Stephanie Malone Email & Phone Number

I research, write and edit reports on new and evolving health technology.

Research new and emerging medical technologies and prepare and present findings for technology assessment. Write medical policy. Manage small corporate/clinical library, including providing reference service for clinical questions and managing small library collection. Subject matter expert and chair of genetic testing work group.

Provided case management services to high risk pregnancy, complex pediatric and transplant populations. Also served as a clinical appeals analyst. In this position I researched member appeals, represented Medica at internal and external hearings and litigation, and responded to regulator inquiries.

Represented Clinical Appeals Department on Medical Technology Assessment Committee, Benefit Interpretation Committee and Benefit Operations and Implementation Committee.Led in the development, implementation, and evaluation of Care Management, Customer/Provider Service, and Appeals processes for cosmetic procedures when jeopardy to mental health claimed.Prepared and presented clinical appeals cases for biannual Minnesota Department of Health audit.Led in the development, implementation, and evaluation of appeals process for pharmacy and personal care attendant services.Led in the development of scheduling and time off guidelines and the creation and implementation of an online time off calendar for team use.Represented health plan and provided contractual defense in cases proceeding to conciliation, arbitration, or litigation court settings.Prepared and presented documentation of the member case history, application of rules, compliance with policy and the benefit determination process for internal hearings and inquiries by regulatory agencies.

Served as lead for a team of eight complex case managers.Provided case management for transplant patients and their families in an effort to prevent adverse health outcomes and promote cost effective, quality care.Accurately administered benefits, initiated benefit exceptions, and negotiated fees for alternative benefit provisions to manage complex cases.Prepared, analyzed, and presented reports reflecting outcomes measurement, caseload, and cost savings for the department.Served as co-chair of the Medica Health Plans Employee Council.Assisted with the development and implementation of new computerized case management system. Served as active participant of committee responsible for development and implementation of letters module.

Conducted inpatient utilization review and case management activities in-house and on-site.Acted as a liaison between providers, patients, community resources and the health plan to optimize the coordination and continuity of care.Provided case management for high-risk prenatal mothers and catastrophic pediatric patients and their families.Served as a resource for internal and external customers for the Medica Primary product.Acted as Internal Medical Review Committee Coordinator.

Provided acute hospital care to childbearing women and their families on high- risk antepartum, birthing, and postpartum units.Assumed role of charge nurse on antepartum unit.Served as a preceptor for newly hired employees. Identified problems in practice and developed solutions to increase competency and decrease patient risk.Participated as active member of Professional Practice Council.

Msls, Library Science

Ba, Nursing

Activities and Societies: Sigma Theta Tau International Honor Society of Nursing, Reentry Adult Program (REAP)