Expert Details
Pediatrics, Adolescent, & Young Adult & Administrative Medicine, Medical-Legal Issues, Public Health
ID: 724613
California, USA
30 years clinical experience in Pediatrics, Adolescent and Young Adult Medicine and preventive medicine (all three with Board Certification), Family Practice, and Adult and Pediatric Emergency Medicine. 14 years experience as a Medical Director reviewing complex care cases of all kinds. Six years in full-time academic health care.
MD, JD with 14 years experience as a Medical Director for Health Plans and Physician Groups. MPH degree as well. Experienced in working with health Departments and regulations, including Workman's Comp.
Masters Degree in Public Health from UC Berkeley with a minor concentration in epidemiology and published in field. Academic experience in questionnaire design.
14 years as a Medical Director for Health Plans and Physician Groups including NCQA preparation and work in Quality Assurance review, grievances and appeals.
MD, MPH, JD with 30 years clinical experience and 14 years experience as a medical director for Health Plans and Medical Groups and 20 years medical legal consulting experience. Taught health care systems including international comparison to graduate students in nursing at University of Phoenix. Expert on delivery of care issues for children and youth. Expertise in cultural diversity.
14 years experience as a Medical Director for Heath Plans, Medical Groups and a Home Health company including all insurance products.
14 years experience as a medical Director for Health Plans and Medical Groups. Extensive medical record review experience going back to PRO work in 1986 and charting quality improvement as early as 1979. Consultant for California Medical, Dental and Cosmetology Boards. 20 years experience in medical legal consulting and now also licensed to practice law in California.
Board Certified in Pediatrics and Sub-Board certified in Adolescent Medicine with 30 years clinical experience, 6 years full time and many more years part-time academics with numerous publications in the field. Medical Legal expert in Pediatrics and AM for 20 years. Consultant to CA Med Bd. in Pediatrics and AM. Currently senior Pediatric case reviewer for Anthem Blue Cross of CA in Pediatrics. Extensive experience in MediCal(Medicaid). National Reviewer in Pediatrics and Adolescent Medicine for MCMC, PRN, MES, Permedion, AMR and others.
Board Certified in General Preventive Medicine with extensive experience as a community organizer, in school-based health care, juvenile justice care and in developing preventive care guidelines. Published in this field.
Board Certified in General Preventive Medicine. Extensive experience in vaccine issues, infectious disease, maternal, child and youth health, and environmental health issues. MPH degree from UC Berkeley with major in Maternal and Child Health and minor concentration in epidemiology. Extensive experience working with PH departments including grant writing. JD degree with interest in regulatory compliance issues. Experience with ADHD and IDEA law issues, autism.
Verimed Inc., Pediatrics Editor – NLM “ADAM” and other on-line health Encyclopedias, pharmaceutical consulting, and articles for WebMD.Consultant in Pediatrics, Adolescent & Preventive Medicine, CA Medical;
Board, Dental Bd. And Cosmetics Bd.
Consultant, UCLA Cent. for Health Policy Research, STDs & Managed CareUtilization Case Review Nationwide: Medical Review Institute of America, Physicians Review Network, MCMC, Covance, MES and others
Design -nursing drug dispensing protocols, San Bernardino County Juvenile Hall.
Education
| Year | Degree | Subject | Institution |
|---|---|---|---|
| Year: 1977 | Degree: MD | Subject: Medicine | Institution: Georgetown University |
| Year: 1981 | Degree: MPH | Subject: Maternal & Child Health, Epidemiology | Institution: University of California Berkeley School of Public Health |
| Year: 2006 | Degree: JD | Subject: Law | Institution: Concord-Kaplan Law School |
| Year: 1973 | Degree: BS | Subject: Psychology, Political Science, and Premed | Institution: Georgetown University |
Work History
| Years | Employer | Title | Department |
|---|---|---|---|
| Years: 2006 to Present | Employer: Undisclosed | Title: Consulting Medical Director | Department: |
Responsibilities:UM consulting |
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| Years | Employer | Title | Department |
| Years: 2001 to Present | Employer: Undisclosed | Title: Consultant | Department: |
Responsibilities:Utilization management for labor trusts, oversees insurance and foreign insurance cos. |
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| Years | Employer | Title | Department |
| Years: 2002 to Present | Employer: Undisclosed | Title: Consultant | Department: |
Responsibilities:MediCal & Healthy Families Managed Care (200,000 insured lives) – Pediatrics, Grievances and Appeals and Emergency Care and Ambulance Transport Reviews, substitute for CMO when he is away, appear at arbitrations and mediations |
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| Years | Employer | Title | Department |
| Years: 2002 to Present | Employer: Undisclosed | Title: Consulting Medical Director | Department: |
Responsibilities:Home infusion company – consulting medical director for Managed Care Issues |
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| Years | Employer | Title | Department |
| Years: 1994 to 1995 | Employer: Aetna Health Plans of California | Title: Associate Medical Director | Department: |
Responsibilities:Utilization and Quality Management chart reviews for HMO, POS, and PPO health insurance products.Chair: Quality Management and Pharmacy Comms. Member of Credentialing Comm. - 9000 MDs/yr. reviewed. Develop health education & community involvement programs for health plan members and employees. Management liaison with Employee Activities Committee. Assist Medical Director in full range of administrative and clinical duties; substituted for Medical Director when she was not available, including National P&T Committee. Accomplishments: Developed several epidemiological, evaluative and interventional studies to improve managed care performance. Developed liaison with mental health provider including clinical studies. Assisted national office in review of technology assessments and preventive health guidelines and programs. Substituted for Medical Director on national Pharm & Therapeutics Comm. Developed processes to streamline physician credentialing. Extensive experience preparing for NCQA review. Able to rapidly learn processes and contribute fully to management in large, advanced market, despite no previous full-time management experience. |
