Triple Board Certified physician executive/consultant, (Board Certified in Internal Medicine, Pulmonary Medicine, and Critical Care Medicine), with vast experience in medical necessity and utilization review. Over 12 years of experience in national insurance and payer companies. Has served as Medical Director for Aetna, Blue Cross Blue Shield Association, and interim CEO for Next Level Health Partners.
Consultation services to companies and manufactures in various areas, (pharmacy, genomics, medical devices, medical management, utilization, etc.), regarding healthcare medical necessity, compliance and educational issues. Fraud and Abuse. Government plans: Medicare & Medicaid. Private insurers all plans: HMO, PPO, Specialty networks. Expert reviews and medical litigation support performed. Sub-specialty medical reviews in Pulmonary and Critical Care Medicine.
Current license: Illinois; New Mexico; Oklahoma; Kentucky; New Mexico

Specialties

• Pulmonary Critical Care Medicine
• Critical Care Medicine

Subpecialties

• Medical Management
• Medical Utilization & Location of Care
• Fraud & Abuse
• Compliance
• Medical Necessity
• Medical Devices
• Pharmacy Management
• Genomics & Personalized Health
• Insurance Reviews of Plan Benefits
• Insurance Clinical Policy Reviews
• Long Term Acute Care & Long Term Care