Page Title

Detail Of Professional Experience (With URL Links) Of

Vice President, Care Management (6/97 to Present)

Director, Utilization Management (1/94 to 5/97)

Guide the Company's medical management operations resources including physician advisors and registered nurses. Provide leadership for development of clinical information systems that facilitate managed care programs. Implement EDI systems for efficiency including electronic precertification and electronic referrals. Project leader for institution of ambulatory patient group (APG) reimbursement methodology. Design and maintain health employer data information set (HEDIS) reporting system based upon the company's IBM Based DB/2 data warehouse. Implement GUI-tools for data analysis using ODBC.

Analyze network performance through ongoing delivery of per member per month (PMPM) statistics. Define clinical requirements for network management through establishment of access standards and evaluation of objectives through use of GeoAccess tools. Lead design team for client/server medical policy system. Responsible for provider practice pattern profiling systems. Manage relationships with the medical community, including implementation of programs designed in conjunction with the Chief Medical Officer. Responsible for the Company's NCQA Accreditation.

Manage Medicare market product line including completion of competitive medical plan application to the Health Care Financing Administration (HCFA). Direct the Company's entry to the workers compensation managed care arena. Develop Strategic Plan for and managed the Company's Pharmaceutical Benefit Management and Prescribing Protocols function.

CONCEPTUAL SYSTEMS CORPORATION - CLEVELAND, OHIO

Product Manager, Physician Practice Management Systems (1/93-12/93)

Responsible for overall operation and product direction of physician practice management PC software package marketed as "MediStat." Activities included management of customer support, hardware installation, training, and direct sales functions. Developed functionality specifications for system enhancements and created spreadsheet analysis tools for system proposal evaluations.