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Nison H. Shleifer, M.D.

Atlanta, Georgia, US +1-404-***-****

Medical Director

National and Commercial accounts for Elevance Blue Cross Blue Shield Health. Make medical necessity Utilization management, Head a team of case management nurses to outreach to members to help them navigate the medical system and help them with medical needs such as home physical therapy or durable medical equipment, Reviewed transplant cases, Performed appeals.

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Utilization Management, Leading a Team of Case Management Nurses, Conducting Peer to Peer discussions, Educational Grand Rounds for the nursing Team National Appeals, Pharmacy Appeals, Organ transplantation reviews.

June 2001 to 2008

Provided patient care in a hospital setting with a team including Interns, Residents and a PHD candidate pharmacy student

Provided patient care in a hospital setting with a team including Interns, Residents and,Medical students Blue Cross Blue Shield of Georgia (Wellpoint) Georgia Commercial 2010-10 present Consultant serving as Associate Medical Director for Utilization 200*-**-****-** management reviews

Blue Cross Blue Shield of Georgia (Wellpoint) Georgia Commercial Blue Cross Blue Shield of Georgia (Wellpoint) Georgia Commercial Utilization 200*-**-****-** Management

Medical Director Westminster Commons Nursing Home 200*-**-****-** Interacted with Administration on medical issues, advised nurses on quality issues, cared for residents in the nursing home

Adjunct Professor 198*-**-****-**

Medicine Mercer University School of Pharmacy

Medical Director Laurel Baye Nursing Home 199*-**-****-** Interacted with Administration on medical issues, advised nurses on quality issues, cared for residents in the nursing home

Assistant Clinical Professor 198*-**-****-**

Internal Medicine Medical College of Georgia

Work experience

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Provided patient care in a hospital setting with a team including Interns, Residents and,Medical students Medicaid HMO, New start up in Georgia worked with the president of the Plan on sales meetings, developed Utilization and pharmacy management plans, educated nurses on Utilization management and pharmacy processes

Responsible for intern and resident teaching and patient care supervision in Resident out patient clinic and resident patient's admitted to the hospital, Teaching, resident recruitment and selection. Supervision of Internal medicine residents in an outpatient clinic, reviewed medical care provided, insured quality of care, reviewed records for quality and completeness. Would see patients with the residents as supervision and as needed for concerns

Reviewed payor denials and provided for appeals and Peer to Peer discussion as needed Reviewed payor denials and provided for appeals and Peer to Peer discussion as needed Adjunct Clinical Instructor 198*-**-****-**

Internal Medicine Medical College of Georgia

Vice President Medical Affairs, American Medical Plans 199*-**-****-** Georgia Inc

Associate Director Department Internal Medicine Residency program 199*-**-****-** Georgia Baptist Medical Center

Director of the Division of General Internal Medicine 199*-**-****-** Georgia Baptist Medical Center

Director of Internal Medicine Sheffield Clinic 197*-**-****-** Georgia Baptist Medical Center

Utilization Review Committee, Georgia Baptist Medical Center 198*-**-****-** Chairman 198*-**-****-**

Utilization Review Committee, Georgia Baptist Medical Center

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Georgia Baptist medical Center Internal Medicine Resident PGY3 197*-**-****-** Emory University Affiliated hospitals PGY1-2 197*-**-****-** Albert Einstein College of Medicine1974-

Education

Three year medical curriculum, graduated top 25% of my class 1971-08 - 1974-08 Apply health plan policies to clinical requests for medical care, pharmacy and organ transplants, Contact treating physician for a Peer to Peer as needed

Support nurses in contact with members, provide out reach approaches, proved education on medical conditions, prognosis and available services including the hospice option

Ran a sucessful Internal Medicine Office, single physician for 30 years. Interaction and education of new hired medical directors, involved in the Interview process. Teach application of MCG, health plan policies and guidelines

Utilization Management

Admin: Case Management

Admin: Outpatient

General: National Accounts

Fluent in the spoken and written word

English

Skills

Languages

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