indicators for the project and oversee implementation of the KPIs. Managed a team of 8 USRN nurses as clinical advisers. Reported to the Chief Executive Officer and Chief Operations Officer of the nursing home clients and Chief Executive Officer of the account. Collaborated with the Chief Operation Officer and the Facility Managers for all the nursing home clients’ staff training needs and process improvement plans based on the identified clinical and compliance risks. Monitored implementation and effectiveness of the improvement plans in place for the facilities. Clinical Risk Assessment of all the assigned residents via various electronic systems/platforms. Identified all possible clinical and standard compliance risks. Created deep dive clinical analysis of the facility’s clinical risks and quality issues that may result in noncompliance with the Accreditation Standard of the Australian Government. Maintained and ensured the accuracy of the monthly KPI report of the nursing home clients. Improved existing Facility SOPs and policies and procedures of the facility. Included creating SOPs, Work Instructions, and rolling out onshore training and toolbox talk to the Facility Staff. Provided daily updates of the teams’ performance and Weekly team progress to the client CEO and COO. Created and Improved the SOPs, Report Template, Training Materials, and Job Aids of the team. Worked closely with Quality and Compliance Officer to identify the team’s Quality Status and identify learning needs and improvement of the clinical team. This included their weekly Quality coaching and feedback sessions, reinforcement training classes, and development of Job Aids. Cognizant Technologies Philippines Clinical Team Lead (Concurrent Clinical Review Team and Discharge Planning Team) July 2016 – December 2017 WORK DESCRIPTION The Concurrent Clinical Review Nurse is responsible for utilization management or concurrent review. The CCR Nurse will perform reviews of current inpatient services and determine medical necessity and care setting appropriateness of inpatient following evaluation of medical guidelines and benefit determination. PRIMARY DUTIES: Supervised 2 USRN teams under different Line of Business. The first team included 18 nurses from the Concurrent Review Process and 7 nurses from Discharge Planning Process. This also included coordination with 2 Process trainers and 2 Quality Analysts. Provided individual weekly performance coaching and feedback to the team members. Performed Weekly Team Root Cause Analysis and Error Trends Report to enhance the quality performance of the teams. Ensured that metrics / KPIs assigned to the team were met and expected results were delivered. Collaborated with the Training and Quality team in improving the reviews of our nurses and addressing error trends, and process and training Gaps. Delivered daily operations reports such as End Day Reports, Case Assignment, Daily Concurrent Inventory, End of Day Quality Reports, and Staffing Assignment to onshore stakeholders. Manage the team’s Inventory and Productivity. Ensured that the cases met the expected turnaround time. Delivered weekly report for the Leadership and Weekly Management meeting for the onshore stakeholders and leadership. Participated in various client calls and represent the team in the performance discussions and concerns Maintained good client relationships with the onshore stakeholders. Worked closely with onshore leadership in maintaining quality reviews and maintaining compliance with NCQA and CMS standards. Worked closely with medical directors for the cases that required secondary reviews. Maintained facility assignment for the 105 assigned facilities in New York to the two teams. Performed daily huddles with the team focusing on the team’s Productivity, Quality Error Trends, Process Updates, and other operations reminders. Planned and executed a career development plan for each team member, identifying possible Future leaders. This includes enhancing both their review and leadership skills. Mentored the team’s SME (Subject Matter Expert). Completed Performance Evaluation and monitor individual progress. Hinduja Global Solutions Clinical Team Lead (Initial Claim Review) May 2015 to July 2016 WORK DESCRIPTION: The Initial Claim Review Nurse is responsible for the utilization review of submitted inpatient and outpatient claims. The ICR or MCR Nurse will perform validation on the submitted services and review the medical necessity of the Inpatient and Outpatient claims submitted by the provider to the insurance based on the set Medical Policies, chosen medical guidelines, members’ benefits, and state /federal mandates. PRIMARY DUTIES: ● Supervised a team of 20 US-licensed nurses as Claim Nurse Reviewers which reviews both inpatient and outpatient claims. Utilized MCG or Milliman Care Guideline as the core guidelines of the review. ● Worked closely with medical directors for cases that required secondary reviews. ● Provided performance weekly feedback to the nurses. ● Performed root cause analysis to effectively-identify gaps. ●Delivered the following Operations Reports: Daily End of Day Report, Weekly Operations Dashboard, Daily Team Inventory Report, Nurse’s Scorecards, Staffing Report, and Team Lead’s audits, Error Logs, and Analysis and Individual Performance Plan. ●Assisted the Shift Manager in preparing the monthly client billing or invoice. ● Worked closely with the onshore Quality Coach Team in enhancing and strengthening the team’s Clinical review skills by providing audit feedback, real-time coaching, enhancement training, andcase study/case discussion. ● Led team huddles and other initiatives to improve both productivity and quality performance ofthe team ● Served as subject matter expert for the team. Reviewed escalated cases. ● Participated in various Operations and Training / Quality Calls. These calls include the weekly inventory and project calls, Weekly Operations Calls, Quality Coach’s meetings, Dr. Hankoff’s meetings, and Quality Calibration. ● Reviewed cases to be abreast of the process and help with team productivity. This also includes responding to client escalation