I was appointed to serve on the North Carolina Medical Board (NCMB). NCMB is responsible for the licensure, monitoring and discipline of all of the state’s 55,000 plus physician and physician assistants. We also work in collaboration with the NC Board of Nursing in regard to Nurse Practitioners. The goal of the NCMB is the protection of the public.

Represented individuals and health providers against insurance companies for denied/ unpaid claims, represented professionals before licensure boards. Professional Licensure Defense: representation of professionals before their licensure boardsResponsibilities: Medical/Legal consultant working on Physician requests for information regarding off label usages for psychiatric medicationsResponsibilities: Medical/Regulatory Monitor – worked with team to review clinical and laboratory data on Effexor XR Panic Disorder trial, wrote all of the Serious Adverse Event narratives, resulted in successful FDA filing and approval of medication for Panic DisorderMedical/Regulatory Monitor – work with teams as psychiatric consultant to review clinical and laboratory data and medical writing for new drug applications for psychotropic medications.International Study Review Chair for non-USA based companies seeking FDA approvals

Responsibilities: provide psychiatric medical leadership to a multidisciplinary utilization management team for cases for members ages 13 and up; follow cases at all levels of care with day-to-day clinical oversight teaching and coaching care advocates in managing behavioral health cases; collaborating directly with providers to shape care managing behavioral health interface case for members who have co-occurring medical and psychological psychiatric or medical conditions. Make utilization management and medical behavioral decisions for determination of medical necessity; case management working with providers to improve outcomes for complicated patients; develop collaborative relationships with providers and network facilities; participate in meetings with key customers and network personnel; develop specific clinical criteria such as for eating disorder cases, and bipolar cases; monitor quality improvement process; conduct appeals and grievance processes at all levels; serve on national committees studying and participating in the determination of company wide approval policies for new technologies; develop and maintain level of care guideline tools for care advocates and physicians to use in making utilization management decisions; develop and provide educational sessions for care advocates; serve as consultant and subject matter expert on eating disorders, compliance, risk management and legal issues.Medical Writing: Write regulatory compliant templates for utilization management, including Medicare and Medicaid complaint letters to the public. Review, revise and approve corporate behavioral health publications prior to publication to the public.Legal Case Review: Review escalated and legal behavioral health cases, including preparing letters, detailed summaries and other documents. Represent organization at Administrative and other hearings.

Responsibilities: Evaluation and treatment providing direct psychiatric care for adolescent and adults, male and females seeing patients in this 7 jail minimum to maximum security county jail complex. Patients are seen for crisis evaluation and management, outpatient services, and responsibilities also include evaluation and management of patients in the in-house psychiatric hospital within the jail. Two years on site practice seeing inmates for psychiatric emergencies, in the psychiatric hospital, and in the office setting. Two and 1/2 years experience seeing patients by telemental health.

Responsibilities: Direct care management of behavioral health patients for all diagnoses ages 13 and up. Inpatient, outpatient and Crisis Services.

Responsibilities: Direct care management of behavioral health patients for all diagnoses ages 13 and up.

PGY-2 though PGY-4 University of PennsylvaniaPhiladelphia, PA

PGY-1 University of North Carolina at Chapel HillChapel Hill, NC

Responsibilities: Worked directly with physicians and hospital representatives regarding service and claims issues; performed contract analysis, negotiation and development; conducted analysis of new healthcare legislation; service as cross-functional team member on multiple task forces; strategized with peers and senior executives regarding provider network issues.

Responsibilities: managed division of over 50 nurses and administered a $4.6 million annual budget; managed professional review of medical claims and appeals; developed and managed reimbursement protocols and implementation; worked directly with providers on medical claims issues; provided legislative analysis and implementation of healthcare mandates; served on cross-functional teams working on quality improvement, NCQA, and other accreditations.

Responsibilities: developed and implemented programs to protect the organization from risk related to managed care and healthcare operations and services; designed and presented risk management programs; provided loss control for the organization’s risk cases; serviced as a leader to the legal department and organization assisting with medical policy and other issues during period of transition and reorganization. Provided on camera interviews to the press for the organization.

Managed plaintiff and defense cases in medical malpractice, personal injury, worker’s compensation and contract cases; litigation experience; professional licensure representation

Managed plaintiff and defense cases in medical malpractice, personal injury, worker’s compensation and contract cases; litigation experience

First year OB GYN residency

M.D. with Honors 1987J.D. 1989Pediatric, Neonatal Intensive Care

July, 1982 – July, 1983Registered Nurse, Staff Nurse IIClinical Research UnitMay, 1981 – June, 1982Registered Nurse, Staff Nurse IIPediatric Intensive CareRegistered Nurse, Staff Nurse I and IINorth Carolina Jaycee Burn UnitUniversity of North Carolina HospitalsChapel Hill, NC