Medicare Advantage and Clinical Operations
Contact this Expert Witness
- Phone: 818-917-6189
- Cell: 818-917-6189
Specialties & Experience of this Expert Witness
General Specialties:
HMO and InsuranceKeywords/Search Terms:
MA, Medicare Advantage, Medicare Operations, Prior Authorization, PA, Appeals, Managed Care, Prior Authorization, Utilization Review, Utilization Management, Senior CareEducation:
B.S. Biology/Chem minor, LIU @ CW Post; Doctor of Medicine, SUNY Health Science Center @ Brooklyn; M.B.A. , Pepperdine University; Board Certification - Emergency Medicine , American Board of Emergency MedicineYears in Practice:
10+Additional Information
Edited for Relevant Experiences National Utilization Committee August 2023 - April 2024 - led the effort to create governance, workflow and procedural requirements to meet CMSS rules changes effective 1/1/2024 - Accountabilities described below and added above responsibility National Director Medicare Operations March 2022 - April 2024 - Grievances and Appeals - STARS Appeals performance - Outpatient Prior Authorization Operations - Collaborated on national work groups/task forces Regional VP Mid-Atlantic State March 2019 - March 2022 - Oversight of Prior Authorization and Concurrent Review Operations - Collaborate on Enterprise Clinical Delivery Models of Care National reviewing medical Director March 2018 - March 2019 - Reviews prior authorizations for medical necessity V.P. Integrated Care and Associate CMO Jan 2015 - March 2018 - Multi-state primary and specialty care clinical operations - Collaborate with HEDIS teams to improve clinical outcomes - Co-Create governance various structures for diverse medical practice - Co-Managed medical leadership for divestiture / merger transaction Concentra Regional Medical Director May 2013 - Jan 2015 - Managed west coast medical operations (OccMed and Urgent Care) Concentra Area Medical Director November 2012 - May 2013 - Managed Southern California medical operations (OccMed and Urgent Care) NuMask, Inc. 2006 - - Investor / Shareholder - Invented and secured patents, FDA filings, prototyping and manufacturing contracts Asst Chief of Service - Emergency Medicine ~Jul 2008 - Oct 2009 - Co-Managed ED medical operations Clinical Emergency Medicine Physician 1998 - ~2014 - Direct patient care FT and per diem 1997 - 1998 Associate Director for Clinical Affairs LAC+USC Medical Center - Managed ED medical operations for Level I Trauma Center 1984 - 1990 Paramedic NYC - Jamaica and various N.Y.C. 911 receiving hospitals