Stephanie Nagy
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Centers for Medicare and Medicaid Services (CMS) · Sky Solutions · Case-management modernization

Modernizing fraud-prevention case management for a national CMS program

Unified Case Management (UCM) supports administrative actions and requests across CMS’s national program-integrity network. I led end-to-end research and design for five UCM NexGen case-management workflows—called record types within UCM—and provided substantial design, testing, and delivery support for four more. I partnered with CMS users and stakeholders, product owners, business analysts, software engineers, and QA to create accessible, buildable workflows.

  • UX research
  • Interaction design
  • Design systems
Nine workflows, two levels of ownership, and one delivery model
Nine workflows, two levels of ownership, and one delivery model

1,200+

UCM production users supported

5

Program Integrity Contractor (PIC) jurisdictions

9

Record types in project scope

5 led · 4 supported

2026

Target NexGen go-live and legacy-system migration

Challenge and discovery

Understanding critical workflows before redesigning them

UCM needed to modernize complex administrative-action workflows without disrupting ongoing fraud-prevention operations or losing business rules embedded in the legacy system. I studied how records are initiated, documented, submitted to CMS, reviewed for an administrative determination, updated with official dates and status, and closed. I validated the current state with PIC users and supervisors, CMS users, business analysts, software engineers, QA, and adjacent partners before translating findings into requirements.

Research evidence and partners

Research inputs

  1. Existing record lifecycle and system behavior
  2. Documents, submission rules, determination paths, and revision loops
  3. External dependencies, status updates, exceptions, and prior process artifacts

People engaged

  • PIC users and supervisors; CMS users, including record specialists and administrators
  • Business analysts, software engineers, QA, Medicare Administrative Contractors (MACs), and law-enforcement stakeholders represented in UCM

The research established a shared evidence base for record requirements, role-specific interactions, business rules, revision paths, external dependencies, and stakeholder review throughout delivery.

Sanitized UCM administrative-action workflow showing research, design, delivery, and release stages
Current-state workflow synthesis, recreated from research and sanitized to protect internal system details.

From research to a reusable system

Translating research into reusable requirements and interaction patterns

Research findings became workflow models, functional and interaction requirements, acceptance criteria, accessible component specifications, and reusable patterns that could support multiple record types without erasing their operational differences.

I also contributed components to UCM’s migration from an inconsistent Sketch library to a Figma system aligned with the Angular Material version used by the codebase. As an expert user, I mentor designers and partner with software engineers on reusable, implementation-ready patterns.

Zoomed-out UCM Figma design-system component library
The migrated Figma system contains 35 base components, 11 custom components, 13 patterns, and two templates aligned with the product’s Angular Material implementation.
35Base components
11Custom components
13Patterns
2Templates

Workflow portfolio and delivery

Leading five workflows and supporting four through delivery

For five workflows, I owned research, requirements, interaction design, stakeholder validation, detailed specifications, and design support through implementation. I provided substantial design, testing, requirements, and delivery support for Payment Suspensions, Zone Restrictions, Overpayments, and the Managed Care Plan (MCP) Audit workflow for the Prepay Edit record.

Led 5 workflows end to end

  • Auto Denial Edit
  • Revocation
  • Deactivation
  • Request for Assistance
  • Request for Information

Each led workflow moved through a 4–8 week research and design cycle: requirements gathering with business analysts, ideation with the human-centered design team, and weekly CMS and specialist PIC reviews. After CMS and PIC sign-off, I supported Agile Jira story development, implementation questions, design changes, QA, user acceptance testing (UAT), and go-live readiness. We prioritized the highest-value user and program needs for committed releases while cataloging future improvements without putting the modernization schedule at risk.

UCM record-type portfolio separating five led workflows from four substantially supported workflows
Workflow scope and delivery model separating five led workflows from four substantially supported workflows.

Outcomes

Moving workflows toward production and release

Full legacy migration remains targeted for the end of 2026.

Production status for the five UCM workflows led end to end
Led-workflow release status as of August 2026: 2 live, 1 in final UAT, and 2 targeted by October.
UCM roadmap toward the planned end-of-2026 legacy-system migration
Supported Overpayment target and planned end-of-2026 legacy-system migration.

Production now

2 of 5 led workflows are live.

Release pipeline

1 enters final user acceptance testing in August; 2 are targeted by October 2026.

Migration target

Full legacy migration remains targeted for the end of 2026.

“I had no concerns trusting Stephanie to be the primary HCD [human-centered design] voice on the project and was unsurprisingly impressed with her ability to not only handle the designs but also to provide significant client-facing input.”
— HCD manager, UCM project

Contact

Need a researcher-designer for a complex public-sector system?

Let’s talk about enterprise modernization, accessible workflows, or responsible AI.

snaggums@gmail.com