Diana Ruiz El-Zaim, M.D. FAAP, CHCQM

Diplomate of the American Board of Pediatrics

*** ******** ******

McAllen, Texas 78504

832-***-**** mobile

adxrrs@r.postjobfree.com

adxrrs@r.postjobfree.com

Education:

Residency, Pediatrics

Baylor Affiliated Hospitals (Baylor College of Medicine, Houston, TX)

01/2003-12/2005

Internship, Pediatrics

Baylor Affiliated Hospitals (Baylor College of Medicine, Houston, TX)

01/2003-12/2004

Doctor of Medicine

University of Texas Medical Branch of Galveston, Galveston, TX

08/1999- 11/2002

Bachelor of Arts, Nuclear Medicine Science, Summa, Cum Laude

University of Incarnate Word, San Antonio, TX

08/1992-06/1996

Employment:

DHR Health

Physician Advisor 2019-Present

• Integral member of the hospital’s Utilization and Case Management department • Involved in daily clinical documentation/medical record reviews concurrent and retrospectively for hospital admissions

• Work together with CM to follow CMS guidelines in accordance with quality standards as determined by the URC and Quality/Compliance Committee

• Consult with staff regarding delegated UM and disease management operations under managed care contracts while meeting all regulator-contractual/accreditation requirements associated with these functions

• Serve as a clinical resource and consultant to case managers and UR Department by reviewing medical records of patients identified by the CM/UR Department to determine admission status certification, assist with level of care and length of stay management, assist with denial management, review and advise related to resource management, perform medical necessity reviews, and perform continued stay review

• Participation in peer-to-peer reviews on behalf of the attending physician to provide evidence of medical necessity that supports appropriate designation of inpatient level of services provided by the hospital

● Assist in disputing claims denials on behalf of the hospital when medical necessity was appropriately met for inpatient level of care services in previously discharged patients.

●Create appeal letters for payors that deny current,concurrent, and retrospective acute inpatient hospital admissions.

MET Healthcare Solutions

Medical Reviewer and Independent Medical Examiner 2016- 8/2023

• Perform chart reviews for treatment/services that have been denied by private insurance carriers

• Provide written documentation of my reviews using evidence-based medicine guidelines in my specialty of Pediatrics to support or negate when medical necessity was appropriately applied for a treatment/service.

• MET is a URAC Accredited Independent Review Organization performing medical necessity chart reviews

Elzaim Pediatrics, LLC

Owner 2015-Present

• Partner with primary care pediatricians in the community on a per diem basis to provide comprehensive, family centered care in a clinical outpatient setting

• Independent affiliations include Kelsey Seybold Clinic, Texas Children’s Hospital OP Clinics, and Children’s Pediatric Clinic in RGV

CSL Plasma

Laboratory Director 2019

• Responsible for the overall operation and administration of the laboratory while meeting all FDA guidelines, including the employment of personnel who are competent to perform test procedures, document test results promptly, accurately, proficiently and assure compliance with federal/state regulations

• Provided medical oversight to Medical Staff Associates including their training. Maintained high medical standards and ensured that cGMPs are adhered to thorough involvement with Center management, Center quality unit, and overall center activities

Pediatric Hospitalist/Outpatient Pediatrician 2006-2015

• Provided and coordinated the care of hospitalized children (0-17 years of age) admitted for a wide range of medical conditions

• Performed administrative issues unique to the hospital setting such as, but not limited to: o Discharge planning

o Utilization review

o Quality improvement

• Practice affiliations included: Calvary Medical Clinic, Kingwood Medical Center, Step Pediatrics, Memorial Herman Hospital of the Woodlands, St. Luke’s Hospital of the Woodlands, Step Pediatrics, and Kelsey Seybold Clinic.

