Medical Management

Jermel J. Hawkins, M.D., M.P.H.

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*** ** ****** *** ** New York, NY 10001

Phone: 504-***-**** E-Mail: *******@********.***

Education

• M.D. Meharry Medical College School of Medicine

Nashville, Tennessee

(08/2004 - 05/2008)

• M.P.H. Columbia University Mailman School of Public Health

(Healthcare Management)

New York, New York

(07/2010 – 05/2012)

• B.S. Xavier University of Louisiana (Chemistry)

New Orleans, Louisiana

(08/2000 - 05/2003)

Graduate Medical Education

• Residency – General Preventive Medicine and Public Health

Stony Brook University Medical Center,

Stony Brook, NY

(07/2010-06/2012)

• Internship/Residency – General Surgery and Cardiothoracic Surgery

Louisiana State University Health Sciences Center

New Orleans, LA

(07/2008-/07/2010)

Board Certification

• General Preventive Medicine and Public Health

Board-Certified (expires 1/31/2025), American Board of Preventive Medicine (American

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Board of Medical Specialties)

Leadership Experience

• Nassau County Department of Public Health – Garden City, NY – (06/2010-12/2010)

Explored budget analysis and cost-effectiveness of the county hospital and community healthcare

centers servicing 3 million patients per year. Worked closely with Commissioner of Public Health in

developing assessment and risk stratification tools for various community health and wellness needs.

Investigated communicable and infectious disease outbreaks as the physician team leader and utilized

medical expertise to interact with local government officials. Diagnosed and treated various

communicable and sexually transmitted diseases in an adolescent and young adult population.

• Consulting Medical Director, Contractors Incorporated - New Orleans, LA – (06/2009-06/2011)

Jermel J. Hawkins, M.D., M.P.H.

Page 2

Advised chief executive officer and chief medical officers of oil drilling and manufacturing company

in all matters concerning health status and impact of injuries in the occupational setting. Recommend

and oversee implementation of occupational risk reduction strategies. Participate in the

incident/occurrence reporting process being mindful of risk management and mitigation, quality,

compliance and client relationships.

• Attending Primary Care Physician, House Calls Division, Essen Medical Associates (Private Practice)

New York, NY- (12/2010 – present)

Conduct the medical evaluation, diagnosis, and treatment of patients with chronic and acute medical

conditions. Perform histories and physical examinations on a daily basis. Refer patients for relevant

medical specialty procedures and consultations. Provide clinical decision-making for patients with

advanced diabetes mellitus, end stage renal disease, essential hypertension, hyper/hypothyroidism,

osteoporosis, and a host of other chronic and acute conditions. Provide primary care for home-

bound/bedbound patients with multiple comorbidities. Provide clinical management for wound care

of complex ulcers and treatment of various emergent conditions such as lacerations and falls. Provide

urgent care for patients including laceration suturing, splinting of non-complex fractures, and

emergency medical attention after non traumatic injuries. Provide preventive care through age

appropriate vaccinations and various primary and secondary prevention measures. Provide clinical

oversight and mentorship to nurse practitioners and physician assistants as well as training to medical

students and foreign medical graduates.

• Veterans’ Administration Hospital – Bronx, NY and Northport, VA – (01/2011-06/2011)

Principal investigator in quality assurance evaluating operating room first case start times. Conducted

administrative meetings with key physician and nursing leaders to investigate quality standards and

develop benchmarks for hospital. Used data management skills and implementation of data to

substantiate and validate working hypotheses. Developed marketing strategies to incentivize patients

and physicians. Conducted medical record reviews for epidemiologic data mining.

• Principal Investigator, Columbia University Department of Anesthesiology – New York, NY –

(06/2011 –06/2012)

Evaluation and analysis of data from the Agency for Healthcare Research and Quality (AHRQ) to

develop a national benchmark for qualifying and decreasing the number of anesthetic complications

experienced in U.S. hospitals and to investigate socioeconomic disparities occurring with the

incidence of anesthetic complications. Utilized SPSS software for statistical analysis and logistic

regressions to effectively demonstrate and investigate the incidence of anesthetic complications in all

US hospitals. First author on resulting paper produced submitted for publication in peer-reviewed

journals.

• Occupational Medicine Physician and Independent Medical Examiner, Woodbury, New York –

(09/2011-04/2012)

Medical evaluation and treatment of patients that have incurred injuries in various occupational

settings. Issuing vaccination series for adults in line with CDC guidelines and practices.

Administering corporate fitness examinations and Department of Transportation fitness to work

examinations to determine eligibility of workers in specific fields of industry and possible extent of

medical limitations. Perform venous blood draws on a routine basis for special screening for heavy

metal exposure and various toxicants. Perform and interpret EKGs on a routine basis for occupational

health screenings. Perform and author independent medical evaluations as an independent medical

examiner for disability insurance providers. Administer appropriate vaccinations for international

travel and for patients completing the U.S. immigrations process. Assist in drug screening process

for employees of corporations.

Jermel J. Hawkins, M.D., M.P.H.

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• Physician Hospital and Safety Monitoring Committee Member, Stony Brook, New York (09/2011-

06/2012)

Responsible for overseeing incident reporting protocols for clinical staff and employees of Stony

Brook University Medical Center. Participated in risk management seminars and conferences

regarding staff members and also facilitated seminars with hospital departmental leaders to increase

awareness for occupational hazards and develop streamlined mechanisms to assist in the accurate and

timely reporting of incidents.

• Physician Advisor, Island Peer Review Organization (IPRO), Lake Success, New York (01/2012-

07/2012)

Responsible for developing an illustrative resource for physicians in New York State to demonstrate

how to adequately implement a patient centered medical home as defined by the National Committee

on Quality Assurance (NCQA) and receive recognition by the NCQA. Utilized clinical knowledge

and expertise in creating practical examples to illustrate how to best fulfill the requirements of the

NCQA.

