Lead teams to share understandings of the economic, political, and financial forces that are transforming health care delivery systems and the types of organizational structures that are emerging in response.
QUALIFICATIONS
Physician Executive: Experienced in California Medi-Cal and DHHS IHS
Direct liaison with State DHS leadership, monitoring their Medicaid program financial activities and practices:
-Managed, directed, and performed work concerned with the administration and operation of fiscal, financial management, accounting, and budgetary programs in Medicaid and related programs.
-Interpreted program requirements and formulated policies, methods, and procedures, and reviewed, evaluated and assessed the integrity and quality of program operations.
-Prepared and evaluated proposals to support the development, implementation and refinement of payment systems and claims processing.
-Highly experienced medical doctor: 30 years family and emergency practice.
-Prior member of the California Medical Association
Health Reform subcommittee, Council on Legislation Participant
-Prior member of the American College of Physician Executives
-Licensed physician in California, in good standing
-Diplomat of the National Board of Medical Examiners
-Board Certified Family Practice. American Asso. of Physician Specialists
-Certified in Medical Management from Carnegie Mellon University
PROFESSIONAL CONSULTING EXPERIENCE: CA DHS Medi-Cal Contract
1993–2003 Medical Director: Electronic Data Systems Corporation
-Business Process Management and Operations Development Consultant
-Client Management: State & Federal Government Fiscal Intermediary
-Resolved provider’s reimbursement issues and Participated in Investigations
-Influenced payment policies: Formulated effective development strategies
-Developed eligibility, authorization and payment criteria changes
-Helped providers understand reimbursement issues to resolve their claims
-Establish medical necessity protocols
-Initiated and monitored studies, interim and final study reports
-Participated with Sales Teams in seminar designs and client presentations
-Engaged work-groups to develop healthcare industry best practice standards
-Guided healthcare data integration projects
-Suggested methodologies for effective regulatory implementations
-Provided medical informatics subject matter expertise
-Led program integrity fraud and abuse detection and determent efforts
-Identified and qualified best-in-class, evidence-based clinical pathways
-Analyzed large claims database extracts to determine patterns-of-care
-Applied appropriate controls to improve health care access
-Bench marked medical necessity and quality of care issues
-Translated health care trends and EDS’ capabilities for commitments
-Discovered and defined new business or client renewals and "add-ons"
-Demonstrated products and services to internal and external customers
-Developed process improvements and advised cross-functional teams
-Qualified products and services to recommend partnerships and pursuits.
KNOWLEDGE AND SKILLS
-Strong Analytic, Negotiation, Conflict Management, & Computer Applications
-Led competitive procurements requiring design, development & deployment: -Data Warehouse architecture and decision support tools used to gather, cleanse, edit and analyze California Health Plan encounter data.
-Leveraged successful decision-making strategies for customers concerning competitors, suppliers, and regulators.
-Identified best-in-class, evidence-based clinical pathways. -Influenced cooperation & gaining acceptance for innovative projects, concept.
Helped benchmark & apply appropriate control to improve health care access, medical necessity and quality of care.
-Medical informatics subject matter expert.
-Program integrity fraud and abuse detection and determent experience
-Combine passion for technology and extensive medical experience to make -positive changes in both industries.
EXECUTIVE LEADERSHIP EXPERIENCE
2004-5 Clinical Director of NV Indian Health Services Chief of medical staff
-Interpreted program requirements and formulated policies and methods
-Provided leadership to health care delivery system with 50,000 annual visits
-Responsibility: planning, development, organization, integration, administration.
-Engaged in activity to maintain working contacts and relations with agencies
-Promoted understanding of clinical services and program implementations
-Formulated clinical program policies and participated in procedural planning
-Integrated health activities with local, state, federal program components.
-Provided recommendations to Service Unit Director relative to medical care.
-Advised executive staff on requirements of problems; -Developed corrective action plans.
-Conducted conferences with staff to explain requirements and procedures.
