President / CEO Founded S.A. Squared Inc. to provide consulting in the area of utilization, case and disease management to Health Maintenance Organizations, Physician Groups, Independent Practice Associations, Hospitals, Home Health Agencies and other managed care entities.
1995-1997
Prudential Health Care Woodland Hills, CA
National Director Case Management Promoted to establish national case management program standards and programs for all Prudential locations
Director, Health Care Management
Responsible for Utilization Management and Case Management throughout the Western States with Health Care Operations, as well as key National initiatives. Served as medical management representative in national sales presentations and with major evaluative groups such as Wm. Mercer. Developed a Case Management training program that was mandatory for all case management associates throughout the United States. Course represented a knowledge gain for associates above 25% with average evaluation ratings of over 4.5 on a scale of 1-5.Decreased Commercial Bed Days by 8% and Senior Bed Days by 26% in the initial year. Re-designed both Utilization and Case Management programs in the first year.
1992-1995
FHP Health Care Inc. Cerritos, CA
Director, Patient Care Management (6/93-10/95) Promoted in order to further expand the Patient Care Management program throughout the Health Care Delivery Unit (Company Owned/Leased and Operated Centers) in all States of FHP Operation. Program produced $8,491,447.00 in savings over two years in California alone. Program costs were $2,772, 447.00 during the same time period.Hospital day usage was decreased by 72% in the program population. Role further included development of outside consulting with HMO’s, Hospitals, Medical Groups, and other Health Care Delivery Systems in order to generate additional revenue. Supervision of over sixty-five staff members in five states.Expansion of the Program included development of a Home Visiting Physician program, Comprehensive Wound Care Center, Pain Management Program, and Geriatric Assessment program.Developed an integrated, outcomes based data management system in collaboration with MIS. Served as independent consultant in Case Management.
Manager, Patient Care Management (9/92 - 6/93)
Promoted in order to establish all aspects of comprehensive, integrated HMO case management program.Program to include program concepts, philosophy and goals; proformas as to potential cost and savings; complete budget process; implementation schedule; development of position descriptions; recruitment, hiring, and training of staff; development of statistical reporting format, medical records documentation and forms; development of eight hour case management orientation and training program (granted eight CEU's by the State of California).Responsible for implementing program at fifteen ambulatory care centers in Orange County/Long Beach staff model, as well as centralized catastrophic and clinical tracking component.Supervision of approximately 25 professionals and para-professionals.Education of entire California staff model in patient care management program.
Alternative Health Care Coordinator (1/92 - 9/92)
Assessment of hospitalized and skilled nursing facility patients for alternatives to in-patient care.Developed and executed transfer plans from in- patient to outpatient alternatives.Performed cost/benefit analysis, negotiated contract rates with non-FHP home health and transitional care providers.Arranged for and provided prior authorization of services required to implement plans.Provided ongoing evaluation and review of plans to assess effectiveness, and to adjust as necessary to maintain patient at most appropriate level of care.