Experience

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  Palm Medical Centers

  • Florida, United States

  • Sr Director of Utilization Managemet

    • Mar 2019 - Present
    • Florida, United States

• 

  Doctor's Medical Center

  • Miami, Florida

  • Director of Utilization Management

    • Oct 2017 - Feb 2019
    • Miami, Florida

     Responsible for daily operations activities of Case Management, High Risk department, Transition of Care Department and Referral Department. Managing over 35 staff members. Financial responsibility of part A and B in the company.

• 

  Humana

  • Miami/Fort Lauderdale Area

  • Director Care Delivery System. Shared Services

    • Jan 2013 - Aug 2017
    • Miami/Fort Lauderdale Area

     Responsible for daily operation activities of case management and referral department across all entities acquired by Humana. Entities are Continucare Corporation, CAC Medical Centers, CAC Care Medical Centers, Metropolitan Medical Centers (Metcare) and PIPC (Partners in Primary Care-Concentra). Managing over 200 staff members. Development and implementation of the organization’s federal and state law and regulations and accreditation standards. Financially responsible for part A and B in those entities. Development and implementation of systems, policies and procedures for concurrent case review, clinical practice guidelines, clinical protocols and reporting quality care issues identified during the utilization review process.

• 

  Continucare Corporation

  • Miami/Fort Lauderdale Area

  • Vice President utilization management

    • Sep 2005 - Aug 2013
    • Miami/Fort Lauderdale Area

     Responsible for daily operation activities of case management and referral department at local and regional centers in Dade, Broward and Hillsborough counties. Report 50+ staff members Development and implementation of the organization’s utilization management plan in accordance with the mission and strategic goals of the organization