-Issued instructions for non-routine complex assignments or process changes.
-Made decisions on problems not covered by precedents, protocols, or policies.
-Studied operations to seek improvements in quality and quantity of services.
-Reported on problem progress-resolution, achieving management objectives.
-Reviewed and analyzed records and reports to evaluate performance. -Approved or denied training.
-Supervised 30 clinical service employees, directly & through subordinate staff
-Ensured performance appraisal promotion, position management, career plans.
-Heard group grievances & employee complaints; reviewed disciplinary actions.
-Recommended disciplinary actions of supervised staff. -Prepared performance evaluations.
-Estimated and justified resources to top management to assure care continuity.
-Approved or rejected leaves, vacations, schedules for health services staff.
-Responsible for EEO implementation, guidelines, progress achievement
-Monitored contract medical services quality & distributed direct care resources.
-Recommended priorities of expenditures for contracted health services funds.
-Assured Medical Quality Review mechanisms operated adequately at facilities.
-Organized, directed staff activity, meetings, committees, & accreditation audits.
-Recommended medical, dental, & pharmacy officer appointments to key posts.
-Coordinated clinical staff continuing medical education for Service Unit Director
-Ombudsman for clinical staff, communicating views/concerns to Area Director.
-Assured satisfactory referral policies & quality medical practices, care facilities.
GENERAL PRACTICE PHYSICIAN EXPERIENCE
-Primary care and Emergency Services: 20 years Clinical and Hospital practice
-Responsibility of diagnosis, care & treatment of inpatients, ambulatory & E.R.
-Worked for large integrated delivery systems for many years – Seasoned MD
-Evaluated medical evidence, made disability decisions, assessed impairments
-Applied guidelines & projected levels of recovery
-Determined safe return to work, determined restrictions, assessed function
-Assisted in medical training and developed consultative panels
-Assessed medical necessity: lab studies, procedures, medical examinations
ACCOMPLISHMENTS
-Supported senior leadership and technical staff -Helped win billion $ multi-year multi-phased administrative contracts for EDS
-Provided market intelligence to Fortune 500 healthcare sales teams
-Led competitive procurement bids requirements: -Designed, developed and deployed Data Warehouse architecture -Evaluated decision support tools used to gather, cleanse, edit & analyze data. -Assisted in analysis of Health Plan encounter data for the State of California
-Global health care solutions consultant and company web content editor.
-New business development broker: Strategically aligned with stakeholders: Codman Research, HPR, Symmetry and MedSTAT to use Episode Treatment Groups, Ambulatory Care Groups, and a variety of HEDIS Quality indicators in business pursuits.
-Aligned PACs RIS technology vendors: Stentor and Kodak to pursue contracts: DoD global telemedicine.
-Brought case management tools to California's Department of Health Services.
-Advised Health Hero Networks on product development issues.
-Managed large projects, creating new processes to leverage technologies .
-Leveraged successful decision-making strategies for customers: concerning competitors, suppliers, and regulators.
-Applied data mapping and process modeling skills to lead system engineering clinical solution teams, to implement effective program policies & changes.
PROFESSIONAL AFFILIATIONS
1994 - 2004 California Medical Association
1994 - 2004 Sierra Medical Society–Sacramento, El Dorado, Yuba Counties
1994 - 2003 American College of Physician Executives
1992 - 1994 American Academy of Family Practice – Fellow
JOB HISTORY
2004 Indian Health Services, Nevada – U.S. D.H.H.S. - Clinical Director
2003 California Department of Corrections - Physician and Surgeon
1993-2002 Electronic Data Systems Corporation Medi-Cal Medical Director
1996-2001 Occupational MD Sacramento and Urgent Care MD Walnut Creek
1992-93 Family Practitioner Fremont-Rideout Medical Group-Yuba City-CA
1991-92 Pacific Physician Services - Hemet Valley Family Physicians - CA
1988-90 Sharp Rees Stealy Integrated Health Network- OC MED San Diego
1985-87 Inland East Medical Clinics - Multi-Specialty Medical Group Practice
1982-85 Southwest Medical Associates Family Physician and UC Physician
1980-83 U.S. Air Force Medical Corp - Military Clinic and Hospital ER MD
EDUCATION
1994–2000 CERTIFICATE-MEDICAL MANAGEMENT -Carnegie-Mellon Univ.
