Resume of Mark Michael Cuevas for career progression in Health Care BPO focusing on people management and enterprise leadership.

1. A leader withdemonstrated history of expertisein clinical and non-clinical utilization management(prior
authorization/pre-certification acrosstheclinical continuum) in cross-functionalareasof Medicare,
Medicaid and Dual Special NeedsPlan and in peoplemanagementinvolving handling new linesof
business. Acted asan influentialkey player in ensuring successfultransition of new teamsoffshorewhile
keeping the trustof statesideleadership,partners,and externalcustomers. With strong conceptsof
peoplemanagementand leadership throughconsistently high employeeengagementand manager
effectiveindex scores, SOP and Job Aid creation and data analysis.
WORK EXPERIENCE
SERVICE DELIVERY MANAGER, CLINICAL AND NON-CLINICAL OPERATIONS
Optum Global Solutions (October 2019 – Present)
 Responsiblefor the overall oversightof the Prior Authorization involving 4 lines of business and meeting
monthly internal and external compliancestandards (48 frontlinestaff and 3 Supervisors)
 Manages overall daily operational activities of the whole business includinginventory/casevolumes,turn-
around times and compliancewith state rules, hiringand attrition monitoring, developingand retaining
talent, delegation of administrativetasks to senior staff, mentoring new staff and developing new leaders
in the team
 Current stakeholder for enterprise-wide projects such as casescreeningand caseallocation tools,case
closureautomations for siteof service reviews and decisioningatpointof care/DTQ (decision tree
questionnaire)
 Collaborates with multiplecustomers (Community and State Health Plan leadership,Legal and Regulatory,
stateside/onshorepartners and leadership,Intakeand Provider advocates,and Medical Directors) to
improve process outcomes, enhance member and provider experience and resolvecustomer experience
issues
 Currently the Pointof Contact (POC) for ensuringstaff activity adherence on meal break and improved
defects significantly by 60% from January to February 2020
 Implemented various efforts to improve business utilization KPI across4 lines of business which resulted
to financial gain on November 2019 through February 2020 from billableFTEs from $334.10 in November
to $2827.28 in February and no financial losses
 Q1 of 2020: Successful passingof Maryland EQRO desk auditwhich involved review of 100+ denied prior
authorization cases and identifyingauditrisksand preparing remediation plans
 Q4 of 2019 through Q1 of 2020: Successfully promoted 1 Supervisor in the clinical team, 6 non-clinical
staff from Level 1 to Level 2 and 2 clinical staff fromLevel 1 to Level 2
ASSISTANT MANAGER (Supervisor), CLINICAL OPERATIONS
Optum Global Solutions (July 2017 – October 2019)
 Responsiblefor the overall oversightof the Prior Authorization involving 16 clinical staff whilemeeting
monthly internal and external compliancestandards
MARK MICHAEL CUEVAS, RN, MAN
Service Delivery Manager (Operations Manager equivalent)
mmjcuevasrn@hotmail.com
+639177151425
Bacoor City, Cavite 4102

