More than 14 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 healthcare business and practice issues.
A self-directed professional with excellent communication, interpersonal and problem solving skills who builds consensus and promotes teamwork.
PROFESSIONAL EXPERIENCE California Consulting, Tustin, California 1995-1998 Consultant Served as a lead consultant on the recruitment of executives including physicians, chief information officers and administrators for the largest healthcare retained search firm.
Consulted with a multi-hospital system, developed job description 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 advisor 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.
Successfully completed two executive searches where the direct report resigned during the recruitment process.
Created a search committee to join two adversarial organizations in the selection and recruitment of two physician executives.
Healthcare Managers, Placentia, California 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.
Played a key role in the expansion of the physician provider base by 300% through direct contact and the integration of two newly contracted IPAs. Established more than 12 educational sessions that addressed changes in utilization and managed care policies and practices.
Decreased bed days in senior plan from 2,300 to 940 in three months through utilizing a total quality management process. Supervised 5,000 prior authorizations per month and conducted concurrent review of an average of 60 patients at three hospitals and out of network facilities. Established corporate policy on utilization and claims payment issues, and broadened utilization monitoring for analysis and trending.
Wrote a business plan for utilization and quality management programs to include report card (Hedis) data elements into a standard reporting system. Received praise during NCQA audit. Expanded scope of quality management beyond NCQA 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.
Acted as liaison with 15 health plans and their medical directors, hospital administration and physicians on utilization and cost concerns. Coordinated agendas for 20 committees. Screened more than 1,000 medical records monthly for compliance to practice standards, quality management, payment issues and appeals.
Established liaison role with claims and information systems staff that increased claims accuracy and improved direct electronic link with 400 providers’ sites.
Designed and instituted automatic referral and direct authorization programs that accelerated patient referrals from two weeks to less than two days.
IPAs of California, Long Beach, California 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 healthcare system. Organized and initiated an expansion of the IPA to two additional hospitals and their medical staffs.
Board of Directors, Executive Committee, Chairman UR/QA (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.
Developed and implemented a computer database for credentialing information that was used for reappointment, claims processing, payor lists, applications and directories.
Quality Care, San Pedro, California 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.
Served as chairman of a CME Committee, and assisted in all phases of development of the first county-wide program that was accredited by the California Medical Association.
Hillview Hospital, Stockton, 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.
Successfully brought medical staff through three JCAHO surveys.
Re-wrote Medical Staff Bylaws to include provisions for Health Care Quality Improvement Act of 1986, National Databank reporting system, and their due-process requirements.
Co-founded Chart Review and Peer Review program for integration into Quality Assurance Program.
Negotiated and prevented collapse of orthopedic and neuro-trauma emergency room back-up panels.
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. Negotiated sale of practice to third party.
EDUCATION Fellowship: Orange County Medical Center (Allergy/Immunology), Anaheim, California, 1980-1981 Fellowship: California Medical Center (Allergy/Immunology), Los Angeles, California, 1978-1979 Residency: Davis Hospital (Pediatrics), Davis, California, 1976-1978 University of California, Davis, California Medical Doctor Degree 1976 Masters of Science Degree in Molecular Biology, 1972 Bachelor of Science Degree in Biological Sciences, 1970
MANAGEMENT TRAINING Medical Infomatics, 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 California Physician and Surgeon, 1976 American Board of Medical Management, 1993 American Board of Allergy and Immunology, 1982 (A conjoint Board of the American Board of Internal Medicine and the American Board of Pediatrics) American Board of Pediatrics, 1981
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 California Medical Association Orange County Medical Association