1979-1980 Residency U.S. Air Force David Grant U.S.A.F. Medical Center
1977-1979 Doctorate-Medicine –Finch Univ., The Chicago Medical School
1972-1977 Bachelor -MEDICAL SCIENCES- Univ. NV- School of Medicine
LICENSES
1985 PHYSICIAN AND SURGEONS CERTIFICATE- Medical Board California
1982 PHYSICIAN CERTIFICATE –Nevada State Board of Medical Examiners
1990 PHYSICIAN ASSISTANT SUPERVISOR
CERTIFICATIONS
2000 MEDICAL MANAGEMENT -- American College of Physician Executives
1996 AMERICAN BOARD OF CERTIFICATION IN FAMILY PRACTICE
1980 DIPLOMAT – NATIONAL BOARD OF MEDICAL EXAMINERS
1985-2004 PHYSICIAN RECOGNITION AWARD Continuing Medical Education 1982- 2009 DEA CERTIFICATE
TEACHING AND PROCEEDINGS
1999 CA Medical Association Leadership Symposia – Faculty Panelist
“MEDICINE MEETS THE INTERNET”
1996 American Medical Informatics Association – Attendee
1996 Medical Records Institute San Diego – Corporate Consultant
“TOWARD AN ELECTRONIC MEDICAL RECORD”
1986 COMDEX – Presentation Session Speaker
“KNOWLEDGE-BASED MEDICAL EXPERT SYSTEMS FOR COMPUTERS”
1990 American Medical Informatics Association Washington D.C. Exhibit
“MacON-CALL™”
1990 Scripps Institute Cardiology Retreat – Honorarium Speaker
"STANDARDS IN MEDICAL INFORMATICS" Continuing Medical Education
RESEARCH, DEVELOPMENT AND PUBLICATIONS
1985–2002 IatroCom - C.E.O., Founder - Project Director - Web Author
January Physicians & Computers, "DIAGNOSIS WITH THE MACINTOSH"
PRIOR HOSPTIAL AFFILITATIONS
1993-95 Fremont Hospital, Yuba City, CA
1993-95 Rideout Hospital, Marysville, CA
1992-93 Hemet Valley Hospital, Hemet, CA
1991-92 Churchill Community Hospital, Fallon, NV
1986-89 Alvarado Hospital Medical Ctr, San Diego CA
1986-87 Grossmont Hospital, San Diego, CA
1985-86 Sunrise Hospital, Las Vegas, NV
1985-86 Desert Springs Hospital, Las Vegas, NV
1985-86 Valley Hosptial Medical Ctr, Las Vegas, NV
1983-85 University Medical Center, Las Vegas, NV
HONORS AND AWARDS
1995 FELLOW American Academy of Family Physicians
1972 Distinguished Flying Cross - Vietnam
CONTINUING MEDICAL EDUCATION
2005- 10 Credits DIAGNOSING AND MANAGING HEADACES
2005- 1 Credit DOMESTIC VIOLENCE EDUCATION–Florida Requirement
2005- 15 Credits SPECIFIC TRAUMA – SEXUAL ABUSE – CME Resource
2005- 6 Credits MEDICAL ETHICS - CME Resource & Thomson Cons.
