Career Highlights
- 17-year clinical career: Internal Medicine, Nephrology, Dialysis, and Renal Transplantation; Clinical responsibility for ESRD Network 15 QI Programs;
- Medical Director of 2 Dialysis and Post-Transplant Patient Management Programs. Acute, In-Patient Critical Care Consultations;
- Attending Faculty: Columbia College of Physicians & Surgeons; Case Western Reserve School of Medicine; Faculty teaching appointments for Fellows, Residents, and Medical Students;
- Medical Director, First Coast Service Options, Inc; Medicare (Part A/B) Administrative Contractor, Jurisdiction N; Extensive background in adjudication of UM decisions; Medicare LCD and NCD policy; preparation of briefs for non-party participation in Administrative Law Judge hearings;
- Medical Research Director to national legal organization; review of fraud committed against Medicare and Medicaid under the Federal False Claims Act; review of medical quality issues in potential Qui Tam actions;
- Medical Director to CMS (ZPIC) Zone 7 Program Integrity prime contractor, including pre- and post-pay medical review;
- Medical Director for a consortium of commercial managed care organizations pursuing relief for pharmaceutical and ESRD billing and clinical practice fraud;
- Transformation of the Medicare Prospective Payment System from Demographic to (HCC) Health Status Risk
- Senior Medical Director/ CMO: Traditional Medicare, Medicaid, & Commercial Managed Care Organizations;
- Quality Management, Physician Network and Account Relations, QIO and Regulatory Compliance, NCQA/URAC Accreditation;
- Rate-setting and Predictive Modeling Systems, Implementation of Medicare Prospective HCC Payment System and Medicaid ACG Reimbursement Systems;
- Management Medicare Part D Benefit, Formulary Management, Mitigation of Coverage Gap;
- Research Fellowship, National Institutes of Health, Bethesda, MD: Genomics, Molecular Biology, Recombinant DNA Research;
- Active, unrestricted licenses in 5 jurisdictions; fully licensable in any state.