2.  Acts as a senior supervisor assisting3 other teams in ensuringinventory management, complianceand
staffing
 Manages overall daily operational activities of the whole team includinginventory/casevolumes,turn-
around times and compliancewith state rules,mentoring new staff and developingnew leaders in the
team
 Collaborates with multiplecustomers (Community and State Health Plan leadership,Legal and Regulatory,
stateside/onshorepartners and leadership,Intakeand Provider advocates,and Medical Directors) to
improve process outcomes, enhance member and provider experience and resolvecustomer experience
issues
 Q1 of 2019: Successful Maryland EQRO (External Quality Review Organization) Auditheld lastMarch 13th
and 14th 2019 where key metrics are met (prior authorization and letter time frames)
 Q3 through Q4 of 2018:Successful roll-outof Manager and Supervisor Toolkit and became the single
point of contactfrom beginningof the project to execution to ensure consistency in meeting deliverables
for all supervisor and managers in stateside
 Q2 of 2018: Successful compliancepassingof Mississippi on-siteAudit
 Q1 through Q2 of 2018: Responsiblefor the exponential growth of 4 teams from 14 staff to 52 which
involved hiring,internal job alignmentand transfers
 Q1 of 2018: Responsiblefor the addition of 2 new lines of business which involved Non-Clinical and
Clinical Operations of Dual Special Needs Plans in OH,WA, WI
 Q2 of 2017: Responsiblefor the successful transition of clinical and non-clinical Medicaid teams from
statesideto offshoreoperations involving2 states (MD and MS clinical and MD, MS, NE and WA non-
clinical)
 Became the recipient of Leadership Awardee of 2018
 2018 Employee Engagement Score of 99% (Against 81% of the whole organization)
 2018 Manager Effectiveness Index Score of 97% (Against 85% of the whole organization)
 2019 October Employee Engagement Score of 93.3% (Against 79.6% of the whole organization)
 Successfully passed the MCG Certification as Care Guidelines Specialist
ASSISTANT MANAGER (Supervisor), CLINICAL ADMINISTRATION (Non-Clinical)
Optum Global Solutions (March 2017 – July 2017)
 Manages overall daily operational activities of the whole team consistingof 20 Coordinators, including
inventory/casevolumes, turn-around times and compliancewith state rules,mentoring new staff and
developing new leaders in the team
 Successfully met Audit compliancemetrics of >95% monthly and productivity exceeding targets
throughout the year
 Collaborates with multiplecustomers (Legal and Regulatory, stateside/onshorepartners and leadership,
Intake and Provider advocates,and Medical Directors) to improve process outcomes
 Became the resource champion for Fax Automation in current clinical platform
 Employee Engagement Score 83% (Against 81% of the whole organization)
 Manager Effectiveness Index Score of 98% (Against 85% of the whole organization)
MANAGEMENT TRAINEE (Supervisor), CLINICAL ADMINISTRATION (Non-Clinical)
Optum Global Solutions (March 2016 – March 2017)
 Handled Medicare and Retirement – 15 Clinical AdministrativeCoordinators
 Monitor casework queues, complianceand adherence to policies and procedures
 Implement procedures,goals and objectives within the department
 Became the Project Champion of a performance improvement initiativeand maintained >98%Level 1
quality scores in 2016 and 99%in End-to-End quality scores in 2017
 Employee Engagement Score of 79% (Against 81% of the whole organization)
 Manager Effectiveness Index Score of 99% (Against 84% of the whole organization)

3. SUBJECT MATTER EXPERT, CLINICAL ADMINISTRATION (Non-Clinical)
Optum Global Solutions (December 2014 – March 2016)
 Handled escalations and day to day operations reporting in the absence of the Assistant
Manager/Supervisor
 Executed process improvement with operations team by means of monthly mentoring, monthly team
feedback and rewards and recognitions
 Became the resource champion for successful automation of caseallocation led by our Six Sigma Black
Belt Consultant
 Became the Global Service Hero Awardee for 2015
CLINICAL ADMINISTRATIVE COORDINATOR
Optum Global Solutions (April 2013 –December 2014)
 Processed notification requirements for outpatient procedures, home health, DME, transition of care and
network gap issues and obtains appropriate clinical documentation for coverage review and determines
benefit coverages
COLLECTIONS SPECIALIST
FCO WorldwideInc.(March 2012 – March 2013)
CARDIOVASCULAR STAFF NURSE
St. Luke’s Medical Center Global City (June 2009 – November 2011)
 Routinely monitors patients who arein their acute phase of coronary conditions with the use of bedside
cardiac monitors with pulseoximetry.
 Assesses individual patientfor careprioritization in takingcareof vulnerablepatients in considerationsof
their comfort, hygiene, diagnosisand others.
 Became the recipient of Serviceexcellence awardee for 2011