Tiffanni Forbes Md

Fayetteville, GA ***** adzscq@r.postjobfree.com 404-***-**** https://www.linkedin.com/in/tiffanni-forbes-7158441a

Medical Director

Results-oriented and highly accomplished leader with experience in medical management, utilization review, and quality assurance processes; develops and implements clinical programs and protocols, enhancing the quality and efficiency of healthcare delivery.

Stellar record of overseeing the implementation of medical policies, ensuring their effective execution, while providing unwavering support to the medical management staff, guaranteeing prompt and consistent responses to members and healthcare providers. Demonstrated excellence in participating actively in the development, implementation, and evaluation of clinical and medical programs, working towards expanding organization’s medical management initiatives to comprehensively address member needs across the entire continuum of care. Remarkable efficiency in revolving around supervising utilization review and quality assurance processes, including conducting predetermination reviews and assessing claim determinations. Seasoned in prior authorization, pre-certification, concurrent reviews, peer-to-peer calls, first-level appeals, special projects, and committee participation, as needed. Contribute valuable clinical expertise and provide strategic guidance in support of medical management programs, actively participating in clinical team activities. Act as a bridge between business and clinical domains, establishing and maintaining strong relationships with network providers and facilities, ensuring effective implementation of medical services programs by clinical teams.

Core Proficiencies

Strategic Business Planning

Medical Affairs & Protocols

Data Analysis & Decision-Making

Innovation & Research

Quality Improvement & Assurance

Staff Training & Development

Resource Management

Health Policy & Advocacy

Regulatory Compliance

Professional Experience

Evicore, Franklin, TN 2016 – 2021

Medical Director/Remote

Collaborated with physicians to create and implement guidelines for the appropriate radiographic use in a clinical setting. Reviewed and instructed providers on relevant studies. Provided strategic leadership and medical oversight to ensure the delivery of efficient, effective, and evidence-based healthcare services.

Stayed abreast of emerging medical trends, research, and industry developments, and apply this knowledge to drive continuous improvement in clinical processes and protocols.

Led the clinical review process, including pre-authorization and medical necessity determination, to ensure appropriate utilization of healthcare services.

Pooled resources with internal teams to develop and implement clinical guidelines, policies, and procedures, ensuring compliance with regulatory standards and best practices.

Cancer Treatment Center of America, Newnan, GA Emory Healthcare, Emory Midtown, Atlanta, GA 2014 – 2016 2015 – 2020

Hospitalist / Associate Professor

Provided exceptional care to patients with advanced cancers in both inpatient and urgent care settings, delivering comprehensive medical management. Administered high-quality inpatient care to hospitalized patients, while also taking on the role of training resident physicians, nursing staff, and physician assistant students. Conducted thorough patient evaluations, including detailed medical histories, comprehensive physical examinations, and precise interpretation of diagnostic tests to establish accurate diagnoses and develop tailored treatment plans. Oversaw the daily care of hospitalized patients, closely monitoring their progress, promptly addressing any acute medical issues, and making necessary adjustments to treatment plans.

Contributed to providing education and mentorship to medical students, residents, and other healthcare professionals, actively supporting the organization's academic mission.

Led primary medical care efforts and effectively managed the medical needs of patients admitted to hospital for cancer treatment.

Engaged in quality improvement initiatives, contributing to the development and implementation of protocols and guidelines aimed at enhancing patient outcomes and safety.

Meticulously documented patient encounters, treatment plans, and progress notes in the electronic medical record system, ensuring accuracy and efficiency.

Adhered to evidence-based medicine practices, continually staying updated on advancements in cancer treatment and supportive care modalities.

Skillfully ordered and interpreted laboratory tests, imaging studies, and other diagnostic procedures, ensuring timely and accurate results to optimize patient care.

Coordinated and collaborated seamlessly with the multidisciplinary team, ensuring cohesive and integrated care for patients through effective communication and information sharing.

Athens Regional Hospital, Athens, GA 2013 – 2014

Clinical Director

Provided strategic leadership and direction to the clinical departments, ensuring the delivery of safe, effective, and patient-centered care. Pooled resources with physicians and other healthcare professionals to establish and clinical policies, procedures, and protocols in alignment with evidence-based practices and regulatory requirements. Evaluated the quality of clinical services, utilizing metrics and performance indicators to identify areas for improvement and implement strategies for enhanced patient outcomes.

Directed quality improvement activities, committee meetings, and leadership forums, contributing to organizational initiatives and strategic planning.

Served as a liaison between clinical departments and hospital administration, effectively communicating departmental needs, goals, and challenges.

Built a culture of safety, promoting adherence to infection control protocols, patient safety guidelines, and other relevant regulatory requirements.

Managed and oversaw the recruitment, training, and development of clinical staff, ensuring the provision of adequate resources and maintaining a high level of competency and professionalism.

Developed and managed departmental budgets, monitoring and controlling expenses while ensuring optimal resource allocation to support quality patient care.

Worked with the interdisciplinary team to promote effective communication and collaboration, enhancing care coordination and patient transitions across departments.

Emory Division of Hospital Medicine, West Georgia Health, LaGrange, GA 2010 – 2013

Medical Director

Supported the recruitment, training, and development of clinical staff, providing guidance and mentorship to ensure a high-performing team. Collaborated with the technology team to leverage innovative solutions, such as artificial intelligence and predictive analytics, to enhance clinical decision-making and optimize healthcare management. Stayed informed about regulatory changes and compliance requirements, ensuring adherence to all applicable laws and regulations.

Participated in quality improvement initiatives, analyzing data and metrics to identify opportunities for enhancing patient outcomes and operational efficiencies.

Fostered strong relationships with external stakeholders, such as healthcare providers and professional associations, to enhance collaboration and facilitate the exchange of medical expertise.

Additional Experience: Lead Hospitalist, 2008 – 2010, Piedmont Medical Care Corporation, Piedmont Newnan Hospital, Newnan, GA Department Director, 2008 – 2010, Hospital Medicine, Piedmont Newnan Hospital, Newnan, GA Hospitalist, 2005 – 2008, Piedmont Medical Care Corporation, Piedmont Fayette Hospital, Fayetteville, GA Hospitalist, 2003 – 2005, Emory Adventist Hospital, Eagle Hospitalist Group, Smyrna, GA Hospitalist, 2002 – 2003, Walker Baptist Hospital, Eagle Hospitalist Group, Jasper, AL

Education & Credentials

Residency in Internal Medicine – Chief Resident, Morehouse School of Medicine, Atlanta, GA

Internship, Internal Medicine, Alton Ochsner Medical Foundation, New Orleans, LA

Doctorate of Medicine, MD, Medical College of Georgia, Augusta, GA

Bachelor of Science, BS in Biochemistry, Xavier University, New Orleans, LA

Awards & Acknowledgments

Michael Hiesler MD, MPH Leadership Award, Division of Hospital Medicine, Emory School of Medicine

Director’s Award, West Georgia Health, Division of Hospital Medicine, Emory School of Medicine

Assistant Professor, Emory Division of Hospital Medicine, Emory University School of Medicine

Clinical Instructor, Emory Division of Hospital Medicine, Emory University School of Medicine

National Committee Membership

Hospitalist Committee Member, Georgia Chapter, American College of Physician

National Membership Committee Member, Conference Facilitator, Society of Hospital Medicine

License/Certification

Georgia Medical License, Active unrestricted

Texas Medical License, Active unrestricted

Advance Cardiac Life Support

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