Medical Director
CurrentIn my role as Medical Director, I oversee clinical managed-care functions related to Utilization Management, including conducting medical necessity reviews on inpatient, outpatient and pharmaceutical reviews; responding to requests for peer-to-peer conversation with providers to discuss case or determination. I prepared and deliver clinical educational presentations to clinical staff in the field of pediatrics; coordinating Care Management and Utilization Management of pediatric cases; and working with state and city agencies to facilitate transition of medically fragile children and foster care children in the state of New York to Managed Medicaid. Additionally, I initiated the Neonatal Intensive Care UM/CM Program; I round with EH nurses and UM team on NICU infants; I oversee Care Management rounds of NICU infants for one year post-NICU discharge; and I work with Claims Department and IT to allow seamless transitions of NICU members.