Medical Management

Location:

Great Neck, NY

Posted:

August 22, 2017

Contact this candidate

Resume:

Lorraine Alice Marin, MD, MBA

* ****** *****, ***** ****, NY 11021

Phone: 516-***-****, Cell: 516-***-****

E-Mail: ac1yi6@r.postjobfree.com

Medical Director of Oncology / Director of Science / Oncology Attending Physician

Versatile and highly competent medical professional offering over 30 years of experience in healthcare organizations and medical centers as Medical Director of Oncology, Regional Medical Director, Director of Science, and attending oncology physician. Specialist in Internal Medicine, Medical Oncology, & Radiation Oncology. Significant Clinical Experience, Utilization Management using McKesson, Interqual, CMS, ASCO, and NCCN Oncology Guidelines. Proven track record of working with national clinical trials and participation in national oncology groups, communicating with colleagues both individually and in group meetings. Managed care for Medicaid, Medicare, and Commercial insurance, both for general medicine and oncology. Delivery of professional presentations. Possess excellent leadership and management skills enabling organization and prioritization of work projects, inspiring and motivating team members to perform their best. Thorough analysis of problems. Decisive. Excellent judgment.

~ Arranged Preuss Foundation Seminars to “mix” clinicians and basic researchers working with brain tumors from multi-national locations ~

~ Developed the credibility of a new foundation (“Preuss Foundation”) for advancing research and treatment of primary brain tumors ~

~Reviewed General Medicine inpatient and outpatient authorization requests for Healthcare Partners IPA~

~Reviewed Oncology inpatient and outpatient authorization requests for Healthcare Partners IPA~

~Medical Director for Case Management Care Team of high risk patients for Healthcare Partners IPA~

~ Wrote Guidelines for Oncology-related treatment, made yearly updates for Healthcare Partners IPA ~

~ Orally defend denied inpatient admissions to Administrative Law Judges at Healthcare Partners IPA ~

~ Chairman of Credentialing Committee at Healthcare Partners IPA ~

Areas of Expertise

Acute Care Facility & Ambulatory Care Experience

Radiation Oncology & Medical Oncology

Utilization Management–Inpatient & Outpatient Review

Transplantation & Genetic/Molecular Marker Testing

Clinical Research via National Clinical Trials

McKesson, Interqual, NCCN, ASCO, & CMS National Guidelines; FDA Approval

Guidelines and policies written and maintained

Multi-tasking in fast-paced environments

Highly Organized and Strong Analytical Abilities

Articulate Oral and Written Communication

Quick Problem Resolution & Decision Making

Patient and Provider Relationship Management

Continuous Process Improvement and Innovation for improved Quality

Team Building, Training, and Development

Professional Experience

HealthCare Partners, IPA, MSO Garden City, NY

Aug 2010 – Jan 2014 & June 2014- June 2017 & AUG 2017-present

HealthCare Partners IPA, MSO is a managed care provider, which is part of Heritage Provider Network based in Northridge, California, United States, and operates in California, Arizona, and New York

Regional Medical Director, Medical Director of Oncology & Biologics, Consultant

Responsible for utilization management review of inpatient hospital admissions, acute/subacute rehabilitation admissions, and outpatient pre-authorization requests including general medicine, radiation oncology & chemotherapy treatment, other injectable medications/biologics, transplantation, and genetic/molecular marker testing. Approvals are made in accordance with McKesson, Interqual, NCCN, ASCO, & CMS National Guidelines as well as FDA approval. Work with pharmacists and prioritize approval for comparable medications according to cost. Manage Out-of-Network Requests/Redirect to In-Network. Write and orally discuss denials with requesting providers. Review appeals of denied treatment and make determinations.

Major Contributions

Participation in Grand Rounds (to discuss management of complex patients), Hospice/Palliative Care Committee, Medical Director, and Medical Advisory Committee meetings

Orally defend denied inpatient admissions to Administrative Law Judges

Write guidelines for specific oncology-related procedures and treatments and maintain yearly updates on these guidelines for HealthCare Partners, IPA

Participate in “oncology team” with nurse, utilization data coordinator, and physician’s assistant to review pre-authorization requests; collaborate with pharmacists for FDA approval, cost/efficacy analysis and prioritization of requested medications/chemotherapy

Guided managed care company on using national guidelines (NCCN, ASCO, ATS) for approval of oncology tests (PET, MRI, CT scans, other diagnostic procedures and biopsies) and treatment (chemotherapy, immunotherapy, and radiation treatment)

Discussed with requesting physicians the need for modification or denial of requests as per guidelines or published medical literature (“evidence-based medicine”); emailed/faxed copies of guidelines and other medical literature to physicians for their future reference

Made oncology presentations for physicians, nurses, and social workers to guide patient management.

Proposed individual care of oncology patients by specially-trained nurses (“Oncology Care Program”) to the Chief Medical Officer (“CMO”) and the HCP Administration

PREUSS FOUNDATION FOR BRAIN TUMOR RESEARCH, LA JOLLA, CA

Jun 1985 – Nov 2015

The Preuss Foundation for Brain Tumor Research provides forums for brain tumor researchers in an effort to increase communication and collaboration among them.

Director of Science (Part Time Position)

Evaluated proposed clinical and basic research projects concerning brain tumors, including analysis of written proposals and visits to the offices/laboratories of the proposed research sites, to study feasibility of proposals. Reviewed proposed budgets and prioritized research projects for their potential impact on treatment. Position involved extensive national and international travel.

MAJOR CONTRIBUTIONS

Developed the credibility of a new foundation to fund basic and clinical research for primary brain tumors and sponsor high level research seminars to accelerate collaborations

Organized multiple (over 30) Preuss Foundation Seminars, each lasting 2-3 days, which “mixed” approximately 25-30 clinicians and basic researchers working with brain tumors or related areas of science

Helped the foundation join several other brain tumor foundations to form The National Coalition of Brain Tumor Foundations. The Coalition’s main purpose was to influence Congressional expenditures in the area of brain tumor research; member foundations worked with a law firm specializing in healthcare legislation.

Prior Clinical Experience

Nassau Radiology P.C., Lake Success, NY Nov 2008 – Dec 2009