Provides medical oversight and expertise for appropriateness and medical necessity of healthcare services provided to members,

DeLorean Artificial Intelligence (www.deloreanai.com) sentient and semi-sentient systems of intelligence to meet the evolving needs of Fortune 500 companies in the areas of Healthcare, Sales, Financial Services, and Natural Resources.• Support Delorean’s Real Time Medical Care Management AI (RTMCM AI).• Advise on managed care organizations’ goals, objectives, and pain points.• Advise on developing client solutions to identify patient rising risk and specific condition trajectory with evidenced-based interventions to delay progression of the condition and decrease inappropriate utilization resulting in increased quality and decreased cost.• Advise on population condition stratifications by rising risk identification allow efficient care management resource allocation.• Advise on Next Best Care Action, Next Best Healthcare Provider Action, Provider Intervention Recommender, Medical Adherence.• Support total quality management• Assist in responding to RFPs • Support the sales team• Support the integration team

Partnered with healthcare organizations to provide knowledge and experience in the managed care arena with expertise in federal and state government health programs serving high-risk, vulnerable populations.• Advised on coordinating biopsychosocial needs of each member through risk stratification, care gap analysis, evidence-based medicine, partnering with community services, appropriate deployment of provider and consumer technology, and integration of care delivery model to improve clinical outcomes.• Delivered innovative program design through data-driven population health analysis.

Hired to build and implement innovative omni-channel patient / physician interactive communication platform leveraging artificial intelligence and automation, delivering high-impact personalized health plan communications to providers and 150,000+ Medicare Advantage plan members.• Spearheaded team on development of 375+ system triggers / tasks activated by mining clinical, claims, social determinants of health & other internal and external data consumed by a rules engine to determine optimal communications and routing to the appropriate stakeholder.• Led development of member and provider messaging to ensure personalization and improve engagement.• Worked with HEDIS measures, STARS ratings, and risk adjustment factors to maximize reimbursement and support total medical expense reduction.• Delivered multi-million-dollar savings for Health Risk Appraisal implementation by researching external resources and evaluating ROI for new vendors and technologies, and significantly increased response rate for Appraisal in year 1.• Responsible for developing and medical oversighting case management programs, establishing new telehealth program and implementing automation including IVR (interactive voice response) solution.• Oversight of care management program, inclusive of transition of care, complex care management, catastrophic case management, disease management, palliative care, social determinants of health & dual special needs program (DSNP).• Member of Medical Policy Committee, advisor to Pharmacy Group and contributor to CMS Part D demonstrations. • Reviewed innovative technology against strategic plans; co-developed virtual health and digital strategies.• Created and evaluated RFPs for vendors, working closely with legal and compliance departments.•••GuideWell Care Solutions, d/b/a Florida Blue Medicare, is an innovative Medicare advantage company leveraging technology to help members optimize their health and live their lives to the fullest.

Set overall clinical direction of digital healthcare Business Process Services Practice-Health Care Delivery. Guided teams developing solutions, technologies, and global clinical services to enable healthcare professionals (payers and providers) to improve healthcare delivery efficiency and reduce expenses.• Liaised between Cognizant’s US healthcare clients and onshore and offshore clinical delivery healthcare professionals ensuring clinical medical management (UM-CM-DM) quality and compliance; played instrumental role in achieving URAC Utilization Management accreditation. • Advised on knowledge management, knowledge transfer methods, continuous quality improvement, and healthcare medical management clinical operations. • Coordinated internal compliance and legal teams regarding federal and state regulations for prospective client accounts and accreditation processes. • Advised Cognizant Healthcare Consulting group on developing client solutions to increase efficiencies and cut cost – by championing transformational thinking and redesign of common processes using automation technology, telehealth, patient engagement tools, remote patient monitoring, and artificial intelligence. •••Cognizant is a multinational company that combines client satisfaction, technology innovation, deep industry and business process expertise and a global, collaborative workforce. Cognizant enables enterprises to operate more efficiently and more cost-effectively by infusing technological innovations. Cognizant’s ability to conceptualize, architect, and implement new and expanded capabilities allows clients to transform their business to the next level.

Led strategic medical management activities impacting market performance and promoting quality of care for members. Oversaw development and implementation of medical programs and policies; cultivated and enhanced relationships with providers and facilities, plan sponsors, and regulatory agencies. Served as key business partner in network development and strategic planning and total quality management.• Supervised administrative staff of five in the Clinical Operations Department. • Provided clinical and business leadership to support key objectives of business segments & plan sponsors. • Oversighted Utilization Management, Care Management, Pharmacy, and Quality.• Performed second level medical and pharmacy reviews.• Co-led evaluation of quality, care, and service, including activities necessary for NCQA accreditation.• Played key role in short/long-range program planning, total quality management and external relationships.

