Medical Management

***** ********* **. 219-***-****

Zionsville, IN *6077 *********@*****.***

Arthur Flores, M.D.

Objective To utilize my skills and experience as a physician executive, clinician and

medical reviewer to lead a healthcare company toward attaining desirable

Work Experience health outcomes through the efficient delivery of quality cost-effective

healthcare

2009 - Present WellPoint - Anthem BC/BS Indianapolis, IN

Regional Medical Director

Case Management Medical Director for Central United States

Disease Management Medical Director Condition Care, Medicare for

Central Region

Provide clinical direction to Case Management and Disease management

programs on clinical issues relating to quality of care, medical management,

and benefits

Conduct provider interfacing, case reviews, multi-state Grand Rounds

Client / Account interfacing through audits reviews and special initiatives

Case Management NCQA Audits

Collaboration with other care management programs, UM, DM

Designed and implemented a case review tracking database for Case

Management Medical Directors to track and monitor productivity

Participation in Corporate Hospital Readmission Reduction workgroup

2009 - Present MDwise Hoosier Alliance Indianapolis, IN

Medical Director Consultant / Medical Reviewer Part-Time

Perform Utilization and Concurrent review for managed Medicaid groups in

State of Indiana

Reviews range from concurrent reviews of inpatient stay, emergency room

utilization reviews, procedures, therapies and imaging requests

2008- 2009 Aetna Indianapolis, IN

Chief Medical Officer – Indiana Plan

Medical Management oversight of Indiana Medicaid Business Unit for

Indiana Care Select Medicaid members and network providers

Medical oversight of Care Management, Disease Management, Utilization

Management, HEDIS, PQI, NCQA, quality metrics

Clinical oversight of the Indiana Medicaid Traumatic Brain Injury Program

for residential rehab facility admissions and concurrent review

Participation with Indiana Office of Medicaid Policy and Planning on

various Medicaid policy and quality committees and initiatives

Contributed to work on utilization Predictive Modeling in conjunction with

Risk Assessment and Member Stratification

Developed Pay for Performance Metrics for Network Providers

Established process for statewide Biannual Network Provider Case

Conferences

Provided State with Mental Health Screening HRA Questionnaire for

Pediatric Population / Wards and Foster Population

Started Collaboration Pilot with Community Mental Health Centers and

case management for case management of members with BH diagnoses

Managed clinical contractual metrics and performance guarantees of State

Contract

2006 - 2008 St. Margaret Medical Associates Hammond, IN

Practice Start Up Physician

Hired for practice start up and development of brand new clinic and

practice.

Inpatient and outpatient scope of Family Medicine.

2006 - Present Unity Physicians Group Valparaiso, IN

ER / Urgent Care Physician

ER Porter Memorial Hospital Valparaiso, Portage, IN

Urgent Care Physician; ICC, Indianapolis, IN

2004- 2006 NorthShore Health Centers Portage, IN

Chief Medical Officer

Clinical Oversight of 3 clinic system Federal Qualified Health Center

Executive management of patient care, quality initiatives, compliance

Management of Physicians, Dentists, NP’s, Nurse Midwives

Implementation of Electronic Medical Records

Creation and Management of an Urgent Care Center

Staff development; expanded services to include Pediatrics and OB/Gyn

Direct Patient Care Inpatient / Outpatient

Creation of Patient Prescription Database

2001-2004 Hamlet Family Medicine Hamlet, IN

Medical Director - Owner

Solo Private Practice, New practice start up

Traditional Family Medicine with Obstetrics

Implementation of Electronic Medical Record

Occupational Medicine; workers comp / company physician for

Norton Packaging

1992-1993 Smith-Nephew Solo-Pak Pharmaceuticals Elk Grove, IL

Microbiology Technician

Product and Environmental testing; Quality Control

Laboratory testing of product in Microbiology lab

Production line and employee monitoring for QA

Appointments

2005-2008 Purdue University West Lafayette, IN

School of Clinical Pharmacy

Affiliate Asst. Professor of Clinical Pharmacy

2004 Bethel College Mishawaka, IN

School of Nursing

Clinical Preceptor

2003-2005 Bayer / Glaxo-Smith Kline

Education Clinical Faculty / Lecturer

2003-2004 Starke Memorial Hospital Knox, IN

Chairman, Medical- Surgical Unit

2002-2004 Indiana University Indianapolis, IN

School of Nursing

Clinical Preceptor; Nurse Practitioners

2001-2003 Pfizer Pharmaceuticals

Clinical Faculty / Lecturer

1998-2001 OSU University Hospital Columbus, OH

Clinical Instructor; Medical Students

1994-1998 The Ohio State University - Columbus, OH

• Doctor of Medicine

1988-1992 Indiana University – Bloomington,

IN • B.S. Biology

Residency 1998.2001 The Ohio State University Department of Family Medicine

• Co-Chief Resident Columbus,

OH

Board Certification American Board of Family Medicine

State Licensure Indiana, Ohio – Active

Research 2000 - Erectile Dysfunction; Pfizer Research Grant Columbus, OH

Presentations 7/11 Case Management of the Member with Louisville, KY

Traumatic Brain Injury

Anthem Care Management

7/10 Assessment and Management of COPD From a

Case Management Perspective Louisville, KY

Anthem Case Management Kentucky

4/09 Emergency Department Utilization Indianapolis, IN

Aetna Care Management Department

11/05 Treatment of Community Acquired Pneumonia

And Upper Respiratory Infections Merrillville, IN

Lake County Medical Association

5/04 Treatment and Management Hobart, IN

Of Erectile Dysfunction

Grand Rounds; St. Mary Hospital

5/04 Allergic Rhinitis/ Sinusitis Knox, IN

WKVI Radio – Ask a Doctor

2/04 Erectile Dysfunction Valparaiso, IN

Porter / Lake County Physicians

1/04 Practice Management Columbus, OH

OSU Department of Family Medicine

11/03 Erectile Dysfunction Culver, IN

Marshal / Starke County Physicians

8/03 Update on Fluoroquinolones Culver, IN

Starke / Marshal County Physicians

6/03 West Nile Virus Knox, IN

WKVI Radio – Ask a Doctor

2/03 Erectile Dysfunction Plymouth, IN

Marshal Co. M.A. Society

11/02 Men’s Health Issues Knox, IN

WKVI Radio – Ask a Doctor

8/02 Erectile Dysfunction Knox, IN

Starke County Medical Society

5/02 Barriers to Diagnosing ED Columbus, OH

OSU Family Medicine Grand Rounds

11/01 Update on Pertussis Columbus, OH

Columbus Health Department

Medical Technology Activities and Accomplishments

NorthShore Health Centers

• Implementation of Electronic Medical Records for clinic system

• Creation of database for tracking patient pharmacy and prescriptions through various patient

assistance and pharmaceutical programs

Ohio State University

• Served as a consultant for Electronic Medical Records implementation in the Integrated and

Alternative Health Clinics.

Aetna

• Representative for Aetna / Schaller Anderson Indiana in workgroup in New York City with

Active Health, on development of Personal Health Record, and Portal System for Indiana

Medicaid Members and Providers

• Contributed to tailoring the commercial PHR product to the Medicaid population

• Created a database for case management tracking, productivity and quantification of work

performed by case managers

• Components of database were incorporated into the Medical Management System

WellPoint

• Creation of case management medical director tracking database for reporting and

quantification of medical cases reviewed by medical directors for National and Commercial Case

Management

References Available on request

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