35+ years of rich experiences in the ever-evolving world of heath care, including clinical practice in Manhattan & The Bronx Medical Director roles of a Taft-Hartley ERISA Welfare Fund long-time Founding Board Member of the New Jersey Health Care Quality Institute Medical Director of two Medicare, Medicaid, & Commercial managed care plans & of an IPA MSO Medical Director of a multi-specialty medical center in the South Bronx and the Director of Case Management & Utilization Management, as well as Finance Medical Director & Physician Advisor at MediSys Management's network of 3 acute care inpatient hospitals for the last 12+ years my daily responsibilities included the creation, effective implementation, & supervision of data-driven hospital & departmental policies & procedures that would improve productivity, accuracy, & results ensuring that clinical reviews faithfully adhered to the standards set forth in MCG Guidelines, Medicare Conditions of Participation, Medicare law, & CMS regulations serving as liaison between the clinical staff & the finance departments training & teaching all clinical & finance staff members through developed & written materials, conferences, as well as direct Peer-to-Peer physician educational conferences recruiting & supervising outside contractors as needed, Nurse Reviewers, & Nurse Case Managers reviewing complete medical records for medical necessity, quality of care, & correct status of admission to inpatient care vs. referral to outpatient observation & appealing coverage denials that appeared to not be in compliance with Medicare payment guidelines and regulations. HEALTHCARE: EXECUTIVE MANAGEMENT HIGHLY QUALIFIED & QUALITY-OF-CARE focused medical leader with 35+ years of rich experience in medical practice, payor & provider health care organizations management, business, finances, & program development, & delivering effective service to clients. Goal-oriented, calm, patient, & dedicated professional, with experience in clinical & administrative medicine, health insurance administration, administrative management, patient care, & program support. Combines strong leadership skills with medical support as an inspirational team member & leader with a proven proficiency in operations management. * Propels & elevates teams in the design & implementation of leading-edge solutions to health care goals, driving the highest standards of teamwork, compliance, & adherence to policies. * Goal-oriented MD with solid experience in case management, medical record analyses, patient care, disease management, medical practice organization & operation, care coordination, & program planning. * Reputed as expert presenter, negotiator, & businessperson able to forge solid relationships with strategic partners & build consensus across various organizational levels as win-win situations. * Knowledgeable, resourceful leader demanding & delivering the highest standards of professional excellence in revenue cycle, compliance, risk assessment, & resource management. * Directs teams in creative programs & initiatives designed to maximize service & satisfaction at all levels while restructuring & replacing weak strategies with healthy & viable solutions. * Exceptionally skilled professional with demonstrated excellence in building & driving superior operational success & strategic planning through goal-oriented teamwork. * Adept & capable of developing business processes that advance organizational goals, with broad company support & buy-in. * Responsible for program & project development operations. Analytical, intuitive expert with proven record of reaching target goals.

Highlights:

• Quality
• Quality Assurance
• Medicare
• ERISA
• Compliance
• Managed Care
• Data Analysis
• Documentation
• Management
• ROI