Utilization Management Expert Witnesses

Santa Monica, California

Family Medicine, Geriatrics - family medicine, primary care, general medicine, urgent care, managed care, utilization management

I have vast experience providing medical legal expertise for both medical defense as well as plaintiff counsels. I also serve as an expert for the medical board of California. I have been in clinical practice for 34 years in the Los Angeles area, 21 years in private/group practice and 13 years in outpatient family medicine in a community practice affiliated with UCLA. I also serve as medical director for the UCLA primary care network, and am involved in clinical operations as well as quality improvement activities for the primary care physicians. The network includes primary care offices as well as urgent care locations and also incorporates telehealth services. While I no longer provide inpatient care, I do maintain hospital privileges at 2 community hospitals and follow my patients closely upon hospital discharge. I have vast experience in managed care, providing utilization review for health plan beneficiaries under HMO insurance. My clinical practice includes pediatrics, ad...

Visalia, California

Internal Medicine, Occupational Medicine - Correctional Healthcare, Independent Medical Examination, Worker's Compensation, Medical necessity determinations, Disability assessments, Medical file chart review, and utilization management

Nkiruka Ndu, MD, FACP, QME, is the Medical Director of Just Law Medical Services, a medical-legal consulting firm that provides medical-legal evaluations in internal medicine. She is a Qualified Medical Examiner in the state of California, She evaluates injured workers and personal injury cases. She performs medical necessity determinations for Independent Review Organizations. for medical necessity determinations and appropriateness of care. She is knowledgeable in the National Commission of Correctional Healthcare Standards.

Redwood city , California

Infectious Diseases, Hospital Administration - Long term care, nursing homes, skilled nursing facilities, Patient safety, Quality of care, Hospital accreditation, immunocompromised patient, medical staff protocols, antibiotic stewardship, infection prevention, infection control, transition of care, utilization management, wound care

Andres Romero is an infectious diseases physician with specialized training in treating immunocompromised patients, having completed his training at Memorial Sloan Kettering Cancer Center. He has built a career providing services in acute care hospital, outpatient facilities including wound care and post-acute care settings (long-term care hospital, skilled nursing facilities and nursing homes). Dr. Romero currently serves as Chief Health Officer at an acute care hospital. In this role, he leads initiatives in utilization management and process optimization, ensuring quality care standards are met throughout the hospital and its affiliated facilities. His notable contributions include refining peer review procedures for medical professionals and implementing workflows to facilitate safe patient transitions within the hospital. Dr. Romero actively streamlines patient safety protocols and workflows across acute and post-acute care facilities. His leadership skills, cultivated throug...

Roseville, California

Addiction Medicine, Family Medicine - Opioids, opiate, methamphetamine, overdose, alcohol, hallucinogens, cocaine, cannabis, club, drugs, illicit, drug rehabilitation, utilization management, drug policy, alcohol and drug treatment, drug intoxication, drug withdrawal, detoxification, drug testing appropriateness, pain

Dr. San Bartolome is board certified in addiction medicine and family medicine. He has extensive experience as a medical director at all levels of care in addiction treatment including detoxification. As a medical director, Dr. San Bartolome has been involved in policy making, setting protocols, utilization management and direct patient care in addiction medicine. Due to the nature of addiction, Dr. San Bartolome is experienced in pain management, mental health and use of psychotropic medications, and in other co-morbidities involving addiction. Dr. San Bartolome is a national expert, serving on committees for the American Society of Addiction Medicine and on the board of the California Society of Addiction Medicine. His experience in addiction medicine spans settings like hospitals, psychiatric units, emergency departments, outpatient clinics and as an administrative medical director of substance use disorders for a large health plan. In all of these settings and at various medical...

Chicago, Illinois

Public Health, Hospital Administration - medical necessity, utilization management, Insurance clinical policy reviews, managed care, obstetrics, gynecology

Board Certified Obstetrician and Gynecologist with more than 3 decades of experience in healthcare. Experience with peer review including 10 years on State Medical Disciplinary Board. More than a decade of experience as Medical Director on provider and payor side, authoring policies and procedures, performing medical necessity review with specialization in prior authorization.

SCHAUMBURG, Illinois

Anesthesiology, Pain Management - Medicine - Chronic Pain, Multi-modal Treatment, Comprehensive treatment, Functional Improvement, Expert Witness, Workmans Comp, Expert case review, Dual Board Certified, Trauma Training, CRPS, Spinal Cord Stimulation, Radiofrequency ablation, Regenerative Medicine, Utilization Management, Deposition

Dual Board Certified Anesthesiologist -Interventional Pain Management Specialist. Diplomate of American Board of Anesthesiology. Diplomate of American Board of Pain Medicine. State of Illinois Physician and Surgeon License, active and unrestricted. Experienced in expert witness and depositions for variety of cases. Trained at Level 1 trauma center with high volume of cardiac, thoracic, high-risk OB, solid-organ transplants. Proficient in delivering Peri-operative care. In addition, completed comprehensive pain management training, proficient experience in performing variety of complex interventional procedures (including spinal cord stimulators, radio frequency ablations, epidural injections, variety of nerve blocks, joint injections). Experience with media communications as Pain Management specialist to provide education to the community/patients. Served on panel discussions for various pain management topics to enhance knowledge. Experience in clinical and lab research along wit...

San Antonio, Texas

Preventive Medicine, Public Health - Health Insurance, Utilization Management, Government Health Contracts, Health Quality, Outbreak, Communicable Diseases, TRICARE, Medicare, Medicaid, HIV, LGBT care, Immigrant Care, Non-profit or indigent care, Correctional facility care, Appeals, Academic health care, Population health, Tuberculosis

Senior C-Suite Executive Physician• Clinical expert in population health management and disease prevention.• Health Plan/Complex Health System• Corporate/Government/Academic• Non-profit Leadership/Boards• Government Relations• Outbreak/Contamination Expert• Procurement/Business Development• Community Advocacy/Engagement• Clinical Quality Process Improvement• Public Health Consulting• Disease Prevention/ HEDIS Attainment• Utilization/Case/Disease Management• Clinical Network Credentialing/Safety• Mentor Inclusion and Diversity• Accreditation, Certification• Public Spokesperson/ Media Trained• Social Determinants of Health• Analytics/Metrics/Deliverables• World Class Employee Satisfaction• Expert Testimony in Public Health, Preventive Medicine, Population Health, Health Insurance and Healthcare. BC Preventive Medicine/BE Family Medicine Physician• Clinical expertise and leadership in public health, population health management and clinical quality.• Experience in large multidisciplin...