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Utilitzation Review Physician Medical Administrator Expert Witness

Provides Opinion & Testimony In:

Mental Health, Drug, Alcohol Rehabilitation, Utilization Review Physican, Medical Administrator, Substance Abuse Physician,

Expert Witness No.1401

Florida

Retired Psychiatrist, Medical Administrator
Utilization Review Physician
UR Director for National Addiction Institute

I have been working in the field of Utilization Review and Substance Use Disorders for many years. I have been director of UR for multiple companies. In my capacity as UR director, I have performed quality assurance reviews, staff training, and development directed to the type of charting required by insurance carriers. To aid in the UR process, I have also worked with staff to upgrading clinical documentation. Each specialty requires a specific type of clinical documentation and UR is no different. The key is to ensure that patients get the treatment they need to obtain recovery while simplifying the documentation process for staff. This overall approach improves the odds of getting a greater number of days certified at higher levels of care. It also improves odds of winning Peer-Peer Review, Expedited Appeals, and all levels of written appeal, and even to win law suits when companies do not pay.

I have trained some of the best UR Staff anywhere, as such can also provide back up of individuals with knowledge and experience. If you are looking for a solution to your UR issues. I believe I can help. I have an established record of accomplishment and extensive experience of dealing with all mayor carriers.

Outsourcing your UR will save money in comparison to having in house employees. Also, most people that UR are individuals that fell into the position because they had some clinical background but no true training in UR. You would not go to a doctor to do Surgery whose specialty is Internal Medicine. UR is a specialty. I believe you will find that my services will pay for themselves in the additional recovery of revenue for the companies you represent and in turn from proceeds received from billing.

UTILIZATION REVIEW PHYSICIAN & MEDICAL ADMINISTRATOR

  • Experience in Mental Health, Drug and Alcohol Rehabilitation
  • Program Development and Enhancement / Interdisciplinary Teamwork
  • Bilingual: English / Spanish
  • Combining a variety of mental health, substance abuse counseling, medical knowledge and medical records review.

Relevant Professional Strengths

  • Diagnostic evaluations / assessments
  • Bio-psychosocial Assessments
  • One-on one / group counseling
  • Intervention planning / execution
  • Regulatory / statutory compliance
  • Crisis intervention / management
  • Discharge planning and follow up
  • Work collaboratively with family member’s
  • Professional

PROFESSIONAL EXPERIENCE

UTILIZATION REVIEW PHYSICIAN/Quality Assurance, Medical Administration Independent Contractor-2015-Present
UTILIZATION REVIEW DIRECTOR, Behavioral Wellness & Recovery of PA-2015-Present

INDEPENDENT CONTRACTOR/ PEERS, EXPEDITED APPEALS, ALL LEVELS OF WRITTEN APPEALS
Southern California Addiction Center & Kool Recovery of CA

Kool Living Recovery Center:
UTILIZATION REVIEW DIRECTOR/ Medical Administration, Lakeview Health Systems- 2010-2015

UR PHYSICIAN SUBSTANCE ABUSE COUNSELING, MEDICAL ADMINISTRATION, CONSULTATION & QUALITY ASSURANCE
SERVICES, Plantation, FL – 2004- 2010

INTERNATIONAL MEDICAL CONSULTANTS, Gainesville, FL – 1997 to 2004
Medical Educator
Created customized educational programs, structured conferences, speaking engagements.
Selected medical issues responsible for the greatest amount of Morbidity & Mortality in Dominican Republic Hospitals that were amenable to staff education.
Keynote / subject matter presenter at conferences of up to 150 medical practitioners / medical students. Topics: HIV-AIDS, Medical Errors, Quality Assurance, Medical Ethics, and the
Treatment of Endemic Medical Diseases.

PROFESSIONAL EDUCATION

Post Doctorate Training in Mental Health, Psychiatry & Medicine, Creedmoor Psychiatric Center, Columbia Presbyterian College of Physicians & Surgeons, Medical Doctor, CETEC Medical School, Dominican Republic, Cum Laude Graduate

With medical student and graduate rotations at:

  • Yale University College of Medicine
  • Cornel University Department of Psychiatry
  • Columbia Presbyterian at Psychiatric Institute
  • Connecticut School of Medicine
  • University of Vermont School of Medicine
  • Bachelor of Arts, Queens College CUNY, Queens, N.Y.
  • Sociology Major with a Minor in Special Physical Education,

ACADEMIC APPOINTMENTS

  • Clinical Teaching Appointment, Columbia University College of Physicians & Surgeons, New York, NY
  • Affiliate Professor, New York School of Medicine, department of Psychiatry, Valhalla, NY
  • Assistant Professor, Miami School of Medicine, department of Psychiatry, Miami, FL

Professional Development

  • Certified in For
  • Board Certification from the American Academy of Pain Management
  • HIPPAA (Health Insurance Portability Accountability Act 1996) Basic Training
  • Substance Abuse Resident, Beth Israel Hospital, New York, NY
  • Addiction Medicine Training CME Credits from FMA & FMPG
  • Psychotherapy Training at Cornel & Columbia Dept. of Psychiatry
  • Medical Administration

Professional Affiliations

Member of the Florida Medical Professional Group (FMPG)
Toastmasters International Club Member

Groups