Charles Parente Email & Phone Number

Performing Medical claim reviews (Facility and Professional) for all LOB.

United States

Sr. Medial Director on the Optum Clinical Affordability team. We partner with Optum CDO's nationwide as well as external payer clients. Develop and deliver Affordability programs. Focus on outpatient UM, decision support and payment integrity.•Doubled annual savings achieved in 2022 and 2023. Increased our program adoption to 6 more Optum entities. during my tenure. Expanded program reach beyond Optum and into UHC entities as well as external clients.•Directed and interpreted affordability data queries and presented affordability data to senior Optum Health leadership.•Led ideation strategy, senior leadership buy in and execution for 3 new Ancillary affordability concepts.

Arizona, United States

Sr. Medical Director of Hospital and Claims review for OptumCare Arizona and New Mexico.•Drove market leading total Obs rate near 40% performing daily case reviews.•Navigated delicate UM relationships with our Arizona market hospital partners in monthly JOC meetings.•Monitored quality/performance metrics for Claims Clinical Review (CCR) nurse and physician teams. •Implemented corrective action when needed.•Collaborated monthly with Optum Payment Integrity teams (CES, FWA, etc.) on pre-pay edits (new edits and revision prior edits) and other affordability opportunities.

Phoenix, Arizona Area

Medical Director work at OptumCare Arizona, which is a Care Delivery Organization (CDO) within the Optum structure. There are numerous Optum CDOs around the company, all serving local or regional markets.•Provided medical case review for Medicare Advantage Hospital IP/OBS and AIR and LTACH concurrent reviews.•Evaluated medical claims case review for professional services and hospital IP/OBS Appeals cases.•Served as Physician leadership for ongoing vendor relationships with Palliative Care and Optum Chronic Renal Failure/Transplant programs.•Co-lead medical director for ANI Map Prior Auth Project. Designing criteria implementation pathways for AI/NLP evaluation of claims history and clinical provider documentation to assist with PA decision making.

Medical director for Clinical Coverage review at UHC. Our division's area of responsibility and focus was Medicare and dual eligibles.•Discussed case decisions and pertinent criteria with ordering providers in Peer to Peer telephone calls.•Conducted lecture presentation to UHC clinical staff regarding criteria selection and case review processes.•Provided UHC delegate oversight/training regarding proper processes and documentation, criteria selection and decision making for Medicare prior auth review cases.

• Provide medical case review for state Medicaid agencies including utilization review for inpatient medical necessity.• Evaluate complete inpatient clinical records against standards of care across entire spectrum of medical conditions requiring hospitalization and applying deep knowledge of medical treatment guidelines and Evidence Based Medicine.

Lahaina, Hi

A lovely Family Medicine and Urgent Care medical practice, owned and run by Ben Azman, MD.

• Providing health care to employees of corporate clients, via on-site Employee Health Clinics• Allscripts EHR experience• Physician and clinic Medical Director for multiple workplace clinic sites; Mid-Level provider oversight and quality management• Created and delivered educational patient multimedia lectures on high impact health conditions

Physician in multiple Urgent Care and Occupational Health settings.

Doctor Of Medicine, Medicine

Bachelor Of Arts (B.A.), Psychology

Activities and Societies: Magna Cum LaudeGraduated with honors in Psychology. Member of Chi Phi fraternity.

Master'S Degree, Medical Informatics

Activities and Societies: HIMSSThis comprehensive curriculum covers the full breadth of Medical Informatics including CPOE, Clinical.

Master Of Science - Ms, Medical Informatics

Md, Medicine

Medical Student at School of Medicine