Medical Director
CurrentMedical Director overseeing over 100 PCPs and nearly 300 specialist in a downtown LA network. Manage Utilization, Quality, Contracts and Claims for this medical group of approximately 10,000 members in an inpatient and outpatient setting. Provide training to physicians and offices in RAF, P4P, and general quality improvement measures. Daily utilzation review of authorizations for specialty and tertiary care based on Miliman or Health Plan gidelines. Act as a liason between Health Plans and the medical group. Oversee members with Medi-Medi, Medicare Advantage and Commercial insurance as well as specialty networks including Blue Shield Trio, Oscar, and Blue Cross Vivity.