Chesterfield, Missouri, United States
Experienced Healthcare Executive with a demonstrated history of success in the hospital & health care industry. Skilled in Healthcare Management, Medicare, and working with Physicians. In addition, extensive experience serving on and leading Boards of Directors.
• Responsible for medical management of Exclusive Choice, an ERISA health plan for SSM St. Louis, as well as Saints Care of Oklahoma, ChoiceCare of Illinois, SMOF, SMOG, and the employee indemnity plan, all totaling more than 33,000 members. • Chairman of SSM MCO Credentialing Committee responsible for the SSM St Louis Credentialing Verifications Office providing primary source credentialing verification services to all seven of the SSM St. Louis hospitals. • Participant in standing and adhoc SSM Network committees including: MCO AC council, SSM MCO Board of Managers, MCO Contracts Committee, among others.
• Chairman of the SSM St. Louis Network Medical Management Committee which provides oversight of an ongoing St Louis Network medical management plan in support of the seven SSM St. Louis Hospital’s medical management committees and programs. - 2009 • Chairman of the Clinical Technology Assessment Committee, a multidisciplinary committee charged with improving patient care by evaluating cutting-edge technological products to determine clinical efficacy and cost-effectiveness. • Chairman of the SSM MCO Network Medical Management Committee from 2000 to 2008 • Responsible for medical management of Exclusive Choice, an ERISA health plan for SSM St. Louis, as well as Saints Care of Oklahoma, ChoiceCare of Illinois, SMOF, SMOG, and the employee indemnity plan, all totaling more than 25,000 members. • Responsible for the SSM St Louis Credentialing Verifications Office providing primary source credentialing verification services to all seven of the SSM St. Louis hospitals. • Chairman of the ECHO Steering Committee, and Champion for the SSM St. Louis Network deployment of the upgraded HealthLine Systems ECHO Credentialing verification system. • Participant in standing and adhoc SSM Network committees including: RACs Implementation Team, Medication Reconciliation, Physician Directory, New Nurse Orientation, Diversity Council, MCO AC council, SSM Corporate Health and Dental Committee, SSM MCO Board of Managers, MCO Contracts Committee, among others.
Organizes and directs the delivery of all required clinical services to Dean Health Plan members to improve the quality and cost effectiveness of patient care with a focus on SSM's corporate goal of providing breakthrough medical and clinical solutions that contribute to the overall organizational growth strategy.
• Medical management and quality management responsibilities in an HMO consisting of 400,000 members and over 5,500 providers. • Chairman of the Quality Management Peer Review Committee. • Chairman of the Policy Committee. • Member of the Credentials Committee, Quality Performance Management Committee, and the Pharmacy & Therapeutics Committee among others.
• Lead medical management activities for a consulting team to GenCare in St. Louis, responsible for developing a provider network including: negotiating capitated agreements with hospitals and physicians, implementing quality assurance protocols, and creating a utilization management program. • Medically managed four full-risk capitation agreements with physician groups and hospitals comprised of over 180 primary care physicians, representing in excess of $31,200,000 in annual gross revenues. • Administered medical management for the Medicare Complete product as it grew from 1,500 to 25,000 members and $120 million annual revenue in three years.
• Lead a department of 25 physicians specializing in internal medicine and several subspecialties in a Staff Model HMO with 150,000 member lives in Southern California • Developed, implemented, and maintained the fulltime hospitalist call system for FHP Charter Community hospital. • Developed, implemented, and maintained the physician extender position for hospital on call and rounding. • Introduced a template driven electronic health record to my practice. • Elected Vice Chief of Staff For FHP Charter Community Hospital.