Dora S. Gaeta 9016 E. Karen Drive Residence: 480-451-4327; Scottsdale, AZ 85260-2750 dg12f66a2@westpost.

net Objective: To obtain an Administrative role in an environment conducive to prof essional advancement. Qualifications: Consistent work history in administration coupled with strong a cademic credentials. Attributes: * Experience and proven success in managing diverse teams and complex programs/p rojects. * Working with senior leadership on project management and reporting, including analysis and communication of financial and operational data for decision-making and strategic planning. * Ability to review and interpret CMS guidelines and regulations specific to Med icare Part D initiatives * Assessing change readiness, creating and managing change management plans, dev eloping and executing communication plans, defining roles and responsibilities a nd measuring departmental impact. * Acting as a performance advisor and mentor for assigned staff. * Participated in project implementation including creating training documents f or continued maintenance of program. * Experience in Managed Care, Prescription Benefit Management, Quality Assurance / Quality Improvement, Utilization Review, Medical Malpractice Case Review, Data Management and in depth Pharmaceutical industry knowledge. * Experience with core software applications including: Power Point, Visio, Proj ect, Word, Excel, Outlook, MedFORCE Scanning Workflow Software system. Health Care/Business Experience: Business Operations Advisor/Project Manager-Caremark9501 E. Shea Blvd, Scottsdale, AZ 85260 2006-present * Project Manager for Multiple Projects. Projects included the ability to perfor m the following: o Due diligence in the analysis and selections of vendors considered for program s o Prepare presentations to obtain funding and approval to Executive Management' o Project cost analysis consistently reviewed and invoices reconciled for Financ e o Infrastructure requirements obtained by working with IT Liaison, SQL team and Enterprise Architecture for Vendor Management's approval o Procure equipment by analyzing needs of the department(s) and budget constrain ts o Create requirement documents for vendor and easily understandable language for Managers, Supervisory staff o Program and develop software to meet internal partner's needs for various plat forms in multiple states o Institute process improvements by programming and developing software to accom modate various tasks, definitions, outcomes, trending, QC monitoring, pharmacy c ontact information and others depending on the project and program. o Developed training material o Identified and interviewed potential candidates for employment in Managerial r oles * Scanning Project with Workflow creating a paperless environment in a Paper Cla ims Department receiving approximately 3 million paper claims per year. Enable F irst Call Resolution for Customer Care Partner.Facilitated "Efficiencies" relate d to response time for Account Management.Create a system to meet the needs that were inconsistent from platform to platform, manager to manager and supervisor Cell: 480-202-9889

to supervisor. * Scanning and Workflow project enabling a paperless environment for SilverScrip t Medicare Part D Plan involving CMS requirements for Enrollments, Disenrollment 's, Attestations, etc. for Member Services and Undeliverable Mail. The ability t o realize TAT in expedited measured success.Oversight of implementation in Scott sdale and in Nashville. * Implemented a SilverScript Member Call Center for a Med D Prescription Drug Pl an servicing USA and Puerto Rico. Project included Cost Analysis, Budget/Finance , Human Resources staffing, Equipment expenditures, Facilities location for mult i-call center components, Training, Information Technology Infrastructure, Infor mation Security, and Telecom set up, continuous communication with Sr. Managemen t, Implementation, Account Management, Sales and Finance. Project required appro val from BITCE Committee, ROI, Cost Analysis, Procurement of Equipment, Strategi c planning and design. * Created a mandated Coordination of Benefits Med D Survey, developed costs anal ysis, negotiating with multiple vendors for printing, data entry and execution o f survey for 800K members nation-wide. * Oversight of outsource Data Entry Vendor. Coordinate and review Request for I nformation (RFI) and Requests for Proposals (RFP) for new services and vendors. * Business/Project Analyst-McKesson Health Solutions (formerly Healthcare Delive ry Systems-HDS),4343 N Scottsdale Road, Scottsdale, AZ 85251 2000-2006 * Function as a liaison involving department or cross-functional teams focused o n the delivery of a product or program, through the design process and into fini shed state for internal or external patients, healthcare professionals, sales re presentatives as well as, pharmaceutical clients. * Monitors the product/program/project from initiation through delivery, interfa cing with customers as appropriate. Assess project issues and develops resoluti ons to meet productivity, quality and client satisfaction goals. * Working in the capacity of "Subject Matter Expert" in conjunction with IT depa rtment in the SDLC of new programs to include, system, programmers, and business analysts, developing a comprehensive all inclusive new reimbursement system app lication. The system includes Real Time Eligibility, product pricing and coding capabilities, off label reference links, accurate concise and easily retrievable insurance, benefits and health plan information for public and private payers. * Assists in the Training, Management and Implementation of new contracted pharm aceutical initiatives. Provide managerial direction until a new program is fully functional and the Team Lead has adequately staffed supervisory personnel. * Provided operational and administrative assessment to enhance program developm ent ensuring regulatory * Compliance, interacting with medical professionals, IT, strategy/marketing and sales. * Communicates with matrix partners: Finance, VP of Operations, Senior Managemen t, Legal and Network Sales Operations. Unit Coordinator-Reimbursement Department 1996-2000 Healthcare Delivery System (HDS) 9700 N 91st St, Scottsdale, AZ 85258 Responsible for client management activities on all assigned accounts * Practiced daily staff- development for reimbursement/customer service represen tatives, in a call center environment. Representatives were responsible for cus tomer related inquires regarding program and payment options, paper claims submi ssion/collection, as well as direct electronic online transactions with pharmaci es. Liaison with Program Management on the cases referred to client in their Pat ient Assistance Programs. Developed, organized, managed and trained staff provi ding direction and procedures, for various positions, in a multi-million dollar a year, Accounts Receivable Cash Application Unit. University Hospital Medical Center at Stony Brook, Stony Brook, NY

Quality Assurance Data Manager ; Medical Care Review Dept.1980-1991 Teaching Hospital-Senior Staff Assistant Managed daily activities of Quality Assurance and Utilization Review programs * Daily oversight of planning, organization, direction and control of day-to-day Quality Assurance and Utilization Review programs effecting hospital-wide polic ies. Designed data collection procedures, methods and systems; coordinating, mon itoring and assessing information obtained by RN staff, identifying indicators, determining standards of care and correct attribution. Compiled concurrent and r etrospective data to perform Trend Analysis to assess whether patient care met e stablished standards. * Developed QA profiles for 28 clinical departments and their staff of 650 Atten dings and 350 Residents. * Provided follow-up assistance indicating hospital as-well-as departmental comp liance of agreed upon corrective actions. Identified, investigated and informed Risk Manager of all incidents with potential medical malpractice implications. S taff liaison to Intra-hospital Personnel for State, Federal and JCAHO standards. Utilization Reviewer for admission and continued stay inpatient and off-site pa tient records. * Shared Personnel duties with the Director of the Medical Care Review Departmen t included: interviewing, hiring, training, written and oral evaluations of tech nical staff and RN staff. * Other Experience Licensed Realtor -Arizona Best Real Estate Scottsdale, AZ 199 2-1994 * Licensed Realtor-Hyland Bay Co Phoenix, AZ 1993-1994 * Customer service and sales of custom homes. Evaluator of sales personnel for n ew home builders. EDUCATION * Masters of Arts -Labor/Management-Health Administration 1989 * New York State Advanced Certificate in Labor/Management Studies 1989 State University of New York, at Stony Brook, N.Y. Baccalaureate of Science Degree-Health Administration 1986 St. Joseph's College, Patchogue, N.Y. * Associate in Applied Science-Paralegal Degree 1984 Suffolk County Community College, Selden, N.Y References furnished upon request.