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| Years | Employer | Title | Department |
| Years: 1997 to 1998 | Employer: Great American Health Plan | Title: Medical Director & Director | Department: Health Services |
Responsibilities:Director of Health Services for this start-up MediCal (Medicaid) Managed Care Company. Responsible for QA, QM, UM, Credentialing, Pharmacy and Health Education Departments and involved in all other aspects of program development, contracting and community planning.Accomplishments: In less than three months brought together a cohesive health services team, enabling GAHP to pass its first Calif. Dept. of Health Services Audit and developed processes to improve quality of care. GAHP was purchased by Universal Health - SD Med. Dir. position eliminated, 8/98 |
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| Years | Employer | Title | Department |
| Years: 1991 to 1994 | Employer: University of Texas Medical Branch, Galveston | Title: Associate Professor, Director of Adolescent Medicine, Faculty | Department: Departments of Pediatrics & Emergency Services |
Responsibilities:Assoc. Prof. In Pediatrics, Preventive Med, Medicine and Surgery Depts.University –wide ER Supervisory Comm, Computer/IS Comm., P&T Comm. Re-established Adolescent Medicine teaching and service component including Juvenile Justice and College health programs, enhanced community programs. Responsible for Pediatric ER program and Child Abuse Program oversite |
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| Years | Employer | Title | Department |
| Years: 1983 to 1985 | Employer: New York Medical College | Title: Assistant Professor, Research Director | Department: Adolescent and Preventive Medicine |
Responsibilities:Research Director, Division of Adolescent Medicine.Author of one of the earliest Robert Woods Johnson School-based Health Clinic grants for a high school in the poorest US Congressional District – Bronx, NY |
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Career Accomplishments
| Associations / Societies |
|---|
| American College of Legal Medicine, Fellow since 2/07; Society for Adolescent Medicine, Fellow since 9/85; American Academy of Pediatrics, Fellow since 11/82; American College of Legal Medicine – 2003 – ; Fellow: 3/07 - Marketing Comm. - 2004 American College of Physician Executives; International Assn. for Adolescent Medicine; American Public Health Association; Society for Adolescent Medicine Member, 1981-1984, Fellow, 1985 - National Advocacy Committee 1994-98 & 2006 – Website Committee 2006; Physicians for Social Responsibility; American Academy of Pediatrics |
| Licenses / Certifications |
|---|
| California Med. License, 1978 -; Texas Medical License, 1992 - 1995 & 1998 - ; N. Y. State Med. License, 1985-1988 (inactive); Drug Enforcement Agency; Passed CA Bar, 7/06 – Licensed to practice law in California; American Ht. Assn. CPR, Neonatal Resuscitation Certification and Pediatric Advanced Life Support- 1993 – 1994 (PALS Instructor), recertified: NN Resuscitation, 5/2002; Recertified – Pediatrics & Adolescent Medicine – 4/00; Board Certified - Preventive Medicine - 11/98; Board Certified - Adolescent Medicine - 11/94; American Board of Pediatrics Certification; National Medical Boards Certification |
| Professional Appointments |
|---|
| Children’s Advocacy Institute, Univ. of San Diego Law School, Board of Advisors 2006 - Physicians for Social Responsibility: Chief Pacific Regional Director, Chief SW Regional Director, Board of Directors Executive Committee, President Westchester, NY Chapter |
| Publications and Patents Summary |
|---|
| Hundreds of peer-reviewed journals, chapters, books, articles, etc. |
Additional Experience
| Expert Witness Experience |
|---|
| 20 years medical legal consulting - and now also licensed to practice law - very experienced in testimony, deposition and declaration work from all points of view - plaintiff and defense background |
| Training / Seminars |
|---|
| Numerous national and international presentations |
| Marketing Experience |
|---|
| Pharmaceutical consultant to numerous companies for over 12 years primarily on relation to managed care markets |
| Other Relevant Experience |
|---|
| Experienced writer and editor including editing ADAM Internet encyclopedia, being an Internet site medical director. |
Language Skills
| Language | Proficiency |
|---|---|
| French | Very Good |
| Spanish | Good |
| Portuguese | Fair |
Fields of Expertise
bioethics, medical ethics, clinical medicine, adolescent medicine, forensic medicine, neonatal resuscitation, young adult, emergency medicine, family medicine, pediatric emergency medicine, Department of Health and Social Security standard, workers' compensation, epidemiology, medication risk assessment survey, survey design, health care industry quality management, health care system, health care management, health insurance, health care plan, managed care, medical record, administrative medicine, case analysis, medical analysis, medical case review, medical center, medical credentialing, medical record review, pediatrics, medicolegal, preventive medicine, public health, environmental health, infectious disease, vaccine, child and adolescent health, pervasive child development disorder, lice infestation, attention-deficit hyperactivity disorder, blue cross, autism, adolescent development, HMO, health care quality assurance, pediatric immunology, adult psychology, adolescent psychology, pediatric emergency nursing, utilization review, HMO insurance, Perinatology, pediatric surgery, clinical study, clinical research, environment, neonatology, environmental epidemiology, eating disorder