Senior National Catastrophic Medical Consultant

• Jan 2021 - Present

Provide expert medical management oversight and supervision of catastrophic (ABI, SCI, burn, etc.) and serious injury cases. Supply medical cost containment recommendations and oversight to our clients’ catastrophically injured workers, collaborating with MEC’s Medical Director, Claim Analysts and Attorneys, external claim administrators (TPAs and others), field nurse case managers and clients. Identify potential risks and mitigation opportunities for catastrophically injured clients. Assist in maximizing injured worker’s medical outcome, including return to function, while minimizing the financial risk to MECC and its clients. Serve as an expert consultant and subject matter expert to MEC and its clients on claim medical management, developing and implementing solutions to a variety of complex medical management issues and offering cost containment options. Provide medical reserve analysis when requested by client. Show less

National Catastrophic Medical Consultant

• Dec 2018 - Jan 2021

Principal Owner

• Sep 2017 - Dec 2018

Differentiators - Insurance Carrier Strategies - Defense and Plaintiff In addition to the legal nurse consulting and life care planning services offered, a unique skill set positions Phyllis above the rest. Having worked with major insurance carriers, including The Hartford and Travelers, enables a clear understanding of key strategies which are employed, providing a distinct advantage over other consultants. These strategies include case reserving, settlement negotiations, subrogation and jurisdictional nuances. Additional Expertise * Provide educational presentations of diseases or conditions for legal staff members to enable better understanding of medical issues, allowing for better engagement with the client * Expert in identifying causal relationship and mechanism of injury and illness * Insurance subject matter medical expert of serious injury and illness cases with individual medical exposures up to several million dollars Basic Services Available: * Medical record review, chronology of events, summary and opinion report for: * Workers' Compensation Injury * Personal Injury * Medical Malpractice * Product Liability * General Liability * Catastrophic Injury (SCI, TBI, Multiple trauma) * Medical record review and client interview to determine medical merit of case * Identify medical documents that are vital to case preparation * Decipher handwritten medical records * Record review for deviation from standards of care * Medical summary with case specific questions for Independent Medical Evaluations * Medical cost projections Advanced Services Available: * Life Care Planning * Life Care Plan Rebuttals *Assess and analyze alleged damages and injuries and identify alternative causation * Identification and selection of medical expert witnesses * Compile deposition questions for healthcare providers * Advanced evidence based, peer reviewed literature searches Show less

Director of Clinical Solutions - Consultant

• Jan 2018 - Oct 2018

I built out the vision for Ametros' Health Navigator Program which included in-house nurse care partners that provide medical care coordination to Ametros’ members after settling their workers' comp or liability case. The focus was on creating and implementing the program, shaping a team to provide quality clinical support for injured parties and their families and promoting wellness for Ametros’ members. The program offers extra clinical support to catastrophically injured members to help them fully understand their treatment plans and the options available to them post settlement. I worked closely with operations to implement the process, with product development to create content for the program and with the marketing team to help with branding the product and to provide education to the sales team. Show less

Medical Major Case Specialist

• May 2013 - Sep 2017

Provided medical oversight and supervision, of catastrophic (ABI, SCI, burn, etc.) and serious injury (RSD, electrical injury, chronic pain, etc.) cases with individual medical exposure from several hundred thousand to several million dollars across the country. Developed medical management strategies, and provided medical reserve analysis, life time medical cost projections and life care plans for catastrophically injured clients. Superior knowledge of rehabilitation processes and costs associated with serious and catastrophic injuries. Provided subject matter expertise to both claim and legal leadership teams to include in depth medical record review, case summaries and chronologies. Developed strategies for catastrophically injured clients, identifying trends, and providing solutions. Developed and delivered training to claim, medical and legal personnel on ABI, SCI, Burns, Chronic Pain and Narcotic overuse. Show less

Manager Medical Quality Assurance and Training for HDI

• Feb 2012 - 2013

Was responsible for managing both medical quality assurance and training programs including Utilization Review and Telephonic Case Management services at a national level. Managed quality assurance analysts and training staff and oversaw all audits completed by the QA staff. Evaluated trends and implemented training programs to improve overall medical quality outcomes globally. Was responsible for managing both medical quality assurance and training programs including Utilization Review and Telephonic Case Management services at a national level. Managed quality assurance analysts and training staff and oversaw all audits completed by the QA staff. Evaluated trends and implemented training programs to improve overall medical quality outcomes globally.

Medical Consultant / Auditor

• Oct 2007 - Feb 2012

Provided in depth analysis and audits of the medical and RTW management of claim files and provided specific recommendations through annual audits. Was accountable for multiple specialty audits: ie: SOX audits, Medical Bill Audits, TPA service audits, vendor audits, medical audits. Medical Quality Audits were completed on Work Comp, Short and Long Term Disability, Life and Leave Management Claims. Audits led to training that drove continuous performance improvement of medical, vocational and behavioral management. Show less

Medical Consultant, Life Care Planner, Medicare Set Aside Consultant

• Aug 2000 - Oct 2007

Provided complete medical analysis of Large Loss cases with paids >500K in medical spend and generated a concise report outlining the medical chronology of the case and provided a lifetime medical cost projection to ensure proper medical reserving on catastrophic cases. Obtained certification in Life Care Planning and Medicare Set Aside allocations and provided in-house Medicare Set Asides for evaluating settlements. Developed the internal Medicare Set Aside submission process for the organization. Show less