Healthcare Operations Professinal
A healthcare executive with a broad-based background and progressive track record in healthcare (provider and payor) management, business development, strategic planning and improving organizational performance of medical group/physician practices, tertiary medical centers, ambulatory care and integrated health systems.
A versatile leader with demonstrated success in problem solving, establishing strong provider and payor relationships, building consensus and enhancing organizational performance.
Pediatric Subspecialty Faculty (PSF), Orange, California 2005-Present
Director, Clinical Operations and Business Development
Manage operations for a medical group with 16 medical subspecialties and more than 100 physicians, supporting both inpatient and ambulatory care services at CHOC and other hospitals and clinics in Southern California. Work with PSF leadership to identify and implement business development strategies and initiatives that expand, diversify and enhance services and financial performance.
- Led the conversion from a cost-sharing model with the hospital to a Stark compliant clinic model. Managed the transition of employees and integrated patient scheduling, insurance verification and authorizations into a newly created centralized Patient Access processing center.
- Spearheaded the opening of two new pediatric specialty clinics (pulmonary and cardiology). Negotiated agreements with the host hospitals for a clinic model that encompassed office arrangements, staffing and support services.
- Identified and negotiated a contract for the medical group to provide statewide medical specialty consulting services with a major tele-medicine company.
- Led the startup of the first surgical practice for the group (opthalmology) with responsibility for facility design and construction, staff recruitment, capital equipment acquisition, and outreach marketing.
- Served as the liaison for the medical group with CHOC for the implementation of an outpatient electronic medical record. Consulted on physician documentation options and practice integration.
- Directed the negotiation of off-site practice lease contracts for five locations, as well as the space planning, relocation and construction of on-site facilities for transcription, hospitalists, nephrology and rheumatology services.
- Increased Gallup employee satisfaction scores from 88.1 to 90.1 in one year by improving relationships and communications with staff and physicians.
Kaiser Permanente, Pasadena, California 1992-2005
Continuing Care Leader (2001-2005)
Inland Empire Service Area, Riverside and San Bernardino County
Responsible for inpatient utilization management/discharge planning, outside claims and referral management, long-term care services, home health, hospice, social services, durable medical equipment and a volunteers program for a service area with 600,000 members, two acute-care medical centers with 600 combined beds, 16 medical offices and an outpatient surgery center. Managed 250 FTEs and an annual operating expense budget of $160 million.
- Implemented a program aimed at improving out-of-plan inpatient and outpatient claims at non-contracted facilities, resulting in more than $5 million annual savings in claims costs. Recognized by corporate leadership for outstanding claims management.
- Worked collaboratively with physician medical group partners to implement numerous resource utilization improvement initiatives in the areas of inpatient, skilled nursing facility, home health, hospice and durable medical equipment services. Improved resource utilization performance across the care continuum, meeting key strategic goals including financial targets for three consecutive years.
- Introduced a palliative care model that bridged patients to hospice and expanded skilled nursing facility contracts to include ventilator care and bedside hemodialysis. Decreased acute-care bed utilization by 300 days annually and increased capacity in a saturated market.
- Achieved JCAHO scores of 98 for the Riverside Home Care/Hospice Service and 96 for the Fontana Home Care/Hospice Service.
- Expanded social services evaluation of patients and access to counseling and treatment in key clinical areas, including post myocardial infarction and postpartum.
Practice Leader, Strategic Business Initiatives (1996-2001)
Southern California Permanente Medical Group, Regional Administration, Pasadena, California
Led the implementation of strategic initiatives for a multi-specialty medical group practice with 3,000 physician partners serving more than 3 million health plan members at 10 acute-care hospitals and 75 full-service medical offices throughout Southern California.
- Spearheaded an automated benefits administration system initiative, which was successfully developed through prototype and was able to provide online adjudication of benefit rules and utilization.
- Led the implementation of a cosmetic skin care venture, including fee-for-service surgery, aesthetician services, botox treatment, laser tattoo removals and skin care products. Impacted success in recruiting and retaining dermatologists, increased health plan member satisfaction, and generated more than $200,000 in net revenues.
