Patrice Robinson Email & Phone Number

Chicago, Il, Us

Chicago, Il, Us

Chicago, Il, Us

Developed and implemented a compressive vendor oversight program which includes building and maintaining long-lasting relationships with vendors, negotiating product pricing and contracts with vendors, establishing vendor performance standards and suggesting improvements. • Manage multiple external vendor relationships for Medicare and Medicaid Alliance Initiatives in parallel with business objectives and industry regulations, ensuring compliance of standard level agreements, accuracy of project scope, alignment of resources, and milestone deliverables• Strong knowledge of regulations and audit planning according to guidance outlined in the Medicare Managed Care Manual• Facilitate monthly client strategy sessions for Dental, Vision, and Over the Counter vendors, providing a metrics per contractual obligations scorecard• Produce and instruct the Vendor Playbook across internal departments working with stakeholders to include executive leadership and senior management• Partner with internal matrix partners to reconcile annual readiness, escalated member issues, contract inquiries and yield monthly Delegation Oversight Auditing

Chicago, Illinois, Us

Implemented and maintained a comprehensive delegation oversight program which supported all aspects of NextLevel Health delegation, including Call Center, Utilization Management, Case Management, Credentialing, Claims, and encounters. • Participated in ongoing pre delegation and annual audits of delegated entities to ensure compliance with Medicaid/NCQA requirements. Assisted with & monitored Compliance or Internal Audit corrective action plans.• Coordinated, conducted, and documented delegation assessments as necessary to comply with state, federal, NCQA, and any other applicable requirements.• Chaired monthly & quarterly meetings to facilitate a venue for sharing and monitoring performance and process improvement opportunities with delegated entity and internal business partners.• Prepared delegation oversight document evidence for state monitoring visits and NCQA accreditation surveys.• Worked collaboratively with leadership to design and implemented strategies to increase delegates’ engagement to drive quality outcomes and compliance initiatives.

Downers Grover, Illinois, Us

In charge of overseeing the development of vendor relations and evaluation of vendor performance. Drafted and presented contract agreements, managed workflow processes and worked closely with internal stakeholders to prepare solutions. • A key participant in the creation of an improved transportation contract. Evaluated effectiveness and identified opportunities for enhancement. Presented findings to supervisor for approval. Awarded responsibility of the project – manage from start to finish.• Handled all facets of contract operations – write contracts, determine protocols and processes, facilitate negotiations, and more. In charge of all assigned related projects and tasks.• Suggested solutions and modifications that resolve vendor performance concerns. Kept an eye on trends and analytics to determine effectiveness. Weighted performance against standards, KPI’s and expectations.• Supported the expansion of new business lines by researching and presenting potential new vendors to leadership team. Completed the on boarding process required to bring new vendors on board.• Served as a point of contact for all vendor related concerns and matters.

Long Beach, California, Us

Accountable for the continued performance and productivity improvements within the Delegation Oversight Department. Oversee all delegation operations and activity to guarantee compliance with regulations and policies. • Coordinated and supported all functions to ensure adherence to state, federal, NCQA, and Molina standards. Conducted careful analysis of annual audits and monitor delegated assignments and tasks. • Arranged annual assessment audits for Utilization Management of Plan by mailing pre-audit letters/ audit tools, scheduling audits, and completing delegation audit tool. Reported outcomes to leadership and perform follow-up duties as needed. • Supervised Utilization Management outpatient referral denials from delegated entities by tracking and analyzing denials. Reviewed all pre-contractual UM Programs/ Plans from entities applying for contact with the Health Plan. • Produced monthly scorecards to monitor compliance of Delegation Oversight activities and performance metrics. • Developed and implemented efficient tracking tools to ensure the timely resolution of matters compliance with set standards.

Long Beach, California, Us

Directly responsible for the regular management of a high volume of diverse client cases and files. Initiated, performed, and completed the required steps within the case management process for all assigned accounts. Consulted clients and coordinated care plans. • Demonstrated exemplary communication skills when corresponding and working closely with family members, care providers, and facility personnel to communicate client status. Generated and conducted phone calls to gather information regarding client such as well-being, status, and condition. Kept accurate notes, documentation, and records. • Traveled to client locations to perform home visits, check-ins, and meetings. Evaluated and assessed client surroundings for signs of neglect or danger. Summarized visits in notes and recaps; keep in client file. • Remained on call for client questions and concerns. Always on stand-by throughout the day to answer client related calls. Primary point of contact for family members and guardians. • Adhered to all healthcare regulations, guidelines, and standards. Safeguard confidential client information. Implemented HIPAA knowledge. • Utilized critical and analytical thinking skills to make decisions on behalf of clients. Sound judgment skills to do what is in the best interest of the client.

Worked alongside Director to ensure organization efficiency through audits, staff coaching, and process evaluation. Collected performance data for review to identify improvement opportunities. • Evaluated, documented, and effectively communicated the progress and performance of employees to leadership. • Reviewed employee performance to provide feedback and additional training as needed. • Met routine deadlines and within a timely matter. Completed special projects within allotted time frames. • Helped develop and carry out implementation plans for organization transformations and updates. • Coordinated support and resources as necessary to aid in the quality improvement efforts.

Master Of Business Administration (M.B.A.), Business Administration

Bachelor'S Degree, Health/Health Care Administration/Management