Consultant, Waldman Health Care Consulting
New York United States
VP / SVP / EVP at a Payer
I am a Board-certified Family Physician with broad experience in clinical practice, teaching and medical administration on both the managed care and hospital sides. I have worked for Blues plans, a regional not-for-profit physician-directed plan and a for-profit plan and was employed by a not-for-profit hospital system with both a large teaching hospital and a smaller community hospital. I have broad experience in utilization management, disease and case management, quality management, medical policy, payment policy and technology assessment, credentialing, provider relations and contracting, including incentive programs and alternative reimbursement strategies, and accreditation. I served on three national committees for the Blues related to medical policy and technology assessment and have taught in various venues with clinical appointments in both medical schools and colleges. My particular strengths include organizational skills, teaching and presentation skills, the ability to identify practical solutions to problems, and a broad clinical background and knowledge base.
Managed Care Organization (MCO)
I make decisions about coverage and/or formulary
Years of Experience
> 20 yrs.
1.1M - 10M
Private plans, Medicare plans, Medicaid plans
Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield Association, Coventry Health Care, Highmark
Consultant at Waldman Health Care Consulting (since Sep 2013)
Vice President Medical Affairs/Senior Medical Director at CDPHP (Jan 2005 - Jan 2013)
Disease Management, Health Insurance, Health Policy, Healthcare Consulting, Healthcare Industry, Healthcare Management, Hospitals, Inpatient, Managed Care, Medicaid, Medical Cost Containment, Medicare, Medicine, Physicians, Provider Relations, Public Speaking, Quality Improvement, Utilization Management
Medical Policy, Technology Assessment, Healthcare, HMO, HIPAA, Medicare Part D, PPO, Network Development