Stacy Mitchell Email & Phone Number

What I have done and what I can do for your organization: Successful CMS bundled payment applications and programs Wining RFP responses for Medicaid and MLTSS Approved Physician gainsharing arrangements and agreements Compliant grievance and appeals process and operations  State licensure of HMOs, PPOs and Certified Utilization Review Entities Acceptable corrective action plans and on-going monitoring programs Successful navigation of state and federal… Show more What I have done and what I can do for your organization: Successful CMS bundled payment applications and programs Wining RFP responses for Medicaid and MLTSS Approved Physician gainsharing arrangements and agreements Compliant grievance and appeals process and operations  State licensure of HMOs, PPOs and Certified Utilization Review Entities Acceptable corrective action plans and on-going monitoring programs Successful navigation of state and federal regulations and reporting programsAdditional Experience:Government Programs – Medicare Advantage, Medicaid and MLTSS• Win theme development• Competitive analysis• RFP/application development and preparation• Technical writing• Bid preparation and submission• Network adequacy• Mock evaluations• Readiness reviews• Implementation support and management• Corrective action plansPayment Innovations• BPCI, CJR, EPM and OCM programs• Value based purchasing• Gainsharing arrangements and agreements• Quality metrics and monitoring• Opportunity and gap analysisGovernment licensing/regulation and federal certification HMOs, PPOs and Utilization Review Entities• Network adequacy• Conditions of Participation• Life safety code enforcement• Hospitals• Skilled Nursing Homes• Ambulatory Service Facilities• Home Health Agencies• Home Care Agencies and Registries• Star reporting programs• Plans of correction Show less

Harrisburg, Pa

• Responsible for filings to obtain PPO and HMO certificates of authority. • Responsible for CMS Medicare Advantage application development and submission. • Business owner of BPO (claims, enrollment and billing), PBM, Fulfillment and Dental contracts, relationships and implementations.• Responsible for product development, including identification and arrangement with supplemental benefit vendors.

• Achieved winning CMS Bundled Payment for Care Improvement (BPCI) awards for client; provided concept development and provider partnership engagement strategy and activities including gainshare agreements. • Served as Implementation Manager for new Medicaid MCO accepting 80,000 covered lives, including HCBS, LTC and Dual eligible populations in Delaware. • Achieved winning bids leading major RFP projects for Medicaid Managed Care and Managed Long Term Care and Support Services in… Show more • Achieved winning CMS Bundled Payment for Care Improvement (BPCI) awards for client; provided concept development and provider partnership engagement strategy and activities including gainshare agreements. • Served as Implementation Manager for new Medicaid MCO accepting 80,000 covered lives, including HCBS, LTC and Dual eligible populations in Delaware. • Achieved winning bids leading major RFP projects for Medicaid Managed Care and Managed Long Term Care and Support Services in Florida and Delaware, including mock evaluations, concept and win theme development and technical writing for multiple managed care clients.• Supported clients with ACA implementations including Consumer Oriented and Operated Health Plans • Assisted clients with various state and federal regulatory, licensing and accreditation issues concerning managed care plan, hospitals, nursing homes, home care agencies and utilization review entities.• Assisted clients to obtain NCQA and URAC accreditation.• Developed and performed audits of utilization management, claims processing, customer service and complaint resolution and worked with clients on performance improvement programs.• Performed due diligence reviews for major acquisitions. Show less

Harrisburg, Pennsylvania

• Responsible for the Department’s licensing and regulation of over 4,570 health care facilities, service providers and insurance plans, including 3 Bureaus and the Department’s Healthcare Associated Infection Prevention section.• Created a strategic vision, operating philosophy and work unit to successfully implement the new healthcare associated infection affecting all hospitals and nursing homes in Pennsylvania.• Implemented Home Care regulations.

Harrisburg, Pennsylvania

• Wrote and implemented new managed care regulation for the Commonwealth (Act 68), including regulations for Certified Utilization Review Entities.• Lead bureau activities to license and monitor managed care plans and other regulated entities, including creating and implementing auditing programs to enforce critical regulations in utilization review and member appeals.

Honolulu, Hi

• Served as Executive Director and CFO of statewide credentials verification service for health plans and health care facilities.

Honolulu, Hi

• Responsible for network development including provider recruitment, contract negotiation and data analysis.• Maintained responsibility for IPA growth, activities and contracts.

Honolulu, Hi

• Consolidated several physician independent physician associations (IPAs) into Hawaii IPA.• Provided technical and professional support to enable Hawaii IPA to obtain an equity position in University Health Alliance.• Negotiated, evaluated, maintained and improved IPA health plan contracts, both risk and modified risk arrangements.

State College, Pennsylvania

General Manager, HealthAmerica of Centre County• Conducted service operations for 48,000 members for three product lines as a total replacement carrier (self-funded indemnity, insured PPO and HMO) for Penn State University.Director of Consumer Affairs• Directed Customer Service employees/support staff to maximize customer service.• Established grievance and appeals process, compliant with State and Federal regulation.• Coordinated Total Quality Management, Risk… Show more General Manager, HealthAmerica of Centre County• Conducted service operations for 48,000 members for three product lines as a total replacement carrier (self-funded indemnity, insured PPO and HMO) for Penn State University.Director of Consumer Affairs• Directed Customer Service employees/support staff to maximize customer service.• Established grievance and appeals process, compliant with State and Federal regulation.• Coordinated Total Quality Management, Risk Management, and Legal/Government Affairs programs.• Developed: Member Guide; Low Utilizer Retention program; Member Outreach programSupervisor/Manager of Consumer Affairs• Created department functions, policies/procedures, and regulatory reporting formats.Senior Marketing Representative• Supervised/Trained Account Representatives assigned to service existing accounts• Analyzed/Prepared all rate quotes for Marketing Department when variable rating was required• Maintained ongoing service and renewal responsibilities for over 150 accounts including FEB, PEBTF, Verizon, Xerox and IBMSales Account Representative• Conducted new business activities including: territory analysis; forecasting; prospecting/closure; follow-up service Show less

Bachelor Of Science (Bs), Business Administration And Marketing

Master'S Degree, Public Health