Melissa Urrea, M.D. Email and Phone Number
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Melissa Urrea, M.D. personal email
✦ WHO I AM ✦I am a board certified Family Medicine Physician with 20+ years of clinical experience. I earned the Health Care Quality Management Certification (HCQM) from the American Board of Quality Assurance and Utilization Review Physicians, and I am sub-specialized as a Physician Advisor through the American College of Physician Advisors.I am currently the CMO for Herself Health, an organization devoted to improving the total health care experience for women over the age of 65. This includes providing great primary care on the path towards value based care. Previously, I was the Vice President of Medical Affairs and Senior Executive Medical Director for naviHealth/Optum Care Transitions serving as the highest physician executive within the Care Transitions organization. I provided clinical leadership, strategic direction, and coordination with internal and external stakeholders to pioneer innovative strategies for post-acute care management for our senior population. I took a proactive approach to the marketplace and corporate wide medical strategies and stakeholder relations. I contributed to the development of clinical action plans and programs, strategic initiatives, and tactics that ensured a coordinated approach to the health care delivery system and to address client/provider areas of concern. I directly managed the regional and national Executive Medical Directors. ✦ WHAT I BRING TO THE TABLE ✦I am forward thinking and goal oriented. I lead by example, and I practice the values of integrity, honesty, and commitment in my daily life and my interactions with teammates and partners. ✦ WHAT DRIVES ME ✦I love the challenge of isolating and solving problems. Whether I’m working to improve utilization management or enhance productivity, I try to think outside the box and come up with strategies that minimize disruption and maximize resources. ✦ MY SKILLSET INCLUDES ✦• Critical Thinking• Appeals Management• Business Development• Change Management• CMS Regulatory Policy• Continuous Improvement• Healthcare Strategy/Operations• Medicare / Medicaid Policy• Partner & Physician Relations• Population Based Medicine• Project Management• Strategic Planning• Utilization Management
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Wbl (Women Business Leaders Of The Us Health Care Industry Foundation) -
Chief Medical OfficerHerself Health Sep 2024 - PresentSt Paul, Minnesota, Us -
AuthorM. J. Urrea Jul 2002 - PresentWhile completing residency training in medicine, I was inspired to write my first published novel, "Thin Yellow Line". Writing gives me a creative outlet to paint with words; to share the experiences and imagination; and to create something rich and beautiful.Published Author, "Thin Yellow Line", Fiction Novel
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Vice President Medical AffairsOptum 2023 - 2024Eden Prairie , Mn, Us -
Senior Executive Medical DirectorNavihealth 2022 - 2024Brentwood, Tn, UsAs the Senior Executive Medical Director for naviHealth, I am a physician executive who provides overall clinical leadership, strategic direction, coordination and management of key clinical relationships with internal and external stakeholders. I take a proactive approach to the marketplace and have responsibility for corporate wide clinical strategies and stakeholder relations. I manage a team of Executive Medical Directors, providing direction to support key strategic initiatives and tactics; business development and growth; development of new initiatives, and process enhancements. I develop and maintain vital relationships with Chief Medical Officers or similar physician executives to drive clinical strategies and innovation. -
Executive Medical DirectorNavihealth 2021 - Aug 2022Brentwood, Tn, UsI work in partnership with naviHealth Market Presidents to support new business development, manage Medical Directors (MDs), and help external stakeholders (health plans and health systems) navigate programs and troubleshoot issues. Much of my time is spent working closely with naviHealth’s COO, VP of Medical Director Operations, and SVP of Utilization Management.• Support 4 health plan clients and 5 value-based care clients by establishing and maintaining strong collaborative relationships with Health System and Health Plan CMOs, Physician Advisors, and Optum Care Physician Leaders. • Play a key role in defining Senior Medical Director and Lead Medical Director roles to aid in the restructuring of the Medical Director Enterprise. • Ensure positive client relationships and help grow business by responding to inquiries and service issues, serving as a SME on utilization management, solving escalated problems, and identifying opportunities to expand or improve service. • Provide guidance and support during new market roll-outs, and work with plan Medical Directors, Regional VPs, and CMOs to align processes market-wide, maintain best practices, and satisfy local stakeholders.
