RAJ DHAMEJA, M.B.B.S, M.H.A
(714) 417-3117 firstname.lastname@example.org
Health System & Hospital Administration | Patient Care Experience | Project Manager
Health Services Administration professional with 15 + years of Clinical and Management experience in acute and tertiary care hospitals, health plans and managed care organizations. Experience focused on project management, operations, program management, business strategy, , analysis, regulatory affairs and compliance. Ability to work broadly across a wide portfolio of projects with teams in Operations, Finance, Patient Services, IT and Ancillary areas.
Reimbursement Internal Communications Supply Chain Patient Access Operations
Medicare Project Management Strategic Planning Business Process Analysis
Acute Care MS Project Clinical Programs Client/Customer Relations
Analytics Compliance Quality Improvement Financial Managemment
M.H.A – Master of Health Administration
University of Southern California (USC), Los Angeles, CA, 2007
Administrative Residency – Leadership Track
L. A. Care Health Plan, Los Angeles, CA, 2007
M.B.B.S / MD – Bachelor of Medicine, Bachelor of Surgery
Faculty of Medicine, Kasturba Medical College, Manipal University, India, 2001
Equivalent of United States MD (Doctor of Medicine)
Healthcare Consultant and Site Administrator
St. Louis, MO | Long Beach, CA | Dallas – Ft. Worth, TX 2009 – 2015
• Executed business and clinical projects, start-ups and led management activities to leading healthcare facilities including Managed Care, Hospitals, TPAs, Medicare, Medicaid and Health Departments
• Ensure highest levels in quality and effectiveness of patient care services, clinical processes, patient satisfaction and compliance.
• Oversee site operations, staff supervision, special projects promote knowledge development, leadership, recruitment and retention.
Summary of Consulting Assignments
Sr.Project Manager, Clinical Programs, Molina Healthcare, Inc., Long Beach, CA
Lead full lifecycle of clinical projects to support leadership initiatives for Medicaid and Medicare operations. These include chronic illness and disability payment system and clinical analytics for risk stratification. Developed project plans, defined scope, tasks, resources, budgeting, project success criteria and presented value proposition, ROI, operational and financial metrics to health system leadership.
Consultant, Joint Commission
Assisted US based healthcare consulting firm with their new business development project for a Middle East client to achieve Joint Accreditation standards for country’s hospitals, LTC facilities, pharmacies, clinics, blood banks and dialysis centers.
Cardiothoracic Surgery Hospital
Assisted in establishing a new cardiothoracic and vascular surgery hospital providing comprehensive inpatient and outpatient services. Proposed growth strategies based on population demographics, specialty physician recruitment and network development.
Improved patient access and revenue cycle process by streamlining pre-registration, benefit verification, pre-authorization and collections.
Outlined personnel supervision guidelines including hiring, salary negotiation, employee training and management and promotion.
Develop success criteria for operational efficiencies, process improvement, reduction in accounts receivable, unbilled services and process errors.
American College of Healthcare Executives
Chair, Communications Committee
Oversee and maintain communication activities among chapter members through effective communication systems, monthly meetings, publication and ensure effective organizational structure and high quality of support services. Provide direction, lead central communication and marketing,and set priorities for the office of strategic initiatives. Serve as liason between board and members.
EXPRESS SCRIPTS, INC., St. Louis, MO
Senior Manager, Medicare Product Development 2008 – 2009
• Assumed responsibility to strengthen Medicare Part D project activities, increase confidence of internal and external clients and compliance adherence.
• Development and deployment of Medicare Product’s large scale Financial Information Reporting project, collaborated with IT and Product teams to achieve deliverables and CMS compliance.
• Achieved board approvals for 3 new process improvement projects $150 – $225K each.
• Maintained approximately 12 current processes including high revenue generators such as Explanation of Benefits (EOB) and Coordination of Benefits.
• Performed on going project monitoring and reviews, identified successful project elements, best practices and proposed recommendations to leadership
L. A. CARE HEALTH PLAN, Los Angeles, CA
Administrative Resident 2006 – 2008
• Led the Predictive Modeling project and program direction to identify high risk patients, forecast future utilization, reduce cost and improve clinical programs including Dialysis program.
• Managed RFP project and analyzed vendor proposals for patient criteria.
• Project manager for cross-functional pilot initiatives chartered to drive performance, continuous improvement, financial gains and patient satisfaction..
• Analyzed competitive landscape and developed organization’s strategic plans
• Designed physician advisory committee to enhance quality of programs, interventions, clinical initiatives and develop clinical practice guidelines..
• Assisted in developing organization’s Medicare Advantage line of business.
• Developed training documents, communication and change management plans.
• Revised Compliance program description for Medicare Advantage. Developed policies and procedures, internal reporting standards corrective action plans.
MOLINA HEALTHCARE, INC., Long Beach, CA
Management Intern 2006
Performed DRG Validations, specifically identifying up-coding as cost-containment effort toward targeted savings of $9 million in 2006.
FMCEA (Now Hospital Clinical Services Group), San Diego, CA
Clinical Specialist, Cardiovascular Perfusion 2003 – 2005
Performed over 300 autologous blood transfusion procedures independently during Orthopedic and Vascular surgeries.Documented procedures, vendor communication and inventory control.
KASTURBA HOSPITAL (Academic Medical Center), Manipal, India
Physician/Medical Doctor 2000 – 2001
Direct patient care in ambulatory and acute care settings including in-patient, emergency room, critical care, intensive care, neonatal and burn ICU.
Participated in daily Morning Report sessions with residents, staff and faculty physicians, weekly Grand Rounds, daily Case-Based Teachings and Intern Reports.
• ACHE (American College of Healthcare Executives)
• USC Alumni Association, School of Policy Planning and Development
• HFMA (Healthcare Financial Management Association
• MGMA (Medical Group Management Association