Medical Director Resume Example
Goal-oriented, board-certified Internal Medicine physician with 30 years experience in direct patient care, ownership and management of robust medical clinic, and enthusiastic participation in managed care development. Proficient in audits of inpatient and outpatient utilization management, medical necessity, and quality assurance. Accomplished Medical Director utilizing peer to peer reviews and collaboration with nurse reviewers and certified coders to ensure optimal use of resources and superior healthcare. Well-versed in clinical case reviews for long term care and rehabilitation facilities. Evidenced innovation in development of algorithms to improve audit accuracy and efficiency. Valued educator for team members, optimizing consistency in records review process. Experienced in use of Optum InterQual, EncoderPro, Microsoft Word, Excel, Power Point, and Outlook.
Committed to integrating medical necessity awareness, cost containment, and efficiency with compassionate quality health care through multidisciplinary education, collaboration, and monitoring for improvement.
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Accenture – Detroit , MI
- Supervise and validate findings of the Clinical Review Team of registered nurses and certified medical coders performing government Medicaid audits.
- Provide medical expert records reviews, rendering decisions regarding Utilization Management and Medical Necessity of healthcare services.
- Perform clinical reviews to assess Program Integrity/compliance and provide Quality Assurance.
- Preside over provider Administrative Appeal Conferences as Clinical Expert authority for initial and final decisions.
- Act as the Medical Director for the Georgia Medicaid Recovery Audit Contractor (RAC) program.
- Direct CMS Medicare Part C Organizational Determinations, Appeals, & Grievances and Part D Coverage Determinations, Appeals, and Grievances.
- Work with Clinical Team to improve efficiency of audits through design .and implementation of clinical review protocols.
- Educate team members regarding medical diagnosis and appropriate patient care.
- Provide expert medical opinions to multiple state Medicaid healthcare programs.
Henry Ford Hospital – Leslie , MI
- Provide primary care, urgent care, and Internal Medicine consultation services to patients, including diagnosis, treatment, and followup care of for acute and chronic illness
- Provide interpretation and discussion of diagnostic studies performed and discuss treatment options
- Endorse and encourage healthy lifestyle activities
- Consult with subspecialty providers when appropriate
- Actively listen and encourage discussion
- Coordinate care between providers
Celerion – Tempe , AZ
- Collected, analyzed and interpreted information, documentation and physical evidence associated with investigations.
- Discussed investigational study protocol, risks, responsibilities of participation with study subject and obtained informed consent.
- Coordinated and participated in periodic Study Coordinator audits.
- Evaluated and reported any/all study adverse events and ensured associated event documentation and subsequent monitoring required.
- Reviewed, documented, and submitted summary of study results.
Quality Care Providers INC. - IPA – City , STATE
- Supervised physician activities for QCPI, the Independent Practice Association contracted with Anthem Blue Cross Blue Shield of GA to manage physician activities for HMO products.
- Performed reviews for Quality Assurance and Utilization Management.
- Board certified - American Board of Internal Medicine
- Graduated summa cum laude
- Board certification - American Society of Clinical Pathology
- Graduated in Top 1% of Class
- Member of National Honor Society
- Member of CWENS/Lambda Sigma Honor Society
- Elected to Student Body Vise-President
- Elected to President of the Student Senate
- Elected Miss Ole Miss
- Elected President Phi Mu Fraternity
- Elected to University Hall of Fame
- Graduated magna cum laude
American Medical Association
Medical Association of Georgia
Southern Medical Association
Cobb County Medical Association
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Resume Overview
School Attended
- Emory University Medicine Internship And Residency
- University Of Mississippi School Of Medicine
- University Of Mississippi School Of Lab Sciences
- University Of Mississippi
Job Titles Held:
- Medical Director
- Internal Medicine Physician
- Principal Investigator
- Executive Board Member
Degrees
- Doctor of Internal Medicine : Internal Medicine
M.D. : Medicine
Clinical Laboratory Scientist,Medical Technologist : Medical Technology
Bachelor of Arts : Biology, Secondary Education, Sociology
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