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Interim Executive Medical DirectorNavihealth 2021 - Jun 2021Brentwood, Tn, UsI work in partnership with naviHealth Market Presidents to support new business development, manage Medical Directors (MDs), and help external stakeholders (health plans and health systems) navigate programs and troubleshoot issues. Much of my time is spent working closely with naviHealth’s COO, VP of Medical Director Operations, and SVP of Utilization Management.• Support 4 health plan clients and 5 value-based care clients by establishing and maintaining strong collaborative relationships with Health System and Health Plan CMOs, Physician Advisors, and Optum Care Physician Leaders. • Play a key role in defining Senior Medical Director and Lead Medical Director roles to aid in the restructuring of the Medical Director Enterprise. • Ensure positive client relationships and help grow business by responding to inquiries and service issues, serving as a SME on utilization management, solving escalated problems, and identifying opportunities to expand or improve service. • Provide guidance and support during new market roll-outs, and work with plan Medical Directors, Regional VPs, and CMOs to align processes market-wide, maintain best practices, and satisfy local stakeholders.
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Lead Medical DirectorNavihealth 2018 - 2021Brentwood, Tn, UsLead Medical Director (2020-Present)Medical Director (2018-2019)Both roles involve continual interaction with health plans and providers to navigate shared relationships and problem-solve. • Continually interact with health plans and providers to navigate shared relationships and problem-solve. • Concurrently provide day-to-day guidance and coaching of up to 20 naviHealth Medical Directors (MDs), and interact with internal cohorts such as market presidents, directors of clinical operations, and others. • Collaborate with and support the SVP of Utilization Management in strategic communication planning.• Represent naviHealth at 30+ Joint Operating Committees (JOCs) and other external events annually.NOTABLE ACCOMPLISHMENTS:> Improved utilization management, enhanced the educational process for MDs, and increased the critical thinking skills of coordinators with a remodel of the MD Rounds process for those serving national accounts. > Improved turn-around times and KPIs by spearheading a Clinical Document Improvement Project for Skilled Inpatient Care Coordinators which was launched in a single market, then adopted and expanded nationwide.> Reduced turn-around times by operationalizing the MD Queue system for continued stay determinations which produces a 90% turn-around time within the first 2 hours of receipt. Achieved 76% user satisfaction rate.> Improved utilization review by operationalizing the MD Queue system for preservice determinations, enhancing work assignments for 47 MDs in 20+ states and obtaining reporting metrics for 10 health plans.> Improved provider satisfaction by collaborating with other Medical Director SME’s to develop processes which help the MD Enterprise maintain the 70% first call connection rate KPI.> Created the MD Library, a standardized repository of vetted clinical documents for use by MDs.> Exceeded productivity goals in 2020 by improving the performance of 4 MDs.
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Market Medical Director / Internal Physician AdvisorCatholic Health Initiatives 2016 - 2018Englewood, Co, UsI was hired as a Physician Advisor and the role evolved into Market Medical Director for the Population Health Management Department. I established processes to make certain that physicians admitted patients under the correct classifications to ensure compliance with CMS guidelines, and served as a liaison between the CMO/VP of Population Health Management and the regional and market-based executives. • Conducted up to 30 medical record reviews per day for medical necessity of inpatient admissions, need for continued hospital stays, the adequacy of discharge planning, and quality care management. • Collaborated and communicated with the Utilization Management, Appeals Management and Clinical Documentation Departments on multiple project, including the development of an Appeals Unit. • Worked with the Revenue Department to improve revenue capture. • Maintained regular communications with key external vendors. NOTABLE ACCOMPLISHMENTS:> Collaborated with the Internal Physician Advisor Service (IPAS) team to internalize the physician advisor process in 100+ hospitals across the country.> Reduced the audit risk and enhanced revenue by improving the clinical documentation of treating physicians to justify medical necessity through individual and group training of MDs and physician groups. > Potentially saved millions of dollars per year by developing an Appeals Unit program which utilized software and an internal appeals service manager, eliminating the need for an external auditor.> Successfully negotiated improved payor contracts. > Improved team communications by utilizing project management software. -