2004- 5 Credits VACCINIA:VACCINE PROTECTION AGAINST SMALLPOX
2004- 2 Credits BIOLOGICAL REVOLUTION IN RHEUMATOID ARTHRITIS
2004- 5 Credits OSTEOPOROSIS – DIAGNOSIS AND TREATMENT
2004- 5 Credits FACILITATING HEALTH/WELLNESS-BIPOLAR DISORDER
2004- 15 Credits EATING DISORDERS – CME Resource
2002- 8 Credits ADVANCED CARDIAC LIFE SUPPORT – AM HEART ASSO
2002- 10 Credits INFECTIOUS DISEASE UPDATE Bayer Pharmaceutical
2002- 10 Credits PAIN & SYMPTOM MANAGEMENT IN END OF LIFE CARE
2002- 5 Credits PALLIATIVE CARE - CME Resource -
2002- 10 Credits ALZHEIMER'S DISEASE: DIAGNOSIS & MANAGEMENT
2002- 5 Credits MANAGEMENT OF CORONARY ARTERY DISEASE
2002- 10 Credits PERMANENT PACEMAKERS - CME Resource
2002- 5 Credits BIOTERRORISM -- CME Resource
2002- 5 Credits MEDICAL ERROR PREVENTION -- CME Resource
2002- 10 Credits PEDIATRIC TRAUMA FOR PHYSICIANS - CME Resource
2002- 5 Credits ALCOHOL AND ALCOHOLISM
2001- 4 Credits ELECTRONIC MEDICAL RECORDS U of California-Davis
2000- 4 Credits INTRODUCTION - MEDICAL INFORMATICS U of CA-Davis
2000-6.5 Credits GENOMICS & ETHICS Stanford University Palo Alto, CA
1999- 8 Credits ADVANCED CARDIAC LIFE SUPPORT UPDATE –UC Davis
1998- 20 Credits FAMILY PRACTICE REVIEW Univ. California, San Francisco
1993- 58 Credits INTERNAL MEDICINE BOARD REVIEW Harvard Med School
1993- 15 Credits FAMILY PRACTICE RECERTIFICATION U Nebraska Med Ctr
1992- 1 Credits STROKE ADVANCES Hemet Valley Medical Center - CA
1992- 15 Credits FAMILY PRACTICE RECERTIFICATION U Nebraska Med Ctr
1991- 16 Credits ADVANCED CARDIAC LIFE SUPPORT Amer Heart Asso
1991- 17 Credits ADVANCED TRAUMA LIFE SUPPORT St. Josephs Hosp AZ
1990- 15 Credits FAMILY PRACTICE RECERTIFICATION U Neb Med Ctr
1989- 16 Credits ACLS Sharp Hospital San Diego
1989- 20 Credits FAMILY PRACTICE BOARD REVIEW Univ CA, San Diego
1988- 35 Credits TOPICS IN INTERNAL MEDICINE Univ California San Diego
1985- 36 Credits EMERGENCY MEDICINE U Southern California - Maui, HI
1984- 16 Credits ADVANCED CARDIAC LIFE SUPPORT Amer Heart Asso
1984- 46 Credits FAMILY PRACTICE UPDATE - University of California – Irvine
1983- 28 Credits CRITICAL CARE MEDICINE University of Southern California
1982- 19 Credits EMERGENCY MEDICINE University of Southern California
1982-108 Credits EMERGENCY MEDICINE - U. of California San Diego
1981- 30 Credits OFFICE MANAGEMENT OF CHRONIC PAIN USC Maui, HI
1981- 16 Credits ADVANCED CARDIAC LIFE SUPPORT Southwest Med Life
1980- 24 Credits 65th Scientific Assembly Postgraduate Medical Asso of N. A.
