STEPHANIE PUNG
Clare
Summary
Solution focused leader with a commitment to providing quality care through all aspects of the healthcare system. Strong interpersonal skills to impact positively and effectively with all members of the healthcare team. Detail driven with a focus on excellence and team driven approaches. Flexible and versatile, a quick learner who adapts well in new situations and enjoys a challenge. Hard working and energetic. Poised and competent, with the ability thrive in deadline-driven environments.
Overview
2026
2026
years of professional experience
1
1
Certification
Work History
Manager, Clinical Operations Oversight
Centene
10.2023 - Current
- Coordinated efforts with stakeholders to integrate departmental initiatives with organizational strategies, driving improvements in operational efficiency.
- Identified key data trends to drive strategic initiatives focused on optimizing processes for greater efficiency.
- Facilitated collaborative strategic planning sessions to outline project objectives and establish timelines.
- Cultivated a supportive learning environment for junior team members, enhancing their professional skills and development.
- Conducted performance monitoring and addressed concerns immediately to foster a positive team environment and ensure adherence to standards.
Supervisor, Clinical Business Monitoring
Meridian Health Plan Illinois
01.2022 - 10.2023
- Aligned the Complex Case Management (CCM) audit to correlate with NCQA requirements that resulted in initial accreditation for the CCM team with NCQA. Worked with the NCQA Accreditation team to complete cases for the NCQA audit and was an active participant.
- Developed UM audit for the Illinois plan for Concurrent Review, Prior Authorization and Referral Specialist, with correlating Excel Workbooks, Job Aids, Dispute Tracker and other audit materials.
- Completed overhaul of the Mobile Crisis Response team audit, incorporated contract specific requirements while aligning with the HSAG requirements for that role.
- Compiles and presents trends identified in audits to Case Management Leadership while collaboratively developing action plans for lowest compliance. This has help to increase compliance at least 10% in most audit types.
- SME for 6 clinical audit types and responsible for monthly workbooks as well as monthly updates that may be needed for all clinical audit materials.
- Collaborates with Non-Clinical leadership to ensure Contractual, NCQA and HSAG aspects are included and when applicable to aspects of all case management audits.
Performance Monitoring Specialist, Clinical Utilization Management and Care Coordination
Meridian Health Plan Michigan and Illinois
01.2019 - 01.2022
- Reviews Care Coordination cases to ensure members receive all appropriate resources available.
- Conducts audit reviews to ensure all NCQA standards are met per the Clinical Care Coordinators.
- Conducts Utilization Management clinical file assessments by reviewing clinical documentation as assigned for UM for required clinical adherence.
- Participates in the development and ongoing review of clinical review tool to ensure that clinical elements accurately capture adherence with required performance standards.
- Participates in meetings with Care Management and others to discuss review findings, areas of opportunity and recommendations for improvement.
- Participates as needed with preparation for State, CMS, and NCQA audits by collecting and/or reviewing clinical areas of relevance.
Clinical Excellence Nurse, Team Captain
Meridian Health Plan
01.2017 - 01.2019
- Responsible for reviewing all aspects of the denial processes to promote consistency and accuracy within the processes and compliance with Medicare, NCQA, URAC or general accreditation, regulatory and HIPAA guidelines.
- Develop and maintain a current knowledge of Meridian Health Plan (MHP) medical and UM policies utilized in the review process.
- Review policies, procedures, documentation standards and identify areas of improvement in clinical documentation.
- Analyzes the daily denial activities to ensure departmental goals are met with regards to timeliness, accuracy and consistency of medical decisions.
- Conducts monthly clinical audit reviews on MCS records following establish audit metrics.
- Analyzes and reports audit outcomes at an individual and aggregate level.
- Responsible for providing expertise or general support to Denials Specialist staff in reviewing, researching, investigating, negotiating and resolving all types of denials.
- Navigate through MCS system as audits performed.
- Meets all relevant regulatory requirements and comprehends and complies with best practices, professional standards, internal policies and procedures.
- Maintain strict confidentiality of employee and organizational information in accordance with MHP, HIPAA and State privacy regulations.
Transitional Case Manager
Meridian Health Plan
01.2016 - 01.2017
- Utilization review with URAC, NCQA, MDCH, and HIPPA guidelines.
- Coordinates discharge planning with SNF, Acute inpatient rehab, home health care, home infusion, DME, and pre-authorization of discharge medications.
- Complete Authorizations with approved authorization according to department processes and procedures.
- Provides verbal determination decisions and discharge planning when needed in these areas.
- Receives and processes clinical updates for continued stay review meetings and all time frames.
- Contacts Hospital/facility reviewers where additional information is necessary to make decision within established timeframes.
Registered Nurse, Emergency Department
My Michigan Medical Center
Clare, MI
2010 - 2016
- Delivered high-quality patient care in fast-paced emergency department environment.
- Collaborated with interdisciplinary teams to develop and implement patient treatment plans.
- Monitored vital signs and assessed patient conditions to ensure timely interventions.
- Educated patients and families on health management and post-discharge care strategies.
- Conducted rapid, comprehensive patient assessments across diverse acute and emergent conditions.
- Triaged patients using Emergency Severity Index (ESI) guidelines.
- Performed venipuncture, administered medications, and initiated timely nursing interventions.
- Assisted providers with procedures and diagnostic testing.
- Delivered thorough discharge education and coordinated follow-up care, including community resource referrals.
- Communicated lab and radiology results as directed by providers.
- Precepted nursing students and supported competency development.
- Monitored compliance with hospital policies and regulatory guidelines to uphold safety and quality standards.
Education
Bachelor of Science of Nursing -
Aspen University
01.2022
Associates Degree in Nursing - undefined
Mid Michigan College
01.2010
Skills
- Comprehensive patient evaluation
- Emergency & Symptom Management
- Skilled in venipuncture and IV placement
- Pharmaceutical administration
- Splinting & Fracture Care Assistance
- Sedation monitoring expertise
- Assessment of pulmonary and cardiac health
- Emergency severity index triage
- Patient Education & Discharge Planning
- Lab & Radiology Result Communication
- Cerner and Epic proficiency
- Decision-making
- Time management
Certification
Registered Nurse: MI 4704279916
Timeline
Manager, Clinical Operations Oversight
Centene
10.2023 - Current
Supervisor, Clinical Business Monitoring
Meridian Health Plan Illinois
01.2022 - 10.2023
Performance Monitoring Specialist, Clinical Utilization Management and Care Coordination
Meridian Health Plan Michigan and Illinois
01.2019 - 01.2022
Clinical Excellence Nurse, Team Captain
Meridian Health Plan
01.2017 - 01.2019
Transitional Case Manager
Meridian Health Plan
01.2016 - 01.2017
Associates Degree in Nursing - undefined
Mid Michigan College
Registered Nurse, Emergency Department
My Michigan Medical Center
2010 - 2016
Bachelor of Science of Nursing -
Aspen University