Our Medical Director has been certified by The American Board of Pediatrics, American Board of Family Practice, American Board of Internal Medicine, and the American Board of Quality Assurance and Utilization Review Physicians. He is a former primary care practitioner and Clinical Associate Professor for the Family Practice Departments of the University of Miami and the University of South Florida, and a former Medical Director in Managed Care. Our Medical Director ensures that National and State Compliance Standards, including HEDIS, are met and maintained.
Our Chief Operating Officer works with the Physicians, Office Managers and office staff to develop systems and relationships that will improve performance and, ultimately, compliance with the standards set by CMS, AHCA and the Managed Care Organization. This collaboration ensures that quality medical care is provided by the PCP or Specialist in the most cost effective setting.
Our Director of Operations and Compliance is a Licensed Clinical Social Worker who works in concert with Case Managers in Waiver Programs, CMS, DCF and other community based agencies in order to deliver all services needed to members and to maximize benefits available to the insured while making sure that the member is in the appropriate program and setting. Our comprehensive, multi-disciplinary team approach to Case Management, beginning with the PCP, is unequalled in the industry.
Our Provider Relations and Contracting Director, is available to all providers on a daily basis. Visits are made to all practices monthly. We ensure all providers have appropriate networks developed to meet the needs of their specific patient base. We collaborate with Health Plan Nurses on HEDIS Measures and MRA Programs, and ensure the provision of on-going education.