Medical Director, Senior Products DivisionHumana 2014 - 2016Louisville, Kentucky, UsIn this role, I provided physician review services for utilization management, case management, and quality management. I developed, maintained, and assured compliance with physician review policies/procedures for utilization management and conducted peer to peer reviews.• Led implementation of a Central Texas Regional Management (geographical alignment) process.• Provided clinical and utilization-based education to Humana nurses, and collaborated with external vendors to improve utilization and case management for the benefit of Humana members.• Initiated crucial Skilled Nursing Facility (SNF) investigations upon evidence of inappropriate utilization and quality concerns, and developed quality improvement strategies. • Provided education, supported collaborative relationships, and participated in JOCs with physicians, large provider groups, hospitals, facilities and ancillary providers. NOTABLE ACCOMPLISHMENTS:> Developed a clinical SNF rounds process for Humana nurses, in collaboration with the Health Services Director, to improve KPIs in the Central Texas Market.> Participated in developing a SNF scorecard for the entire state of Texas to assist providers in choosing the appropriate facilities for their patients with a goal to reduce overly long stays and return patients to their highest level of function as quickly as possible.> Cut costs by identifying medically unnecessary services and care delivery settings, and recommending alternatives based on patient-specific needs.> Streamlined the Medical Director assignment system to even out the workflow among the MDs. > Conducted a patient survey of a poorly reviewed SNF to identify areas needing improvement. -
Senior Medical Director / Team Lead / Physician AdvisorOptum 2010 - 2014Eden Prairie , Mn, UsI started my career at Executive Health Resources/Optum Physician Advisors as a physician advisor and was promoted to Team Lead/Senior Medical Director within 18 months of hiring. In this role, I served as the clinical review and appeals expert, and a SME on government retrospective appeals. I assisted in developing quality assurance processes and procedures, and trained novice physicians with no prior clinical appeals experience.• Managed a physician team of 10 responsible for written and verbal appeals to Medicare contractors and administrative law judges. • Advised and educated hospital CEOs and CFOs regarding documentation quality, the Code of Federal Regulations, and regulatory compliance to improve quality and decrease avoidable denials. • Evaluated CMS regulatory policies regarding Inpatient Rehabilitation Facilities (IRF).• Provided real time evaluations of medical necessity for hospitals and physicians regarding government and commercial payersNOTABLE ACCOMPLISHMENTS:> Successfully overturned hundreds of denials at the Medicare contractor and administrative law judge level with written and verbal appeals. > Authored and initiated protocols and procedures for emerging markets in Medicare Appeals, including IRF, long term acute care hospital (LTAC), and Cardiac Rehabilitation appeals.> Developed the training process for physicians to participate in IRF and Cardiac Rehabilitation Recovery unit audits.
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Physician OwnerTrinity Family Medicine 2006 - 2011I was the sole physician for a 5,000+ patient practice with 5 staff. I oversaw the activities of an office manager and accounting professional in managing the budget, payroll, bill collection, insurance coding, EMR implementation, etc. > Created a house calls service to eliminate barriers to care for elderly and autistic patients, and those with transportation or other issues which limited their access to medical services. > Developed an affordable care delivery system for patients without insurance.
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Independent ContractorTexas Department Of Criminal Justice - Office Of The Inspector General Jul 2007 - Oct 2009Austin, UsIndependent contractor for the Office of the Inspector General charged with the evaluation of medical records to investigate fraud and abuse of the Texas Medicaid Program -
Physician, Family MedicineAustin Regional Clinic Aug 2002 - Jun 2006Austin, Texas, UsFamily Medicine Physician -
StudentThe University Of Texas At Austin 1990 - 1994Austin, Tx, Us
Melissa Urrea, M.D. Skills
Melissa Urrea, M.D. Education Details
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The University Of Texas At AustinChemistry -
The University Of Texas Medical BranchDoctor Of Medicine - Md
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The University Of Texas At AustinChemistry
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The University Of Texas At Austin
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University Of Texas At AustinChemistry
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Waco Family Medicine InstitudeFamily Medicine Residency Program
Frequently Asked Questions about Melissa Urrea, M.D.
What company does Melissa Urrea, M.D. work for?
Melissa Urrea, M.D. works for Wbl (Women Business Leaders Of The Us Health Care Industry Foundation)
What is Melissa Urrea, M.D.'s role at the current company?
Melissa Urrea, M.D.'s current role is Chief Medical Officer.
What is Melissa Urrea, M.D.'s email address?
Melissa Urrea, M.D.'s email address is mu****@****ana.com
What schools did Melissa Urrea, M.D. attend?
Melissa Urrea, M.D. attended The University Of Texas At Austin, The University Of Texas Medical Branch, The University Of Texas At Austin, The University Of Texas At Austin, University Of Texas At Austin, Waco Family Medicine Institude.
What are some of Melissa Urrea, M.D.'s interests?
Melissa Urrea, M.D. has interest in Fiction Writing, Health.
What skills is Melissa Urrea, M.D. known for?
Melissa Urrea, M.D. has skills like Medicine, Physicians, Medical Records, Medical Writing, Research, Medical Directors, Technical Writing, Internal Medicine, Medical Education, Healthcare Management, Emr, Medicare.
Who are Melissa Urrea, M.D.'s colleagues?
Melissa Urrea, M.D.'s colleagues are Eleanor Whitley Rosiak, Jennifer Nelson Carney, Erum Shahzadi, Kim Boyd, Laura Williams, Ashley Blanton, Lori Ashby.
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