Patrice Stevens Email & Phone Number

Wah, Nh

Accountable for the design, development and implementation of member and provider appeal and grievance programs for new Aetna Medicaid Administrators (AMA) plans as well as the ongoing management, support and training of appeal and grievance systems and processes.• Contribute to the composition of and ensure accuracy of A&G RFP responses.• The design, development and implementation of the A&G program for all new health plan implementations.• Monitoring and auditing of AMA health… Show more Accountable for the design, development and implementation of member and provider appeal and grievance programs for new Aetna Medicaid Administrators (AMA) plans as well as the ongoing management, support and training of appeal and grievance systems and processes.• Contribute to the composition of and ensure accuracy of A&G RFP responses.• The design, development and implementation of the A&G program for all new health plan implementations.• Monitoring and auditing of AMA health plan member and provider appeal and grievance system programs and processes. • Oversight of the AMA plans through biennial assessments, off cycle file reviews and annual timeliness validations to identify risks and potential issues.• Development of activities to address any identified risks and issues to minimize or mitigate compliance risk for the organization. • Provide case specific, day to day and intensive support to AMA plans as needed.• A&G application configuration and ongoing maintenance and support.• Serve as liaison for the Executive Resolution Team (ERT), Social Media Resolution Team (SMRT) and Regulatory complaints team and facilitate resolution. Show less

Work At Home, Nh

Accountable for the development, implementation and ongoing management of more complex projects for new health plan implementations which typically impact more than one of the following: process, system, product and/or function and may run a year in duration.•All aspects of new health plan implementation for the following segments; appeal and grievance system as well as reporting across functional areas•Contribute to the writing of RFP / RFA responses related to the appeal and grievance… Show more Accountable for the development, implementation and ongoing management of more complex projects for new health plan implementations which typically impact more than one of the following: process, system, product and/or function and may run a year in duration.•All aspects of new health plan implementation for the following segments; appeal and grievance system as well as reporting across functional areas•Contribute to the writing of RFP / RFA responses related to the appeal and grievance system and reporting•Design, development and implementation of the grievance and appeal program and the related application for new health plans•Identification of all statutory compliance reports and deliverables•Facilitate collection of all required elements for the statutory compliance reports and deliverables and ensure that all items are developed to meet the specified requirements•Identifies gaps and recommends enhancements related to new and/or existing products, services and workflows based on broad view of the organization•Solicits and evaluates internal and external customer feedback to enhance continuous quality improvement•Group facilitation/presentation influencing various internal (these may be cross-functional/segment) and external parties (e.g., vendors)•Identifies issues that may stall project and addresses them by either resolving the issue or creating an alternative solution•Tracks progress and communicates project(s) status on a regular basis to all impacted parties•Builds communication plans for implementation to ensure all impacted parties (up stream/down stream) are informed of next steps for completion Show less

Bachelor Of Science (Bs), Human Development And Family Studies, General

Diploma, General Studies