• Independent Medical Reviewer, Medxm, New York, NY (08/2012- 11/2012)

Provide utilization management review of patients insured by WellPoint Anthem, Blue Cross Blue

Shield, and various Empire Plan subsidiaries by conducting clinical assessments of patients and

documenting various medical conditions and the appropriateness of the medical care being

administered currently by their primary care providers and specialists.

• Medical Director, Centers Plan for Healthy Living, New York, NY (10/2012- 08/2014)

Responsible for providing clinical oversight and medical management to this managed care

organization. This company had a Medicaid Managed Long Term Care and Medicare Advantage Part

D program under its books of business and had received a 3 year agreement for a FIDA (Fully

Integrated Dual Advantage) designation as well. I chaired the quality assurance/improvement

committee, credentialing committee, policies and procedures committee, vendor delegate oversight

committee, utilization management committee, care management committee, quality peer review

committee and the grievances and appeals committee. In addition to these medical management

functions, I also work closely on the continued development of our Part D program with our PBM

(Medimpact) to develop cost effective pharmaceutical programs that are in agreement with rules and

regulations set forth by the Medicare Managed Care Manual. Developed and gave trainings on

Medicare rules and guidelines to new employees. In this position I also maintained an active role in

high dollar coverage determinations and routinely employed Interqual criteria and other evidence

based guidelines in making such determinations. At the same time, I also actively participated in

senior leadership meetings with members of the executive level management to define and implement

goals regarding access to services, staff training, and quality improvement initiatives. I was also

responsible and the author of many of the plans marketing materials for our lines of business

including the Summary of Benefits, Evidence of Coverage, and Explanation of Benefits as well as the

provider and pharmacy network manuals. Facilitated and level set expectations for the company’s

behavioral health partner (Optum Behavioral Health) in order to provide comprehensive services that

fit our members’ needs.

• Statewide Medical Director, Utilization Management and Quality, Fidelis Care, New York, NY

(08/2014-Present)

Responsible for providing clinical oversight and medical management to this managed care

organization with over 1.5million members. Provide initial determinations and appeals decisions and

resolve grievances for Medicaid, Medicare, Long term Care, and Health Exchange members. Provide

utilization management review of pharmaceutical claims and provide special investigations on

matters involving coding/miscoding of network and out of network providers. Review inpatient

claims for medical necessity and also outpatient services including special genetic tests and surgical

procedures for medical necessity.

Jermel J. Hawkins, M.D., M.P.H.

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• Statewide Medical Director, FIDA and MLTC Programs, Fidelis Care, New York, NY (11/2014-

Present)

Responsible for $2 billion dollar budget to manage NY State Medicaid long term care beneficiaries

and NY State Medicaid/Medicare dual eligible population for NY State’s 2 nd largest non-profit

healthcare insurer. Develop policies and procedures for cost-saving initiatives to improve medical

loss ratio. Instruct and lead other medical directors and non-clinical and clinical management in

strategic process implementation needed to improve financial viability of the organization. Identify

and partner with key community leaders and network partners to improve financial outlook of the

company. Provide knowledge of regulatory processes and clinical judgment to areas centered around

improvement of interdisciplinary care teams, case management workflows, and utilization

management of services for an underserved population.

Licensure

• New York State Medical License

# 259311

• DEA Registration

Number Available by Request

Faculty Appointments

• Clinical Instructor- Biostatistics and Epidemiology

Stony Brook University Medical Center

Stony Brook, New York

(01/2011 – 07/2012)

Publications

• Bowens C Jr, Gupta RK, O'Byrne WT, Schildcrout JS, Shi Y, Hawkins JJ, Michaels DR, Berry JM.

“Selective local anesthetic placement using ultrasound guidance and neurostimulation for

infraclavicular brachial plexus block.” Anesthesia and Analgesia. 2010 May1; 110(5);1480-5.

Presentations

• Hawkins J. Medicare Advantage Part D: Facts and Information. Presentation Date

• Hawkins J. American Hospital Inpatient Anesthetic Complications: A Cross-Sectional Observational

Study. Presentation Date: June 30, 2012, Stony Brook University Medical Center.

• Hawkins J. Risk Management and Communication Strategies. Presentation Date: May 17, 2012,

Suffolk County Department of Public Health.

• Hawkins J. A Clinical Update: DHHS Regulations Modification on when to begin antiretroviral

therapy in HIV-1 and HIV-2 infected patients. Presentation Date: March 12, 2012, Stony Brook

University Medical Center.

• Hawkins J. Management of Stakeholders Needs in a Competitive Healthcare Economy. Presentation

Date: September 28, 2011, Columbia University, Mailman School of Public Health.

• Hawkins J. A Clinical Review Update: Drug Eluting Stents versus Bare Metal Stents in the treatment

of Coronary Artery Disease in Diabetic Populations. Presentation Date: March 9,2011, Stony Brook

University Medical Center.

Jermel J. Hawkins, M.D., M.P.H.

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• Hawkins J. Drug Safety in America: How to Develop a Phase 1 Clinical Trial that meets FDA

Regulatory Standards. Presentation Date: July 8, 2010, Columbia University, Mailman School of

Public Health.

Hobbies:

• Weight-lifting, cycling, reading historical biographies, travel

Affiliations/Memberships

• Phi Lambda Upsilon - National Chemistry Honor Society

• American Chemical Society

• American Society of Regional Anesthesia and Pain Medicine

• American College of Surgeons

• American College of Preventive Medicine

• American Medical Association

• American College of Occupational and Environmental Medicine

• Medical Society of the State of New York

• New York County Medical Society

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