More than (#) years' diverse leadership experience as a physician executive with significant accomplishments in developing managed care strategies, integrating delivery systems, improving quality and utilization management programs and coaching medical staff on health care business and practice issues.
A self-directed professional with excellent communication, interpersonal and problem solving skills who builds consensus and promotes teamwork.
Professional Experience:
SSS Consulting, 1995-1998
Consultant
Served as a lead consultant on the recruitment of
executives including physicians, chief information officers and
administrators for the largest health care retained search firm.
Consulted with a multi-hospital system, developed job descriptions and recruited the chief information officer to further the development of an information technology strategy. Helped to create a selection process that involved physician leaders, clinical staff and the executive team.
Served as an adviser to a 14-hospital system for the creation and recruitment of a new corporate Chief Medical Officer position to facilitate an integrated physician structure and involvement in the organization's leadership.
Health care Managers, 1993-1995
Medical Director
Led the creation and operational set up of an MSO that managed
three IPA's with 600 physicians and 60,000 lives located in four
counties. Participated on the physician Board of Directors founded in
1993. Oversaw operations with involvement in claims management,
authorizations, utilization, provider and health plan relations, and
quality management. (HMO capitation contracts were managed for
professional, facility and ancillary health care, with full risk and
stop loss agreements.) Supervised four clinical case managers.
Wrote a business plan for utilization and quality management programs to include report card data elements into a standard reporting system. Expanded scope of quality management beyond Coalition requirements to include database trending of potential quality of care/service issues. Adapted re-credentialing program and a confidential file system of internally generated incident reports.
IPAs of SYS, 1988-1993
Medical Director (1990-1993)
Responsible for utilization review, quality assurance, provider
relations, claims problems, and fiscal analysis of provider costs and
budgets for an IPA with 200 physicians and 10,000 members. Acted as
liaison with the corporate offices of a billion dollar for-profit
health care system. Organized and initiated an expansion of the IPA
to two additional hospitals and their medical staffs.
Board of Directors, Executive Committee, Chairman (1988-1993)
Presided over the credentials committee through a provider base expansion from 60 to 180 while patient enrollment doubled in two years.
Organized and developed a claims payment system which paid $2 million to providers during a sudden reorganization, facilitating a smooth transition to a new management company.
Quality Care, 1992
Medical Director
Recruited as the project director for the development of a
potential county-wide EPO product for an organization that provided
medical necessity and benefits review for 65,000 members.
Consulted with self-funded employers, third party administrators and brokers to evaluate new services, including contract analysis, recommendations for benefit packages, claims payors and brokers and the allocation of health care dollars.
Hospital, California 1984-1990
Chief of Staff (1989-1990) Vice Chief of Staff (1987-1988)
Founder, Chairman of Bioethics Committee (1984-1986)
Elected as chief of all clinical services of 185-bed, acute care
hospital with responsibility for physician quality issues including
legal credential challenges.
Clinical Experience: - 1981-1993
Began and built a two-office solo practice in adult and pediatric allergy, asthma and immunology medicine. Developed pro-formas and established capitation and case rate schedules for IPA and medical groups with 150,000 patients.
Education:
Fellowship: County Medical Center (Allergy/Immunology), 1980-1981
Fellowship: Medical Center (Allergy/Immunology), 1978-1979
Residency: Hospital (Pediatrics), 1976-1978
University of SYS,
Medical Doctor Degree 1976
Masters of Science Degree in Molecular Biology, 1972
Bachelor of Science Degree in Biological Sciences, 1970
Management Training:
Medical Informatics, 28 hours
Perspectives in Medical Management, 22 hours
Mastering the Art of Power Negotiation, 12 hours
Physician in Management, Parts 1, 2, 3, 93 hours
Health Care Finance and Accounting, 14 hours
Perspectives in Medical Management, 18 hours
The One Minute Manager, 7 hours
Legal Issues in Health Care, 14 hours
Completed more than 15 management training courses on leadership, quality, information systems and finance.
Board Certification and Licensure:
Physician and Surgeon, 1976
American Board of Medical Management, 1993
American Board of Allergy and Immunology, 1982
Professional Affiliations:
American College of Physician Executives, Member, Advanced Standing
American Academy of Pediatrics, Fellow
American Academy of Allergy and Clinical Immunology, Fellow
American College of Allergists, Fellow