and review inquiries. Also performs team lead’s audit apart for the Quality Department audits, to have a higher hold of quality control. ● Coordinated closely with HR for any HR-related concerns of the team. UnitedHealth Group Clinical Operations Senior Trainer (Medical Claims Review) November 2012 to May 2015 WORK DESCRIPTION The Initial Claim Review Nurse is responsible for the utilization review of submitted inpatient and outpatient claims. The ICR or MCR Nurse will perform validation on the submitted services and review the medical necessity of the Inpatient and Outpatient claims submitted by the provider to the insurance based on the set Medical Policies, chosen medical guidelines, members’ benefits, and state /federal mandates. PRIMARY DUTIES ● Facilitated New Hire and upskill training classes for clinical and non-clinical Medical Claims Review (Retrospective Review) for Philippine and US-based nurses. Certified trainer for both Clinical and Non-Clinical MCR. ● Led the launching of MCR in Manila together with the Operations Manager. This included hiring nurses, training preparation, development of the training curriculum, precepting the 22 newly trained trainees until they pass the precept phase metrics, and being fully endorsed to operations. Follow up the newly trained nurses for 8 months during the ramp period until the team reaches full steady-state ● Audited and precepted all MCR training for both Philippine and US-based nurses. This included performance feedback, coaching, root cause analysis identification, and performance management. ● Led all MCR training-related calls. ● Assisted in launching the MCR Team in Manila. Participated in the hiring process, training development of the account, and identification of process improvement until a steady state. ● Enhanced training materials and curriculum. ● Created tools and other initiatives that helped the business. Created the Clinical Quality Audit Tool used in auditing the completed claims for MCR Nurses, training decks, and a Case Sample bucket that houses various case samples to be used for training. The Quality Audit Tool paved way for an 18% quality improvement and shorten the ramp period from 9 months to 6 months due to more focused coaching and better-quality scores. ● Consistent STAR Awardee for UHG Training Team for the years 2013 and 2014. Also received the “STAR Sustaining EDGE Award” for the 1 st quarter of 2014. Recognized for Service Excellence Award For OPTUM 2 nd and 3 rd Quarter 2014 Results Companies – Manila Training Professional July 2010 - November 2012 WORK DESCRIPTION Health Insurance Customer Service assists inquiries for both member and provider queries on the plan member benefit coverage, plan benefits, pre-authorization status, covered providers, premiums, billing and claim (only for the provider) PRIMARY DUTIES: ● Certified trainer to facilitate New Hire and Upskilling classes for a provider and member customer services for Medicare and Medicaid process. This includes Member Customer Service, Provider Hotline, and Claims Escalations. ● Facilitated small size (3 trainees) to a large training class size (40 trainees) ● Supported Operations through training initiatives ● Participated in enhancing the operations-Training process by creating the End of Training Handoff Checklist and Guidelines that are now used by all Global accounts. ● Developed Trainers’ Interview Process and Trainer’s Assessment grid in recruiting or interviewing new hires. The creation of the tool helped the company hire more competent employees and has a 15% increase in retention rate. Created the Training Master List and Attrition list for the entire account and Login Tracker ● Mentored 3 SME-Trainers and prepared their development plan and executed this plan. ● Consistent top 5% Results Global Trainers. ● 2011 No. 1 Trainer for 3 quarters – Global Category RELATED WORKING EXPERIENCE STI College Clinical and Academic Coordinator May 2007 – July 2010 ● Prepared the teaching load of the clinical instructors both in classroom or lecture and hospital-related learning experiences. ● Worked with the College Dean on the annual budget of the department and faculty salary package. ● Prepared necessary documents and required standard facilities of the Commission of Higher Education Department for their Annual Regulatory visit. ● Coordinated with the accredited hospitals or facilities for the scheduling of the clinical rotation ofthe student. ●Monitored the overall performance of the faculty, done through Faculty monitoring and method observation, facilitating faculty evaluation, and one on one mentoring. ● Provided leadership and teaching techniques seminar to fellow faculties. ● Provided feedback to the parents on their child’s performance and plan with them how to improve their performance. Senior Clinical Instructor and Lecturer April 2006 to May 2007 ● Facilitated classroom discussion for Nursing students’ year level II to IV for major Nursing Subjects such as Foundations of Nursing, Maternal and Child Nursing, Medical-Surgical Nursing and Nursing Research ● Facilitated Nursing students in their Clinical Rotation to the following hospital area: Medical-Surgical Ward, Pediatrics Ward, Delivery Room, ICU, and Emergency Room ● Leads the review classes for PNLE takers. ● Coordinated with the hospital for the clinical rotations of Level II and III. This includes student Scheduling for their clinical rotation, clinical rounds, and contract facilitation by the agreed terms. ● Created Courses / Lecture Decks and Modules used for facilitation and student guide. ● Provided clinical reports and student academic performance evaluations ● Best Faculty Awardee for SY- and Faculty with a Heart for SY- LICENSURES: US Nurse License: State of Connecticut R14151 (Active) Philippine Nurse License:- (Active) EDUCATION St Paul University of Manila June 2001 – March 2005 Bachelor of Science in Nursing Cum laude St. Paul University of Quezon City June 1996 – March 2000 Secondary School Leadership Awardee – Silver CHARACTER REFERENCES Gene Cortes Regional Operations Director Alphanumeric (- Walter Acut SEA Region-Operations Manager Alphanumeric (-