Experience

ATRIO Health Plans

• United States
• Insurance
• 1 - 100 Employee

• Chief Medical Officer

  • Apr 2022 - Present

  Atrio Health Plans offers Medicare Advantage plans in Oregon, Nevada, partnering with providers and members in advancing the care of the communities served. Atrio offers DSNP and PPO plans.



Blue Cross Blue Shield of Arizona

• United States
• Insurance
• 700 & Above Employee

• Vice President

  • Jul 2019 - May 2022

  Phoenix, Arizona, United States Oversee all full-time and contract physicians, serve as senior clinical officer for URAC (accreditation) and serve as physician representative on Crisis Management Team. Manage high-cost claimant review unit and clinical coding guidance group. Focus on new initiatives and execute special projects, including management of outlier governance process. Bring a collaborative approach to team leadership and operational planning to help meet objectives and carry out the mission of… Show more Oversee all full-time and contract physicians, serve as senior clinical officer for URAC (accreditation) and serve as physician representative on Crisis Management Team. Manage high-cost claimant review unit and clinical coding guidance group. Focus on new initiatives and execute special projects, including management of outlier governance process. Bring a collaborative approach to team leadership and operational planning to help meet objectives and carry out the mission of BCBSAZ. Committee responsibilities include: • Medical policy. • Focused provider review. • Oversee Pharmacy and Therapeutics Committee.

• Interim Corporate Medical Director, Clinical Operations

  • Jan 2019 - Jun 2019

  Phoenix, Arizona, United States Managed corporate medical directors, clinical advisors and related staff in clinical operations for BCBSAZ commercial and Medicare Advantage products. Interacted with senior leadership, community leaders, providers and plan members, lending clinical expertise and strategic direction. Additional responsibilities: • Planning committee participant: Medical policy, credentials, benefits, coding. • Co-leader of enterprise-wide payment integrity project.

• Chief Medical Officer

  • May 2015 - Jun 2019

  Phoenix, Arizona, United States Medical executive providing sound guidance in matters of medical expenditure and strategy. Oversaw pharmacy, quality and utilization management teams. Responsible for institutional quality assessments. Oversaw Stars, RAF, HOS and HEDIS processes. Chaired committees for: Quality management, credentials, peer review and pharmacy and therapeutics.



Aetna

• Medical Director

  • Jun 2011 - Apr 2015

  Greater St. Louis Physician lead for implant review team. Managed skilled nursing facility (SNF) length of stay and all-cause readmission initiatives. Oversaw concurrent review nurses. Directed prior authorization reviews. Committee chairs: • Midwest Regional Credentials Committee (2013) • Special Investigations Committee (2012 – 2013) Served as medical director for Coventry Health Care from 2011 – 2013, which was acquired by Aetna in 2013.



SSM Medical Group

• Physician

  • Dec 2006 - Jul 2011

  St Louis, Missouri, United States Practiced internal medicine. Member of the Board of Directors.



SSM St. Mary's Health Center

• Physician

  • 1994 - 2010

  St Louis, Missouri, United States Attending physician. Provided inpatient adult medical care in acute care, intermediate care and ICU settings, as well as medical detox unit. Administrative leadership roles: • Chair, Credentials Committee (2007 – 2010). • Member, Medical Executive Committee (2002 – 2009). • Medical Staff President (2006 – 2007).



Midwest Medical Specialists

• Physician

  • Jul 2001 - Nov 2006

  St Louis, Missouri, United States Practiced internal medicine. Co-owned the two-physician practice.



Emory University School of Medicine

• United States
• Higher Education
• 700 & Above Employee

• Resident

  • 1988 - 1991

  Atlanta, Georgia, United States