Stephen E. Email & Phone Number

Los Angeles, Ca, Us

Los Angeles, California, United States

- Support the Independent Review Organization’s (IRO) California Department of Managed Health Care (DMHC) activities- Provide advice and counsel to the DMHC as needed- Address clinical case questions from appeals officers and administrative staff.- Provide clinical advice to legal counsel and internal teams- Clinical panel physician oversight function- Perform quality reviews as requested by the DMHC- Serve as the medical expert in ISO and URAC audits- Participate in quality improvement initiatives

Los Angeles Metropolitan Area

For over 26 years, I’ve had extensive medical writing, analytic, and consulting experience as an administrative healthcare physician. I’ve communicated healthcare information and persuaded readers in many areas of healthcare, ranging from specific medical content to issues involving the healthcare payer system.Writing styles include: - Blog-style projects - “Listicle” projects - Website content - Patient/medical layperson educational pieces - Formal healthcare communications writing - Administrative healthcare writing - B2B healthcare and medical writing (e.g., pharmaceutical industry, healthcare software vendors) - B2C materials - Advertising - Brochures - Healthcare practitioner biographies - Case studies - Medical knowledge exam question writing - Abstract writing - Journal edits - …And more!My writing includes all levels, from basic (for medical laypersons) to advanced (for professionals). I write public-facing and internal-facing materials.

Greater Los Angeles Area

- Medical Director for the startup phase of the new national Community and State (Medicaid) provider reconsideration process (inpatient and outpatient services). - Medical Director for Employer and Individual (Commercial) reconsideration determinations.- Medical Director for Medicaid provider reconsideration determinations.- Medical Director for Medicare provider reconsideration determinations.- Made clinical and administrative decisions for all provider types, including: physicians; medical groups; hospitals; hospital systems; laboratories; therapy providers; therapists (physical, occupational, speech); mental health services; and other ancillary providers.- Assisted in implementing the reconsiderations process for medical services. The reconsiderations process was less constrictive and more cost-effective than formal appeals processes. - Supervised physician assistants in their medical and administrative activities.

Greater Los Angeles Area

- On a national basis, was responsible for responding to and resolving appeals, complaints, disputes, and disagreements from physicians, physician groups, laboratories, therapy providers, other ancillary medical providers, and institutions such as hospital networks. - Assessed coverage, coding, payment, benefit determinations, level of care, and medical necessity determinations. - Covered Medicare, Medicaid, and commercial insurance products.- Performed individual case reviews for appeals and grievances. - Communicated with UnitedHealthcare medical directors regarding appeals decision rationales and clinical/administrative benefit interpretations. - Communicated with UnitedHealthcare regional and plan medical directors and network management staff regarding access, availability, network, and quality issues. - Actively participated in team meetings focused on communication, feedback, problem-solving, process improvement, staff training and evaluation, and the sharing of program results. - Provide clinical and strategic input when participating in organizational committees, projects, and task forces.- Authored Independent Review Organization responses.- Provided regulatory guidance and recommendations as needed.

Greater Los Angeles Area

- Obtained physician expertise in the Medi-Cal Program (California's Medicaid Program).- Advised and had oversight functions for medical quality-of-care issues.- Performed extensive medical record auditing against claim and medical policy standards.- Performed extensive medical record reviewing for value-based care assessments. - Participated in detecting and evaluating fraud and abuse in medical services, including advising and working with investigative agencies and their attorneys.- Advised management.- Worked with legal staff in preparing recovery cases for hearings before administrative law judges.- Developed policies, procedures, and standards to: protect and improve the health of Medi-Cal beneficiaries; improve medical coding and adjudication; and optimize cost containment.- Advised government agencies.- Advised non-government professional organizations.- Provided advice and guidance to other physicians, nurses, management, pharmacists, auditors and other staff regarding medical audit adjudication and medical coding.- Was the team physician during managed care organization reviews in Los Angeles County, with responsibility for evaluating and making recommendations for improvement of managed care organizations' quality improvement and utilization management programs. - Advised on CPT and HCPCS coding and interpretation.

Greater Los Angeles Area

- Extensive duties and experience in outpatient clinical care.- Extensive duties and experience in inpatient/hospital medicine.- Extensive duties and experience in intensive care unit and critical care medicine.- Extensive duties and experience in urgent care and emergency room medicine.- Extensive duties and experience in consultative medicine, for other specialties (e.g., surgery, gynecology), and within internal medicine and its subspecialties.- Experience and participation in peer review and utilization management activities

Completion Of Internal Medicine Residency

Internal Medicine Residency

Doctor Of Medicine (M.D.), Medicine

With thesis in pediatric cardiology.

Bachelor'S Degree, Major In Biology With Minor In Biochemistry

Summa Cum Laude