PROFILE
Exceptionally well-qualified and highly successful healthcare executive with 29 years of experience in all facets of healthcare management. Uniquely integrated perspective regarding health services delivery due to managerial experience in all major sectors comprising the U.S. health delivery system, including: integrated delivery system development and operations; physician practice financial/operations management in the university and community-based arenas; managed care/health plan operations; hospital program and service line administration. Diverse background and experience facilitates excellence in health care administration.
PROFESSIONAL EXPERIENCE
UPMC & THE UNIVERSITY OF PITTSBURGH SCHOOL OF MEDICINE 2004 – Jan. 2016
Executive Administrator, UPMC Eye Center, Department of Ophthalmology
Serve as lead administrative executive responsible for all fiscal and operational aspects of the ophthalmology clinical and academic service lines, doing business as UPMC Eye Center. Position includes dual employment by UPMC, Physician Operations & Professional Services, LLC for oversight of clinical faculty medical practice operations and by the University of Pittsburgh School of Medicine for oversight of basic science research and related academic affairs. Span of control includes:
- 59 faculty (37 clinical faculty and 22 basic science research faculty).
- 18 residents/house staff in training.
- 198 departmental staff (122 clinical support staff / 58 research support staff / 18 residents).
- 9 professional office locations serving Oakland and Allegheny County.
- Professional practice book of business with an annual value of $54M in gross charges, $18M in net revenues, and an annual operating budget of $26.7M in expenditures.
- Basic science grant portfolio comprised of 54 active grants, valued at $6.3M in combined direct/indirect costs, with an annual research budget of $12.5M in expenditures.
Key areas of responsibility:
- Fiduciary Oversight & Performance: Develop and manage budgets. Monitor financial performance and implement strategies for improvement and adherence to targets.
- Clinical Practice Management: Provide guidance to clinical management team to facilitate excellence in patient service delivery.
- Research Administration: Oversee administration of basic science research grant portfolio, including pre/post award management, reporting, and accounting. Oversee clinical research program, ensuring trial protocols are administered in compliance with IRB and regulatory requirements.
- Academic Affairs: Administer academic programs in fulfillment of the Department’s educational mission, including: graduate medical education and ophthalmic residency program; sub-specialty fellowship training; Department-sponsored continuing medical education events; and medical and graduate student coursework.
- Faculty Employment & Affairs: Serve as the primary resource for faculty recruitment, employment contracting, compensation negotiation, career pathway coordination, academic promotion and appointment, clinical/research program start-up package development and management, and retention efforts.
- Strategic Planning, Business Development & Analytics: Develop strategic plans in support of departmental missions in the areas of patient care, research and teaching. Serve as executive in charge of ophthalmic business development and implementation, including acquisitions, mergers, consolidations, and joint-ventures. Develop and maintain data mining and related analytic/decision support programs for evaluation of clinical, business and research endeavors.
- Care Management & Clinical Quality: Provide administrative oversight and support for the development and implementation of ophthalmic specific clinical and service quality programs, including care management pathways and condition management protocols.
- IT Development: Direct all ophthalmic related clinical and business IT development activities. Oversee customization of electronic health record system installations to ensure optimization of clinical workflows, data collection, and documentation. Develop tele-medicine solutions for populations in need of ophthalmic screening and care.
- Infrastructure: Secure funding and manage capital construction and renovation projects to ensure optimal physical resource availability for clinical, research and educational activities.
MAGELLAN HEALTH SERVICES 1999 - 2004
Vice President, Operations, Magellan Behavioral Health of Western Pennsylvania
Directed the operational functions necessary to support the delivery of behavioral health care management services comprised of mental health, substance abuse and employee assistance products for all managed and indemnity lines of business to 2.6 million members covered by client health plan, Highmark Blue Cross Blue Shield.
- Consumer Relationship Management: Directed a high-volume inbound customer call center servicing Highmark enrollees in all product lines and markets.
- Quality & Accreditation: Ensured compliance with Magellan and Highmark mandated production and quality performance metrics. Monitored compliance with member service-related MBHO/health plan accreditation requirements specified by: NCQA, AAHCC/URAC, CMS, and the PA DOH. Oversaw quality programming for all member service-related functions, including service accessibility and member complaints and grievance processing.
- Care Management Technology: Served as the executive sponsor and project manager for new application development, EDI specification development, and application life cycle management for key insurance platforms, including: claims, eligibility, benefits, and provider networks.
- Informatics & Reporting: Responsible for all data warehousing, mining, analytics and reporting services for internal monitoring as well as external client reporting.
- Infrastructure: Executive in charge of all Pittsburgh based information and telecommunication systems. Responsible for physical and information security, systems continuity and recovery.
HIGHMARK BLUE CROSS BLUE SHIELD 1997 - 1999
Director, Operations, Healthcare Management Services
Responsible for the support of care management services for all managed and indemnity lines of business covering 2.6 million members through the operational oversight of the customer service, physician advisor, and business management/analysis departments.
- Consumer Relationship Management: Directed staff and management of internal call center units with peak staffing of 75 agents responsible for telephonic processing of incoming medical, surgical and behavioral health benefit determination and pre-authorization requests from provider network for all lines of business in both the regional and national account markets.
- Physician Advisory Services: Managed physicians and staff responsible for medical necessity determinations and peer-reviewed grievances of denied claims.
- Quality & Accreditation: Responsible for monitoring and maintenance of member-services related MBHO/health plan accreditation requirements specified by: NCQA, AAHCC/URAC, CMS/HCFA and the PA Department of Health.
- Business Support Services: Managed t...
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