1980- 31 Credits DISASTER PREPAREDNESS David Grant USAF Med Center
PHYSICIAN EXECUTIVE COURSES – ACPE AND CARNEGIE MELLON UNIV
2000 – 72 Credits CERTIFICATE OF MEDICAL MANAGEMENT
H. John Heinz III School of Public Policy and Management - Pittsburgh, PA
10/2000 – 16 Credits CMA ANNUAL LEADERSHIP ACADEMY
California Medical Association La Quinta, California
10/1999 – 16 Credits CMA ANNUAL LEADERSHIP ACADEMY
California Medical Association La Quinta, California
11/1998 – 24 Credits American College of Physician Executives - Tucson, AZ
MANAGING CHANGE and INNOVATION in MEDICAL ORGANIZATIONS
11/1997 – 24 Credits ACPE Indian Wells, California
MANAGING PHYSICIAN PERFORMANCE IN ORGANIZATIONS
1/1997 – 24 Credits THE THREE FACES OF QUALITY
Forum on Quality – ACPE Institute - La Jolla, California
10/1997 – 16 Credits CMA ANNUAL LEADERSHIP ACADEMY
California Medical Association - La Quinta, California
2/1996 – 24 Credits TECHNIQUES OF FINANCIAL DECISION MAKING
American College of Physician Executives - La Jolla, California
2/1996 – 24 Credits FUTURE FORUM
American College of Physician Executives - La Jolla, California
7/1995 – 36 Credits American College of Physician Executives Lake Tahoe, NV
HEALTH LAW
FUNDAMENTALS OF MEDICAL INFORMATICS
ETHICAL CHALLENGES of PHYSICIAN EXECUTIVE
2/1995 – 31 Credits - PHYSICIAN IN MANAGEMENT SEMINAR III
American College of Physician Executives - Newport Beach, California
2/1995 – 31 Credits PHYSICIAN IN MANAGEMENT SEMINAR II
American College of Physician Executives - Dana Point, California
9/1994 – 31 Credits PHYSICIAN IN MANAGEMENT SEMINAR I
American College of Physician Executives San Francisco, California
REFERENCES
John Lewin, M.D. C.E.O., Exec V.P. California Medical Asso (916) 444 5532
Gerald Rogan, M.D. Healthcare Consultant (530) 514 1139 (916) 978 9636
Medicare Carrier - N. California email: jerry.roganmd@sbcglobal.net
Marie Vann-Beckman C.E.A., Adult Social Services (916) 765 2824
Chief, Medi-Cal Case Management Department of Health Services Ops
Chief, Division of Plan Surveys Office of Health Plan Oversight (916) 229 4034
Michael Farber, M.D. California Department of Health Services
Senior Medical Policy Physician Medi-Cal Policy Section (916) 552 9568
Raymond Blain, M.D., MPA/HAS California Department of Health Services
Medical Policy Consultant Medi-Cal Benefits Branch: (916) 552 9463
Arthur Lurvey, MD United Govt Services, LLC 5151 - B Camino Ruiz,
Camarillo, CA 93012-8645 arthur.lurvey@cobalt-corp.com (805) 367-0509
George Pennebaker, Pharm.D. Electronic Data Systems Corp Medi-Cal FI
Chief Pharmacy Consultant george.pennebaker@eds.com (916) 636 1000
Balwinder Malhi, M.D. 1095 Stafford, Yuba City, CA 95991 (530) 674 2800
Harold Tate, M.D. Sacramento Occupational Medical Group (916) 372 9893
1550 Harbor Blvd Ste 110 West Sacramento, CA 95691
James Battista EDS Business Management Solutions
Sales Director, Western Region State and Federal Operations (213) 636 4432
Richard Callahan Client Executive - Electronic Data Systems Corporation
10888 White Rock Road Rancho Cordova CA 95670 (916) 636 4440
Thomas Nesbitt, M.D. Asso Dean, Grad Medical Edu U CA, Davis Medical Ctr
2315 Stockton Blvd. Sacramento, CA 95817 (916)734 1358
Kathy Chorba TeleHealth, Univ CA, Davis Med Ctr. (916) 734 8858
Edwin Priest-Systems Engineer–EDS Business Solutions (916) 636 4306
11050 Olson Drive, Rancho Cordova, CA 95670 edwin.priest@eds.com
