Stephen Sullivan Email & Phone Number

Greenwood, IN, US

Bangalore, Karnataka, IN

Hampton Roads, VA, US

• Oversee, inform, and enhance the ingestion and exporting of eligibility/financial data to upstream/downstream trading partners (vendors, data warehouses, integrated systems, etc.)
• Reconcile data integrity issues and implement data handling procedures
• Lead the business requirement definition for new business expansions and core administrative program migration to QNXT 6.0 from legacy system
• Business owner of eligibility file data accuracy and timeliness processing for the entire health plan organization, spanning Medicare Advantage, Medicaid, Commercial Groups, and Individual products
• Stand-up a new Eligibility CRM tool utilizing Salesforce and enhance existing QWE (Quoting/Web Enrollment) product to integrate seamlessly via web APIs to configure new groups in QNXT
• Analyze and enable RPA solutions to reduce enrollment work queue volume and required resources

• Guidepoint – Evolent Health – 8/2023
• Stream Research – Value Based Care – 3/2023
• proSapient – Clinical Administrative Solutions – 10/2022
• Stax – B2B Data Integration – 9/2022
• Optimum – Healthcare IT – 6/2022
• proSapient – Care Management Vendors – 3/2022

Arlington, VA, US

• Build business cases and represent Enrollment Operations for cross functional resource allocation, budget, and supports in Health Plan Review Board meetings
• Complete, implement, manage, and refine business processes to deliver expected business results. Anticipate market changes and consult with market growth teams on partner development.
• Lead technical implementation team to stand-up new client operations and lead systems development initiatives with engineering support to create business solutions
• Oversee and govern operational teams during post go-live implementations. Responsible for future production support as the result of efficiency benefits, regulatory changes, P&L, action plans, governance, and market.
• Maintain a position of high visibility with executive operations, stakeholders, internal functional areas, and external entities (clients/partner administrators, health plan leaders, government regulators, SMEs, etc.).
• Spearhead and strategize for consumer growth initiatives in partner markets through innovative means in digital and print media, with compliance to state and/or federal regulations

Arlington, VA, US

• As derived by membership populations, areas of risk, planned efficiency opportunities, contracted rates, anticipated revenue, and other factors, regularly design staffing models that are both cost and performance.
• Follow best-practices in team management utilizing Lead-Six Sigma attributes and values to employ a successful governance strategy
• Complete client and provider contract analysis to determine internal SLAs and KPIs for operational teams. Strategize for the most optimal and efficient operational performance.
• Develop and embrace SMART inspired goals and objectives for org. management consisting of 10 teams; managers/ADs, ICs, and analysts
• Design an Agile inspired backlog method to join operationally derived enhancement requests to improve quality outcomes, improved partner satisfaction, and quick returns on technical investments
• Analyze capacity of leadership roles within org and align their responsibilities for new client implementations, large-scale projects, existing partner support, and potential disruptors

Arlington, VA, US

• Domain Technical Lead (DTL) for Enrollment Operations and Health Plan Implementation
• Implement, manage, and refine business processes required to deliver expected business results.
• Ensure the timely and accurate delivery and maintenance of new and existing enrollment data, including system set-up, cross-departmental communication, and exception reporting with proficient use of SQL.
• Build a reconciliation program and team for IFP/Exchange markets Evolent operates in. Utilize available technical resources to inform the program. Develop/facilitate internal trainings on reconciliation, in.
• Perform socioeconomic and geographic analysis to determine strategic premium rating approaches for new and renewing markets of IFP plans, and determine growth projections for new market opportunities
• Lead technical writers in creation of various forms of documentation (implementation related playbooks, and develop SOPs, Job Aids, and Desktops) for new processes. Aid in training and development of employees assigned.

Hartford, Connecticut, US

• Lead a team of 12 field-based Clinical Care Coordinators tasked with the development of service and care plans for Managed Medicaid beneficiaries across the Chicagoland area.
• Guide and instruct team members to validate member enrollment using MEDI, 834, and supplemental data sources to determine shifts in Medicaid and/or Medicare eligibility, thus navigate members around the intricacies of.
• Complete routine quality audits and performance-based management oversight
• Developed a successful cost-savings program directed at reducing the over utilization (in excess of $1 million in SFY16) pertaining to Individual Provider services for HCBS waiver eligible adults in the Department of.
• Enhanced an Excel based HCBS waiver service tool to advance staff understanding of service rate determinations, promote inter-rater reliability across care coordination, reduce overturned appeals, and effectively.
• Liaison to the enterprise Learning and Performance team to aid in the development of individualized learning environments and curriculums across care management

Hartford, Connecticut, US

• Initiated and routinely determined home and community based waiver and SNF/SLF/SMHRF services for managed Medicaid, Medicare/Medicaid (Duals), TANF, and Expansion (ACA) recipients in face-to-face home visits largely in.
• Conducted needs-based and condition specific evaluations of health plan members with use of motivational interviewing approaches to identify psychobiosocial strengths and barriers
• Developed member-centered, interdisciplinary care plans built upon concurrent assessment data, consultations with members’ care team participants, and healthcare providers
• Provided on-going face-to-face and telephonic case management to health plan members to aid in navigating health plan intricacies, close gaps in care, and obtain healthier outcomes
• Co-facilitated a behavioral health discharge planning program to guide care managers in assisting members to seek post-acute follow-up care leading to reductions in readmissions and medication errors
• Hosted on-going groups consisting of care managers to pilot processes changes/implementations, collect participant feedback/statistics via review of custom-designed surveys, and develop proposals

- Conduct intake assessments with utilization of substance abuse, functioning level, and general psychological scales- Apply psychoanalytic interviewing to evaluate a comprehensive psychobiosocial background of newly admitted patients- Facilitate/Co-facilitate process/therapeutic, psychotherapy, life-skills, art/music therapy, and movement groups.

Chicago, Illinois, US

• Trained and supervised a group of 4-6 direct reports in a residential mental health facility
• Guided newly hired reports through on-boarding, training, and provide post-hire mentoring
• Routinely tracked staff productively to identify deficits, implemented re-trainings, hosted team meetings/1:1’s, and presented remediation strategies to management.
• Developed a 12 week clinical curriculum involving psychoeducation to conduct group therapy sessions with oversight by clinical staff (LPHA/QMHP)
• Utilized crisis intervention, community support, case management services, mental health assessments, treatment plan development, and psychotropic medication monitoring/training of 10+ client caseload
• Coordinated and consulted with psychiatrists/primary care physicians on clients’ behalf during interdisciplinary rounds to promote treatment progression

- Developed ability to acquire strong professional relationships and rapport with clientele- Conduct intake/admission interviews in an acute psychiatric in-patient unit. Adult population.- Lead art therapy and GROW program groups- Observed 50+ hours of clinical therapy groups in acute and chronic units- Design testing constructs using standard methods with.

- Generate individual lesson plans to promote development of math and reading skills with developmentally disabled children.- Consult with parents and teachers of clients to ensure of clients’ proper skills progression on a daily basis- Assist teachers in classroom and computer lab settings to support individual students

Bachelor Of Arts (B.A.), Applied Psychology

(Partial) Masters Of Social Work (Msw), Mental And Social Health Services And Allied Professions