Erin Leigh O’Brien MD

*** ******** ****** ***** **** H

Tierra Verde, FL 33715

407-***-****

ad4o4s@r.postjobfree.com

PROFESSIONAL SUMMARY

Dedicated, motivated and energetic obstetrician gynecologist with added certification in genetics and genomics that is highly skilled in utilization and case management. Excellent leadership skills with experience in complex clinical care coordination, quality improvement and credentialing. Exceptional at creating innovative approaches to enhance member and provider experience. Passionate about incorporating social determinants of health into collaborative physical and behavioral health improvement strategies. Partner with thought leaders in my market to implement statewide programs to improve maternal child health. CAREER EXPERIENCE AND CONTRIBUTIONS

Centene Corporation · Florida · 2018- Present

MEDICAL DIRECTOR- Ambetter Marketplace - Medical Affairs

• Lead Marketplace/ Exchange/ Off Exchange Medical Director responsible for clinical and business oversight of the plan.

• Adjudicate health plan case reviews for Acute care, post-acute care, prior authorization, high cost/risk members, appeals, grievances, peer to peer, pharmacy and other assigned reviews related to utilization management.

• Oversaw the Maternal Child Health program Smart Start for Babies and acted as Subject Matter Expert for Obstetrics, Gynecology, Women’s Health 2018-present

• Subject Matter Expert Added Certification in Genetics and Genomics by American College of Obstetrics and Gynecology

• Instituted an interdisciplinary Maternal Health Care program including OB rounds, OB Home Health collaborations with Optum, OB Mental Health programs with Brave Health and 180 Health Partners and ASAP and postpartum support programs with WIC and NICA. Incorporated physical health, behavioral health, case management, utilization management and medical affairs.

• Established a relationship with Florida Association of Nurse Midwives and American College of Nurse Midwifery to promote midwifery care to our members.

• Established communication with Commission on Accreditation of Birth Centers to increase the number of Accredited Birth Centers in our network.

• Established relationship with Spora Health to decrease racial disparities in African American populations.

• Oversaw the credentialing process improvement project for Certified Nurse Midwives, Licensed Midwives and Certified Professional Midwives and created an educational program for the credentials committee and medical director team on the various licensure and scope of each type of provider.

Acting OB/GYN/Genetics Medical Director for Texas Market Jan-Feb 2022

• Covered Superior Health Plan as specialty medical director. Learned UM for all lines of business and contractual nuances of state specific programs.

• Responsible for census management and discharge planning with concurrent review and post-acute teams. Encouraged interdisciplinary rounds with behavioral health, home health/ DME team, contracting team to facilitate discharge planning challenges and reduce length of stay. Oversaw the Ambetter rounds for Florida statewide, Obstetric rounds for all lines of business, and complex discharge planning rounds for all lines of business.

• Medical Director for Medicare Interdisciplinary Conferences for Medicare Advantage and Dual Enrolled members.

• Medical Director liaison with the Special Investigations Unit team. Work with Sunshine Health and Centene Corporate on Fraud Waste and Abuse projects.

• Medical Director liaison with the contracting department to facilitate special case agreements for challenging cases requiring out of state or complex care not available within the network.

Central Florida Health Care, Inc. 05/2014-01/2018

Physician and Department Head- Ob/Gyn Winter Haven, FL A Place for Women 03/2013 – 04/2014

Physician - Ob/Gyn Celebration, FL

Hope Clinic Inc. 05/2011 – 02/2013

Physician – Ob/Gyn Houston, TX

Kelsey Seybold Clinic 02/2007 – 04/2011

Physician – Ob/Gyn Houston, TX

Physician Wetherby Locums – Dr. N. Rao, FACOG 02/2007 – 02/2007 Physician – Ob/Gyn Webster, TX

Bluebonnet Ob/Gyn 09/2003 – 12/2006

Physician – Ob/Gyn Bastrop,

TX Women’s Hospital of Texas 05/2003-05/2003

Treatment Room Staff Physician – Ob/Gyn Houston, TX Louis J. Brunoforte, PA 06/1995 – 01/1999

Patent Agent – Prosecuting patent applications/property matters Tampa, FL

Florida State University Dept. of Chemistry 01/1995 – 05/1995 Laboratory Instructor – General Chemistry

Hillsborough Community College 09/1994 – 05/1995

Instructor for Undergraduate Courses Tampa, FL (Human Reproduction, Environmental Science, & Nutrition and Disease)

Education:

Residency Obstetrics and Gynecology 11/2000 – 06/2003 Baylor College of Medicine Houston, TX

Obstetrics and Gynecology 06/1999 – 10/2000

Medical University of South Carolina Charleston, SC Medical School Doctor of Medicine 08/1995 – 05/1999 University of South Florida Tampa, FL Undergraduate Bachelor of Science in Biological Science 08/1990 - 05/1994

Florida State University Tallahassee, FL

Certification:

Diplomate American Board of Obstetrics and Gynecology 01/2006 – current

Fellow American Congress of Obstetrics and Gynecology 2006 – current Junior Fellow, American College of Obstetrics and Gynecology 2003 – 2006

United States Patent Bar – Registration Number 42,948 Staff Privileges: Florida Hospital Celebration 2013 – 2014 Women’s Hospital of Texas 2007 – 2011

Bay Area Surgicare 2008 – 2011

Clear Lake Regional Hospital 2008 – 2010

St. David’s Surgicare of South Austin 2005 – 2006

St. David’s South Austin Hospital 2004 – 2006

Smithville Regional Hospital 2003 – 2006

Fayette Memorial Hospital 2004 – 2005 Women’s Hospital of Texas 2003

– 2003

Committee/Workgroups

Medical Director for Ambetter Provider Manual workgroup 2022- present Medical Director for Ambetter Explanation of Coverage workgroup 2021- present

Medical Director for Ambetter Post Acute Workgroup 2022-present Medical Director for Ambetter Readmission Workgroup 2019- present Member of Sunshine Health Credentials Committee and Peer Review Committee 2018-2020.

Member of Sunshine Health Quality Innovation Committee 2020- present Chair of Sunshine Health Utilization Management Committee 2022- present

Chair of Sunshine Health Clinical Policy Workgroup 2022- present Member of Sunshine Health Network Optimization Workgroup 2019-2021 Member of Sunshine Health Transportation Committee 2022- present Member of Centene Enterprise Wide Safety Workgroup 2022-present Member of Centene HPAC 2022-present

Member of Centene Payment Integrity Workgroup 2022-present Presenting Medical Director “Doc Talk” 2022

Presenting Medical Director OB/GYN Clinical Policy Workgroup 2020- present

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