Senior academic official responsible for ensuring integrity and seamless operation of third- and fourth-year clerkship rotation sites including evaluation of sites in the US, Canada and the UK. • Supervised administrative staff of seven in the Clinical Science Department.• Worked across departments of the Registrar, Billing, Alumni Relations, and Admissions on joint projects.• Reviewed hospital affiliation agreements and new programs to enhance academic clerkship experience.• Liaised with students, preceptors and hospitals to improve performance and address any disciplinary issues.

• Implemented and led national HFS medical maternity team, partnering with multidisciplinary team of board-certified physician OB/GYNs, obstetrical nurse case managers, social workers, health coaches, pharmacists, data analytics, and other member advocates to offer state-of-the-art, member-focused quality obstetrical care. • Responsible for oversight of delivery of the highest quality of evidence-based and cost-effective care and eliminating $5 M annual spend on unproven obstetrical outpatient treatments. • Spearheaded initiatives to improve service and quality of care, provide a consistent member experience, improve birth outcomes, achieve higher overall provider and member satisfaction through effective partnering and drive higher overall business performance across state Medicaid plans. • Served as subject matter expert (OB/GYN & Reproductive Endocrinology, Fertility); partnered with utilization and care management, medical policy, pharmacy, appeals, provider relations & joint projects across UnitedHealth Group. • Drove down inappropriate Hospital inpatient admissions by 20%• Drafted UnitedHealthcare Medical & Drug Policies and Coverage Determination Guidelines regarding 17-Alpha-Hydroxyprogesterone Caproate (Makena® and 17P)•••UHC-Community & State, a business unit of UnitedHealth Group, at the time served over 2M low-income beneficiaries of state government health care programs in all states and D.C. and is an innovative developer of public sector health care solutions. Optum, a part of UnitedHealth Group, is an international pharmacy benefit manager and care services group.

Provided clinical leadership and led care management functions for 1.5 million members in multiple states. Collaborated with Case and Disease Management, Care Management Directors, and senior leadership to implement clinical programs to support and meet organizational goals. Performed daily clinical evaluations of care and services; collaborated with network and community providers, hospital leaders, and vendors. Liaised between home health care solutions and home therapy products company.•••WellCare is a leading provider of managed care services dedicated to government-sponsored healthcare programs, focusing on Medicare and Medicaid; employs 3,500+ professionals and serves 2.3 million members.

Led start-up efforts for practice. From pro forma to implementation of a full spectrum of assisted reproductive technologies, including IVF, PGD, GIFT, gamete/embryo cryopreservation, intracytoplasmic sperm injection, and 3rd-party parenting. Performed reproductive surgeries, including operative endoscopy encompassing laser laparoscopy and hysteroscopy. Administered treatment efforts for fertility, menopause, reproductive endocrinopathies, and pelvic structural anomalies. Created marketing and educational campaigns for print, radio, and TV media targeting patients and referring physicians. Ensured adherence to OSHA, HIPAA and all state and federal regulations. Negotiated personnel issues, insurance contracts, vendor agreements, constructions, and joint ventures with other practices and academic programs.

Provided instruction to medical students, residents, faculty, and resident clinical practice. Fostered partnership with local private IVF program while awaiting division funding.

Head, Division of Reproductive Endocrinology & InfertilityDirector, Undergraduate Medical Education: Department of OB/GYN & Reproductive Sciences Assistant Professor, Obstetrics, Gynecology, and Reproductive Sciences--Taught medical students and residents as Undergraduate Medical Education Clerkship Director for OB/GYN Department; instructed faculty and resident clinical practice, research, and IVF. Supervised 1 medical doctor, 3 nurses, 2 administrators, and 3 lab technicians within clinical practice; oversaw one academic administrator. Conceptualized and executed marketing campaigns to grow the patient base. Actively participated on medical school Promotions and Curriculum Committees. • Facilitated changes relating to fertility coverage policies through negotiating and lobbying 3rd-party payers regarding contractual language and reimbursements for fertility services; interfaced with insurance companies concerning cost-effective reproductive technologies.• Boosted percentage of students applying for OB/GYN match positions 300% over prior year.• Cultivated and maintained alliances, fostering prompt referrals, through networking with private practice community physicians, including general OB/GYN, family practice, internal medicine, psychology, and urology.• Transformed clinical clerkship by introducing outpatient experiences and limiting inpatient experience; initiated small group clinical problem solving, limited didactics, implemented live pelvic models, and provided realistic expectations of the clerkship and real-world clinical practice.--Albany Medical College is one of the nation’s oldest medical schools and a national leader in curriculum development.