I am an experienced physician executive in the health insurance industry and have been certified as a Health Insurance Executive. Having worked for national insurance companies (Oxford Health Plans, Blue Cross & Blue Shield, Wellpoint, Anthem, Cigna), my areas of responsibility and accountability have included case management, fraud & abuse, physician credentialing, peer review, physician grievances & appeals, patient grievances & appeals, and patient safety. I am Yale-educated and NIH trained.

Metrics managed during my career include: average length of stay, discharge and readmission rates, pharmacy management, physician follow-up, comprehensive quality and patient safety metrics, emergency department visits, mental health management, and fraud & abuse by doctors and patients.

I have conducted over 5,000 physician credentialing reviews; over 5,000 medical necessity/utilization management reviews; and over 2,000 patient/physician committee and in-person grievance & appeal reviews. In addition, I have served as an Examiner for the Malcolm Baldrige National Quality Award, as well as the National Committee for Quality Assurance.

I hold patents for improved emergency patient flow system design and improved effectiveness for patient engagement in obesity, cholesterol, high blood pressure, and diabetes management.

With current licensure in Kentucky, North Carolina, Pennsylvania & Virginia, I am board certified in emergency medicine and internal medicine. As an experienced public speaker, I serve as Chief Medical Correspondent at station WVGB-FM in Beaufort, South Carolina.