Experience across many areas of health care management The main areas include medical cost analysis with a focus on the clinical management of patients across all areas of care, utilization management, reimbursement policy for professionals and institutions, contracting including fee schedule design and capitation models, appeal and grievance policy creation (and administration) for members and providers, root
Experience across many areas of health care management The main areas include medical cost analysis with a focus on the clinical management of patients across all areas of care, utilization management, reimbursement policy for professionals and institutions, contracting including fee schedule design and capitation models, appeal and grievance policy creation (and administration) for members and providers, root cause analysis of managed care processes (green-belt in Six Sigma) with unique expertise in linking claim and clinical information for problem solving and business planning. I have worked with and in many models of managed care including; group model HMOs, IPAs, PPOs, open and closed model HMOs, in commercial, self-insured, Medicaid and Medicare health insurance administration operations across 22 states and over 35 markets.
My goal is to continue to evolve my skills in a rapidly changing health care environment focusing in on changing patterns of care (to improve outcomes) for members of our community served by government funded health insurance programs.
VP, Medical Director @ Medical Director for Healthfirst NJ FamilyCare Medicaid and Medicare Advantage operations fro. 2008 to present. Also Medical Director for Healthfirst responsible for Medical Cost Management, Delegation Management and Utilization Management as well as overseeing the Managed Long Term Care products for New York (all products). From October 2008 to Present (7 years 3 months) VP, National Standards @ AmeriChoice was bought by UHG and merged with UnitedHealthcare. AmeriChoice continued to manage government programs and took over the managed of the existing UHC government programs for Medicaid, CHP and FHP. From February 2002 to July 2008 (6 years 6 months) Vice President @ Physician Executive for a national managed care organization
(Note UnitedHealthcare (UHC) purchased AmeriChoice in 2002 and merged AmeriChoice into UHC From February 2002 to July 2008 (6 years 6 months) VP, Health Services @ Managed care company specializing in Medicaid and Medicare HMOs From February 2002 to January 2003 (1 year) Vice President, USQA @ Was responsible for integrating the data management and business analysis units of Prudential Healthcare including medical economics and quality metrics into USQA at Aetna. Following the integration managed a team of health care analysts for USQA supporting national and regional business analysis for business operations. From August 1999 to December 2001 (2 years 5 months) VP, Medical Services @ Prudential Healthcare, part of Prudential specialized in selling health insurance and benefit management products to ASO clients, traditional group products, HMO, PPO and POS products. I began as an associate MD in the Southwest Region and ended up as a national medical officer supporting medical management operations for the CMO. From December 1986 to August 1999 (12 years 9 months) Medical Director @ Medical Director for TakeCare of Oklahoma which is now doing business as Blue LInks for Blue Cross and Blue Shield of Oklahoma. Was an IPA model HMO established in 1983 in Tulsa expanding to Oklahoma City and SE Oklahoma in 1985. From September 1983 to December 1986 (3 years 4 months) Physician Executive @ No longer existing as a business)
Practicing Physician for a group model HMO and Chief of Internal Medicine in Suffolk County NY. From July 1980 to April 1982 (1 year 10 months) Medical School @ From August 1973 to May 1977 (3 years 10 months)
Postgraduate, Internal Medicine @ University of Pittsburgh School of Medicine From 1977 to 1980 Medicine, Medicine @ University of London From 1977 to 1977 MD, Medicine @ University of Oklahoma College of Medicine From 1973 to 1977 None, Physical Chemistry and Medicine @ University of St. Andrews From 1972 to 1973 BS, Chemistry @ Emory University From 1969 to 1973 Deborah MD is skilled in: Medicaid, Managed Care, Disease Management, Medicare, Healthcare Information Technology, Healthcare Management, Insurance, Leadership, Medicine, PPO, Policy, Hospitals, Healthcare Industry, Healthcare Consulting, Health Policy
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