Charles Parente Email and Phone Number
Charles Parente work email
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Charles Parente personal email
I am a Board Certified Family Medicine physician with deep experience in the UM and VBC space. Medicare Advantage, Medicaid and Commercial populations.My career journey includes 6 years at Optum, 3 years at UHC and 2 years of contractor UM work. I currently serve on the Medical Claims Review team at Optum Enterprise Clinical Services.Prior roles include Sr. Medical Director on the Ancillary Clinical Value team at Optum Clinical Performance. Owning $30M Affordability budget. Managing a 15 member team. Developed and delivered Affordability programs driving best practices and data supported decision making for providers and patients. Clients include internal Optum provider groups as well as external payer clients. Many years experience with UM work including PA, hospital concurrent review and claims review (facility and professional). I particularly enjoyed my work with ideation and development of custom claims edits in support of payment integrity.Extensive practice experience in Urgent Care, Family Medicine, Occupational Medicine. Corporate on-site employee health care clinic Medical Director experience with Walgreens Take Care Health Systems.
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Medical Director-Medical Claim ReviewOptum Oct 2024 - PresentPerforming Medical claim reviews (Facility and Professional) for all LOB. -
Sr. Medical Director, Clinical AffordabilityOptum Aug 2022 - May 2024United StatesSr. 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.
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Sr. Medical DirectorOptum Oct 2021 - Aug 2022Arizona, United StatesSr. 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.
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Medical DirectorOptum Jul 2018 - Aug 2022Phoenix, Arizona AreaMedical 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.
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Medical Director-Clinical Coverage ReviewUnitedhealth Group May 2015 - Jul 2018Medical 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. -
Physician Expert ReviewerDelmarva Foundation Nov 2012 - May 2015• 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. -
PhysicianUrgent Care West Maui/West Maui Health Care 2010 - May 2015Lahaina, HiA lovely Family Medicine and Urgent Care medical practice, owned and run by Ben Azman, MD.
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PhysicianTake Care Health Systems 2008 - 2010• 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
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PhysicianInova Health System 1999 - 2008Physician in multiple Urgent Care and Occupational Health settings.
Charles Parente Skills
Charles Parente Education Details
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Medicine -
Psychology -
Medical Informatics -
Medical Informatics
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Medicine
Frequently Asked Questions about Charles Parente
What company does Charles Parente work for?
Charles Parente works for Optum
What is Charles Parente's role at the current company?
Charles Parente's current role is Informatics Physician | Affordability | Value Based Care.
What is Charles Parente's email address?
Charles Parente's email address is ch****@****uhg.com
What schools did Charles Parente attend?
Charles Parente attended University Of Virginia, Bucknell University, Northwestern University, Northwestern University, University Of Virginia.
What skills is Charles Parente known for?
Charles Parente has skills like Informatics, Ehr, Emr, Healthcare Information Technology, Cpoe, Utilization Review, Evidence Based Medicine, Statistical Data Analysis, Urgent Care, Family Medicine, Occupational Health, Hospitals.
Who are Charles Parente's colleagues?
Charles Parente's colleagues are Mukul Verma, Suny K, Shakira Bannister, Gavin Yahna, Cristopher Colon Lopez, Syed Nabeela Banu, Gavin Crowther.
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Charles Parente
Human Resources Adm. At Lackawanna Insurance Group And Pagnotti Enterprises, Inc.Wilkes-Barre, Pa2lccsaves.com, jeddocoal.com -
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Charles Parente
New York, Ny1gmail.com -
2va.gov, verizon.net
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