Certifications:

Fellow Diplomate of American Board of Pediatrics

Fellow Diplomate of American Board of Quality Assurance and Utilization Review Physicians PALS provider AHA (active)

BLS provider AHA (active)

Texas Medical Board License (active)

Lab Director Certification-CLIA (active)

Professional Societies:

Fellow Member, American Board of Quality Assurance 2021-Present Fellow of the American Academy of Pediatrics 2002-Present Member, Texas Medical Association 2006-2019 Member, Montgomery County Medical Society & TMA 2002-2016 Resident Member, Texas Pediatric Society 2002-2010 American Society of Clinical Pathologists and Society of Nuclear Medicine 1997-1999 TDHL, Department of Radiologic Technologists 1996-1998

Research and Educational Experience:

WHO COVID-19 Clinical Platform, 2019.

● Physician Contributor, Collaboration project to share data collections for active surveillance of MIS-C-cases.

Clinical Preceptor, Physician Assistant Program, UTMB, 2006-2015

● Supervise family nurse practitioner at current place of employment perform well child exam (newborns- adolescent), and ill visits.

Clinical Preceptor, Physician Assistant Program, Baylor College of Medicine, 2006-2012. ● Supervise physician assistant students during their clinical experience in Pediatrics. Preceptorship/Clinical Elective, Texas Pediatric Society, Dr. Roosevelt Alcorn, Department of Pediatrics, Houston, TX, 2002.

Research Assistant, Dr. Villanueva-Meyer, Dept. of Nuclear Medicine; Program Director, University of Texas Medical Branch of Galveston, Galveston, TX, 1999-2001.

● Performed and assisted in data analysis and radiographic interpretation of data. ● Oversaw data collection of clinical studies performed on patients.

● Collected and compiled nuclear medicine imaging studies.

Pre-Medical Internship, College of Liberal Arts Boston University, Boston, MA. 1994. ● Early Entrance to Medical School Program

Preceptorship, Rice University, Baylor College of Medicine, Houston, TX, 1993. Clinical/Research Preceptorship, Robert Wood Johnson Award

● Ben Taub Hospital, Ward, Houston, TX 1993

Publications and Presentations:

El-Zaim, DR, Virginia Neighbur, Leigh Smith. A Coordinated Effort between Pediatricians, School Nurses, and Parents, for Successful Management of Children with ADHD. Department of Pediatrics, University of Texas Medical Branch of Galveston, Galveston, TX, Poster Presentation, August 2001; UTMB Newsletter Publication, Dec. 2001

Javier Villanueva-Meyer, Sunny Hatch, Elipida Bavastro, William Velasquez, El-Zaim, DR, Elma Briscoe, Zoran Gatalica, and Declan Fleming. Assessing the Response of Neoadjuvant Chemotherapy in Advanced Breast Cancer. Departments of Radiology, Medicine, Radiation Oncology, Surgery and Pathology. University of Texas Medical Branch of Galveston (submitted). Annual Scientific Poster Presentation, Galveston, TX. August 2001

Acute Renal Failure. Presented to Baylor College of Medicine students and residents, May 2003.

Dysfunctional Uterine Bleeding. Presented to Adolescent Medicine Service faculty and residents August 2004.

CSL Plasma -Medical Staff -Quality Management Training 4/2019-9/2019

Interests:

Drawing, jogging, paddle boarding, gardening, crafting, and yoga.

Languages:

Spanish, English

References:

Steven Edwards, MD, FAAP, Hospitalist, TCH - The Woodlands, mobile: 915-***-****

Shemeka Banger-Hill, MD: Internal Medicine-Pediatrics, Dayton Family Medicine Clinic, mobile: 832-***-****

Martin Garza, MD: Pediatrician, DLC Pediatrics, mobile: 956-***-****, fax: 956-***-**** Marsha Griffin, MD, UTRGV School of Medicine, mobile: 956-***-****

Olga Gomez, MD, FAAP, Children’s Clinic, office: 956-***-****, mobile: 956-***-****

Jennifer Sanez M.D., Pediatrician, Pediatric Center at Renaissance, McAllen,Texas 78504

Juna J. Saenz,M.D., Pediatrician, Pediatric Center at Renaissance, McAllen,Texas 78504

Contact this candidate