- Served as the first Southern California HIPAA Implementation and Compliance Healthcare Operations leader, resulting in successful healthcare operations, systems risk assessment and compliance training programs that were in alignment with corporate and federal government HIPAA program guidelines.
Assistant Medical Group Administrator (1992-1996)
Professional and Support Services, Orange County Member Service Area
Directed hospital and medical office based ancillary and support service departments, including clinical lab, pathology, physical medicine services, diagnostic imaging, cardio/pulmonary, behavioral medicine, social medicine and outpatient medical records for a 275-bed medical center serving a market with 200,000 members, 300 physicians, multiple contracted facilities and 10 medical offices.
Queen of Angels, Hollywood Presbyterian Medical Center, Los Angeles, California 1990-1992
Vice President, Operations
Oversaw daily operations for clinical and support services for a 420-bed hospital and skilled nursing facility. Responsible for $75 million in revenues, $40 million in operating expenses and 400 FTEs.
- Participated in the timely and significant financial and regulatory compliance turnaround of a severely distressed inner-city hospital from a loss of $12 million annually to an $8 million profit.
- Built a new physical medicine rehabilitation program with a 15-bed inpatient unit and opened service within six months. Generated $3 million in revenue.
- Established a radiation oncology program, negotiated a 70% discount on a dual-energy linear accelerator and contracts with radiation oncologist, physicist and equipment vendor. Grew revenue to $4 million in one year.
- Identified an alternative supplier of blood products and negotiated a contract, saving $50,000 per year.
- Renegotiated contracts with hospital-based physicians in pathology, radiology and respiratory services, saving $1.5 million annually while maintaining a collaborative working relationship.
- Worked with nursing services to convert the hospital's conditional JCAHO accreditation status to full accreditation, preserving 20% of revenue.
University of California, Irvine, Medical Center, Orange, California 1980-1990
Assistant Director, Professional and Support Services (1987-1990)
Responsible for day-to-day operations of ancillary and support departments, including laboratory, radiology, physical rehabilitation, behavioral medicine, cardiology, respiratory, dietary and environmental services for a 400-bed university teaching hospital.
Principal/Senior Administrative Analyst, Operations (1982-1987)
Management Fellow (1981-1982)
Clinical Laboratory Scientist (1980-1981)
Introduced the first biliary lithotripsy program on the West Coast by negotiating a joint partnership with a hospital, medical group and an outside medical research and equipment manufacturing company. Oversaw compliance with clinical trials criteria, attracted 15 cases per month and generated $450,000 per year.
- Successfully secured approval for a joint venture that created a partnership with a diagnostic imaging company for the initiation of dual energy cardiac cath fluoroscopy. Spearheaded the construction of a $2.5 million lab and grew volume to 300 procedures annually.
- Grew a clinical reference lab that offered esoteric testing in disciplines such as special chemistry, toxicology, hematology and microbiology. Increased revenues to more than $1 million annually.
California State University, Fullerton, Fullerton, California 1988
Instructor, Graduate School of Biology, Medical Technology Program
EDUCATION/ SPECIAL TRAINING
California State University, Long Beach, Long Beach, California
Master of Science, Healthcare Administration
California State University, Fullerton, Fullerton, California
Master of Arts, Biology, Clinical Lab Operations
University of California, Santa Barbara, Santa Barbara, California
Bachelor of Arts, Biological Sciences
Veterans Administration Medical Center, School of Medical Technology, Los Angeles, California
University of Southern California, Los Angeles, California
Kaiser Permanente Middle Management, Kaiser Permanente Advanced Leadership
University of California, Irvine Medical Center, Orange, California
Management Skills Assessment Program
Kaiser Permanente, Pasadena, Los Angeles, California
Continuous Quality Improvement, Juran
American Society of Clinical Pathologists (ASCP), Board Certified in Medical Technology
California Department of Health Services, Licensed Clinical Laboratory Scientist
PAST AND PRESENT PROFESSIONAL AFFILIATIONS
American College of Healthcare Executives
Medical Group Management Association
American Heart Association, Board of Directors, Anaheim, California
Orange County Office on Aging, Health Services Committee
Keiro Senior Health Services of Orange County, Chairman, Board of Directors - Community Advisory Council
National Eagle Scout Association, Lifetime member